Mortality In CKD Patients Research Articles

Systemic Inflammatory Response Index (SIRI) is associated with all-cause mortality and cardiovascular mortality in population with chronic kidney disease: evidence from NHANES (2001-2018).

To examine the correlation between SIRI and the probability of cardiovascular mortality as well as all-cause mortality in individuals with chronic kidney disease. A cohort of 3,262 participants from the US National Health and Nutrition Examination Survey (NHANES) database were included in the study. We categorized participants into five groups based on the stage of chronic kidney disease. A weighted Cox regression model was applied to assess the relationship between SIRI and mortality. Subgroup analyses, Kaplan-Meier survival curves, and ROC curves were conducted. Additionally, restricted cubic spline analysis was employed to elucidate the detailed association between SIRI and hazard ratio (HR). This study included a cohort of 3,262 individuals, of whom 1,535 were male (weighted proportion: 42%), and 2,216 were aged 60 or above (weighted proportion: 59%). Following adjustments for covariates like age, sex, race, and education, elevated SIRI remained a significant independent risk factor for cardiovascular mortality (HR=2.50, 95%CI: 1.62-3.84, p<0.001) and all-cause mortality (HR=3.02, 95%CI: 2.03-4.51, p<0.001) in CKD patients. The restricted cubic spline analysis indicated a nonlinear relationship between SIRI and cardiovascular mortality, with SIRI>1.2 identified as an independent risk factor for cardiovascular mortality in CKD patients. Heightened SIRI independently poses a risk for both all-cause and cardiovascular mortality in chronic kidney disease patients, with potentially heightened significance in the early stages (Stage I to Stage III) of chronic kidney disease.

The Relationship Between Indoxyl Sulfate Levels and Functional Ability of End-Stage Renal Disease Patients Undergoing Regular Haemodialysis Using the Karnofsky Scale Measuring Instrument at Haji Adam Malik Central General Hospital Medan

Background: ESRD is a burdensome disease with high prevalence, mortality, and treatment costs. Indoxyl sulfate is one of the most studied solutes accumulating in plasma when the kidneys fail. Clinical studies have shown that indoxyl sulfate can predict the prognosis of CKD and CVD in CKD patients. Serum levels of IS are associated with all-cause mortality and cardiovascular mortality in CKD patients. The general objective of this study was to determine the relationship between indoxyl sulfate levels and the functional ability of CKD patients undergoing regular hemodialysis using the Karnofsky scale measuring instrument at the Haji Adam Malik Central General Hospital Medan. Methods: This research is an observational analytic study with a cross-sectional design. Data collection involved recording indoxyl sulfate levels in kidney failure patients undergoing hemodialysis at Haji Adam Malik Hospital. Results: Of all 56 study samples, the mean age was 49.35 years, with a standard deviation of 12.3 years. Most patients were male, from the Batak ethnicity, with hypertension as the etiology. The mean indoxyl sulfate level was 47.32 µg/mL with a 29.19 µg/mL standard deviation. Most patients presented with functional ability calculated by Karnofsky score in category A. The analysis results with the Spearman test showed a moderate negative correlation between indoxyl sulfate levels and the functional ability of patients. Conclusion: Indoxyl sulfate levels can be an objective parameter to predict a patient's functional ability. Keywords: Indoxyl Sulfate, Haemodialysis, End Stage Renal Disease, Functional Ability

Prolonged fibrinolysis time is a risk factor for mortality in patients with chronic kidney disease - a propensity score matched analysis

Abstract Purpose To investigate the role of fibrinolysis time and clot structure on cardiovascular mortality of patients with chronic kidney disease. Methods Clot characteristics were measured in 56 propensity score matched patients (i.e. based on gender, BMI, presence of CAD, presence of CVD and CKD stage) by a modified ROTEM assay with the addition of 175 ng/ml of tPA from the Care4HOMe study. Results In total 462 patients with CKD stage II-IV were included in the Care4HOMe study. Patients with cardiovascular death differed significantly from patients without cardiovascular mortality with respect to presence of cardiovascular disease (CVD), presence of coronary artery disease (CAD) and CKD stage (all p &amp;lt; 0.001). Therefore, to assess clot characteristics in a less confounded environment we propensity score matched patients with and without cardiovascular death in a 1:1 ratio. After matching a total of 56 patients with similar baseline characteristics remained. Interestingly, clot-formation time (CFT) and maximal lysis (ML) were significantly altered in patients that suffered cardiovascular death (CFT Event-free: 150±172sec; CFT CV-death: 80±61sec p = 0.035; ML Event-free: 30±61%; ML CV-death: 10±81% p = 0.021). To assess the prognostic importance of both parameters we stratified CFT and ML based on the median and calculated Kaplan-Meier curves and performed a Cox-proportional hazard regression analysis. Combined assessment revealed that a ML lower than the median significantly increased the cardiovascular mortality risk (HR 3.7 95%CI 1.3 – 10.3, p = 0.009; Log-rank 0.0059) while the stratified-CFT remained insignificant (HR 0.99 95%CI 0.99 – 1.00, p = 0.28, Log-rank p = 0.79). Additional C-statistic demonstrated that the predictive value of ML with respect to cardiovascular mortality in CKD patients was comparable to established CKD mortality predictors including Cystatin-C plasma levels and Urine Albumin/Creatine Ratio (UACR) (ML 0.69, 95%CI 0.53-0.86; CystatinC 0.70, 95%CI 0.51 – 0.80; UACR 0.70, 95%CI 0.56-0.84). Conclusions Prolonged fibrinolysis time may be an important prognostic parameter that links atherothrombotic risk to cardiovascular mortality in patients with chronic kidney disease.Maximum Lysis

Association of dietary total antioxidant capacity with all-cause and cardiovascular mortality in patients with chronic kidney disease: based on two retrospective cohort studies of NHANES

Background The relationship between dietary total antioxidant capacity (DTAC) and death risk among CKD populations remains unclear. Methods Based on vitamin C equivalent antioxidant capacity (VCEAC) and the component dietary antioxidant index (CDAI) indices, we analyzed two cohorts to investigate the association of DTAC with all-cause and CVD mortality in CKD patients using data from National Health and Nutrition Examination Survey (2007–2018). VCEAC (n = 6330) and CDAI (n = 6300) cohorts with mortality follow-up data available through 2018 were included. Cox models with restricted cubic splines was used to model the nonlinear association between VCEAC/CDAI and outcomes in CKD patients. Results Our results showed L-shaped associations of DTAC with all-cause mortality among individuals with CKD stages 1–2 in both cohorts. Compared to the lowest quartile, higher dietary total antioxidant intake was associated with lower all-cause mortality risks among CKD stages 1–2 after adjustment for covariates, with HRs (95%CI) of 1.00, 0.91 (0.71,1.17), 0.69 (0.53,0.90), and 0.70 (0.54,0.91) in VCEAC, and similar respective estimate trends in CDAI. After sensitivity and subgroup analyses, there were no benefits for patients with stage 3–5 CKD or albuminuria. Mediation analysis revealed that the proportions mediated in both cohorts were less consistent. Conclusions Moderate dietary total antioxidants intake has potential benefits for early-stage CKD patients. However, further evidence is needed to confirm whether patients with worsening CKD can benefit in the long term.

Redefying the therapeutic strategies against cardiorenal morbidity and mortality: Patient phenotypes.

Chronic kidney disease (CKD) patients face an unacceptably high morbidity and mortality, mainly from cardiovascular diseases. Diabetes mellitus, arterial hypertension and dyslipidemia are highly prevalent in CKD patients. Established therapeutic protocols for the treatment of diabetes mellitus, arterial hypertension, and dyslipidemia are not as effective in CKD patients as in the general population. The role of non-traditional risk factors (RF) has gained interest in the last decades. These entail the deranged clinical spectrum of secondary hyperparathyroidism involving vascular and valvular calcification, under the term "CKD-mineral and bone disorder" (CKD-MBD), uremia per se, inflammation and oxidative stress. Each one of these non-traditional RF have been addressed in various study designs, but the results do not exhibit any applied clinical benefit for CKD-patients. The "crusade" against cardiorenal morbidity and mortality in CKD-patients is in some instances, derailed. We propose a therapeutic paradigm advancing from isolated treatment targets, as practiced today, to precision medicine involving patient phenotypes with distinct underlying pathophysiology. In this regard we propose two steps, based on current stratification management of corona virus disease-19 and sepsis. First, select patients who are expected to have a high mortality, i.e., a prognostic enrichment. Second, select patients who are likely to respond to a specific therapy, i.e., a predictive enrichment.

Protein carbamylation associates with collagen in atherosclerotic plaque and impacts macrophage functions

Background and Aims : Carbamylation is a post-translational protein modification increased in CKD patients as well as in late-stage atherosclerotic plaques in patients without CKD. Carbamylation was shown to cause pro-atherogenic alteration in plasma proteins and was significantly associated with increased mortality in CKD patients. However, the exact mechanisms and role of protein carbamylation in atherogenesis are not known.

Red Blood Cell Distribution Width Is Associated With Adverse Kidney Outcomes in Patients With Chronic Kidney Disease.

BackgroundChronic kidney disease (CKD) is a global public health issue. Red blood cell distribution width (RDW) is a recently recognized potential inflammatory marker, which mirrors the variability in erythrocyte volume. Studies indicate that elevated RDW is associated with increased risk of mortality in CKD patients, while evidence regarding the impact of RDW on kidney outcome is limited.MethodsAltogether 523 patients with CKD stage 1–4 from a single center were enrolled. We identified the cutoff point for RDW level using maximally selected log-rank statistics. The time-averaged estimated glomerular filtration rate (eGFR) slope was determined using linear mixed effects models. Rapid CKD progression was defined by an eGFR decline >5 ml/min/1.73 m2/year. The composite endpoints were defined as doubling of serum creatinine, a 30% decline in initial eGFR or incidence of eGFR < 15 ml/min/1.73 m2, whichever occurred first. Multivariable logistic regression or Cox proportional hazards regression was performed, as appropriate.ResultsDuring a median follow-up of 26 [interquartile range (IQR): 12, 36] months, 65 (12.43%) patients suffered a rapid CKD progression and 172 (32.89%) composite kidney events occurred at a rate of 32.3/100 patient-years in the high RDW group, compared with 14.7/100 patient-years of the remainder. The annual eGFR change was clearly steeper in high RDW group {−3.48 [95% confidence interval (CI): −4.84, −2.12] ml/min/1.73 m2/year vs. −1.86 [95% CI: −2.27, −1.45] ml/min/1.73 m2/year among those with RDW of >14.5% and ≤14.5%, respectively, P for between-group difference <0.05}. So was the risk of rapid renal function loss (odds ratio = 6.79, 95% CI: 3.08–14.97) and composite kidney outcomes (hazards ratio = 1.51, 95% CI: 1.02–2.23). The significant association remained consistent in the sensitivity analysis.ConclusionIncreased RDW value is independently associated with accelerated CKD deterioration. Findings of this study suggest RDW be a potential indicator for risk of CKD progression.

IMPACT OF BLOOD PRESSURE VARIABILITY ON CARDIOVASCULAR MORTALITY IN CHRONIC KIDNEY DISEASE PATIENTS

Objective: It is well known that blood pressure (BP) variability is associated with development of target-organ damage and adverse cardiovascular outcome in hypertensive patients. However, the impact of BP variability (BPV) on cardiovascular outcome in chronic kidney disease patients (CKD) is unclear. Aim of the study was to examine the impact of home BPV on cardiovascular mortality in chronic kidney disease patients. Design and method: A total of 137 CKD patients, referred for evaluation at the Hypertension Unit of our department, underwent home BP monitoring. Participants were instructed to take duplicate morning and evening measurements in the sitting position, after 5-min sitting rest and with 1 min between measurements for 7 working days. The average home BP value of the morning, evening and all measurements was analyzed. Home BPV was quantified by using standard deviation (SD), coefficient of variation (CV) and morning minus evening BP values. Median follow-up for fatal cardiovascular events was 3 years. Statistical analysis was performed by means of cox regression analysis. Results: The study population consisted of 102 men (75%). Mean age was 70 years, mean office BP was 142/76 mmHg and mean home BP was 137/74 mmHg. During follow-up, there were 12 fatal cardiovascular events. The multivariate Cox regression analyses revealed that the SD of systolic home BP was an independent predictor of cardiovascular mortality (HR: 1.19, 95%CI 1.02–1.38, p = 0.022) after adjustment for age, sex, history of diabetes mellitus and hyperlipidemia, smoking, antihypertensive treatment and mean systolic home BP. Conclusions: Home BPV is an independent predictor of cardiovascular mortality in CKD patients

MO845: COVID-19 Sequels in Nephrology CKD Patients More Prone to Fatality

Abstract BACKGROUND AND AIMS This strange, prolonged, very exhausting and costly pandemic still is remaining in our world showing us that we are so weak, so unprotected, so fragile. It initiated and continued mostly like a respiratory syndrome but soon after it was seen that it has a systemic impact and consequences in our body. There were patients presented with hematuria, proteinuria and deteriorating of kidney function after the infection. Direct kidney involvement, cytokine storm, coagulopathy, rhabdomyolysis, antibiotic use, sepsis and haemodynamic instability then acute tubular necrosis, all of these factors contribute in this picture of kidney failure. Very difficult to treat and to rehabilitate a part of these patients are going through kidney replacement therapy and a part are dying. METHODS We studied a population of 77 patients that had passed the COVID-19 infection, confirmed by RT PCR. Males 58% and females 42%. Mean age was 67.1 years old, the BMI 29.6. Comorbidities were present in our cohort in 59.7% only one comorbidity and in 31.1% of patients two comorbidities. Mean time from COVID-19 infection was 56 days. There were CKD 70% patients and 30% non-CKD. Diagnoses of CKD patients were: hypertensive nephrosclerosis 49%, diabetic nephropathy 32%, chronic glomerulonephritis 9%, ADPKD 8% and transplanted patients with CAN 1%. RESULTS It resulted that our patients had higher D dimer (mean 3660 mcg/dL = 7-fold higher), PCR (mean 35 mg/dL, 7-fold higher) and ferritin (mean 634 ng/dL). Levels of lymphocytes remained lower (mean 13.9%). Proteinuria was found in 92% and hematuria was found in 88% of our patients. There were a significant correlation between need for KRT and diabetic nephropathy was p = 0.037 and also between need for KRT and proteinuria presence was P = 0.048. It was seen that higher the BUN levels lower the lymphocytes counts (P = 0.028) and lower the time post COVID lower the albumin levels (P = 0.007). It was seen that patients with CKD were more prone to need for haemodialysis treatment during the hospitalization and the mortality rate was higher in this group of patients. CONCLUSION COVID-19 infection and its short term sequels play an important role on morbidity and mortality of CKD patients. It was a decisive factor for KRT in these patients. CKD patients with their immunosuppression, several drugs used, anemia, hypertension, diabetes are more prone for post COVID-19 complications, hospitalizations, dialysis and then death. Being aware of this dangerous infection and being vaccinated are the mainstay and crucial things for being healthy and being alive.

Effect of dry body weight on intra-dialytic hypertension in patients on regular hemodialysis

Background: In chronic kidney disease, hypertension is influenced by both blood pressure (BP) and the progression of renal disease. In end stage renal disease (ESRD) on maintenance hemodialysis, hypertension is a main feature and more than 85% of new patients with ESRD present with hypertension. The aim of this study: was to assess the relationship between dry body weight and intra-dialytic hypertension in patients on regular hemodialysis. Patients and Methods: This was an observational cohort study with retrospective data analysis including (age and sex matched) patients with end stage renal disease. The study will be conducted in Nephrology Unit national institute of nephrology &amp;urology. Results: there was statistically significant difference found between the two studied groups regarding LL edema, Sacral edema, Pl. effusion, Increased cardio/thoracic ratio, and Increased IVC diameter with (p-value= 0.016, 0.027, 0.019, 0.003 and 0.008) respectively. Conclusion: IDH is preventable if we control modifiable risk factors such as, reducing interdialytic weight gain, correction of serum albumin and urea reduction ratio. This will reduce cardiovascular morbidity and mortality in CKD patients on maintenance hemodialysis.

Predictive Value of the CHA2DS2-VASc Score for Mortality in Hospitalized Acute Coronary Syndrome Patients With Chronic Kidney Disease.

BackgroundChronic kidney disease (CKD) patients have a high prevalence of coronary artery disease and a high risk of cardiovascular events. The present study assessed the value of the CHA2DS2-VASc score for predicting mortality among hospitalized acute coronary syndrome (ACS) patients with CKD.MethodsThis was a retrospective cohort study that included CKD patients who were hospitalized for ACS from January 2015 to May 2020. The CHA2DS2-VASc score for each eligible patient was determined. Patients were stratified into two groups according to CHA2DS2-VASc score: <6 (low) and ≥6 (high). The primary endpoint was all-cause mortality.ResultsA total of 313 eligible patients were included in the study, with a mean CHA2DS2-VASC score of 4.55 ± 1.68. A total of 220 and 93 patients were assigned to the low and high CHA2DS2-VASc score groups, respectively. The most common reason for hospitalization was unstable angina (39.3%), followed by non-ST-elevation myocardial infarction (35.8%) and ST-elevation myocardial infarction (24.9%). A total of 67.7% of the patients (212/313) received coronary reperfusion therapy during hospitalization. The median follow-up time was 23.0 months (interquartile range: 12–38 months). A total of 94 patients (30.0%) died during follow-up. The high score group had a higher mortality rate than the low score group (46.2 vs. 23.2%, respectively; p < 0.001). The cumulative incidence of all-cause death was higher in the high score group than in the low score group (Log-rank test, p < 0.001). Multivariate Cox regression analysis indicated that CHA2DS2-VASc scores were positively associated with all-cause mortality (hazard ratio: 2.02, 95% confidence interval: 1.26–3.27, p < 0.001).ConclusionThe CHA2DS2-VASc score is an independent predictive factor for all-cause mortality in CKD patients who are hospitalized with ACS. This simple and practical scoring system may be useful for the early identification of patients with a high risk of death.

Study of pulmonary arterial hypertension in patients of chronic kidney disease stage IV and V

Background: Pulmonary arterial hypertension (PAH) in advanced CKD patients (stage 4/5) is important to recognize, as PAH is an independent predictor of mortality in CKD patients especially those receiving renal replacement therapy and significant PH is felt to be a relative contraindication to renal transplantation. Present study was aimed to study Pulmonary Arterial Hypertension in Patients of Chronic Kidney Disease Stage 4/5 at a tertiary hospital. Material and Methods: Present study was cross-sectional, prospective and observational study, conducted patients Age ≥18 years, of either gender, diagnosed case of CKD in stage IV and stage V, underwent evaluation for PAH by echocardiography. Results: In present study, total 68 patients were included. Mean age in study was 51.93 ± 12.63 years. Male patients (73.53 %) outnumbered female patients (26.47 %). Associated Co-morbidities in present study were anemia (70.59 %), diabetes mellitus (57.35 %), systolic hypertension (32.35 %) and diastolic hypertension (26.47 %). majority of patients had stage 4 CKD (69.12 %). Mean duration of CKD was 43.11 + 26.78 weeks while mean duration of dialysis was 21.45± 15.74 weeks. 61.76 % patients had attained Dry weight in present study. In present study, incidence of pulmonary hypertension was 51.35 %. In patients with pulmonary hypertension most common etiology for CKD were diabetes mellitus (34.29%), hypertension (31.43 %), undetermined (17.14 %). In present study 47 patients (69.12 %) had stage 4 CKD. Among stage 4 patients mild PH was noted in 11 patients (16.18 %), while moderate and severe PH was noted in 4 (5.88 %) and 2 (2.94 %) patients respectively. While 21 patients (30.88 %) had stage 5 CKD. Among stage 5 patients mild PH was noted in 7 patients (10.19 %), while moderate and severe PH was noted in 5 (7.35 %) and 4 (5.88 %) patients respectively. Conclusion: Higher incidence of pulmonary hypertension is noted among chronic kidney disease and incidence increases with advanced stages.

New Insights to the Crosstalk between Vascular and Bone Tissue in Chronic Kidney Disease-Mineral and Bone Disorder.

Vasculature plays a key role in bone development and the maintenance of bone tissue throughout life. The two organ systems are not only linked in normal physiology, but also in pathophysiological conditions. The chronic kidney disease–mineral and bone disorder (CKD-MBD) is still the most serious complication to CKD, resulting in increased morbidity and mortality. Current treatment therapies aimed at the phosphate retention and parathyroid hormone disturbances fail to reduce the high cardiovascular mortality in CKD patients, underlining the importance of other factors in the complex syndrome. This review will focus on vascular disease and its interplay with bone disorders in CKD. It will present the very late data showing a direct effect of vascular calcification on bone metabolism, indicating a vascular-bone tissue crosstalk in CKD. The calcified vasculature not only suffers from the systemic effects of CKD but seems to be an active player in the CKD-MBD syndrome impairing bone metabolism and might be a novel target for treatment and prevention.

CLINICAL CHARACTERISTICS AND SHORT-TERM OUTCOMES IN COVID-19 POSITIVE PATIENTS REQUIRING HEMODIALYSIS AT A TERTIARY HOSPITAL IN A DEVELOPING COUNTRY

Background: The presence of comorbidities and relative immunosuppression in chronic kidney disease patients on hemodialysis raises concerns that these patients may have an increased risk of severe COVID-19. We aimed to examine the presentation and in-hospital outcomes of COVID-19 patients with end stage renal disease requiring hemodialysis. Methods:To examine presentation and in-hospital outcomes of COVID-19 in patients with end stage renal disease requiring hemodialysis. The study was conducted in a tertiary care centre from June 2020 to December 2020. We collected clinical &amp; laboratory data of 126 COVID-19 positive in-patients requiring hemodialysis. CKD patients referred to our centre for hemodialysis patients were also included. Patients requiring invasive ventilation and management in intensive care units were excluded. Patients were categorised into two groups based on their outcomes; survivors and non-survivors. Detailed history &amp; biochemistry results were recorded and analysed using SPSS 20.0. Results: A total of 126 patients were included in our study, with male predominance, n=91(72.2%). The median age of our study population was 53 years. The main presenting complaints were fever, n=78(61.9%); cough, n=69(54.8%), dyspnea, n= 62(49.2%), fatigue, n=102(81%) and myalgia, n=51(40.5%). Eighty nine(70.6%) patients were hypertensives, 48 (38.1%) known diabetics and 13 (10.3%) had pre-existing chronic obstructive pulmonary disease. Lung involvement in CT imaging at the time of admission, were found in 93(85.5%) patients. On comparison between survivor and non-survivors, there was no statistical difference in the biochemical prole, however there was signicant chest imaging ndings (p&lt;0.001) and requirement of ventilator (p&lt;0.001) in the non-survivor group. Conclusion: In our study, mortality was high in patients showing chest imaging ndings and also in those requiring non-invasive ventilation even in non-intensive care setting, at admission. The high mortality in CKD patients on hemodialysis emphasizes the need of dedicated COVID hemodialysis units,to prevent interruption in routine outpatient stable dialysis patients.

Prediction of mortality among patients with chronic kidney disease: A systematic review.

BACKGROUNDChronic kidney disease (CKD) is a common medical condition that is increasing in prevalence. Existing published evidence has revealed through regression analyses that several clinical characteristics are associated with mortality in CKD patients. However, the predictive accuracies of these risk factors for mortality have not been clearly demonstrated.AIMTo demonstrate the accuracy of mortality predictive factors in CKD patients by utilizing the area under the receiver operating characteristic (ROC) curve (AUC) analysis.METHODSWe searched Ovid MEDLINE, EMBASE, and the Cochrane Library for eligible articles through January 2021. Studies were included based on the following criteria: (1) Study nature was observational or conference abstract; (2) Study populations involved patients with non-transplant CKD at any CKD stage severity; and (3) Predictive factors for mortality were presented with AUC analysis and its associated 95% confidence interval (CI). AUC of 0.70-0.79 is considered acceptable, 0.80-0.89 is considered excellent, and more than 0.90 is considered outstanding.RESULTSOf 1759 citations, a total of 18 studies (n = 14579) were included in this systematic review. Eight hundred thirty two patients had non-dialysis CKD, and 13747 patients had dialysis-dependent CKD (2160 patients on hemodialysis, 370 patients on peritoneal dialysis, and 11217 patients on non-differentiated dialysis modality). Of 24 mortality predictive factors, none were deemed outstanding for mortality prediction. A total of seven predictive factors [N-terminal pro-brain natriuretic peptide (NT-proBNP), BNP, soluble urokinase plasminogen activator receptor (suPAR), augmentation index, left atrial reservoir strain, C-reactive protein, and systolic pulmonary artery pressure] were identified as excellent. Seventeen predictive factors were in the acceptable range, which we classified into the following subgroups: predictors for the non-dialysis population, echocardiographic factors, comorbidities, and miscellaneous.CONCLUSIONSeveral factors were found to predict mortality in CKD patients. Echocardiography is an important tool for mortality prognostication in CKD patients by evaluating left atrial reservoir strain, systolic pulmonary artery pressure, diastolic function, and left ventricular mass index.

CAPILLARY DENSITY DURING POSTOCCLUSIVE REACTIVE HYPEREMIA AND VENOUS CONGESTION DETERIORATES WITH ADVANCING CKD STAGES

Objective: Cardiovascular disease is the main cause of mortality in CKD patients. Endothelial dysfunction and capillary rarefaction are established cardiovascular risk factors. Nailfold video-capillaroscory provides a thorough assessment of capillary density and microcirculation changes. The aim of this study is to examine structural and functional capillary density in CKD patients of stages 2 to 4. Design and method: A total of 96 CKD patients were included in the study. The population consisted of 4 equal groups according to CKD stage (2, 3a, 3b and 4). All patients underwent nailfold video-capillaroscopy, during which capillary density was measured at baseline, after a 4-minute arterial occlusion (postocclusive reactive hyperemia) and at the end of a 2-minute venous occlusion (congestion phase). Arterial stiffness and arterial wave parameters were measured with applanation tonometry and common carotid intima-media thickness (IMT) with a 2D ultrasound device. Results: Capillary density at baseline showed a progressive reduction with advancing CKD stages (stage 2: 32.63 ± 2.79, stage 3a: 31.23 ± 3.84, stage 3b: 32.48 ± 3.34, stage 4: 28.50 ± 3.09, p &lt; 0.001). Similar reductions were observed in capillary density during postocclusive hyperemia (39.42 ± 3.00, 37.63 ± 4.24, 38.35 ± 3.83, and 33.77 ± 3.34, respectively, p &lt; 0.001) and after venous congestion (41.10 ± 3.09, 39.02 ± 4.41, 39.90 ± 3.51, and 35.21 ± 3.40, p &lt; 0.001). Office pulse wave velocity showed a non-significant increasing trend with advancing CKD, but carotid IMT did not. In multivariate regression analysis, eGFR showed a positive association (per ml/min increase; OR: 0.053, 95%CI: 0.004 to 0.101), whereas diabetes (OR: -1.706, 95%CI: -3.176 to -0.236), and parathormone (PTH) (per pg/ml increase; OR: -0.022, 95%CI: -0.036 to -0.008) negative associations with post-occlusive capillary density. Conclusions: Both structural and functional capillary density progressively decrease with advancing CKD stages. Apart from reduced eGFR, the presence of diabetes and increased PTH levels are independently associated with this reduction. This capillary rarefaction may play a central role in the increased burden of cardiovascular events in CKD patients.

Serum Uric Acid and Mortality in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Background: Existing studies suggested conflicting relationships between serum uric acid (SUA) and mortality in CKD patients. The present meta-analysis aimed to determine whether SUA can be a predictor for mortality in CKD cohorts. Method: A systematical search was conducted on PubMed, EMBASE, and The Cochrane Library to identify studies reporting the relationship between SUA level and all-cause and cardiovascular mortality in CKD populations. In addition, random-effects models were adopted to calculate the hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). Results: On the whole, 29 studies were involved. In the present meta-analysis, patients exhibiting the maximum SUA level showed an association with a significantly higher risk for all-cause mortality (HR, 1.30; 95% CI, 1.06–1.59) compared with patients exhibiting the minimum SUA level. As revealed from the meta-analysis of 8 studies, low level of SUA was another predictor for all-cause mortality in patients with CKD (HR, 1.36; 95% CI, 1.20–1.54). No significant relationship was identified between SUA and cardiovascular mortality. Conclusions: Higher and lower SUA levels are both associated with significantly increased risk of all-cause mortality in patients with CKD. A appreciate dose of treatment of lowering SUA agents should be confirmed.

Effect of Marital Status on Depression and Mortality among Patients with Chronic Kidney Disease from National Health and Nutrition Examination Survey 2005–2014

Background: The relationship between marital status and CKD is rarely studied. We aimed to explore the effect of marital status on the depression and mortality of patients with CKD. Methods: The data sources came from the NHANES database during 2005–2014 and 3,865 participants were included in this study. We used logistic regression models to examine the relationship between marital status and depression of CKD patients. The Cox proportional hazard models were used to evaluate the association between marital status and mortality of CKD patients. Results: In terms of depression in CKD patients, unmarried patients had a worse situation than married patients. Meanwhile, after adjusting the covariables, unmarried patients had increased risk of depression (OR = 1.26, 95% CI: 1.01–1.57) compared with married CKD patients, especially in males (OR = 1.45, 95% CI: 1.02–2.06) and patients with more than college education level (OR = 12.4, 95% CI: 3.75–41.02). There was a significant relationship between marital status and mortality of general CKD patients (HR = 1.36, 95% CI: 1.17–1.58). Moreover, marriage showed a protective effect against death among male patients, patients with school graduate or less and more than college educational level, patients with high income, and patients in different estimated glomerular filtration rate groups. Conclusions: The use of large numbers of participants has revealed the effect of marital status on CKD patients. Unmarried ones had a higher risk of depression than married ones among CKD patients. Meanwhile, the risk of death was higher in unmarried ones than married ones among CKD patients in this study.

Cardiac changes in patients of chronic kidney disease

Uremic Cardiomyopathy thought to be the pathological cardiac hypertrophy, indicating the influence of impaired renal function on the myocardium. It is the result of pressure overload, volume overload, and the uremic state itself. LV pressure overload occurs frequently from hypertension and arteriosclerosis, and occasionally from aortic stenosis; LV volume overload occurs as a result of the presence of an arteriovenous fistula, anemia, and hypervolemia. Cardiovascular complications are a major cause of morbidity and mortality in CKD patients, accounting for approximately 50% of deaths. Written informed consent was obtained from the all the subjects included in the study. In the present study, 36 cases presented with systolic dysfunction. Among them 6% cases had mild systolic dysfunction, 18% had moderate systolic dysfunction and 12% had severe systolic dysfunction. In the present study 09 cases presented with diastolic dysfunction and 05 cases constituted grade 1 diastolic dysfunction, 04 cases constituted grade II diastolic dysfunction.

Characteristics Of Chronic Kidney Failure Patients Using Vascular Access For Hemodialysis In Vascular Surgical Division Dr. Mohammad Hoesin General Hospital Period 1 Januari – 31 Desember 2018

Abstract&#x0D; Hemodialysis has been accepted as a method of treatment in patients with CKD in stage 5. A-V fistula is the closest ideal hemodialysis vascular access, so that it can reduce morbidity and mortality of CKD patients. This research is a retrospective descriptive study with data obtained from the A-V fistula surgery form archive in the Vascular and Endovascular Division of the Department of Surgery, FK UNSRI in January 2018-December 2018 and from the patient's medical record. Data processing was carried out with SPSS 16.0. The results of the study obtained 203 patient data with the use of AV Shunt that met the inclusion criteria. The mean age of patients was 50.53 years. There were 114 (56%) male patients and 89 (44%) female patients. Risk factors such as smoking were found in 9 (4%) patients. History of the disease prior to experiencing chronic renal failure was hypertension in 115 patients (56.6%) and diabetes in 81 (40%). There were 69 patient’s Hb data before AV shunt with Hb &lt;7 (1%) in 2 people, 7-8.9 (33%) 67 people, 9-10.9 (53%) 108 people,&gt; 11 (13%) 26 people. 128 (63%) patients had double lumen catheters installed in the right jugular, 5 (2%) patients were placed in the left jugular, and 70 (34%) patients did not have a double lumen catheter. A total of 169 (83%) patients had a history of using AV Shunt. There were 71 (35%) patients with the wrist region anastomosis, 132 (65%) patients with cubiti region anastomosis. Native AV shunt was the most commonly performed in 202 (99.5%) patients. There were no recorded complications after AV Shunt placement in 99 (48.8%) patients, 51 (25.2%) patients had AVF branches, 23 (11.3%) had AV Shunt rupture, 18 (8.8%) AVF stenosis, 1 (0.5%) central stenosis, 1 (0.5%) thrombus, and 11 (5.4%) infections. A total of 167 (82.2%) patients took AV Shunt after 3 months.