Mortality In Dialysis Patients Research Articles

#5069 THE EFFECT OF DIFFERENT DIALYSATE SODIUM CONCENTRATIONS ON AMBULATORY BLOOD PRESSURE AND PULSE WAVE VELOCITY ON HEMODIALYSIS PATIENTS

Abstract Background and Aims Hypertension and arterial stiffness are associated with increased morbidity and mortality in dialysis patients. The purpose of the present study is to investigate the effect of sodium concentration in the dialysate on 72h ambulatory blood pressure and arterial stiffness, as well as its effect on body weight. Method The study involved adult patients on thrice weekly maintenance hemodialysis program. All patients initially underwent six sessions with dialysate sodium concentration of 137 meq/l, subsequently another six sessions with dialysate sodium concentration of 139 meq/l and finally six sessions with dialysate sodium concentration of 141 meq/l. At the start of the sixth hemodialysis session at each different sodium dialysate concentration, the Mobil-o-graph device was placed for 72h in order to cover the 3-day interdialytic interval. The parameters evaluated by the Mobil-o-graph device were peripheral and central systolic (pSBP and cSBP) and diastolic (pDBP and cDBP) blood pressure and pulse wave velocity (PWV). All patients were screened for hydration status with lung ultrasound before entering the study and body weight was actively monitored before each session. Results Overall, 29 patients with a mean age of 57.9±14.9 years were included in this prospective interventional study. Body weight did not change significantly between the 3 dialysate concentrations. There was a significant increase of 6 mmHg in the mean pSBP with the change in sodium concentration from 137 to 139 and to 141 meq/l (from 122.7 to 125,6 and to 128.3 mmHg respectively, p = 0.032). Mean cSBP was also significantly increased by 5 mmHg (from 110.3 to 112.6 and to 115.1 mmHg respectively, p = 0.02). Peripheral and central DBP did not change significantly (from 71.4 to 73.2 and to 74.1 mmHg, p = ns and from 73.9 to 74.8 and to 75.3 mmHg, p = ns, respectively), as well as PWV (from 8.4 to 8.2 cm/sec, p = ns). Conclusion The increasing sodium concentration in the dialysate causes a significant increase in systolic blood pressure and body weight, without a change in PWV.

Home Pulse Pressure Predicts Death and Cardiovascular Events in Peritoneal Dialysis Patients.

Increased arterial hypertension represents a prevalent condition in peritoneal dialysis patients that is often related to volume expansion. Pulse pressure is a robust predictor of mortality in dialysis patients, but its association with mortality is unknown in peritoneal patients. We investigated the relationship between home pulse pressure and survival in 140 PD patients. During a mean follow-up of 35 months, 62 patients died, and 66 experienced the combined event death/CV events. In a crude COX regression analysis, a five-unit increase in HPP was associated with a 17% increase in the hazard ratio of mortality (HR: 1.17, 95% CI 1.08-1.26 p < 0.001). This result was confirmed in a multiple Cox model adjusted for age, gender, diabetes, systolic arterial pressure, and dialysis adequacy (HR: 1.31, 95% CI 1.12-1.52, p = 0.001). Similar results were obtained considering the combined event death-CV events as an outcome. Home pulse pressure represents, in part, arterial stiffness, and it is strongly related to all-cause mortality in peritoneal patients. In these high cardiovascular risk populations, it is important to maintain optimal blood pressure control, but it is fundamental to consider all the other cardiovascular risk indicators, such as pulse pressure. Home pulse pressure measurement is easy and feasible and can add important information for the identification and management of high-risk patients.

Trends and outcome of statin therapy in dialysis patients with atherosclerotic cardiovascular diseases: A population-based cohort study.

Although statins are an effective strategy for the secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in the general population, the benefits for dialysis patients are controversial. We sought to assess trends of statin use and evaluate outcomes of statin therapy in dialysis patients with different types of ASCVD. This nationwide retrospective population-based cohort study using data from the Korean National Health Insurance Service included adult patients (aged ≥ 18 years) undergoing chronic dialysis who had an initial ASCVD event in the time period of 2013 to 2018. Annual trends of statin use according to age, sex, and ASCVD types were analyzed. The association between 1-year mortality and statin use was examined using multivariable Cox proportional hazards regression analyses. Among 17,242 subjects, 9,611(55.7%) patients were statin users. The overall prevalence of statin use increased from 52.9% in 2013 to 57.7% in 2018; the majority (77%) of dialysis patients were prescribed moderate-intensity statins. The proportions of low- or moderate-intensity statin use were similar, but high-intensity statin use increased from 5.7% in 2013 to 10.5% in 2018. The use of the statin/ezetimibe combination has gradually increased since 2016. Statin use was independently associated with the reduced 1-year all-cause mortality after adjusting for confounding factors (hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.80-0.96, P = 0.004). The prevalence of statin prescriptions in dialysis patients after ASCVD event increased from 2013 to 2018. Most patients received moderate-intensity statin. However, high-intensity statin and statin/ezetimibe combination therapy has remarkably increased. Statin use was associated with decreased 1-year all-cause mortality in dialysis patients with ASCVD.

Association between CKD-MBD and mortality in older patients with advanced CKD - results from the EQUAL study.

Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) is a common complication of CKD, associated with higher mortality in dialysis patients, while its impact in non-dialysis patients remains mostly unknown. We investigated the associations between parathyroid hormone (PTH), phosphate, and calcium (and their interactions) and all-cause, cardiovascular (CV), and non-CV mortality in older non-dialysis patients with advanced CKD. We used data from the European Quality study, which includes patients aged ≥65 with eGFR ≤20ml/min/1.73m2 from six European countries. Sequentially adjusted Cox models were used to assess the association between baseline and time-dependent CKD-MBD biomarkers and all-cause, CV, and non-CV mortality. Effect modification between biomarkers was also assessed. In 1294 patients, the prevalence of CKD-MBD at baseline was 94%. Both PTH (aHR 1.12, 95%CI 1.03-1.23, p 0.01) and phosphate (aHR 1.35, 95%CI 1.00-1.84, p 0.05), but not calcium (aHR 1.11, 95%CI 0.57-2.17, p 0.76), were associated with all-cause mortality. Calcium was not independently associated with mortality, but modified the effect of phosphate, with the highest mortality risk found in patients with both hypercalcemia and hyperphosphatemia. PTH level was associated with CV mortality, but not with non-CV mortality, whereas phosphate was associated with both CV and non-CV mortality in most models. CKD-MBD is very common in older non-dialysis patients with advanced CKD. PTH and phosphate are independently associated with all-cause mortality in this population. While PTH level is only associated with CV mortality, phosphate seems to be associated with both CV and non-CV mortality.

Total cholesterol and mortality in peritoneal dialysis: a retrospective cohort study

BackgroundTotal cholesterol is inversely associated with mortality in dialysis patients, which seems implausible in real-world clinical practice. May there be an optimal range of total cholesterol associated with a lower mortality risk? We aimed to evaluate the optimal range for peritoneal dialysis (PD) patients.MethodsWe conducted a retrospective real-world cohort study of 3565 incident PD patients from five PD centers between January 1, 2005, and May 31, 2020. Baseline variables were collected within one week before the start of PD. The associations between total cholesterol and mortality were examined using cause-specific hazard models.Results820 (23.0%) patients died, including 415 cardiovascular deaths, during the follow-up period. Restricted spline plots showed a U-curved association of total cholesterol with mortality. Compared with the reference range (4.10–4.50 mmol/L), high levels of total cholesterol (> 4.50 mmol/L) were associated with increased risks of all-cause (hazard ratio [HR] 1.35, 95% confidence index [CI] 1.08–1.67) and cardiovascular mortality (HR 1.38, 95% CI 1.09–1.87). Similarly, compared with the reference range, low levels of total cholesterol (< 4.10mmol/L) were also associated with high risks of all-cause (HR 1.62, 95% CI 1.31–1.95) and cardiovascular mortality (HR 1.72, 95% CI 1.27–2.34).ConclusionTotal cholesterol levels at the start of PD between 4.10 and 4.50 mmol/L (158.5 to 174.0 mg/dL), an optimal range, were associated with lower risks of death than higher or lower levels, resulting in a U-shaped association.

Chronic kidney disease-related sarcopenia as a prognostic indicator in elderly haemodialysis patients

BackgroundThe mortality of dialysis patients greatly exceeds that of the general population and identifying predictive factors for mortality may provide opportunities for earlier intervention. This study assessed the influence of sarcopenia on mortality in patients on haemodialysis.MethodsThis prospective, observational study enrolled 77 haemodialysis patients aged 60 years and over, of whom 33 (43%) were female, from two community dialysis centres. Baseline demographic and laboratory data were collected, and sarcopenia was diagnosed using grip strength, muscle mass by bioimpedance analysis (BIA) and muscle function by timed up-and-go according to European Working Group on Sarcopenia in Older People criteria. Nutritional status was assessed using a subjective nutritional assessment score, comprising functional changes in weight, appetite, gastrointestinal symptoms and energy.. A comorbidity score (maximum 7 points) was derived from the presence or absence of hypertension, ischaemic heart disease, vascular disease (cerebrovascular disease, peripheral vascular disease, and abdominal aortic aneurysm), diabetes mellitus, respiratory disease, a history of malignancy and psychiatric disease. Outcomes over six years were linked to the Australian and New Zealand Dialysis and Transplant Registry.ResultsThe median participant age was 71 years (range 60–87). Probable and confirmed sarcopenia was present in 55.9% and severe sarcopenia with reduced functional testing in 11.7%. Over 6 years, overall mortality was 50 of the 77 patients (65%), principally from cardiovascular events, dialysis withdrawal and infection. There were no significant survival differences between patients with no, probable, confirmed, or severe sarcopenia, or between tertiles of the nutritional assessment score. After adjustment for age, dialysis vintage, mean arterial pressure (MAP) and the total comorbidity score, no sarcopenia category predicted mortality. However, the total comorbidity score [Hazard Ratio (HR) 1.27, Confidence Intervals (CI) 1.02, 1.58, p = 0.03] and MAP (HR 0.96, CI 0.94, 0.99, P = < 0.01) predicted mortality.ConclusionSarcopenia is highly prevalent in elderly haemodialysis patients but is not an independent predictor of mortality. Haemodialysis patients have multiple competing risks for mortality which, in this study, was predicted by a lower MAP and a higher total comorbidity score.Trial registrationRecruitment commenced December 2011. The study was registered 10.01.2012 with the Australian New Zealand Clinical Trials Registry (ACTRN12612000048886).

Interleukin‐6 levels can be used to estimate cardiovascular and all‐cause mortality risk in dialysis patients: A meta‐analysis and a systematic review

Although previous studies have explored the correlation of interleukin (IL)-6 with mortality risk in dialysis patients, the findings have been conflicting. Hence, this meta-analysis aimed to comprehensively assess the use of IL-6 measurement for estimating cardiovascular mortality and all-cause mortality in dialysis patients. The Embase, PubMed, Web of Science, and MEDLINE databases were searched to identify relevant studies. After screening out the eligible studies, the data were extracted. Twenty-eight eligible studies with 8370 dialysis patients were included. Pooled analyses revealed that higher IL-6 levels were related to increased cardiovascular mortality risk (hazard ratio [HR] = 1.55, 95% confidence interval [CI]: 1.20-1.90) and all-cause mortality risk (HR = 1.11, 95% CI: 1.05-1.17) in dialysis patients. Further subgroup analyses suggested that higher IL-6 levels were associated with elevated cardiovascular mortality in hemodialysis patients (HR = 1.59, 95% CI: 1.36-1.81) but not in peritoneal dialysis patients (HR = 1.56, 95% CI: 0.46-2.67). Moreover, sensitivity analyses indicated that the results were robust. Egger's test revealed potential publication bias among studies exploring the correlation of IL-6 levels with cardiovascular mortality (p = .004) and all-cause mortality (p < .001); however, publication bias was not observed when using Begg's test (both p > .05). This meta-analysis reveals that higher IL-6 levels could indicate higher risks of cardiovascular mortality and all-cause mortality in dialysis patients. These findings suggest that monitoring IL-6 cytokine may help to enhance dialysis management and improve the general prognosis of patients.

Cost-effectiveness analysis of intravenous paricalcitol vs. oral calcitriol in the treatment of hyperparathyroidism secondary to chronic kidney disease.

Hyperparathyroidism (SHPT) secondary to chronic kidney disease (CKD) is characterized by high levels of parathyroid hormone (PTH), hyperplasia of the parathyroid glands and cardiovascular disease. Selective and non-selective and selective vitamin D-receptor activators, calcimimetics, are available in the Brazilian market to reduce PTH levels. To develop a cost-effectiveness (C/E) and budgetary impact (BI) analysis of intravenous paricalcitol vs. oral calcitriol for patients on dialysis with SHPT, from the perspective of the Brazilian Public Health Care System (SUS). We built a decision-tree model to analyze C/E, which considered the outcome of avoided death and a time horizon of 1 year. As for the BI analysis, two scenarios were considered, one of demand and one of epidemiological approach, based on data from the Brazilian Society of Nephrology. The analysis showed that the C/E ratio was R$ 1,213.68 per year, and an incremental effectiveness of 0.032, referring to avoided death. The incremental C/E ratio was R$37,927.50 per death averted by paricalcitol. It was estimated that the incremental BI with the expansion of paricalcitol use will be between R$1,600,202.28 and R$4,128,565.65 in the first year, considering the main and epidemiological scenarios. At the end of 5 years after the expansion of its use, an incremental BI was estimated between R$ 48,596,855.50 and R$ 62,90,555.73. Intravenous paricalcitol has superior efficacy and similar safety to oral calcitriol, reducing the overall mortality of dialysis patients, although it implies a higher cost.

Hyponatraemia and fluid overload are associated with higher risk of mortality in dialysis patients.

The 5-year mortality rate for haemodialysis patients is over 50%. Acute and chronic disturbances in salt and fluid homeostasis contribute to poor survival and are established as individual mortality risk factors. However, their interaction in relation to mortality is unclear. We used the European Clinical Database 5 to investigate in a retrospective cohort analysis the relationship between transient hypo- and hypernatremia, fluid status and mortality risk of 72163 haemodialysis patients from 25 countries. Incident haemodialysis patients with at least one valid measurement of bioimpedance spectroscopy were followed until death or administrative censoring from 1 January 2010 to 4 December 2019. Fluid overload and depletion were defined as >2.5L above, and -1.1L below normal fluid status, respectively. N=2272041 recorded plasma sodium and fluid status measurements were available over a monthly time grid and analysed in a Cox regression model for time-to-death. Mortality risk of hyponatremia (plasma sodium <135mmol/L) was slightly increased when fluid status was normal [hazard ratio (HR) 1.26, 95% confidence interval (CI) 1.18-1.35], increased by half when patients were fluid depleted (HR 1.56, 95% CI 1.27-1.93) and accelerated during fluid overload (HR 1.97, 95% CI 1.82-2.12). Plasma sodium and fluid status act independently as risk factors on mortality. Patient surveillance of fluid status is especially important in the high-risk subpopulation of patients with hyponatremia. Prospective patient-level studies should examine the effects of chronic hypo- and hypernatremia, risk determinants, and their outcome risk.

Left-sided valvular heart disease in dialysis recipients: a single-centre observational study.

With the increasing prevalence of chronic kidney disease, the number of people receiving renal replacement is expected to increase by 50% by 2030. Cardiovascular mortality remains significantly higher in this population. The presence of valvular heart disease (VHD) in patients with end-stage renal disease is associated with poor survival. In a dialysis cohort, we assessed the prevalence and characteristics of patients with significant VHD, the association with clinical parameters and the impact on survival. Echocardiographic parameters for dialysis recipients from a single centre in the UK were collected. Significant left-sided heart disease (LSHD) was defined as moderate or severe left valvular lesions or left ventricular systolic dysfunction (LVSD) (ejection fraction <45%) or both. Baseline demographic and clinical characteristics were ascertained. In 521 dialysis recipients {median age 61years [interquartile range (IQR) 50-72], 59% male}, 88% were on haemodialysis and the median dialysis vintage was 2.8years (IQR 1.6-4.6). A total of 238 (46%) had evidence of LSHD: 102 had VHD, 63 had LVSD and 73 had both. Overall, 34% had evidence of left-sided VHD. In multivariable regression analysis, age and use of cinacalcet were associated with higher odds of VHD {odds ratio [OR] 1.03 [95% confidence interval (CI) 1.02-1.05] and OR 1.85 [95% CI 1.06-3.23], respectively}, while the use of phosphate binders was associated with increased odds of aortic stenosis [AS; OR 2.64 (95% CI 1.26-5.79)]. The 1-year survival was lower in VHD [78% versus 86% (95% CI 0.72-0.84 and 0.83-0.90), respectively] and in LSHD [78% versus 88% (95% CI 0.73-0.83 and 0.85-0.92), respectively]. In AS, the 1-year survival was 64% (95% CI 0.49-0.82). Using propensity score matching to adjust for age, diabetes and low serum albumin, AS was significantly associated with lower survival (P=.01). LSHD was significantly associated with worse survival (P=.008) compared with survival in LVSD (P=.054). A high proportion of dialysis patients have clinically significant LSHD. This was associated with higher mortality. In valvular heart disease, the development of AS is independently associated with higher mortality in dialysis patients.

Impact of COVID-19 on the mortality of dialysis patients and kidney transplant recipients during the Omicron fifth wave in Hong Kong.

Impact of COVID-19 on the mortality of dialysis patients and kidney transplant recipients during the Omicron fifth wave in Hong Kong.

Prognostic Nutritional Index as a Predictor of Mortality in 101,616 Patients Undergoing Hemodialysis.

High mortality in dialysis patients is linked to malnutrition and inflammation. Prognostic nutritional index (PNI), calculated from serum albumin level and total lymphocyte count, has been developed as a prognostic marker for cancer patients. We investigated the clinical utility of PNI in predicting mortality in patients undergoing hemodialysis. Thus, 101,616 patients who initiated hemodialysis in United States dialysis centers between 2007 and 2011 were included in this retrospective cohort study. Using the Cox regression model, we assessed the relationship between PNI and mortality. Further, the predictive value of PNI for one-year mortality was compared with that of its constituent using area under the receiver operating characteristic curve, net reclassification improvement, and integrated discrimination improvement. Higher PNI quartiles were incrementally associated with lower mortality; in patients with PNI values of 39.5-&lt;43.1, 43.1-&lt;46.6, and ≥46.6 (reference: PNI &lt; 39.5), case-mix adjusted hazard ratios (95% confidence intervals) were 0.66 (0.64, 0.68), 0.49 (0.48, 0.51), and 0.36 (0.34, 0.37), respectively. PNI predicted mortality better than serum albumin level or total lymphocyte count alone. In the subgroup analysis, PNI performed well in predicting mortality in patients aged &lt; 65 years. Our results indicate that PNI is a simple and practical prognostic marker in patients undergoing hemodialysis.

Chronic Kidney Disease—Mineral and Bone Disorder (CKD-MBD), from Bench to Bedside

Chronic kidney disease—mineral and bone disorder (CKD-MBD) is a systemic disorder that increases the risk of morbidity and mortality in dialysis patients. CKD-MBD is highly prevalent in dialysis patients, and appropriate treatment is important for improving their outcomes. Inorganic phosphate, fibroblast growth factor 23, parathyroid hormone, and calciprotein particles are markers for critical components and effectors of CKD-MBD, and higher circulating levels of these markers are linked to cardiovascular diseases. In this short review, we focus on the pathogenesis and management of CKD-MBD in CKD patients, especially those on dialysis therapy, and discuss the prospects for improving the management in CKD patients, including those on dialysis.

PS-C03-5: REAL-WORLD DATA OF BLOOD PRESSURE IN DIALYSIS PATIENTS WITH AND WITHOUT DIABETES IN JAPAN USING THE WEB-BASED DATABASE

Objective: Diabetic nephropathy was the most common primary disease among patients undergoing dialysis, and the number is growing each year. Despite advancements in dialysis technique, cardiovascular complications and mortality in dialysis patients with diabetes remain higher than in those without diabetes. Furthermore, hypertension is commonly known to contribute to the development of cardiovascular complications in dialysis patients, and we aimed to compare the systolic blood pressure (SBP) in dialysis patients with and without diabetes using the Web-based Analysis of Dialysis Data Archives (WADDA) system database. Design and Methods: From 2014 to 2020, we enrolled dialysis patients who had their predialysis SBP measured using the WADDA system 2.1. We classified SBP and evaluated its trends over time by gender, age, and presence of diabetes using the Japanese Society of Hypertension guidelines 2019 (JSH2019). Furthermore, we looked at the relationship between SBP and cardiovascular death in patients with and without diabetes. Results: Dialysis patients with diabetes (n = 168,227) had a mean age of 69.2 (11.7) years versus 69.4 (13.3) years, a mean predialysis history of 5.5 (5.3) years versus 9.4 (9.3 years), and a mean dialysis SBP of 156.6 (25.0) mmHg versus 147.9 (23.6) mmHg, respectively. Dialysis patients with diabetes had higher rates of cardiovascular complications than those without diabetes. From 2014 to 2020, the percentage and absolute values of hypertension were higher in dialysis patients with diabetes than across all age groups and in both men and women. Patients with cerebrovascular death had a higher rate of hypertension, but there was no difference in the rate of grade I and II hypertension between the two groups. Conclusion: We summarized the recent trends in SBP of Japanese dialysis patients with and without diabetes using the WADDA system. Dialysis patients with diabetes had higher SBP than those without diabetes in all age groups and in both men and women. As a result, optimal blood pressure management for dialysis patients with and without diabetes is important for the prevention of cerebrovascular death.

Acute effects of online hemodiafiltration versus high-flux hemodialysis on serum levels of asymmetric dimethylarginine and tumor necrosis factor-alpha

Background Chronic inflammation as a major determinant of ‘dialysis syndrome’ is considered as the main factor of morbidity and mortality in dialysis patients. Tumor necrosis factor-alpha (TNF-α) may play important roles in the development of T helper (Th) imbalance, cardiovascular disease, and wasting in the uremic milieu. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide that may be an independent risk factor for endothelial dysfunction and cardiovascular disease. In hemodialysis (HD) patients, plasma ADMA is a strong and independent predictor of overall mortality and cardiovascular outcome. The aim of this study to evaluate the acute effects of hemodiafiltration (HDF) compared with conventional HD on blood levels of ADMA and TNF-α. Patients and methods A cross-sectional study was conducted on 20 patients with end-stage renal disease receiving dialysis in the dialysis unit of Ain Shams Specialized Hospital receiving twice weekly HD session with high-flux (HF) dialyzer and once weekly HDF session. Blood samples were collected from all participants before and after HD session and from the same participants before and after HDF session. ADMA and TNF-α levels were assessed by enzyme-linked immunosorbent assay techniques. Results The decrease in TNF-α was higher after HDF session versus HF HD session (79.47 ± 14.16 vs. 50.43 ± 31.05), with P value of 0.001. Moreover, the decrease in ADMA was higher after HDF session versus HF HD session (75.01 ± 12.55 vs. 41.79 ± 24.73), with P value of 0.001. Conclusion The use of online HDF technique showed a significant reduction of ADMA and TNF-α in adults with end-stage renal disease.

Prognosis of Heart Valve Calcification on Cardiovascular Events in Hemodialysis Patients without Central Venous Catheters

Introduction: Heart valvular calcification (HVC) is an important predictor of cardiovascular events (CEs) and all-cause mortality in dialysis patients. Patients in the early stage of dialysis or those with central venous catheters (CVC) are also at high risk of cardiovascular and all-cause mortality. It could be a confounding factor for the prognosis of HVC on CE. Methods: From March 2017 to April 2022, the prognosis of HVC on CE and all-cause mortality was studied retrospectively in 158 hemodialysis (HD) patients who used arteriovenous fistulas or arteriovenous grafts as vascular access and entered HD for more than 12 months. Results: Out of 158 patients, 70 (44.3%) were diagnosed with HVC via echocardiography. A total of 180 CEs occurred during follow-up. Among them, acute heart failure accounted for 62.66%, and its prevalence was significantly higher in the HVC group than that in the non-HVC group (p < 0.0001). The cumulative incidence of CE-free survival in the HVC group was significantly lower than that in the non-HVC group (p = 0.030). Only 11 patients died, and there was no significant difference in all-cause mortality between the two groups (p = 0.560). Multivariate COX regression analyses showed that HD vintage, mitral valve calcification, and aortic valve regurgitation (AR)/aortic valve stenosis (AS) but not aortic valve calcification were risk factors for CE (p < 0.05). Conclusion: After excluding the factors of the early stage of HD and CVC, HVC remained a predictor of adverse CE in HD patients.

A new approach to predicting mortality in dialysis patients using sociodemographic features based on artificial intelligence

One of the main problems that affect patients in dialysis therapy who are on the waiting list to receive a kidney transplant is predicting their survival time if they do not receive a transplant. This paper proposes a new approach to survival prediction based on artificial intelligence techniques combined with statistical methods to study the association between sociodemographic factors and patient survival on the waiting list if they do not receive a kidney transplant. This new approach consists of a first stage that uses the clustering techniques that are best suited to the data structure (K-Means, Mini Batch K-Means, Agglomerative Clustering and K-Modes) used to identify the risk profile of dialysis patients. Later, a new method called False Clustering Discovery Reduction is performed to determine the minimum number of populations to be studied, and whose mortality risk is statistically differentiable. This approach was applied to the OPTN medical dataset (n = 44,663). The procedure started from 11 initial clusters obtained with the Agglomerative technique, and was reduced to eight final risk populations, for which their Kaplan-Meier survival curves were provided. With this result, it is possible to make predictions regarding the survival time of a new patient who enters the waiting list if the sociodemographic profile of the patient is known. To do so, the predictive algorithm XGBoost is used, which allows the cluster to which it belongs to be predicted and the corresponding Kaplan-Meier curve to be associated with it. This prediction process is achieved with an overall Multi-class AUC of 99.08 %.

Higher serum trimethylamine-N-oxide levels are associated with increased abdominal aortic calcification in hemodialysis patients

Introduction Vascular calcification (VC) is high prevalent and predicts cardiovascular mortality in dialysis patients. The mechanisms are not known clearly. Trimethylamine-N-oxide (TMAO), a gut-microbiota derivate metabolite, is also associated with cardiovascular outcomes in hemodialysis (HD) patients. This study aims to evaluate serum TMAO levels and establish their relation to VC in HD patients. Methods Serum TMAO concentrations were measured by high-performance liquid chromatography–mass spectrometry. Vascular calcification was evaluated by abdominal aortic calcification (AAC) scores. Taking the AAC score value 5.5 as the cutoff value, the participants were divided into the high AAC score group and the low AAC score group. Results A total of 184 HD patients and 39 healthy controls were enrolled in this cross-sectional study. Serum Ln(TMAO) (the natural logarithm of TMAO) concentrations were significantly higher in HD patients than that of control subjects (1.82 ± 0.62 vs. −1.60 ± 0.77, p < 0.001). Compared with the group with low AAC scores, the HD patients with high AAC scores showed significantly higher serum Ln(TMAO) levels (2.09 ± 0.55 vs. 1.67 ± 0.54, p < 0.001). In the multivariate regression analysis, serum Ln(TMAO), HD vintage, with diabetic mellitus, age and plasma intact parathyroid hormone (iPTH) were independent determinant factors for VC in HD patients. Conclusions Higher serum TMAO levels, older age, longer HD vintage, higher plasma iPTH and with diabetes mellitus were independent risk factors for VC in HD patients. The underlying mechanism deserves further investigations and the finding hints at a new target for the treatment of VC.

The association between long-term ambient fine particulate exposure and the mortality among adult patients initiating dialysis: A retrospective population-based cohort study in Taiwan

Fine particulate matter (PM2.5) has been reported to be associated with increased risk of chronic kidney disease (CKD) and progression to end-stage renal disease (ESRD). However, studies on whether long-term exposure to PM2.5 negatively impacts the survival of patients with ESRD are very limited. To conduct this study, we linked Taiwan Air Quality-Monitoring Database (TAQMD) and the National Health Insurance Research Database (NHIRD) by zip-code. A retrospective population-based cohort of 34,088 adult patients initiating dialysis over six months was formed. Cox proportional regression models were used to estimate the risk of mortality in dialysis patients per 10-μg/m3 increase of PM2.5 and by PM2.5 levels divided into quintiles. Restricted cubic spline analysis was performed to delineate the concentration-response relationship between PM2.5 and mortality. The adjusted hazard ratio (aHR) per 10-μg/m3 increase of PM2.5 for mortality was 1.11 (95% confidence interval [CI] = 1.08–1.13). When analyzing PM2.5 exposure divided into quintiles, patients with mean PM2.5 exposure over 29.33 μg/m3, including level III (aHR 1.00, 95% CI = 0.94–1.07), level IV (aHR 1.09; 95% CI = 1.03–1.16), and level V (HR 1.11; 95% CI = 1.05–1.19), were at stepwise higher risks of mortality compared with level I. Spline analysis showed a non-linear concentration-response function between PM2.5 and mortality, with the lowest mortality aHR identified at a mean PM2.5 of 26 μg/m3, followed by a concentration interval with a gradual increase of aHR, and finally a steep rise of mortality risk when mean PM2.5 exceeded 37 μg/m3. Individuals with older age, those were male, with selected comorbidities, and with low socioeconomic status (SES) were at higher mortality risk. Male and non-diabetics participants were more sensitive to the effect of a 10-μg/m3 of PM2.5 increase on mortality than their counterparts. In conclusion, long-term exposure to PM2.5 exceeding a threshold was observed to be associated with increased risk of mortality among dialysis patients.

SARS-CoV-2 Infections and Mortality in Dialysis Patients: A Multicenter Prospective Trial

SARS-CoV-2 Infections and Mortality in Dialysis Patients: A Multicenter Prospective Trial