Mortality In ESRD Patients Research Articles

The Significance of Neutrophil-to-Lymphocyte Ratio as an Inflammatory Marker of COVID-19 in Hemodialysis Patients

Abstract Background One of the emerging -rapidly spreading- leading causes of pneumonia worldwide is a novel Corona virus, severe acute respiratory syndrome (SARS-CoV-2) causing coronavirus disease 2019. (COVID 19). ESRD patients are at high risk for COVID 19 associated morbidity and mortality. Aim To determine the significance of Neutrophil-to-Lymphocyte Ratio (NLR) as an inflammatory marker of COVID 19 in ESRD patients. Patients and Methods This is a prospective cohort study conducted on 84 ESRD patients on maintenance hemodialysis, receiving their treatment at Ain Shams University Hospitals from February 2021 till the end of July 2021. The study population was divided into 2 groups: Group 1: 42 ESRD patients who tested positive by reverse transcription polymerase chain reaction (RT-PCR) for SARSCoV-2 on nasopharyngeal swab samples or by typical COVID 19 radiological images on thoracic computed tomography scan. Group 2: 42 ESRD patients who tested negative by RT-PCR for SARS-CoV2 on nasopharyngeal swab samples or by normal images on thoracic computed tomography scan. Results Our data revealed that a higher level of NLR in COVID 19 group with a cut off value of 5.26. NLR was the most specific (95.24%) and sensitive (76.19%) predictor of COVID 19 among other hematological parameters. Also, NLR has a significant positive correlation with the mortality of the COVID group. Compared to the lymphocyte and neutrophil counts, NLR alone was positively correlated with the CRP in the COVID group. Our data stated that the use of anticoagulation and antiviral significantly improved the outcome of the COVID 19 patients on maintenance hemodialysis. Our study showed that COVID 19 ESRD patients had a significantly higher D dimer, LDH, CRP and hyperferritinemia than the non- COVID 19 ESRD patients. The COVID group in our study had significant hypoalbuminemia, anemia and reduced urea reduction rate (URR). Conclusion NLR, neutrophilia and lymphopenia are considered predictors of COVID 19 disease in ESRD patients. However, NLR has the highest sensitivity and specificity. Higher levels of NLR were attributed to higher mortality in ESRD patients with COVID 19 disease.

Short- and Medium-Term Mortality in ESRD Patients Undergoing MitraClip Therapy – a Multicenter Retrospective Cohort Study

Short- and Medium-Term Mortality in ESRD Patients Undergoing MitraClip Therapy – a Multicenter Retrospective Cohort Study

CRT-700.23 Short- and Medium-Term Mortality in ESRD Patients Undergoing MitraClip Therapy – a Multicenter Retrospective Cohort Study

CRT-700.23 Short- and Medium-Term Mortality in ESRD Patients Undergoing MitraClip Therapy – a Multicenter Retrospective Cohort Study

Early fluid management affects short-term mortality in patients with end-stage kidney disease undergoing chronic hemodialysis and requiring continuous renal replacement therapy

BackgroundEarly fluid management is considered a key element affecting mortality in critically ill patients requiring continuous renal replacement therapy (CRRT). Most studies have primarily focused on patients with intrinsic acute kidney injury requiring CRRT, although end-stage kidney disease (ESKD) patients generally exhibit greater vulnerability. We investigated the association between fluid balance and short-term mortality outcomes in ESKD patients undergoing chronic hemodialysis and requiring CRRT.MethodsThis retrospective study included 110 chronic hemodialysis patients who received CRRT between 2017 and 2019 at Ewha Womans University Mokdong Hospital. The amounts of daily input and output, and cumulative 3-day and 7-day input and output, were assessed from the initiation of CRRT. The participants were classified into two groups based on 7-day and 14-day mortalities. Cox regression analyses were carried out on the basis of the amounts of daily input and output, cumulative input and output, and cumulative fluid balance.ResultsDuring follow-up, 7-day and 14-day mortalities were observed in 24 (21.8%) and 34 (30.9%) patients. The patients were stratified into two groups (14-day survivors vs. non-survivors), and there were no significant differences in demographic characteristics between the two groups. However, diabetes mellitus was more common among survivors than among non-survivors. Univariate analyses showed that the amounts of daily output at 48, and 72 h, and 3-day cumulative input and output, were significantly associated with 7-day mortality risk regardless of the cumulative fluid balance (HR: 0.28, 95% CI: 0.12–0.70, p = 0.01 for daily output at 48 h; HR: 0.34, 95% CI: 0.13–0.85, p = 0.02 for daily output at 72 h.; HR: 0.72, 95% CI: 0.61–0.86, p = 0.01 for 3-day cumulative input; HR: 0.65, 95% CI: 0.41–0.90, p = 0.01 for 3-day cumulative output). Adjusted multivariate analyses showed that the lower 3-day cumulative output is an independent risk factor for 7-day and 14-day mortality.ConclusionsIn our study, increased cumulative output were significantly associated with reduced short-term mortality risk in chronic hemodialysis patients undergoing CRRT regardless of cumulative fluid balance. Further prospective studies to investigate the association between fluid balance and mortality in ESRD patients requiring CRRT are warranted.

Predictors of Mortality within 24 Months of Initial Arteriovenous Access Creation

End Stage Renal Disease is increasingly common, with approximately 785,880 patients currently dialysis dependent in the United States. 86% of these patients utilize hemodialysis. Arteriovenous (AV) access with either a fistula or graft is preferred over a catheter due to lowered complication risk. The purpose of this paper is to identify mid- term predictors of mortality to guide the type of AV access in patients with suboptimal cephalic veins. This is a retrospective review of patient characteristics at the time of initial AV access placement. All patients receiving first time AV access were reviewed. Mortality data was found via electronic medical records review, social security death index review, and internet search. Patients in whom mortality data could not be found were excluded from the final analysis. Univariate analysis using Chi-Squared testing and Student T-Test was performed. Binary logistic regression analysis was also performed for multivariate investigation. A total of 176 patients underwent first time AV access during the study period. Two year mortality data was available for 149 of these patients. Mortality occurred within 2 years for 27% of patients. Advanced age (70 vs. 61, P < 0.01), arrhythmia (48% vs. 24%, P < 0.01), abnormal EKG (36% vs.14%, P < 0.01), CHF (47% vs. 24%, P < 0.01), white, non-Hispanic race (51% vs. 22%, P < 0.01) and history of smoking (48% vs. 15%, P < 0.01) were statistically significant univariate predictors of 2-year mortality. Advanced age, white race and smoking were multivariate predictors with smoking having the largest impact (multivariate adjusted OR 11.8, P < 0.001). History of tobacco smoking has a profoundly negative effect on two year survival in patients undergoing initial AV access. Absence of smoking history provides significant 2-year mortality protection and thorough attempt at autologous AVF creation should be made in these patients. Cardiac disease and advanced age continue to be lead predictors of mortality in ESRD patients.

Correlation between Hypervolemia, Left Ventricular Hypertrophy and Fibroblast Growth Factor- 23 in Prevalent Hemodialysis Patients

Abstract Background Patients with end-stage renal disease are exposed to extreme volume shifts and thereby cardiovascular strain as a consequence of interdialytic weight gain, fluid removal during hemodialysis and also chronic fluid overload. In long-term hemodialysis patients, higher IDWG (interdialytic weight gain) is associated with poor survival and increased cardiovascular death. Patients with the lowest interdialytic fluid retention have the greatest survival. It was found that increased interdialytic volume load is associated with increased both LVMI and FGF-23 level. Objective To evaluate correlation between hypervolemia, left ventricular hypertrophy and FGF-23 in prevalent hemodialysis patients. Patients and Methods This cross sectional study was conducted in Ain shams university hospital and Al Agoza hospital, on 60 prevalent hemodialysis patients.Three patient died during the study. Results FGF-23 had a positive correlation with (weight gain, (PO4)3-, PTH, IVS, PW and LVMI). Conclusion FGF-23 might be a marker of volume overload and LVH in ESRD patients, as it positively correlated with (weight gain, IVS, PW and LVMI). FGF-23 is a marker of bone diseases, as it positively correlated with (PO4)3- and PTH. Volume overload has a negative impact on morbidity and mortality in ESRD patients.

The Effect of Hemodiafiltration on Inflammatory Biomarkers in Comparison to High Flux Dialyzers in Prevalent Hemodialysis Patients

Abstract Introduction Inflammation in patients with ESRD undergoing HD is an increasing concern for physicians and has been related to increase the rates of morbidity and mortality. Interestingly, patients with ESRD in conventional HD have frequent infections and a suboptimal response to vaccines; this is probably related to an immune inflammatory disorder associated either with uremia and/or nutritional status. In addition to CRP, which seems to be the most important marker for the identification and control of inflammation in clinical practice, many other markers are also available for the evaluation of inflammatory state. Decreased renal clearance clearly accounts for higher levels of circulating cytokines, although increased production has also been described. Hemodiafiltration has been shown to improve cardio-protection and the immunologic system and reduces infection and mortality compared with conventional HD. A recent study showed that hemodiafiltration compared with conventional HD reduced the risk of mortality in ESRD patients. Analysis of pooled individual participant data from randomized controlled trials has shown survival benefits of high volume-HDF on all-cause mortality and especially cardiovascular mortality rate. The mechanisms that lead to improved outcomes are not clear, but it is thought that HDF may reduce the production of inflammatory mediators through the use of biocompatible dialysers and ultrapure dialysate and also improve clearance of larger molecular weight substances, many of which are associated with oxidative stress, inflammation and endothelial dysfunction. Objective The aim of this study is to detect, prospectively, the effect of 3 months dialysis with Hemodiafiltration on inflammatory and nutritional biomarkers in comparison to conventional dialysis with high flux dialyzer in stable HD patients. Patients and methods 30 adults aged 20-75 years who were selected from Dialysis Unit, Kobary El-Kobba Military Hospital. 30 male patients known to have chronic kidney disease and are on dialysis with high flux dialyzer more than 3 months were divided into 2 groups:15 Patients are shifted to be on dialysis with HDF and 15 Patients are continued to be on Regular Hemodialysis with high flux dialyzer. Full medical history and clinical examination. Anthropometric measurements and Laboratory investigations including Complete Blood Picture (WBCs, platelets, Hb), Coagulation profile PT, PTT&amp;INR, Liver function tests (ALT, AST, T. Bilirubin and S. Albumin), Lipid profile (Triglycerides, total cholesterol, VLDL), S. creatinine, BUN, Na, K, Uric acid, Total Proteins, Serum Calcium, Serum Phosphorus, PTH, Serum ferritin, High sensitivity CRP (Enzyme- Linked Immunosorbent Assay (ELISA)) and IL6 (ELISA). Results The current study was conducted on 30 patients with chronic kidney disease on regular dialysis. The patients were divided into two groups A representing patients on hemodiafiltration (n = 15) and group B representing patients on dialysis with high flux dialyzer (n = 15). A high statistical significant difference (P &amp;lt; 0.01) was found regarding K 4.3±0.6 meq/l in group A while it is 5.2±0.5 meq/l in group B, a high statistical significant difference (P &amp;lt; 0.01) was found regarding phosphorus 4.6±1.0 mg/dl in group A while it is 6.1±0.9 mg/dl in group B and no statistical significant difference (P &amp;gt; 0.05) was found as regard the uric acid. A statistical significant difference (P &amp;lt; 0.05) was found regarding CRP 63.5±40.9 mg/dl in group A while it is 73.4±33.2 mg/dl in group B, a statistical significant difference (P &amp;lt; 0.01) was found regarding IL6 85.3±37.6 mg/dl in group A while it is 156.7±151.9 mg/dl in group B after 3 months and no statistical significant difference (P &amp;gt; 0.05) was found as regard those inflammatory markers before 3 months. A statistical significant difference (P &amp;lt; 0.05) was found regarding CRP. A statistical significant difference (P &amp;lt; 0.05) was found regarding IL6. Conclusion The present study revealed that there was no significant change in CRP and IL6 in patients on HDF compared to patients undergoing hemodialysis with high flux dialyzer before 3 months but there was a significant decrease in CRP and IL6 in patients on HDF compared to patients undergoing hemodialysis with high flux dialyzer after 3 months.

Estimated left ventricular pressure-myocardial strain loop as an index of cardiac work predicts all-cause mortality in patients receiving regular hemodialysis.

A non-invasive method for left ventricular pressure-strain analysis has recently been introduced to provide information on cardiac work and detect subtler changes in cardiac function. This study aims to verify and construct a novel index that could accurately and independently predict the prognosis of patients with end-stage kidney disease (ESRD) receiving regular hemodialysis. Patients with end-stage kidney disease (ESRD) receiving maintenance hemodialysis (4-h sessions, 3 times weekly for 3 months or more) and who underwent echocardiography between 2009 and 2014 in China Medical University Hospital, Taichung, Taiwan, were enrolled. Conventional (left ventricular ejection fraction, LVEF) and strain echocardiography parameters (global longitudinal strain, GLS; cardiac work index, CWI) in 102 eligible patients were analyzed and compared. CWI was calculated from estimated LV pressure-myocardial strain loop area. Results show that, while no significant differences were found between LVEF (0.57 ± 0.12 vs. 0.59 ± 0.09, P = 0.27) and GLS (-16.12 ± 6.57% vs. -18.44 ± 5.54%, P = 0.07), deceased patients had significantly lower CWI (1339 ± 683.05 mmHg% vs. 1883.38 ± 640.99 mmHg%, P = 0.0002) than surviving patients. The predictive values defined by area under the curve (AUC) of LVEF, GLS and CWI were 0.499, 0.619 and 0.724, respectively. In conclusion, CWI is an accurately independent predictor of all-cause mortality in ESRD patients receiving regular hemodialysis and may superior to the current predictors such as LVEF and GLS.

P0887MAJOR OSTEOPOROTIC FRACTURES AFTER KIDNEY TRANSPLANTATION: INCIDENCE, PREDICTORS AND ASSOCIATION WITH MORTALITY

Abstract Background and Aims Major osteoporotic fractures (MOF) are associated with increased morbidity and mortality in ESRD patients. We investigated incidence, predictors and clinical outcomes associated with first MOF (MOFfirst) following kidney transplantation (KT). Method In Swedish Renal Registry of 3992 first KT recipients (2005 -2016) (age 53 years, 65% men), we identified all MOFfirst in hip, spine, humerus and forearm following KT. We estimated incidence rates and predictors of MOFfirst using flexible parametric hazard models and Fine-Gray analysis accounting for competing risk of death, and risk of all-cause mortality following MOFfirst using Cox proportional hazards models with fracture as time-varying exposure. Results During median follow-up of 4.8 years (IQR 2.2-7.9 years), there were 279 fractures of which 139 were forearm fractures. The crude incidence rate of MOFfirst (n=279) was 14/1000 patient-years and that of hip fractures (n=69) 3/1000 patient-years. The multivariate-adjusted fracture incidence rates were highest during the first 6 months following KT, and two-fold increased among women. High age, female sex, previous history of MOF, diabetes nephropathy, pretransplant dialysis therapy and acute rejection were associated with increased risk for MOFfirst, whereas pre-emptive KT was associated with lower risk of MOFfirst. Spline curves showed that impact of age in women on MOFfirst was markedly higher than in men. MOFfirst (including all cases) independently predicted increased all-cause mortality (hazard ratio, HR, 1.78(95%CI 1.35-2.36)). Among MOFfirst, hip fracture (HR, 4.68(95%CI 1.56-14.06)) and spine fracture (HR, 4.02(95%CI 1.19-13.54)) were significantly associated with increased all-cause mortality. Conclusion The initial six months following kidney transplantation is a high-risk period for major osteoporotic fractures, especially forearm fractures. MOFs, especially hip and spine fracture, are associated with increased mortality.

Vitamin K for the Treatment of Cardiovascular Disease in End-Stage Renal Disease Patients: Is there Hope?

In Chronic Kidney Disease, vascular calcification (VC) is highly prevalent even at early stages and is gradually enhanced, along with disease progression to End-Stage Renal Disease (ESRD). The calcification pattern in uremia includes all types of mineralization and contributes to the heavy cardiovascular (CV) burden that is common in these patients. Ectopic mineralization is the result of the imbalance between inhibitors and promoters of vascular calcification, with the latter overwhelming the former. The most powerful, natural inhibitor of calcification is Matrix Gla Protein (MGP), a small vitamin K dependent protein, secreted by chondrocytes and vascular smooth muscle cells. In uremia, MGP was reported as the only molecule able to reverse VC by "sweeping" calcium and hydroxyapatite crystals away from the arterial wall. To become biologically active, this protein needs to undergo carboxylation and phosphorylation, reactions highly dependent on vitamin K status. The inactive form of MGP reflects the deficiency of vitamin K and has been associated with CV events and mortality in ESRD patients. During the past decade, vitamin K status has emerged as a novel risk factor for vascular calcification and CV disease in various populations, including dialysis patients. This review presents evidence regarding the association between vitamin K and CV disease in ESRD patients, which are prone to atherosclerosis and atheromatosis.

Platelet and Monocyte Activity Markers and Mortality in Patients with End-Stage Renal Disease.

The association of platelet and monocyte activity markers with long-term mortality was assessed in hemodialysis (HD) patients. In 41 HD patients (25 male, 16 female), surface expression of CD40L and CD62P on platelets, tissue factor (TF) binding on monocytes, and platelet-monocyte aggregates were measured by flow cytometry. Plasma levels of MCP-1, IL-6, TNFα, and soluble CD40L were analyzed by enzyme linked immunosorbent assay. Cox proportional hazard regression analyses and Kaplan-Meier curve were calculated. The predefined endpoint was all-cause mortality. The study follow-up was 11.54 years. Thirty-one patients (75.6%) died within the study period. Mean patient survival after study inclusion was 5.45 +/- 4.24 years. TF on monocytes above the median of the study population was significantly and independently associated with total mortality (HR (95% CI) 3.45 (1.32 - 9.07); p = 0.01). Cumulative mortality in patients with TF on monocytes above median was significantly higher compared to pa-tients with TF on monocytes below median value (log rank p < 0.01). Platelet-monocyte aggregates, the expression of CD40L and CD62P on platelets, and plasma levels of sCD40L, IL-6, MCP-1, and TNFα were not significantly correlated with mortality. The present study confirms a high mortality in ESRD patients. TF binding on monocytes was significantly correlated with increased mortality and may identify a subgroup of patients at higher risk.

SUN-063 MORTALITY RISK OF FLUID OVERLOAD IN DIABETIC ESRD PATIENTS

Chronic fluid overload has been related to severely increased mortality in ESRD patients. In addition, the increasing prevalence of diabetes along with concomitant diseases make fluid management more difficult and calls for individualized fluid targets, taking co-morbidities into account. Aim of this work was to assess the mortality risk of diabetes in different degrees of chronic fluid overload, and to identify potential target ranges for optimal outcome. Data from more than 90,000 patients treated in the Fresenius NephroCare clinic network from 26 countries were included in the analysis, including 1.3 million measurements of fluid status (determined as fluid overload, FO [L]) by bioimpedance spectroscopy using the BCM Body Composition Monitor. Hazard ratios (HR) were calculated by time dependent cox analysis (adjusted for 30 different parameters) over deciles in both diabetic and non-diabetic patients. In both groups, the decile with best outcome served as reference (HR=1). Prevalence of diabetes was strongly related with pre-dialysis fluid status (Figure 1). In patients who were normally hydrated (or even slightly dehydrated), prevalence of diabetes was around 15%, rising to threefold (>45%) in states of severe fluid overload. The HR of pre-dialysis fluid overload in the highest decile was 2.7 in non-diabetics, and 2.0 in diabetics (Figure 2). The HR of FO was lower in diabetics since the underlying mortality is generally higher in this more co-morbid group, and fluid overload (while still being a risk factor) adds less relative hazard on top as compared with non-diabetics. Dehydration was found to be a significant risk factor in both groups. The pre-dialysis fluid overload range in which the mortality risk is increased by no more than 50% compared with the reference was relFO<15% (relFO=FO/ECW, ECW: extracellular water) in non-diabetics, and relFO<22% in diabetics.Figure 2Adjusted hazard ratios for all-cause mortality in non-diabetic (left) and diabetic patients (right). In both diagrams patients were separated into 10 deciles of relative pre-dialysis fluid overload. The third decile (corresponding with the best outcome) was used as reference in both cox models.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Both the prevalence of diabetes and the risk of mortality in diabetic patients strongly depend on degree of long-term chronic fluid overload. Whether there is a causal relationship or this is just an association needs to be further investigated.

High Left Ventricular Filling Pressure on Doppler Echocardiography Is Associated With Graft Failure and Overall Mortality Following Kidney Transplantation.

Although E/e´ is prognostic of mortality in patients with end-stage renal disease (ESED), little is known about the prognostic implications of E/e´ following kidney transplant (KT). The objective of this study was to evaluate whether an elevated E/e´ is associated with graft function, postoperative hemodialysis, and overall mortality in end-stage renal disease patients following KT. A retrospective observational study. Tertiary teaching hospital. In total, 1,045 patients underwent KT at the authors' hospital between January 2006 and December 2013. None. Patients were divided into groups with an E/e´<15 or≥15, as assessed by preoperative echocardiography (median time from preoperative assessment of echocardiography to surgery: 37 days [IQR: 16-68 days]). Of 1,045 patients, 821 patients (78.6%) had an E/e´<15, and 224 patients (21.4%) had an E/e´≥15. Multivariate analysis indicated that age (odds ratio [OR]: 1.03; 95% confidence interval [CI]: 1.01-1.04, p = 0.001), diabetes mellitus (OR: 2.7; CI: 1.94-3.83, p<0.001), β-blocker (OR: 1.4; CI: 1.03-1.95, p = 0.034), left atrial dimension (OR: 1.07; CI: 1.04-1.11, p<0.001), and left ventricular mass index (OR: 1.02; CI: 1.01-1.03, p<0.001) are predictive of E/e´≥15. After adjustment using inverse probability of treatment weighting, E/e´≥15 also was associated independently with postoperative hemodialysis (OR: 2.0; 95% CI: 1.5-2.6, p<0.001), graft failure (OR: 1.7; 95% CI: 1.4-2.2; p<0.001), and overall mortality (hazard ratio [HR]: 3.2; 95% CI: 2.1-4.8, p<0.001). Preoperative E/e´ is a prognostic indicator of overall mortality in ESRD patients undergoing KT.

Sequence variants of peroxisome proliferator-activated receptor-gamma gene and the clinical courses of patients with end-stage renal disease.

Background. PPAR-γ single nucleotide polymorphisms (SNPs) reportedly play an important role in determining metabolic risk among diverse population. Whether PPAR-γ SNPs affect the clinical courses in ESRD patients is unknown. Methods. From a multicenter cohort, we identified 698 patients with prevalent ESRD between 2002 and 2003, and other 782 healthy subjects as control. Two PPAR-γ SNPs, Pro12Ala (rs1801282) and C161T (rs3856806), were genotyped and their association with ESRD was examined. Both groups were prospectively followed until 2007, and the predictability of genotypes for the long-term survival of ESRD patients was analyzed. Results. After multivariable-adjusted regression, GG genotype of Pro12Ala was significantly more likely to associate with ESRD (P < 0.001) among patients with non-diabetes-related ESRD. Cox's proportional hazard regression showed that both Pro12Ala and C161T polymorphisms were significant predictors of mortality in ESRD patients with DM (Pro12Ala: GG versus other genotypes, hazard ratio [HR] <0.01; P < 0.001; for C161T, CC versus TT genotypes, HR 2.86; P < 0.001; CT versus TT genotypes, HR 1.93; P < 0.001). Conclusion. This is the first and largest study to evaluate PPAR-γ SNPs in ESRD patients. Further mechanistic study is needed to elucidate the role of PPAR-γ among ESRD patients.

Impact of Hyperuricemia on Cardiovascular System in ESRD Patients

Background: Hyperuricemia was found to be associated with hypertension, coronary heart disease, metabolic syndrome and chronic kidney disease. However there are no specific data about the relationship of uric acid to cardiovascular disease and mortality in ESRD patients on chronic hemodialysis. So, we aimed to study the impact of hyperuricemia on cardiovascular system in chronic kidney disease and in ESRD patients on regular hemodialysis Patients and methods: This study included 100 patients in Ashmoun hospital, nephrology department. Patients were chosen and divided into two groups: Group A, 50cases with chronic kidney disease and Group B, 50cases of ESRD on regular hemodialysis. All cases were subjected to full clinical examination, measurement of eGFR, laboratory tests for blood urea, serum creatinine and serum uric acid and ECG. Results: Serum uric acid was significantly higher in dialysis group than CKD group (p 0.05). Conclusion: In cases of CKD uric acid is involved in the pathogenesis of renal failure and hypertension. In patients with ESRD, hyperuricemia is not a risk factor for the development of cardiac disease; but it shows reversed epidemiology and becomes a marker of good nutritious status. Further studies should be done on wider scales to evaluate the impact of hyperuricemia on cardiovascular system in hemodialysis patients.

Association between 25-hydroxyvitamin d and cardiac troponin t level in korean esrd patients

Growing evidences have shown that 25-hydroxyvitamin D [25(OH)D] deficiency may be associated with cardiovascular (CV) mortality in ESRD patients. However, it has not been sufficiently investigated in the Northeast Asian ESRD population. From 2009 to 2011, 208 patients have newly commenced renal replacement therapy (RRT) in our unit. Among them, 136 patients who were measured for 25(OH)D and cardiac troponin T (cTnT) level at the start of RRT were analyzed (M:F=74:62, Age 54.1±14.7 yrs, DM 53.7%). The patient experienced coronary artery disease within 3 months was excluded. Patients divided into 3 groups according to cTnT level: group 1 (n=36), cTnT not detected (

Cardiovascular mortality and C-reactive protein in elderly patients beginning dialysis: reverse epidemiology?

Cardiovascular disease is a major cause of mortality in end-stage renal disease patients (ESRD). The rate of elderly and polypathologic patients in ESRD is increasing. Elevated levels of C-reactive protein (CRP) have been shown to be associated with increased mortality in ESRD patients. The aim of this study was to examine whether, in elderly ESRD patients, the conventional relationship between elevated CRP and cardiovascular mortality is maintained. This prospective European cohort study included 150 ESRD patients. Data obtained at baseline included demographics, comorbidity, late referral to a nephrologist, high-sensitivity CRP, and serum albumin and hemoglobin levels. Cardiovascular events were analysed as a combined end-point. The mean age of the cohort was 61 years (22-90), with 33.3% of patients over 70 years (75 yrs, 70-83 yrs). Forty-two patients (28.2%) experienced at least one cardiovascular event. Interaction between age over 70 years and CRP exceeding 3 mg/L was a protective factor. Patients over 70 years beginning dialysis with a CRP value <3 mg/L had a higher cardiovascular risk than those with a CRP value >3 mg/L. Multivariate analysis showed that the independent risk factors for cardiovascular events were, in the whole cohort, age over 70 years, previous cardiovascular comorbidity, and interaction between age and CRP. This trial shows a reverse relation between cardiovascular risk in dialysis patients over 70 and CRP level. This may be a useful element in evaluating older patients before long-term dialysis.

Which Echocardiographic Parameters Predict Mortality in ESRD Patients?

Which Echocardiographic Parameters Predict Mortality in ESRD Patients?

Clinical Variables Predictive of Mortality in ESRD Patients

Clinical Variables Predictive of Mortality in ESRD Patients

Prognostic Value of Reduced Left Ventricular Ejection Fraction at Start of Hemodialysis Therapy on Cardiovascular and All-Cause Mortality in End-Stage Renal Disease Patients

Cardiac failure is directly affected by left ventricular (LV) dysfunction, and particularly LV systolic dysfunction is strongly associated with survival in ESRD patients. The aim of this study was to determine the prognostic value of reduced LV ejection fraction (LVEF) measured at the time of initiation of hemodialysis (HD) in incident HD patients. 1254 consecutive ESRD patients who electively started HD therapy were screened by echocardiography within 1 month after its inception. They were divided into five groups according to LVEF levels with a decrease of 0.1 each and were followed up for up to 7 years. Survival was examined with the Kaplan-Meier method and compared using the log-rank test. Among the 1254 patients, LVEF levels ≥0.6, 0.5 to 0.6, 0.4 to 0.5, 0.3 to 0.4, and <0.3 were seen in 842 (67.1%), 247 (19.7%), 107 (8.5%), 41 (3.3%), and 17 (1.4%) patients, respectively. On Kaplan-Meier analysis, 7-year event-free rates from cardiovascular death were 84.2, 83.7, 73.6, 59.4, and 30.9% in order of groups with decreasing LVEF of 0.1 each, respectively. Seven-year event-free rates from all-cause death were 69.2, 61.7, 57.1, 45.9, and 23.1% in the respective groups. Even after adjustment for other risk factors, decreasing LVEF was a strong independent predictor for cardiovascular death. Reduced LVEF on starting HD therapy could stratify risk of cardiovascular and all-cause mortality in ESRD patients. Screening by echocardiography at start of HD therapy might be recommended to predict prognosis in patients with ESRD.