Group Of Hemodialysis Patients Research Articles

Analysis of 2-Year Survival Outcomes of Japanese Older Populations on Hemodiafiltration: A Propensity Score-Matched Study Based on Insurance Claims Data

Despite the lack of evidence that suggests hemodiafiltration (HDF) offers a better survival outcome than standard hemodialysis (HD), the number of patients initiating HDF in Japan continues to rise. This study examined the temporal change in the number of HDF incidents, evaluated factors associated with all-cause mortality, and compared the mortality risk and survival time of patients on HDF with patients receiving standard HD in three sets of 2-year cohorts. The primary analyses included the insurance claims data of 460 HDF patients and propensity score-matched 903 standard HD patients who initiated dialysis therapy between 1 April 2012 and 31 March 2018. Patient follow-up was censored at the time of death or the end of the 2-year study period. The number of patients who initiated HDF and the proportion of all-cause mortality cases were evaluated. Additionally, the survival outcomes between propensity score-matched HDF and standard HD patient groups were compared throughout cohorts. The number of HDF patients increased throughout cohorts, but the proportions of mortality cases across cohorts slowly decreased. Adjusting for all study covariates, we observed that HDF patients had a lower mortality risk and longer survival time than patients on standard HD. This study supports the notion that HDF lowers all-cause mortality compared with standard HD in an incident dialysis population in Fukuoka Prefecture, Japan.

Comparison of pathological electrocardiographic changes between long-term kidney transplant recipients and hemodialysis patients

Aims: We aimed to reveal electrocardiographic changes in kidney transplant recipients (KTRs) compared with hemodialysis patients. Methods: We included 70 KTRs who had underwent a kidney transplantation for more than one year and 84 patients who had been on hemodialysis for more than one year. We recorded age, sex, body-mass index (BMI) (kg/m2), primary disease (makes chronic kidney disease) and duration of hemodialysis treatment. Standard measurements such as heart rate (HR), P wave, PR interval, P axis, QRS complex, QRS axis, T axis, QT interval and QTc interval were performed for all electrocardiography (ECG). Results: KTRs were younger than the hemodialysis patients group (HPG) (31.5 vs. 54.5, p

#1587 Decreased NK cell-mediated cytotoxicity is associated with hypoalbuminemia in hemodialysis patients

Abstract Background and Aims The significance of Natural Killer (NK) cells in cancer immunity and immunotherapy has garnered substantial attention. Impaired NK cell function can severely compromise the host’s immune system. End-stage kidney disease (ESKD) and hemodialysis (HD) are known among various factors contributing to NK dysfunction. Nonetheless, the precise mechanisms underpinning this phenomenon remain insufficiently elucidated. Method We conducted a comprehensive multivariate and comparative analysis of NK cell subtypes and surface receptors across different age and gender categories in healthy donors (HC). Furthermore, we compared these parameters in HD patients to healthy controls. Additionally, NK cell cytotoxicity between HD patients and HC is assessed. The study also examines the biochemical data in HD patients with varying levels of NK cell cytotoxicity. Results The analysis of NK cells in 44 HC reveals age-related increases in the proportions of total NK cells, CD56dim cells, and CD56dimCD16bright cells, accompanied by reductions in CD56bright cells and CD56dimCD16dim cells. Gender differences were not observed. Among 30 age-matched HD patients and 30 HC individuals, CD56bright cells increased, while CD56dim cells decreased in HD patients. As a result, premature aging-related NK cell phenotypes were not observed in HD patients. Nevertheless, HD patients exhibit reduced NK cell cytotoxicity across all four effectors: target ratios. Furthermore, a comparison within the HD patient group, distinguishing those with high and low cytotoxicity (7 in the former, 11 in the latter), reveals higher albumin levels in the high cytotoxicity group. Conclusion This study uncovers significant functional impairment in NK cell cytotoxicity between HD patients and healthy individuals. Impaired cytotoxicity among HD patients is attributable to malnutrition, possibly mediated by hypoalbuminemia. This research is the first to elucidate the connection between serum albumin levels and NK cell dysfunction in ESKD.

Molecular Detection of Van A and bap Genes in Staphylococcus Species Isolated from Hemodialysis Patients with Blood Stream Infections

AbstractBackground:Bloodstream infections (BSIs) are a frequent consequence of hemodialysis caused by bacterial pathogens associated withStaphylococcusspp. especiallyStaphylococcus aureusfollowed by coagulase-negative Staphylococci, which can produce biofilms, and also show its ability to increase resistance to vancomycin.Objectives:Estimate the percentage ofStaphylococcusspp. associated with BSIs in hemodialysis (HD) patients. Study the antibiogram pattern of isolates and detection of the resistance genevan Aand virulencebapgene.Materials and Methods:A total of 120 blood samples, 60 from patients on hemodialysis and 60 patients suspected of bacteremia, were collected. The isolation of bacteria was performed by blood samples inoculated in BacT/ALERT bottles and then subcultured on blood agar. Identification and antibiotic sensitivity testing detection were performed by the Vitek-2 system; then a conventional polymerase chain reaction forvan Aandbapgenes was done.Results:The percentage ofS. aureuswas 64.7% within the group of HD patients followed byStaphylococcus lentus11.8%,Staphylococcus hemolyticus8.8%, andStaphylococcus hominis5.9%, whereas in non-HD patients’ group,S. aureuswas 50.0% andS. lentus25.0%. AllStaphylococcusspp. was completely resistant to vancomycin in HD and non-HD patients. The percentage ofvan Agene was 91.2% and 83.3% within HD and non-HD patients, respectively. The percentage ofbapgene was 55.9% and 58.3% within HD and non-HD patients, respectively.Conclusion:Staphylococcus aureusis the most common bacterium that causes bacteremia in dialysis patients, while other types contribute with a lower frequency.

Association of Circulating Endothelial Nitric Oxide Synthase Levels with Phosphataemia in Patients on Haemodialysis.

The amount of evidence indicates that hyperphosphataemia (HP) can induce endothelial damage and significantly impair endothelial nitric oxide synthase (eNOS) expression. There are no clinical studies that have assessed HP and its correlation with circulating eNOS concentration in patients with end-stage renal disease (ESRD). Our preliminary study aimed to evaluate the relationship between plasma inorganic phosphorus (P) levels and circulating plasma eNOS concentration in patients on haemodialysis (HD). A total of 50 patients on HD were enrolled to the study. They were divided into groups according to the tertiles of P. The examined HD group was also analysed and compared with controls as a whole group; then, the group was divided into patients with and without dyslipidaemia (D) as well as into those with and without type 2 diabetes mellitus (type 2 DM). A total of 26 age-matched healthy volunteers were included in the study as the control group. The plasma levels of eNOS in HD patients are reduced in comparison to those in healthy subjects. There was no difference in plasma eNOS concentrations between HD patients with type 2 DM and those without DM as well as between those with D and without D. In the entire group of HD patients, there were positive correlations between circulating levels of eNOS and plasma P concentrations. In HD patients with D, higher systolic and diastolic blood pressure were accompanied by decreased plasma eNOS concentrations. In conclusion, HP and high blood pressure appear to decrease the circulating eNOS levels. These findings demonstrate an additional negative impact of HP on eNOS activity.

The Role of Zinc and Copper in Anemia and Erythropoietin Responsiveness in Patients on Hemodialysis and Peritoneal Dialysis

Introduction: Imbalance in copper (Cu) and zinc (Zn) homeostasis is a frequent finding in patients undergoing dialysis. These patients have higher serum Cu and lower serum Zn levels compared to controls. This study is designed to investigate the relationship between blood Cu and Zn levels and Cu/Zn ratio and, ESA (erythropoietin stimulating agent) dosage, erythropoietin responsiveness and anemia in dialysis patients. Methods: Clinical and demographic data for 151 participants (men=79) with a median dialysis vintage of 69.7 months [101 on Hemodialysis (HD), 50 on Peritoneal Dialysis (PD)] and mean age of 56.25±15.6 years was collected in November 2022. Zn and Cu levels were measured with atomic absorption. Erythropoietin responsiveness was evaluated by the erythropoietin resistance index (ERI) and ESA dosing. Results: In HD patients, mean serum Zn and Cu levels were 61.33 ± 15.77 μg/dL and 95.1 ± 21.1 µg/dL, respectively, with a Cu/Zn ratio of 1.58 ± 0.69. In PD patients, mean serum Zn and Cu levels were 54.8 ± 10.3 µg/dL and 97 ± 20.2 µg/dL, respectively, with a Cu/Zn ratio of 1.72 ± 0.55. In Spearman analyses serum Cu was negatively correlated with hemoglobin (p=0.018), serum iron (p=0.03), transferrin saturation (p=0.019), and iron supplementation (p <0.01) in the HD patient group. Serum Cu was found to be positively correlated with erythropoietin (EPO) dosage (p=0.03), ERI (p=0.04), high sensitive C reactive protein (hsCRP) (p=0.01), and Kt/V (p=0.033). Cu/Zn ratio was positively correlated with EPO dosage (p=0.043), ERI (p=0.051) and hsCRP (p=0.015). Conversely, it was negatively correlated with iron supplementation (p=0.014) and serum albumin levels (p=0.049). Serum Zn levels was solely correlated with albumin level (p=0.039). In PD, patient’s serum Cu level was correlated positively with hsCRP (p=0.036); serum Zn levels correlated positively (p=0.01), and Cu/Zn ratio was correlated negatively with albumin (p=0.042). Conclusion: This study has shown a possible association between both serum Cu and Cu/Zn ratio, ESA dosage and hsCRP in HD patients.

Left Ventricular Mass Index in End-Stage Renal Disease Patients during Hemodialysis and Continuous Ambulatory Peritoneal Dialysis.

One of the primary reasons for high mortality in end-stage renal disease (ESRD) is cardiovascular disease in patients with renal replacement therapy (RRT). Left ventricular hypertrophy (LVH) significantly predicts mortality and cardiovascular events. We assess the left ventricular mass index change in two dialysis methods: hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). The factors associated with increased left ventricular mass index (LVMI). We recruit more than 50 HD patients and 45 CAPD patients with LVH of similar age, gender, dialysis duration, and LVMI for one-year follow-up. The LVMI in the group of HD patients after one year increased from 180.28 ± 45.32 g/m2 to 212.58 ± 66.22 g/m2 (p = 0.001), while the LVMI in the group of patients with CAPD increased from 190.16 ± 66.01 g/m2 to 197.42 ± 78 g/m2 (p = 0.32). Multivariable logistic regression analysis, we demonstrated that dialysis by HD (β = -1,167, 95% CI: 0.104-0.938, p = 0.036) and anemia treatment lower the goals (β = 1.9566, 95% CI: 1.466-34.094, p = 0.015) were two factors associated with the progression of the LVMI. The LVH of end-stage renal disease patients with HD treatment is worse than CAPD treatment after a follow-up in one year. Dialysis by periodic hemodialysis and anemia treatment that fails to achieve the goal are risk factors associated with increased progression of LVMI in patients with ESRD.

Kolekalsiferol sonrası endotel disfonksiyonu ve damar sertliğinin diyaliz modalitesine göre değerlendirilmesi

ABSTRACT
 Objective: The risk of developing cardiovascular disease (CVD) increases significantly in children with chronic kidney disease (CKD) especially with low serum 25- hydroxyvitamin D (25OHD) levels. Herein; we aimed to compare the effects of vitamin D deficiency and the impact of cholecalciferol treatment on endothelial functions and vascular stiffness in children with CKD receiving hemodialysis (HD), peritoneal dialysis (PD) and non- dialysis(ND).
 Methods: 7 HD, 7 PD and 27 ND patient groups consisting of 41 children totally with low 25OHD levels were compared among each other in regards of biochemical parameters, flow-mediated dilatation(FMD) and local arterial stiffness before and after a single dose of 300.000 units of cholecalciferol treatment.
 Results: There was no difference in FMD and local arterial stiffness values between HD, PD and ND patient groups before vitamin D supplementation. Significant increase in endothelium-dependent FMD was observed in all patient groups after intervention with cholecalciferol; however the improvement in endothelium-independent FMD and local arterial stiffness measurements was demonstrated in patients with PD and ND. Baseline parathormon level was higher in patients on dialysis; at the end of the study, significant decrease was detected only in patient group not receiving diaysis.
 Conclusions: Endothelial dysfunction and impaired vascular stiffness were determined in children with CKD with low 25OHD levels regardless of the disease severity.. Recovery with cholecalciferol therapy revealed that vitamin D deficiency should be corrected even in early stages of CKD to prevent the development of CVD

Fluctuations in Interleukin-6 Levels during Hemodialysis Sessions with Medium Cutoff Membranes: An Analysis on COVID-19 Case Series

Introduction: Interleukin-6 (IL-6) is one of the most important mediators of inflammation. It is also the culprit for a severe disease course in COVID-19. While COVID-19 has higher mortality in hemodialysis (HD) patients, medium cutoff (MCO) membranes were previously suggested as promising tools for better patient outcomes by purging inflammatory mediators. The aim of this study was to analyze changes in IL-6 levels of HD patients who were dialyzed via MCO membranes during their COVID-19 treatments. Methods: This is an observational study on a group of HD patients who were admitted with COVID-19 diagnosis in a university hospital and intermittently dialyzed using MCO membranes during their hospital stay. IL-6 levels of the patients were measured before and after consecutive dialysis sessions by a commercial kit. Measurements were interpreted together with the clinical data. Results: Nine patients with a total of 54 measurements were evaluated. IL-6 levels were significantly higher in patients who died (median and interquartile ranges [IQRs] of IL-6 levels for patients who died and survived were 112.0 pg/mL [48.3–399.4] and 5.3 pg/mL [2.2–27.4], respectively; p < 0.001). In the comparison of changes in IL-6 levels with dialysis sessions, patients who survived had lower post-dialysis levels (median: 4.5 pg/mL; IQR: 2.2–7.6). However, IL-6 levels had a tendency to increase with dialysis sessions in patients who could not survive COVID-19 (median: 237.0 pg/mL; IQR: 53.8–418.2). Conclusion: This study describes over time variations in IL-6 levels of COVID-19 patients undergoing HD with MCO membranes. The trend for the changes of IL-6 levels during dialysis sessions was not uniform for all patients. Surviving patients had decreasing levels of IL-6 with consecutive dialysis sessions, while nonsurvivors had an increasing trend.

Factors associated with SARS-CoV-2 antibody titers and prognosis of breakthrough infection in hemodialysis patients.

BackgroundThe mortality rate of Coronavirus disease 2019 (COVID-19) is extremely high in hemodialysis patients (HDP). These patients also develop lower antibody titers after vaccination. Therefore, factors associated with antibody titers and vaccine efficacy in HDP with breakthrough infection need to be investigated.MethodsWe measured anti-S1 antibody titers in HDP (n = 104) and controls (n = 35), evaluating the influence of background on HDP by multivariable regression analysis. We classified 26 HDP patients admitted with COVID-19 into the unvaccinated (n = 15) and breakthrough infection group (n = 11), performing between-group comparisons of laboratory findings and prognosis. Vaccinated COVID-19 patients were classified into HDP and non-HDP controls, and compared the relationship between antibody titer and severity, and the prognosis of breakthrough infection.ResultsThe antibody titer was significantly lower in the HDP group than in the control group. Among HDP, age and smoking history were significantly independent factors associated with antibody titer. The breakthrough infection group had significantly better laboratory findings (KL-6 and LDH), severity, and hospitalization period than the unvaccinated group even if antibody titers were lower than the known threshold for neutralization (p < 0.05). There was no significant difference in prognosis between the HDP and non-HDP with breakthrough infection. Severity of COVID-19 tended to be higher with lower antibody titer in non-HDP, but not in HDP.ConclusionVaccines improved the severity of COVID-19 and hospitalization period of breakthrough infection in HDP, although HDP, especially in elderly smokers had lower antibody titers than control. There was no significant association between antibody titer and severity in HDP.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10157-022-02188-y.

Medication non-adherence and the achievement of therapeutic goals of anemia therapy among hemodialysis patients in Jordan

ABSTRACT Objectives Anemia is prevalent in hemodialysis (HD) patients. Data about factors associated with medication non-adherence in anemic HD patients is limited. This study examined determinants of medication non-adherence and its association with achievement of therapeutic goals of anemia measures among HD patients. Methods A cross-sectional study was conducted among a representative group of HD patients in Jordan. Medication adherence was assessed using Morisky Green Levine Medication Adherence Scale (MGL). Other utilized instruments were modified Charlson Comorbidity Index (mCCI), general Health-Related Quality of Life (HRQoL) EQ-5D-5 L, and Hospital Anxiety and Depression Scale (HADS). Pharmacy claim data during the years of (2016–2017) were also retrieved from patients’ medical records. Logistic regression was conducted to identify factors associated with medication non-adherence and achieving therapeutic goals of anemia therapy. Results More than two-thirds of the participants (69.1%) were found non-adherent and the mean score of MGL scale was 2.4 ± 1.4. The non-adherence rate measured using refill data (69.6%) was comparable to that observed using self-reported MGL instrument. Education level of college or over was significantly associated with lower odds of non-adherence (OR = 0.365, p = 0.036), while complaining of a headache was associated with 2.5-fold risk of medication non-adherence (OR = 2.5, p = 0.017). A trend toward better achievement of iron indices therapeutic goals was observed with improved adherence measured using refill data. Multiple factors such as improved knowledge about prescribed medications was significantly associated with achieving anemia therapeutic goals (p < 0.05). Conclusion The findings suggest poor medication adherence among HD patients with anemia. Future interventions by health-care providers should target modifiable factors to improve medication adherence and, hence, health outcomes among HD patients with anemia.

The association of erythropoietin-stimulating agents and increased risk for AV-fistula dysfunction in hemodialysis patients. A retrospective analysis

BackgroundPatients in maintenance hemodialysis (HD) need a patent vascular access for optimal treatment. The recommended first choice is a native arteriovenous fistula (AVF). Complications of AVF are frequent and include thrombosis, stenosis and infections leading to worsening of dialysis efficacy. Some known risk factors are age, gender and the presence of diabetes mellitus. The aim was to investigate if further risk variables are associated with dysfunctional AVF.MethodsThis retrospective observational study included 153 chronic HD patients (Cases) referred to a total of 473 radiological investigations due to clinically suspected complications of their native AVF. Another group of chronic HD patients (n = 52) who had a native AVF but were without history of previous complications for at least 2 years were controls. Statistical analyses included ANOVA, logistic regression, parametric and non-parametric methods such as Student’s T-test and Mann-Whitney test.ResultsAmong Cases, at least one significant stenosis (> 50% of the lumen) was detected in 348 occasions. Subsequent PTA was performed in 248 (71%). Median erythropoiesis-stimulating agent (ESA) weekly doses were higher in Cases than in Controls (8000 vs 5000 IU, p < 0.001). Cases received higher doses of intravenous iron/week than the Controls before the investigation (median 50 mg vs 25 mg, p = 0.004) and low molecular weight heparin (LMWH, p = 0.028). Compared to Controls, Cases had a lower level of parathyroid hormone (median 25 vs 20 ρmol/L, p = 0.009). In patients with diabetes mellitus, HbA1c was higher among Cases than Controls (50 vs 38 mmol/mol, p < 0.001). Multiple regression analysis revealed significant associations between Cases and female gender, prescription of doxazocin, and doses of ESA and LMWH.There was no difference between the groups regarding hemoglobin, CRP or ferritin.ConclusionIn conclusion, the present study indicated that the factors associated with AVF problems were high doses of ESA, iron administration, and tendency of thromboembolism (indicated by high LMWH doses); the use of doxazocin prescription, however, requires further investigation.

The optimal range of serum intact parathyroid hormone for a lower risk of mortality in the incident hemodialysis patients

The serum intact parathyroid hormone (iPTH) is associated with the prognosis of hemodialysis (HD) patients, however, its optimal range for reducing mortality remains inconsistent. We designed a prospective cohort study of 346 incident HD patients to assess the association between different serum iPTH level and mortality. According to the Kidney Disease Outcomes Quality Initiative (K/DOQI) international guidelines (2003), we divided patients into three groups (iPTH < 150 pg/mL, 150–300 pg/mL and >300 pg/mL). During the median follow-up of 58 months, 157 patients (45.38%) died. Multivariate Cox regression analysis showed that iPTH < 150 pg/mL and >300 pg/mL were associated with all-cause and cardiovascular mortality. Then, we performed a sensitivity analysis of patients divided into 6 serum PTH levels groups according to the folds of the K/DOQI target range. Multivariate Cox regression analysis showed that patients with serum iPTH ≥750 pg/mL, 600–749 pg/mL, 450–599 pg/mL had significantly higher risk of all-cause and cardiovascular mortality compared with those with serum iPTH in the range of 150–299 pg/mL. The association between serum iPTH and mortality shows a U-shaped curve. The optimal serum iPTH level which confers the lowest risk of all-cause and cardiovascular mortality could range from 150 pg/mL to 450 pg/mL in this group of incident HD patients.

Importance of PGC-1α gene expression in Egyptian hemodialysis patients

IntroductionThe peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α) is an upstream transcriptional regulator of mitochondrial biogenesis and function. Its function is immediate elimination of reactive oxygen species to get rid of their cellular destruction sequelae. Decreased PGC-1α count and less mitochondrial function take part in renal failure. COX6C gene encodes mitochondrial oxidative phosphorylation proteins. Reaction of excessive reactive oxygen species with linolenic acid results in malondialdehyde (MDA) as a breakdown product. It is an important marker for evaluating oxidative damage.Patients and methodsA total of 58 hemodialysis (HD) patients in the National Institute of Urology and Nephrology and 20 apparently healthy participants as controls were enrolled in the study. PGC-1α and COX6C gene expressions were assessed by quantitative real-time PCR. Plasma MDA was assayed by ELISA. We followed up patients for 50 months for cardiovascular disease (CVD) and mortality.ResultsPGC-1α expression level was insignificantly downregulated (P = 0.07), COX6C gene expression level was significantly downregulated (P < 0.001), and plasma MDA level was significantly higher (P < 0.001) in HD patients than in controls. There was a significant negative association between PGC-1α expression and MDA in both HD patient and control groups (r=−0.73 and r=−0.76, respectively; P ≤ 0.001 for both). We also found in patients who developed HD-related CVD, lower PGC-1α gene expression (P < 0.001), lower COX6C gene expression (P < 0.001), and higher plasma MDA level (P < 0.001) when compared with HD patients without CVD. By multivariate regression analysis, we found that PGC-1α gene expression was an independent predictor factor (P < 0.001) of CVD development.ConclusionPGC-1α could be a risk factor for occurrence of HD-linked CVD. Pharmacological modification of PGC-1α protein activity might be a hopeful therapeutic way to minimize oxidative stress-related clinical complications in HD patients.

Correlation between Depression Severity and Thiol Disulfide Homeostasis in Patients undergoing Hemodialysis.

To investigate the correlation between depression severity and oxidative stress in patients undergoing hemodialysis (HD) using thiol disulfide homeostasis (TDH). Descriptive, analytical study. Konya Health Application and Research Center, Konya, Turkey from September 2019 to March 2020. A total of 67 patients including 35 males (52.2%) and 32 females (47.8%), receiving HD treatment, were included in the study. The Hamilton depression rating scale (HAM-D) was applied to the participants. Thiol disulfide homeostasis (total thiol (TT), native thiol (NT), disulfide, disulfide/NT ratio, disulfide/TT ratio, and NT/TT ratio) parameters, albumin, and ischemia modified albumin (IMA) levels were determined. The study groups were investigated by dividing them into groups according to their gender and HAM-D score. According to HAM-D score, there were 32 (47.8%) patients with depression symptom (DS, HAM-D score of ≥8) and 35 (52.2%) patients without DS (HAM-D score: 0-7). Modified Charlson comorbidity index (MCCI), disulfide, disulfide/NT%, and disulfide/TT% levels were statistically and significantly higher and NT/TT% was statistically and significantly lower in DS group than the values of the groups without DS (p = 0.003, p =0.043, p = 0.017, p=0.017 and p = 0.017, respectively). HAM-D score and MCCI were statistically and significantly higher in females than males (p <0.001, p = 0.001, respectively). While, 21 patients (65.6%) had DS in women; according to HAM-D score, this rate was found to be statistically higher than men (11 patients, 31.4%, p = 0.005). Almost half of HD patients had at least moderate depression symptoms. In the group of HD patients with DS, TDH shifted in the oxidative direction. This may contribute to the future studies in enlightening depression etiology in HD patients. Key Words: Hemodialysis, Depression, Thiol disulfide homeostasis (TDH), IMA.

Serum Lipoprotein(a) Level and Apolipoprotein B/A1 Ratio in Patients of Hemodialysis and Peritoneal Dialysis: A New Approach to Predict Cardiovascular Risks in Chronic Kidney Disease

Background: Serum lipoprotein(a) and Apolipoprotein B/A1 ratio are new, independent cardiovascular risk factors in patients on dialysis. Conversely, the choice of dialysis procedure influences the uremic dyslipidemia in chronic kidney disease (CKD) patients.&#x0D; Objective: To compare lipoprotein(a) levels and apolipoprotein B/A1 ratio in patients of chronic kidney disease (CKD) stage 5 undergoing hemodialysis or peritoneal dialysis.&#x0D; Methods: This cross-sectional study was conducted in Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from September 2016 to March 2018. A total of 55 CKD stage 5 patients were included in the study – 31 in hemodialysis (HD) (group A) and 24 in continuous ambulatory peritoneal dialysis (CAPD) (group B). Group A patients were on low flux dialysis with bicarbonate dialysate 4 hours twice weekly dialysis with unfractionated heparin as anti-coagulant with a dialysis adequacy (Kt/V) &gt;1.2. Group B patients were on 3 exchanges over 24 hours with 2 litres of 1.5% glucose fluid with a weekly measured Kt/V &gt;1.7. Serum levels of Lipoprotein(a), Apolipoprotein B/A1 ratio were measured in both groups by using the standard laboratory technique.&#x0D; Results: In group A, most of the patients were in 31-50 years age group (45.1%), while in group B, majority belonged to &gt;50 years age group (54.16%). Patients’ gender showed a male predominance in both groups, i.e. 54.83% and 70.83% respectively. Most of the patients were from urban areas, i.e. 87.1% and 70.8% group A and B respectively. Dialysis adequacy (Kt/V) was found 1.46 for HD patients (group A) and 1.81 for CAPD patients (group B). Dyslipidemia was evident more in CAPD patients than HD patients, as per raised serum Lipoprotein(a) level (83.3% vs 74.1%) and raised Apolipoprotein B/A1 ratio (100% vs. 77.4%). Moreover, comparing with HD patients, CAPD patients showed increased level of serum Lipoprotein(a) (41.4±23.5 mg/dl vs 37.4±25.3 mg/dl; p&gt;0.05) and Apolipoprotein B/A1 ratio (1.59±0.24 vs 1.04±0.22; p&lt;0.001).&#x0D; Conclusion: The maintenance CAPD treatment is associated with more pronounced alterations of the lipoproteins and lipid metabolism than those observed during HD treatment. Besides, serum lipoprotein(a) level and apolipoprotein B/A1 ratio were found simple, accessible and effective markers of dyslipidemia in both groups.&#x0D; Bangladesh Crit Care J September 2020; 8(2): 91-95

Dyslipidemia in End Stage Renal Disease: A Study on Dialysis Patients in Bangabandhu Sheikh Mujib Medical University Bangladesh

Background: Dyslipidemia contributes to the high cardiovascular risk in end stage renal disease (ESRD) or in dialysis patients; however, it remains an underestimated problem.&#x0D; Objective: To see the extent of dyslipidemia in patients of end stage renal disease i.e. chronic kidney disease (CKD) stage 5 who underwent hemodialysis or peritoneal dialysis procedure.&#x0D; Materials and Methods: This cross-sectional study was conducted from September 2016 to March 2018 Bangabandhu Sheikh Mujib Medical University (BSMMU) on 55 CKD (stage 5) patients where 31 in hemodialysis (HD) (group A) and 24 in continuous ambulatory peritoneal dialysis (CAPD) (group B). Serum lipid profile was estimated in both groups by using the standard laboratory technique.&#x0D; Results: Dialysis adequacy (Kt/V) was found 1.46 for HD patients (group A) and 1.81 for CAPD patients (group B).All serum lipids were higher in amount in CAPD patients than HD patients-total cholesterol (222.3±24.2 mg/dl vs. 198.9±28.4 mg/dl; p&lt;0.05), triglycerides (179.6±24.7 mg/dl vs. 176.6±24.4 mg/dl; p&lt;0.05), HDL cholesterol (40.8±3.90 mg/dl vs. 38.5±4.95 mg/dl; p&gt;0.05) and LDL cholesterol (145.5±22.1 mg/dl vs. 123.2±26.5 mg/dl; p&lt;0.05). Besides, dyslipidemia was more evident in CAPD patients than HD patients, as per raised serum total cholesterol (83.33% vs. 70.97%), raised triglycerides (95.83% vs. 83.87%), raised LDL (100% vs. 77.42%) and lowering of HDL cholesterol (87.5% vs. 80.65%) were found more in group B in comparison to group A.&#x0D; Conclusion: Dyslipidemic risk factors are highly evident in dialysis patients and the extent of dyslipidemia is observed more in CAPD than HD patients.&#x0D; KYAMC Journal Vol. 11, No.-3, October 2020, Page 113-117

P1030ENDOTHELIAL DYSFUNCTION AND CARDIAC VALVE CALCIFICATION IN PATIENTS WITH DIABETIC KIDNEY DISEASE UNDERGOING CHRONIC HEMODIALYSIS

Abstract Background and Aims The character of endothelial dysfunction (ED), especially of nitric oxide (NO) system, in patients with diabetic kidney disease (DKD) undergoing chronic hemodialysis (HD) was not asserted enough. In this condition not clearly established the relationship of structural and functional activity of endothelium with the presence and severity of cardiac valve calcification (CVC) as independent predictor of cardiovascular morbidity and mortality. The purpose of the current study was to determine the role of ED in mechanisms of mitral (MVC) and aortic (AVC) valve calcification in HD patients with DKD. Method We enrolled 136 patients undergoing HD (male/female, 78/58; age, 53.9±1.0 years; HD duration, 47.6±4.2 month) in this observational cross-sectional study. According to the study design, depending on the presence of type 2 diabetes mellitus with kidney injury patients were divided into two groups: the 1st one – without DKD (n=88); the 2nd one – with DKD (n=48). All subjects underwent echocardiographical examination for detection of CVC; the MVC and AVC degree were scored as follows: 1, no calcification; 2, valve thickening without calcification; 3, valve annulus or cusps calcification. Vasomotional function of endothelium was assessed using a test with reactive hyperemia (brachial artery flow-mediated dilatation (FMD)). Plasma content of nitrites (NO2), circulating endothelial cells (СECs) and serum concentration of C-reactive protein (CRP) were measured as markers of ED. Data are expressed as means±SEM. Used nonparametric statistics methods: Mann-Whitney U-test, χ2-test, Spearman’s rank R correlations. Results In group of HD patients with DKD indices of СECs (22.3±1.3 vs. 14.2±0.7 × 104/L, Z=4.98, p&amp;lt;0.001), CRP (9.94±1.12 vs. 7.07±1.09 mg/L, Z=3.47, p&amp;lt;0.001) were higher, and NO2 (4.16±0.41 vs. 9.01±1.37 umol/L, Z=3.15, p=0.002), FMD (2.27±0.66 vs. 5.13±0.52%, Z=3.26, p=0.001) – lower compared to the group without diabetes. CVC was detected in 66.6% of patients with DKD with predominance of calcification of both valves (35.4%) over isolated MVC (20.8%) and AVC (10.4 %). Combined valve calcification in the HD patients of the 2nd group was observed 2.6 times more often (χ2=8.78, p=0.003) than in the 1st one. For the first time it was established that in DKD the presence of CVC closely associated with indices of FMD (Rs=-0.59, p&amp;lt;0.001), NO2– (Rs=-0.56, p&amp;lt;0.001), СECs (Rs=0.63, p&amp;lt;0.001) and СRP (Rs=0.54, p&amp;lt;0.001). The MVC as well as AVC degree were related with the level of FMD (Rs=-0.47, p&amp;lt;0.001; Rs=-0.43, p=0.003), content of NO2– (Rs=-0.40, p=0.005; Rs=-0.62, p&amp;lt;0.001), СECs (Rs=0.47, p&amp;lt;0.001; Rs=0.62, p&amp;lt;0.001) and СRP (Rs=0.48, p&amp;lt;0.001; Rs=0.41, p=0.004) concentrations respectively. Conclusion (1) HD patients with DKD are combined with damaged endothelium, disturbance of vasoreactivity and lack of NO. (2) Type 2 diabetes mellitus with kidney injury is characterized by the large-scale combined MVC and AVC, which in turn are closely associated with the ED markers. (3) Complex estimation of the character of CVC and endothelium activity in HD patients with DKD permits a better identification of their cardiovascular risk.

Fluid overload is associated with use of a higher number of antihypertensive drugs in hemodialysis patients.

Hypertension is multifactorial, highly prevalent in the hemodialysis (HD) population and its adequate control requires, in addition to adequate volume management, often the use of multiple antihypertensive drugs. We aimed to describe the use of antihypertensive agents in a group of HD patients and to evaluate the factors associated with the use of multiple classes (≥3) of antihypertensives. We analyzed the baseline data from the HDFit study. Clinically stable patients with HD vintage between 3 and 24 months without any severe mobility limitation were recruited from sites throughout southern Brazil. Fluid status was measured pre-dialysis with the Body Composition Monitor (BCM; Fresenius, Germany). Fluid overload (FO) was considered when the overhydration index (OH) was greater than 7% of extracellular water (OH/ECW > 7%) and overweight was defined as a body mass index (BMI) greater than 25 kg/m2 . Prescriptions of antihypertensive drugs were obtained from participants' reports and medical records. Logistic regression was employed to determine factors associated with excessive use of antihypertensive medication (≥3 classes). Of 195 studied patients, 171 with complete data were included (70% male, 53 ± 15 years old, 57% of them with FO). Pre-dialysis systolic blood pressure (SBP) was 150 ± 24 mmHg and patients used a median of 2 (1-3) antihypertensive drugs. Vasodilators (20%) were of lowest prevalence, use of other classes varied from 40% to 53%. Sixty-two (36%) subjects used ≥3 classes and presented a higher prevalence of diabetes and FO, lower prevalence of overweight, and higher SBP. In a logistic regression model age, BMI <25 kg/m2 , and OH/ECW > 7% were associated with excessive drug use. More than one-third of participants used ≥3 classes of antihypertensive drugs, and it was associated with older age, BMI <25 kg/m2 and FO. Strategies that better manage FO may aid better blood pressure control and avoid the use of multiple antihypertensive medications.

Structural and functional changes of the heart in patients with diabetic nephropathy undergoing hemodialysis

Systematic analysis of cardiac remodeling peculiarities in patients with V D stage of chronic kidney disease (CKD VD) caused by diabetes mellitus is important both in the stratification of cardiovascular risk and in the choice of adequate treatment strategies.&#x0D; The purpose of the study was to determine the character of structural and functional reconstruction of myocardium in patients with diabetic nephropathy (DN) on maintenance hemodialysis (HD) by identifying left ventricular hypertrophy (LVH), its geometric types, assessment of the severity of heart dysfunction, pulmonary hypertension (PH), as well as determination of frequency of cardiac valve calcification (CVC), development of defects of mitral (MV) and aortic (AV) valves.&#x0D; Materials and methods. The study included 136 patients on chronic HD (men, 78, age, (53,9±1,0) years, duration of HD, (47,6±4,2) months). Depending on the presence/absence of type 2 diabetes mellitus (DM) with kidney damage, they were divided into two groups: the first one – without DN (n=88); the second one – with DN (n=48). All patients were followed up by standard echocardiography (EchoCG) examination by standard procedure.&#x0D; Results. LVH was diagnosed in 84.6% of patients with CKD VD stage, significantly more often (93.8 vs. 78.4%, p=0.020) in patients with DN, with the incidence of eccentric LVH in the second group being higher (47.9 vs. 28.4%, p=0.023) than in the first one. Prevalence of pseudonormal and restrictive types of LV diastolic dysfunction (62.5 vs. 28.4%, p&lt;0.001), LV systolic dysfunction (27.1 vs. 9.1%, p=0.006) and PH (64.6 vs 35.2%, p=0.001) were significant in HD patients with DN. CVC was detected in 66.6% of patients with type 2 DM with renal injury with a predominance of calcification of both valves (35.4%) over isolated calcification of MV (MVC) (20.8%) and AV (AVC) (10.4 %). Combined valve calcification in the HD patients of the second group was observed 2.6 times more often (p=0.003) than in the first one. Patients with DN, unlike those without diabetes, were associated with a higher prevalence of stenoses of MV (16.7 vs. 3.4%, p=0.007) and AV (39.6 vs. 15.9%, p=0.004), and insufficiency of MV (66.7 vs. 44.3%, p=0.013) and AV (35.4 vs. 14.8%, p=0.006). The most significant EchoCG parameters that distinguished groups of HD patients with the presence of DN were: left atrial diameter (p&lt;0.001), end-diastolic LV dimension (p&lt;0.001), thickness of interventricular septum (p=0.001), LV myocardial mass index (p=0.001), ratio of transmitral flows in early and late diastole (p=0.009), time of deceleration of early diastolic transmitral blood flow (p&lt;0.001), LV ejection fraction (p=0.009), diameter of the right ventricle (RV) (p=0.003), diameter (p=0.007) and mean pulmonary artery pressure (p&lt;0.001).&#x0D; Conclusions. In patients with CKD VD stage with DN the maladaptive cardiac remodeling with predominance of unfavorable types (eccentric (to a greater extent) and concentric) LV hypertrophy, RV dilatation, PH, expressive of LV diastolic and systolic dysfunction, large-scale combined MVC and AVC occurs, which, in turn, leads to the formation of valve defects, can contribute to the progression of diastolic myocardial stiffness and heart failure.