Disease In Hemodialysis Patients Research Articles

#941 Pentraxin-3 as a marker of coronary artery disease in hemodialysis patients

Abstract Background and Aims Pentraxin-3 (PTX3), a novel inflammatory biomarker, has been recognized as a predictor of cardiovascular events in the general population, including coronary artery disease (CAD). Although PTX3 is elevated in dialysis patients, its potential diagnostic value for the estimation of CAD severity is still insufficiently studied. The aim of this study was to evaluate the association between PTX3 and CAD in hemodialysis patients. Method This cross-sectional study included 60 angina-free chronic hemodialysis patients (60% men, mean age 60 ± 11 years, mean dialysis vintage 26 ± 14 months). Coronary artery calcium score (CACS) and coronary computed tomography angiography (CCTA) were performed to evaluate CAD burden and stenosis severity, which was defined as significant if obstructing more than 50% of the vessel lumen. PTX3 was quantified using an enzyme-linked immunosorbent assay kit. Results Significant coronary artery stenosis was detected in 24 (40%) patients, of which the majority (17; 70.83%) had one-vessel disease. PTX3 was 194.82 ± 68.58 ng/mL in patients with significant CAD, whereas 83.55 ± 11.89 ng/mL in those without significant coronary artery stenosis (p = 0.028). PTX3 levels tend to increase in patients with CACS higher than 200 Agatston units, however statistically significant difference was not reached (p = 0.504). PTX3 levels correlated with age (p < 0.05) and c-reactive protein (p = 0.007), while negatively correlated with body mass index (p < 0.05). Conclusion PTX3 is significantly increased in hemodialysis patients with coronary artery disease. Further studies should elucidate if including PTX3 as a marker for detecting CAD prior to invasive imaging could improve cardiovascular risk stratification even in angina-free hemodialysis patients.

#2141 Lipoprotein a levels and atherosclerotic cardiovascular disease in hemodialysis patients

Abstract Background and Aims Lipoprotein a (Lp(a)) is an LDL cholesterol-like particle to which two apolipoprotein(a) molecules are attached. Epidemiological and genetic studies strongly support a causal and continuous association between Lp(a) concentration and atherosclerotic cardiovascular (CV) disease, including aortic valve stenosis, even with low levels of low-density lipoprotein cholesterol. On the other hand, it is well known that patients on hemodialysis (HD) have high comorbidity due to cardiovascular pathology. Method We conducted a cross-sectional, observational, retrospective study in a cohort of patients on HD, with the aim of evaluating whether there was any correlation between Lp(a) concentration and atherosclerotic cardiovascular disease (ASCVD). For this purpose, in December 2023 we measured Lp(a) levels (in nmol/L) in all prevalent HD patients in the province of Cáceres (Spain) and collected their major adverse coronary events (MACE): acute myocardial infarction (AMI) and angina, as well as major adverse non-coronary cardiovascular events (MANCE): cerebrovascular disease and peripheral artery disease. Aortic valve stenosis/calcification was also assessed by echocardiography. SPSS version 21 software was used for statistical analysis. Results A total of 214 patients were included, 68.7% male, with a mean age of 70.5 years. The mean Lp(a) value was 76.9 nmol/L, without differences in both sexes. A total of 66.4% had Lp(a) < 75 nmol/L and 23.8% had levels ≥ 125 nmol/L. The main cardiovascular event was peripheral artery disease (14.9%), followed by AMI (14.1%), aortic valve stenosis (10.7%), stroke (8.4%), angina (2.8%) and transient ischemic attack (1.4%). Some 23.4% (50 patients) had a CV event and, among them, almost half (42%) had Lp(a) levels >75 nmol/L. A statistically significant linear correlation was found between Lp(a) concentration and AMI (p 0.03) and aortic valve stenosis (p 0.001). No correlation was observed between Lp(a) and the other CV events analyzed (peripheral artery disease, stroke, angina, transient ischemic attack), nor between Lp(a) and sex. Conclusion There is a linear and positive correlation between Lp(a) levels and coronary pathology, and with aortic valve stenosis in HD patients in the cohort studied. Studies are needed to assess whether reducing their levels reduces cardiovascular disease in these patients.

The role of intact parathyroid hormone, total calcium and inorganic phosphate in prediction of cardiovascular disease in hemodialysis patients

The role of intact parathyroid hormone, total calcium and inorganic phosphate in prediction of cardiovascular disease in hemodialysis patients

High-sensitivity cardiac troponin T in detecting obstructive coronary artery disease in hemodialysis patients listed for kidney transplantation.

Cardiovascular diseases are the leading cause of morbidity and mortality in patients with end-stage renal disease. This study aimed to assess the prognostic value of high-sensitivity cardiac troponin T (hs-cTnT) in identifying patients with obstructive coronary artery disease (CAD) among patients on hemodialysis listed for kidney transplantation. The study prospectively enrolled consecutive adult hemodialysis patients listed for kidney transplantation. They underwent laboratory tests and a standardized set of imaging and functional tests, including coronary angiography, according to patient characteristics. The study included 100 consecutive patients (72 men)at a median age of 56.5 years. Ultimately, 48% of the patients were diagnosed with obstructive CAD. Age and plasma hs-cTnT levels predicted the diagnosis of obstructive CAD (OR, 1.13; 95% CI, 1.08-1.20; P < 0.001 and OR, 1.03; 95% CI, 1.01-1.05; P = 0.001, respectively). The calculated cut-off value for age was 53 years, which showed sensitivity of 87.5% and specificity of 76.9% for obstructive CAD diagnosis. The calculated value for hs-cTnT was 0.067 ng/ml, which showed sensitivity of 61.4% and specificity of 82.2% for the detection of obstructive CAD. In patients aged >52 years, 79.2% were diagnosed with obstructive CAD. However, in the group of patients ≤52 years and with hs-cTnT >0.069 ng/ml, the incidence of obstructive CAD was significantly higher than in the group with hs-cTnT level ≤0.069 ng/ml. Baseline hs-cTnT level is a useful prognostic biomarker in the diagnosis of obstructive CAD in hemodialysis patients listed for kidney transplantation.

Small Oversized Stent Graft Is Associated With Increased Patency for the Treatment of Central Venous Disease in Hemodialysis Patients.

The purpose of this study was to identify the independent predictors of higher patency rates and investigate the selection of specifications of stent graft in the treatment of central venous disease. This retrospective study included 54 patients who underwent stent-grafts' placement for the treatment of central venous disease between March 2017 and September 2022 at a tertiary hospital. The demographic data for the patients and the clinical data of the treated lesions were collected and analyzed. The patency rates of the treated lesions with different oversizing range were calculated via the Kaplan-Meier and log-rank analyses. The multivariate Cox proportional hazard models were constructed to identify the independent predictor of the target site primary patency. The median follow-up period was 21.5 months. The primary patency rates of the target sites were 90.7%, 72.2%, and 55.1% at 6, 12, and 24 months, respectively. The assisted primary patency rates of the lesions were 96.3%, 92.5%, and 80.3% at 6, 12, and 24 months, respectively. The log-rank analysis showed that the stent-grafts' placement with small oversizing had significantly higher primary patency rates than those with large oversizing (p=0.022). The multivariate analysis revealed that concomitant stenosis and large oversizing stent graft were the independent predictors of target site primary patency. Stent grafts showed reasonable primary patency for the treatment of central venous disease in hemodialysis patients. A stent graft with small oversizing is associated with better target site primary patency rates than those with large oversizing. Stent grafts showed reasonable primary patency for the treatment of central venous disease in hemodialysis patients. Few studies, however, have explored the efficiency of stent grafts to treat CVD by considering different factors such as sizing considerations, the rate of oversizing percentage, etc. A stent graft with small oversizing is associated with better target site primary patency rates than those with large oversizing. Excessive oversizing should be avoided to prevent infolding or stent collapse.

Evaluation of abnormal Chest X-rays for hemodialysis patients

Background: A chest x-ray is the most practical way to evaluate lung disease. There are different degrees of pulmonary abnormalities in hemodialysis patients. The diagnosis of pulmonary disease in hemodialysis patients can be challenging due to the complex findings and multiple manifestations. Objective: This study aimed to identify and evaluate the accuracy and consistency of chest radiographs in the diagnosis of pulmonary abnormalities in hemodialysis patients, Also highlight the limitations of CXR for diagnoses. Materials and methods: We collected and reviewed chest radiographs of 60 hemodialysis patients with various pulmonary manifestations. Two experienced radiologists independently interpreted CXR uptake to diagnose pulmonary disease. The degree of incompatibility among radiologists was assessed using SPSS statistical analysis (chi-square test).Results: The two radiologists showed slight agreement in pneumonia (29.6%), pleural effusion (28.6%), pulmonary edema (25.0%) and cardiomegaly (20.0%). Where the level of disagreement between radiologists 1 and 2 was in cardiomegaly (80.0%), pulmonary edema (75.0%) ), pneumonia (70.4%) and pleural effusion (71.4 %). The total level of agreement was 31.7% and 63.3% disagreement. This result indicates that there is a significant difference in terms of diagnosis (X2 = 8.067, p-value &lt;0.05).Conclusion: The chest X-ray upon admission is limited in accurately diagnosing pulmonary abnormalities in hemodialysis patients, primarily due to the presence of multiple diseases in the same patient and the increased occurrence of pulmonary edema in these patients. This poses a challenge to diagnosis without clinical data or the utilization of other imaging techniques.

Pave and Pop: A novel addition to the endovascular treatment of hemodialysis access aneurysms.

Hemodialysis access sites can be complicated by both true and false aneurysms with significant potential morbidity. Aneurysms have traditionally been treated by a variety of surgical methods. Less commonly, endovascular treatment with stent graft placement has been used as an alternative to open surgery. Four patients with symptomatic aneurysmal disease in the hemodialysis access site were treated. All patients had stent grafts (SGs) placed across the diseased segment. Once the diseased segment was excluded, blood was drained from the aneurysm with an 18 g needle. All patients were seen in clinic at 1- and 3-months post procedure. All patients were able to receive adequate hemodialysis post procedure. Two patients were cannulated via the SG after 1 month. No aneurysm refilling was seen. No SG infections or fractures were seen. A novel addition to the endovascular treatment of aneurysmal disease in hemodialysis patients is described, that both excludes the aneurysm and drains it, providing improvement in the aesthetic appearance of the access site.

Pruritus associated with chronic kidney disease in hemodialysis patients: a survey in French nephrologists

Chronic kidney disease-associated pruritus (CKD-aP) is common in hemodialysis patients and severely impairs their quality of life, but the practices of nephrologists remain poorly known. The objective of this on-line survey was to describe the management of CKD-aP in French nephrologists affiliated with the French-speaking Society of Nephrology, Dialysis and Transplantation (SFNDT) and involved in hemodialysis. In total, 122 questionnaires were completed and 100 were usable. Nephrologists reported they personally managed a median of 52 patients; they estimated that the CKD-aP prevalence in their hemodialysis patients was a median of 10% (IQR, 6.3-17.2); 6% of nephrologists reported not following any patient with CKD-aP. In case of CKD-aP, the first-intention intervention was the evaluation of phosphocalcic metabolism (53.5%) and verification of dialysis adequacy (52%). For moderate-to-severe CKD-aP, the first-line prescription was topical therapy (71.3%), antihistamine (23.2%) and membrane change (15.9%). Patients were referred to a dermatologist mainly in case of treatment failure (86.9%) or scratching lesions (40.4%). Available treatments were considered ineffective for 50.5% of nephrologists, partially effective for 45.5% and effective for only 4%. These results show that according to the opinion of nephrologists, the pruritus prevalence is low in dialysis patients. This is inconsistent with studies based on systematic patient interviews, thus suggesting that pruritus is a symptom overlooked by nephrologists. In the context of the arrival of a new drug for pruritus, patients should be more questioned about this symptom in order to propose this treatment.

Impact of Hemodialysis on Left Ventricular-Arterial Coupling in End-Stage Renal Disease Patients

Introduction: As a key determinant of cardiovascular performance, vascular-arterial coupling (VAC) has been reported to be a predictor of clinical outcomes in various clinical scenarios. However, few studies have explored how acute fluid removal during hemodialysis (HD) impacts the interaction between cardiac function and the arterial system. Methods: We recruited 317 HD patients from an established renal dialysis unit for this cross-sectional study and a total of 285 were included in the final analyses. We measured left ventricle end-systolic elastance (Ees), the effective arterial elastance (Ea), and VAC before and after HD using noninvasive echocardiographic measurements. We also compared echocardiographic and hemodynamic parameters in ventriculo-arterial coupling and ventriculo-arterial uncoupling patients. Results: HD significantly altered partial ventricular and vascular function parameters such as blood pressure, left ventricular end-diastolic volume, stroke volume, left ventricular ejection fraction, and systemic vascular resistance index. Ea increased following HD from 3.5 ± 1.4 to 4.2 ± 1.8 mm Hg/mL (p < 0.0001), Ees increased following HD from 7.9 ± 5.5 to 9.2 ± 6.9 mm Hg/mL (p = 0.04), whereas VAC did not markedly alter as a result of HD. Ventriculo-arterial uncoupling was found to be related to abnormal cardiac structure and worse systolic function. Conclusions: VAC obtained from echocardiography is likely to be load-independent and useful as a reliable index for stratifying the risk of cardiovascular diseases in HD patients. Further investigations on larger patient cohorts are needed to further validate our findings.

Peripheral arterial disease in hemodialysis patients 10 years later

Background and objectivePatients with chronic kidney disease (CKD) on hemodialysis present high cardiovascular comorbidity. Peripheral arterial disease (PAD) is associated with higher mortality and the interest in its early detection and treatment is increasing. The objective of this study is to determine the frequency and severity of symptomatic PAD, and to establish its relationship with mortality in HD patients that have received treated early and compare them with a cohort of our center already reported. Material and methodsRetrospective study on a cohort of incident patients since 2014 and followed up until December 2019. Demographic data, cardiovascular risk, the presence of symptomatic PAD at baseline and during follow-up were collected. Trophic lesions were graded using the Rutherford scale. ResultsInitially, there were 91 patients and 7 cases that were not included in the study were lost to follow-up. Age 64 ± 16 years, men 51.6% (47/91). The percentage of baseline PAD was 10.7% (9/84). During a median follow-up of 35 months (20−57), the diagnosis of PAD increased to 25% (21/84). Half of the patients with PAD 52.38% (11/21) obtained a score greater than 3 in the Rutherford Clinical Classification, which corresponds to severe disease. 13/21 patients required reoperation due to recurrence of symptoms (61.9% of cases with PAD).The development of PAD was significantly associated with: an elevated index of Charlson (3.9±2.1 vs. 7.7 ± 3.5; P = 0.001),being male (19 vs. 2; P = 0.001), diabetic (no: 7; yes: 15; P = 0.001) and with a history of chronic ischemic heart disease (no: 13; yes: 8; P = 0.001), 38.1% (8/21) had ischemic heart disease in patients who developed PAD, while in the absence of PAD the presence of ischemic heart disease was 9.5% (6/63). Furthermore, more than half (66.7% [14/21]) of those who developed PAD were diabetic.Univariate analysis showed that age, C reactive protein, albumin, and number of surgical interventions, but not PAD, were associated with mortality. In the multivariate analysis adjusted for other factors, only C reactive protein was related to overall survival Exp β: 2.17; P = 0.011; CI (1.19–3.97). Regarding cardiovascular mortality, in the multivariate Cox analysis, only PAD was related to mortality of cardiovascular origin Exp β: 1.73; P = 0.006; CI (1.17–2.56). ConclusionsA significant number of patients on hemodialysis develop PAD requiring peripheral vascular surgery. PAD was not associated with overall mortality in our cohort, but it did show an association with cardiovascular mortality. Prospective studies with a larger sample size are necessary. New surgical treatments and Follow-up by vascular surgeons could improve the severity of PAD and the long-term prognosis.

XperCT facilitates sharp recanalization for the treatment of chronic thoracic venous occlusive disease in hemodialysis patients.

Our objective was to evaluate the feasibility of XperCT combined fluoroscopy to guide sharp recanalization for the treatment of chronic thoracic venous occlusive disease in hemodialysis patients. The records of hemodialysis patients with chronic thoracic venous occlusive disease who received endovascular sharp recanalization after conventional techniques failed were retrospectively reviewed. The sharp devices used for recanalization included the stiff end of a guidewire, Chiba biopsy needle, RUPS-100 set, and transseptal needle. The needle was advanced toward a target placed at the opposite end of the occlusion and was guided by fluoroscopy and/or XperCT. While the guidewire crossed the occlusion, endovascular procedures such as percutaneous angioplasty were performed for the treatment of the occlusion. The analysis included 32 sharp thoracic vein recanalization procedures in 29 patients. Two attempts in one patient failed, and in one patient the first attempt failed but the second attempt was successful. In one patient, two separate successful procedures were performed, and the other 26 procedures in 26 patients were successful. The overall technical success rate of sharp recanalization was 90%. The mean number of puncture attempts in the combined group was less than that of the fluoroscopy-guided alone group (2 vs 5, p < 0.05). The success rate of sharp recanalization in the combined group was higher (100% vs 86%), and the recanalization time (28.5 min vs 36 min, p > 0.05) was no different. There was no statistical difference in procedure-related complications between the groups. XperCT can facilitate sharp recanalization for the treatment of chronic thoracic venous occlusive disease in hemodialysis patients.

Malnutrition leads to the progression of coronary artery calcification in hemodialysis patients.

Malnutrition is considered a risk factor for cardiovascular disease in patients with chronic kidney disease. However, no in vivo studies have reported on using optical coherence tomography to evaluate the effect of nutritional status on coronary atherosclerosis in hemodialysis patients. We aimed to conduct a detailed analysis of the effect of nutritional status on the coronary arteries in hemodialysis patients. Among 64 hemodialysis patients who underwent percutaneous coronary interventions, 41 that underwent optical coherence tomography imaging were included in this study. And, among them, 24 patients that could also be evaluated using OCT also at the 6-month follow-up were included in this study. The patients were divided into two groups based on nutritional evaluation using the geriatric nutritional risk index. Culprit and non-culprit lesions were evaluated at baseline and after 6 months. In the culprit lesions at baseline, the length of the lipid plaque was significantly smaller in the malnutrition group. In contrast, the thickness and length of the calcified plaque and the angle of the calcified nodule were significantly larger (each p < 0.01). In the non-culprit lesions, the 6-month change in the angle of the calcified plaque was significantly greater in the malnutrition group (p = 0.02). The significant factors that affected the change in the angle of calcification were "malnutrition at geriatric nutritional risk index" [odds ratio, 8.17; 95% confidence interval, 1.79 to 37.33; p < 0.01] and "serum phosphorus level" (odds ratio, 3.73; 95% confidence interval, 1.42 to 9.81; p < 0.01). Appropriate management of nutritional status is crucial for suppressing the progression of coronary artery disease in hemodialysis patients.

The Association between Epicardial Adipose Tissue and Coronary Artery Disease in Hemodialysis Patients Using a Systematic Review

The role of epicardial adipose tissue (EAT) may play in the pathogenesis of coronary vascular disease CVD in patients on hemodialysis and whether imaging of EAT may hold prognostic implications for CVD events and mortality within this patient group .This systematic review investigated the association between epicardial adipose tissue and developing coronary artery diseases in patients undergoing hemodialysis. A search strategy was developed to identify primary studies published until 2 November/2019. Studies were obtained from multiple electronic databases (PubMed, HINARI, Science Direct). Searches were supplemented by hand searching and checking the reference lists of included articles. After the removal of duplicates, the search identified 89 titles, following title and abstract review twenty–three publications were considered potentially relevant, of which 6 studies were retrieved plus two studies from references list. The eight studies were included in the current review. Epicardial Adipose tissue thickness or volume is correlated significantly with coronary artery calcification in hemodialysis patients regardless its long term or incident. This systematic review suggests the significant relationship between epicardial adipose tissue and developing coronary artery disease in this special cohort of patients, hemodialysis patients. Further research should consider more the availability of using EAT as a non-invasive method to assess cardiovascular risk in HD patients.

Not baseline but time-dependent erythropoiesis-stimulating agent responsiveness predicts cardiovascular disease in hemodialysis patients receiving epoetin beta pegol: A multicenter prospective PARAMOUNT-HD Study

BackgroundResponsiveness to erythropoiesis-stimulating agents (ESAs) has been reported to be associated with increased cardiovascular disease (CVD) and mortality in patients undergoing hemodialysis (HD). However, the association between hyporesponsiveness to the long-acting ESA, epoetin beta pegol (CERA), and CVD remains unknown. MethodsThis multicenter prospective study included 4034 patients undergoing maintenance HD. After shifting from prior ESA to CERA, we studied the association between erythropoietin resistance index (ERI) at six months and outcomes, including cardiac events, major adverse cardiovascular events (MACE), and all-cause mortality, using Cox proportional hazards models (Landmark analyses) and marginal structural models to adjust for time-dependent confounding factors, including iron-containing medications and hemodiafiltration (HDF). ResultsThe median dialysis vintage and the observational period were 5.0 years and 22.1 months, respectively. The landmark analyses revealed that the highest tertile of baseline ERI (T3) was associated with a significantly higher all-cause mortality than the lowest tertile (T1) (hazard ratio [HR]: 1.48, 95% CI: 1.03–2.13). Furthermore, marginal structural models revealed that time-dependent ERI T3 was significantly associated with increased cardiac events (HR: 1.59, 95% CI: 1.14–2.23), MACE (HR: 1.60, 95% CI: 1.19–2.15), all-cause mortality (HR: 1.97, 95% CI: 1.40–2.77), and heart failure (HF) (HR: 2.05, 95% CI: 1.23–3.40) compared to T1. A linear mixed effects model showed that iron-containing medications and HDF are negatively associated with time-dependent ERI. ConclusionsBaseline ERI at six months predicted only all-cause mortality; however, time-dependent ERI was a predictor of cardiac events, all-cause mortality, MACE, and HF. The widespread use of iron-containing medications and HDF would ameliorate ESA hyporesponsiveness.

High-risk screening for Fabry disease in hemodialysis patients in Chiba Prefecture, Japan.

High-risk screening for Fabry disease in dialysis patients is an effective means for reducing the number of undiagnosed cases. However, such screening has not been conducted in Chiba Prefecture, Japan. Herein, we aimed to estimate the prevalence of Fabry disease among patients undergoing hemodialysis in Chiba Prefecture by high-risk screening using α-galactosidase A (αGal A) activity measurement, and examine the hemodialysis effect on αGal A activity. Patients who underwent maintenance hemodialysis at 25 facilities in Chiba Prefecture were recruited. The αGal A activity was measured using the dried blood spot (DBS) test as the first screening. If the enzyme activity was lower than the cut-off, the second screening was performed with the same method before and after dialysis. Overall, 2924 patients (2036 men and 888 women) were included from which 94 cases (45 men and 48 women) showed decreased αGAL activity in the first screening and 3 (two men and one women) in the second screening. Genetic testing was performed in 3 patients, and the c.1078G > A mutation in GLA gene was detected in one male patient (0.03%). There has been a statistically significant decrease in αGal A activity of DBS at post-dialysis compared to that at pre-dialysis (20.5 ± 10.4pmol/h/disk and 22.7 ± 11.5pmol/h/disk, p < 0.0001). The prevalence of Fabry disease among patients undergoing hemodialysis in Chiba Prefecture was estimated as 0.03%. This is the first time that dialysis has been shown to affect the αGal A activity.

Outcomes of stent grafts for treatment of central venous disease in hemodialysis patients.

To evaluate the effectiveness of stent graft (SG) for the treatment of central venous disease (CVD) in hemodialysis patients. Between January 2014 and April 2022, 122 patients on hemodialysis with symptomatic CVD were treated with percutaneous transluminal angioplasty (PTA) and bare-metal stent (BMS) or SG placement. The mean follow-up was 14.5 months (IQR: 8.0, 24.2). Patency rates of the target sites were calculated using Kaplan-Meier and log-rank studies. Multivariate Cox proportional hazard models were used to evaluate the association between various characteristics and target site primary patency. Technical success rate was 100%. At 3, 6, 12, and 24 months, the target sites primary patency rates were 86.4%, 74.2%, 45.1%, and 30.4% for PTA; 94.7%, 78.6%, 60.8%, and 45.6% for BMS; and 94.0%, 92.0%, 82.4%, and 66.8% for SG, respectively, and the assisted primary patency rates were 86.5%, 80.4%, 63.8%, and 46.0% for PTA; 94.7%, 89.5%, 77.5%, and 71.1% for BMS; 100%, 100%, 97.8%, and 83.4% for SG, respectively. The Kaplan-Meier analysis indicated that SGs achieved better primary and assisted primary patency than PTA or BMS (p<0.05). SG use and concomitant stenosis were the independent predictors of target site primary patency dysfunction in the multivariate analysis. This study confirmed the better long-term patency of SG in comparison with PTA and BMS for the treatment of CVD in hemodialysis patients.

Clinical characteristics and management of hemodialysis patients with pre-dialysis hypertension: a multicenter observational study

Background Hypertension is a leading preventable risk factor for cardiovascular disease in hemodialysis patients. Pre-dialysis systolic blood pressure (SBP) more than 160 mmHg was thought to be associated with increased risk of cardiovascular events and all-cause mortality. The present study was performed to explore the clinical characteristics and management of hemodialysis patients with pre-dialysis SBP ≥ 160 mmHg. Methods A total of 1233 patients undergoing hemodialysis from nine hemodialysis centers were enrolled. Pre-dialysis and home BP were measured and clinical data were collected. The characteristics of patients with pre-dialysis SBP ≥ 160 mmHg were explored. Clinical parameters between hypertensive and non-hypertensive patients were compared. The partial correlation analyses performed to identify the associations between BP and clinical parameters. Results There were 24.6% of the hemodialysis patients had pre-dialysis SBP ≥ 160 mmHg and the average SBP was 173.8 ± 10.9 mmHg. Only 21.4% of the patients achieved dry weight after dialysis and up to 30.2% of patients were not given combination therapies of antihypertensive drugs. Compared to patients with pre-hemodialysis SBP < 160 mmHg, patients with pre-dialysis SBP ≥ 160 mmHg had lower target-reaching rate of Kt/v and higher incidences of intradialytic hypotension and muscle spasm. Most patients (96%) with pre-dialysis SBP ≥ 160 mmHg had home SBP≥ 135 mmHg. Patients with home SBP ≥ 160 mmHg had higher left ventricular weight index and lower hemoglobin levels when compared to their counterparts with home SBP <160 mmHg. Conclusions Pre-dialysis SBP ≥ 160 mmHg is common in clinical practice and most of the patients could diagnosed to be hypertensive according to their home SBP. Patients with pre-dialysis SBP ≥ 160 mmHg are more likely to be subjected to dialysis insufficiency and intradialytic complications. Achieving dry weight and sufficient pharmacologic interventions should be strengthened to improve BP control in the hemodialysis population.

The Frequency of Fabry Disease in Hemodialysis Patients in The Western Mediterranean Region of Turkey

Aims: The aim of the present study was to identify patients with chronic kidney disease of unknown etiology or of other detected etiology among those who were undergoing hemodialysis in the Western Mediterranean region and to detect the prevalence of Fabry mutation in these patients. In addition, we aimed to screen the family members of the cases with mutations in our study.&#x0D; Methods: A total of 664 patients over the age of 18 who received hemodialysis treatment in 11 different hemodialysis centers in the Western Mediterranean region of Turkey were screened. Alpha-galactosidase A enzyme levels were first tested in male patients, and for patients with alpha-galactosidase A levels &lt; 3.3 nmol/mL/h, GLA gene sequence analysis was performed. GLA gene sequence analysis was performed directly in female patients. &#x0D; Results: In total 664 patients [313 (47.1%) male and 351 (52.9%) female] have been scanned. Fabry mutation was positive in eight female patients and one male patient. &#x0D; Conclusion: According to the output of the research, the prevalence of Fabry disease among the patients who receive hemodialysis treatment determined 1.35%. In order to eliminate the conflicts upon whether the mutations which is effective on the etiology of Fabry disease are pseudo alleles it is required that new researches should be done, prospective scanning programs in a wider patient population and genetic consultancy and preventive medicine services should become more prevalent.

The Effects of Nigella Sativa Oil on Serum Levels Inflammatory Markers, Oxidative Stress Markers, and Lipid Profile in Dialysis Patients: A Double-Blind Clinical Trail

Background: High concentrations of serum inflammatory and oxidative stress markers and lipid abnormities are important risk factors for cardiovascular diseases in hemodialysis patients. This study aims to investigate the effects of Nigella sativa oil on serum levels inflammation and oxidative stress markers and lipid profile in hemodialysis patients.&#x0D; Methods: Fifty hemodialysis patients participated in this randomized, double-blind, placebo-controlled clinical trial. The patients were randomly assigned into two groups, including receiving 2 tablets of Nigella sativa oil (1000 mg/day, NG) and receiving placebo (PG), for 8 weeks. Blood samples were taken from the patients at the beginning and the end of the study after 12 to 14 hour fasting for measuring serum markers. Then, levels of triglycerides (TG), total cholesterol (TC), LDL-c, HDL-c, high sensitivity C-reactive protein (hs-CRP), and malondialdehyde (MDA) were measured.&#x0D; Results: Consumption of Nigella sativa oil as a supplement decreased levels of TC (P = 0.0002), LDL-c (P = 0.001), mean serum hs-CRP, and MDA compared to the PG (P = 0.001).&#x0D; Conclusion: The Nigella sativa oil supplement may reduce serum hs-CRP and MDA, TC, LDL-c, and risk factors for cardiovascular diseases in hemodialysis patients.

Plasma C4 level was associated with mortality, cardiovascular and cerebrovascular complications in hemodialysis patients

BackgroundPatients on maintenance hemodialysis (HD) exhibit a high risk of death, cardiovascular and cerebrovascular diseases (CCDs). Previous studies indicated complement activation associated with the increased risk of cardiovascular diseases in HD patients. This study aimed to explore whether the critical complement factors were associated with the adverse outcomes in HD patients.MethodsA total of 108 HD patients were included and followed up for 52 months. The baseline clinical characteristics and plasma C3c, C1q, CFH, CFB, C4, MAC, C5a, C3a and MBL were measured. The three endpoints were death, cardiovascular and cerebrovascular events (CCEs) and the composition of them. Univariate and multivariate Cox regression identified factors associated with the three endpoints respectively. X-tile analyses determined the optimal cut-off values for high risks. Restricted cubic spline plots illustrated the dose–response relationships. Correlations between the complement factors and risk factors for CCDs were analyzed.ResultsBaseline plasma C4 was finally selected by univariate and multivariate Cox regression analyses for three endpoints, including all-cause mortality, CCEs and the composition of them. When baseline plasma C4 exceeded 0.47 (P = 0.001) or 0.44 (P = 0.018) g/L respectively, the risks for death or achieving the composite endpoint enhanced significantly. The relationships of C4 and HR for the three endpoints showed a positive linear trend. Plasma C4 had prominent correlations with blood TG (r = 0.62, P < 0.001) and HDL (r = -0.38, P < 0.001).ConclusionsA higher baseline plasma C4 level was significantly associated with the future incidence of decease, CCEs and either of them. Plasma C4 level correlated with blood TG and HDL.