Chronic Hemodialysis Group Research Articles

In-Hospital Outcomes and Recurrence of Infectious Spondylitis in Patients with and without Chronic Hemodialysis: A Nationwide Cohort Study.

PurposeThe incidence of bloodstream infection among end-stage kidney disease (ESKD) patients on chronic hemodialysis (HD) was 26-fold higher than population controls, causing higher morbidity and costs. The aim of this investigation was to clarify the prognostic factors, in-hospital outcomes and recurrence of infectious spondylitis of patients with and without chronic HD.Patients and MethodsThis nationwide study analyzed 2592 patients who admitted for first-time infectious spondylitis between January 1, 2003, and December 31, 2015. Patients were classified into the chronic HD or the non-HD group. The logistic regression model and the general linear model were utilized to determine the impact of chronic HD on in-hospital mortality and recurrence. The Cox proportional hazard model was used to estimate the predictive factors of in-hospital mortality and recurrence.ResultsCompared to the non-HD group, patients in the chronic HD group had a higher risk of respiratory failure, sepsis, in-hospital mortality, longer hospital stay, and higher medical spending. Chronic HD was an independent risk factor for in-hospital mortality (hazard ratio 2.21, 95% confidence interval 1.34–3.65, p=0.0019), but not for recurrence. Intravascular device implantation or revision was a prognosticator for the mortality of both groups and a predictor for recurrence of the non-HD group. Surgical treatment was associated with a decreased risk of recurrence, whereas treatment with CT-guided abscess drainage was associated with an increased risk of recurrence in both groups.ConclusionPatients with infectious spondylitis who were receiving chronic HD had a higher in-hospital mortality compared to those without HD. Intravascular device implantations or revision within 6 months was a significant predictor of in-hospital mortality and disease recurrence. Surgical treatment of infectious spondylitis had a lower risk of recurrence than those with CT-guided abscess drainage in both patient groups.

Shear Wave Velocity Measurements of the Median Nerve in Patients on Chronic Hemodialysis.

Chronic dialysis causes changes in the structure of median nerve. This is a risk for the development of carpal tunnel syndrome in patients on dialysis. The aim of the present study was to evaluate the diagnostic capacity of shear wave velocity (SWV) and the cross-sectional area (CSA) to detect the structural changes of the median nerve in patients with end-stage chronic kidney disease on hemodialysis. Twenty-five patients with chronic kidney disease undergoing hemodialysis 3 times per week and 26 healthy controls were included. None of the participants had any signs or symptoms of carpal tunnel syndrome specified according to the criteria of the American Academy of Neurology Practice Parameters. Both patients and controls underwent sonographic and elastographic examinations of the median nerves in both hands to evaluate CSA and SWV values, and they were compared regarding these parameters. The mean CSA of the median nerve in the chronic hemodialysis group was significantly higher than that in the control group (12.74 ± 1.88 mm2 versus 8.89 ± 1.45 mm2 ; P < .001). The mean longitudinal and axial SWV values in the hemodialysis group (3.86 ± 0.54 m/s and 3.92 ± 0.52 m/s, respectively) were significantly higher than those in the control group (2.98 ± 0.31 m/s and 3.04 ± 0.31 m/s, respectively; P < .001). Patients on chronic hemodialysis had higher mean CSA and SWV values of the median nerve compared with the healthy controls. Structural changes in the median nerve that occur in patients on chronic hemodialysis can be detected by shear-wave sonoelastography.

Chronic Kidney Disease Distinctly Affects Relationship Between Selenoprotein P Status and Serum Thyroid Hormone Parameters.

Chronic kidney disease (CKD) impairs thyroid hormone (TH) metabolism and is associated with low serum triiodothyronine (T3) concentrations in patients with a low glomerular filtration rate (GFR). Whether this results from decreased T3 formation from thyroxine (T4) by impaired 5'-deiodinase (DIO) activity and/or enhanced degradation of T3 and increased reverse triiodothyronine (rT3) formation from T4 by elevated 5-DIO activity remains unclear. Both activating 5'- and the inactivating 5-deiodination of TH are catalyzed by three selenium (Se)-dependent DIO isoenzymes. Selenoprotein P (SePP) is the major constituent of serum selenium, and functions as Se transport protein from liver to kidney and several other organs. This study tested the hypothesis that serum SePP and TH status are associated with the degree of renal impairment in patients with CKD. A total of 180 CKD patients (stages 1-5) and 70 chronic hemodialysis (CHD) patients undergoing hemodialysis three times per week for at least two years were prospectively investigated for clinical data, parameters of renal function, serum TH profile (thyrotropin, T4, free thyroxine [fT4], T3, free triiodothyronine (fT3), rT3, thyroxine-binding globulin [TBG]), C-reactive protein (CRP), and serum SePP. In CKD patients, renal function was negatively associated with SePP concentration (standardized β = -0.17, p = 0.029); that is, SePP concentrations increased in more advanced CKD stages. In contrast, significantly lower SePP concentrations were found in patients on hemodialysis compared with CKD patients (M ± SD = 2.7 ± 0.8 mg/L vs. 3.3 ± .9 mg/L; p < 0.001). Notably, in CKD patients, the SePP concentration was negatively associated with T4 (standardized β = -0.16, p = 0.039) and fT4 (standardized β = -0.16, p = 0.039) concentrations, but no association was found with T3, fT3, rT3, T3/T4, rT3/T3, rT3/T4, or TBG concentrations. The SePP concentration was also negatively associated with CRP levels (standardized β = -0.17, p = 0.029). In the CHD group, no association was detected between SePP and the investigated TH parameters. Impaired renal function is positively correlated with serum concentrations of SePP. In patients undergoing CHD treatment, SePP concentrations were significantly reduced, but the TH profile remained unaffected. These findings indicate an important contribution of kidney function on serum SePP homeostasis, and consequently on Se status.

Correlation of Lower Concentrations of Hydrogen Sulfide with Activation of Protein Kinase CβII in Uremic Accelerated Atherosclerosis Patients.

Background:Hydrogen sulfide (H2S) plays a protective role in chronic hemodialysis (CHD) patients. In this study, we further investigate the relationship between H2S and conventional protein kinase CβII (cPKCβII) in CHD patients with uremic accelerated atherosclerosis (UAAS).Methods:A total of 30 healthy people, 30 CHD patients without AS and 30 CHD patients with AS (CHD + AS) were studied. Plasma H2S was measured with a sulfide sensitive electrode, and cPKCβII membrane translocation was detected by Western blotting.Results:Plasma H2S in CHD + AS group was significantly lower than that in CHD patients. cPKCβII membrane translocation in CHD + AS group increased significantly compared with CHD group. Plasma H2S concentration was negatively correlated with cPKCβII membrane translocation in CHD + AS patients.Conclusions:These findings suggest a possible linkage between H2S metabolism and cPKCβII activation, which may contribute to the development of UAAS in CHD patients.

Comparative Assessment of 2-Dimensional Echocardiography vs Cardiac Magnetic Resonance Imaging in Measuring Left Ventricular Mass in Patients With and Without End-Stage Renal Disease

While echocardiography (ECHO)-measured left ventricular mass (LVM) predicts adverse cardiovascular events that are common in hemodialysis (HD) recipients, cardiac magnetic resonance imaging (CMR) is now considered the reference standard for determination of LVM. This study aimed to evaluate concordance between LVM measurements across ECHO and CMR among chronic HD recipients and matched controls. A single-centre, cross-sectional study of 41 chronic HD patients and 41 matched controls with normal kidney function was performed to compare LVM measurements and left ventricular hypertrophy (LVH) designation by ECHO and CMR. In both groups, ECHO, compared with CMR, overestimated LVM. Bland-Altman analysis demonstrated wider agreement limits in LVM measurements by ECHO and CMR in the chronic HD group (mean difference, 60.8 g; limits -23 g to 144.6 g) than in the group with normal renal function (mean difference, 51.4 g; limits -10.5 g to 113.3 g). LVH prevalence by ECHO and CMR in the chronic HD group was 37.5% and 22.5%, respectively, while 17.5% and 12.5% had LVH by ECHO and CMR, respectively, in the normal kidney function group. Intermodality agreement in the designation of LVH was modest in the chronic HD patients (κ = 0.42, P = 0.005) but strong (κ = 0.81, P < 0.001) in the patients with preserved kidney function. Agreement was strong in assessing LVH by ECHO and CMR only in those with normal kidney function. Our results suggest that the limitations of LVM measurement by ECHO may be more pronounced in patients receiving HD, and provide additional support for the use of CMR in research and clinical practice when rigourous assessment of LVM is essential.

The Role of Arterio-Venous Shunt in the Pathogenesis of Pulmonary Hypertention in Patients with End-stage Renal Disease

Pulmonary hypertension (PHT) is an overlooked cardiovascular morbidity in patients with end stage renal disease. The pathogenesis of PHT in this group of patients is not explained satisfactorily. The aim of our study to evaluate the prevalence and the role of AV shunt in pathogenesis of pulmonary hypertention. Our study included 58 patients with ESRD without a known cause of PHT who were either in the predialysis period (stage 1V CKD) (14 patients) or maintained on chronic hemodialysis (stage V CKD) (44 patients) in Theodor Bilharz Research Institute (TBRI), Cairo, Egypt. In the chronic hemodialysis group, there were 27 males and 17 females with a mean age of 57.11 ± 12.31 years (range 28–65). In the predialysis group, there were 8 males and 6 females with a mean age 53.45 ± 9.41 years (range 28–66). Pulmonary arterial pressure (PAP) and cardiac output were evaluated by Doppler echocardiography in the 14 pre-dialysis patients without PHT few (4.3 ± 0.8) months after creation of AV fistula and in the 44 hemodialysis patients (33.6 ± 4.2 months) after creation of AV fistula within 1 h of completion of hemodialysis session. Arteriovenous fistula (AVF) flow was measured by Doppler sonography. PHT (systolic PAP ≥35 mm Hg) was observed in 25 (56.8%) patients receiving hemodialysis with a mean systolic PAP of 46.4 ± 13.6 mm Hg. In the predialysis group after creation of AV fistula, PHT was found in 6 (42.9%) patients with a mean systolic PAP of 42.8 ± 12.8 mm Hg. The cardiac output and AV shunt flow were found to be increased in patients with elevated systolic PAP in both groups (p < 0.05). CRF duration and AV fistula duration were positively correlated with systolic PAP in patients receiving hemodialysis (p < 0.05). After compression of AV fistula in 11 hemodialysis patients, the mean value of PHT decreased (from 43.98 ± 15.6 to 33.22 ± 11.7 mm Hg). This study demonstrates a high prevalence of PHT among patients with ESRD in predialysis period after creation of AV fistula and on chronic HD via a surgical A-V fistula. Cardiac output, AV shunt flow and duration, and ESRD duration may be involved in the pathogenesis of PHT. The development of PHT following access formation represents a failure of the pulmonary circulation to accommodate the access-mediated elevated CO. Pre-dialysis patients scheduled for access formation should be screened for the presence of sub-clinical PHT.

Hospital-acquired infections among chronic hemodialysis patients

The epidemiological characteristics of nosocomial infections among patients requiring chronic hemodialysis, a high-risk and rapidly growing population, have not been fully elucidated. During a 30-month cohort study, rates of bloodstream infections (BSIs), urinary tract infections (UTIs), pneumonia, and diarrhea caused by Clostridium difficile and the distribution of pathogens among hospitalized chronic hemodialysis patients were compared with hospitalized patients not requiring chronic hemodialysis. To identify risk factors for developing a nosocomial infection among chronic hemodialysis patients, a matched case-control study was performed. A total of 1,557 nosocomial infections were detected during 1,317 of 68,361 admissions (2%). Of these, 47 nosocomial infections occurred in chronic hemodialysis patients during 31 of 578 admissions (5%). Nosocomial infections were significantly more frequent among the chronic hemodialysis group (9.1/1,000 patient-days) compared with the non–chronic hemodialysis group (3.8/1,000 patient-days; relative risk [RR], 2.4; 95% confidence interval [CI], 1.8 to 3.2; P < 0.001). UTIs were the most common nosocomial infections among chronic hemodialysis patients, accounting for 47% of all infections in this population. UTIs were significantly more common among chronic hemodialysis patients (4.2/1,000 patient-days) compared with non–chronic hemodialysis patients (0.7/1,000 patient-days; RR, 6.2; 95% CI, 3.8 to 9.5; P < 0.001). Among chronic hemodialysis patients, Candida spp and enterococci were the most common pathogens in contrast to coagulase-negative staphylococci and Staphylococcus aureus among patients not requiring hemodialysis. Using conditional logistic regression, a greater index of comorbidity was significantly associated with nosocomial infections among the chronic hemodialysis population (odds ratio, 3.6; 95% CI, 1.2 to 10.7; P = 0.02). Chronic hemodialysis patients are at a substantially greater risk for developing a nosocomial infection compared with other hospitalized patients.