Prognosis In Maintenance Hemodialysis Patients Research Articles

Relationship between carotid-femoral pulse wave velocity and prognosis in maintenance hemodialysis patients.

Carotid-femoral pulse wave velocity (Cf-PWV) can well predict the prognosis of the general population. However, whether Cf-PWV can be used as a prognostic indicator in maintenance hemodialysis (MHD) patients remains mysterious. The present study endeavored to explore the prognostic value of Cf-PWV among the MHD population. Patients who received MHD and underwent Cf-PWV examination at the hemodialysis center of Zhejiang Provincial People's Hospital between March 1, 2017 and October 15, 2019 were enrolled. Relevant clinical data were collected from these patients, who were subsequently followed up for a minimum of 1 year. During the follow-up period, the occurrence of all-cause death was recorded as a prognostic indicator. Based on the predetermined inclusion and exclusion criteria 178 patients were included in the final analysis. These patients were categorized into 2 groups based on Cf-PWV values: group 1 (Cf-PWV < 13.8 m/s), and group 2 (Cf-PWV ≥ 13.8 m/s). Thirty-four patients succumbed to their conditions within a median follow-up period of 23.3 months. Kaplan-Meier survival analysis revealed that the median survival time of group 2 was significantly shorter than group 1 (log-rank test, χ2 = 12.413, P < .001). After adjusting for various factors, including age, cardiovascular disease, peripheral arterial diastolic pressure, central arterial diastolic pressure, albumin, blood urea nitrogen, serum creatinine, left ventricular ejection fraction, 25 hydroxyvitamin D3, C-reactive protein and serum phosphorus, it was found that Cf-PWV ≥ 13.8m/s was an independent risk factor for all-cause mortality in MHD patients (relative risk = 3.04, 95% confidence interval [CI] = 1.22-7.57; P = .017). A high level of Cf-PWV (≥13.8 m/s) is an independent risk factor for all-cause death in MHD patients.

Relationship between bioelectrical impedance analysis-derived fluid status and nutritional indicators and the prognosis in patients undergoing maintenance hemodialysis

Objective: To explore the relationship between bioelectrical impedance analysis (BIA)-derived fluid status and nutritional indicators and the prognosis in patients undergoing maintenance hemodialysis (MHD). Methods: A retrospective cohort study was conducted. The clinical data of MHD patients in Jiangsu Province Hospital between January 2014 and December 2016 were analyzed. BIA data of healthy volunteers in Gulou District, Nanjing City, collected between April and October 2022, were used to determine the cut-off value of body cell mass index (BCMI). Referring to previous research, using 0.15 as the cut-off value for the ratio of overhydration and extracellular water (OH/ECW). The data were transformed into binary variables based on these cut-off values to categorize patients into different groups. Kaplan-Meier analysis was used to plot survival curves, and the Cox proportional hazards model was performed to analyze risk factors for all-cause mortality. Results: A total of 706 MHD patients (407 males and 299 females) were included, aged (54±15) years. MHD patients were classified into four groups based on whether BCMI was<5.4 kg/m2 and OH/ECW was≥0.15, which included non-overhydration and non-malnutrition group, overhydration group, malnutrition group, and overhydration and malnutrition group, with 269, 186, 151, and 100 patients, respectively. During a median follow-up of [M(Q1, Q3)] 33 (26, 37) months, 162 patients died. Kaplan-Meier analysis showed that the median survival periods of the four groups were 52 months (95%CI: 41-54 months), 46 months (95%CI: 44-49 months), 37 months (95%CI: 34-40 months), and 34 months (95%CI: 30-38 months), respectively, with a statistically significant difference (P<0.001). The 1-year survival rates were 95.5%, 93.5%, 92.1%, and 88.0% (P<0.001), respectively, and the 2-year mortality rates were 92.6%, 87.1%, 83.4%, and 77.0% (P<0.001), respectively. Multivariate Cox regression analysis showed that compared with non-overhydration and non-malnutrition group, the risk of all-cause mortality increased by 1.18 times in the malnutrition group (HR=2.18, 95%CI: 1.29-3.71, P=0.004), and by 1.59 times in the overhydration and malnutrition group (HR=2.59, 95%CI: 1.48-4.54, P=0.001). Conclusions: BIA-derived fluid status and nutritional indicators are associated with the prognosis of MHD patients. Compared with patients without fluid overload and malnutrition, patients with malnutrition and fluid overload have an increased risk of all-cause mortality.

Increased indexed proximal aortic diameter is a predictor of poor prognosis in maintenance hemodialysis patients

Background: Recent studies have shown that the baseline values of absolute aortic root diameter (ARD) and indexed diameter are associated with all-cause mortality and cardiovascular events in the general population, even in the absence of aneurysmal aortic disease. However, there is limited available data on the association between ARD and prognosis in end-stage renal disease (ESRD) patients receiving maintenance hemodialysis (MHD). Accordingly, the purpose of this study is to investigate the predictive value of ARD for all-cause mortality and cardiovascular events in this specific population.Methods: ARD was measured by echocardiography at the level of the sinuses of Valsalva at end diastole and indexed to body surface area (BSA). The primary endpoint was all-cause mortality. The secondary endpoint was major adverse cardiovascular events (MACE), including cardiovascular mortality, myocardial infarction and stroke. Cox proportional hazards models were conducted to evaluate the association between baseline ARD/BSA and clinical outcomes.Results: A total of 391 patients were included in this study. The primary endpoint occurred in 95 (24.3%) patients while the secondary endpoint occurred in 71 (18.2%) patients. Multivariate Cox regression analysis showed that ARD/BSA was an independent prognostic factor for all-cause mortality (HR, per 1-SD increase, 1.403; 95% CI, 1.118–1.761; p = 0.003) as well as MACE (HR, per 1-SD increase, 1.356; 95% CI, 1.037–1.772; p = 0.026).Conclusions: Our results show that ARD/BSA is predictive of all-cause mortality and MACE in MHD patients with ESRD and support the view that assessment of ARD/BSA may refine risk stratification and preventive strategies in this population.

Serum ferritin and neutrophil-to-lymphocyte ratio predict all-cause mortality in patients receiving maintenance hemodialysis: a prospective study.

Introduction: Maintenance hemodialysis is an effective treatment for end-stage renal disease patients. A critical factor contributing to the deterioration and death of maintenance hemodialysis patients is inflammation. Therefore, we focused on two inflammatory markers, serum ferritin and neutrophil-to-lymphocyte ratio, to speculate whether they could predict the prognosis of maintenance hemodialysis patients. Patients and methods: We followed 168 patients with maintenance hemodialysis from July 2019 to July 2022 with the endpoint of all-cause death or follow-up completion. Receiver operating characteristic curves were plotted to assess the values of serum ferritin, neutrophil-to-lymphocyte ratio and serum ferritin combined with neutrophil-to-lymphocyte ratio to predict the outcomes of maintenance hemodialysis patients. Kaplan-Meier survival curves were constructed to compare survival rates over time. Results: Receiver operating characteristic curves demonstrated that the best cut-off value of serum ferritin for predicting the prognosis of maintenance hemodialysis patients was 346.05μg/L, and that of neutrophil-to-lymphocyte ratio was 3.225. Furthermore, a combination of both had a more excellent predicting value than either index (p < 0.05). Kaplan-Meier survival curve analyses revealed that low serum ferritin levels and low neutrophil-to-lymphocyte ratio had a higher probability of survival than high ferritin levels and high neutrophil-to-lymphocyte ratio, separately. Conclusion: Elevated serum ferritin and neutrophil-to-lymphocyte ratio are closely related to all-cause mortality among maintenance hemodialysis patients, for which they may be predictors of all-cause mortality. Additionally, the combination of the two has a much higher predictor value for the prognosis of maintenance hemodialysis patients.

Prognostic risk factors of catheter-related bloodstream infection in patients with maintenance hemodialysis

To analyze the pathogen distribution and prognostic risk factors of catheter-related bloodstream infection (CRBSI) in patients with maintenance hemodialysis (MHD) during non-hospitalization. A retrospective comparative study was conducted. Thirty-four patients of MHD with semi-permanent catheter admitted to the department of nephrology of Gansu Provincial Hospital from January 2020 to May 2023 due to CRBSI during non-hospitalization were enrolled. The distribution characteristics of pathogens causing CRBSI in MHD patients during non-hospital period were analyzed. All patients were actively given anti-infection treatment after admission. The general data, laboratory indicators and prognosis during hospitalization were collected through the electronic medical record system. Patients were divided into poor prognosis group (14 cases) and good prognosis group (20 cases) according to the treatment results during hospitalization. Univariate and binary Logistic regression were used to analyze the risk factors affecting the prognosis of patients, and receiver operator characteristic curve (ROC curve) was drawn to evaluate its predictive value for prognosis. A total of 28 pathogenic bacteria were isolated from 34 patients, of which 25 were Gram-positive, Staphylococcus was the most common pathogen, accounting for 82.15% of the total, and 16 strains of Staphylococcus aureus (57.15%), including 6 methicillin-resistant Staphylococcus aureus (MRSA, 21.43%). There were 7 strains of Staphylococcus epidermidis (25.00%), including 3 strains of methicillin-resistant Staphylococcus epidermidis (MRSE, 10.71%). There were 3 strains of Gram-negative bacteria, 1 strain each of Pseudomonas aeruginosa, Escherichia coli and Acinetobacter baumannii. Univariate analysis showed that the fever duration of MHD patients with CRBSI in the poor prognosis group was significantly longer than that in the good prognosis group [days: 8.50 (3.75, 45.00) vs. 2.50 (1.00, 4.75), P < 0.01], serum erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and random blood glucose (GLU) were significantly higher than those in the good prognosis group [ESR (mm/1 h): 82.36±24.98 vs. 56.95±35.65, CRP (mg/L): 123.45±74.10 vs. 67.35±55.22, GLU (mmol/L): 8.74±3.66 vs. 6.42±1.95, all P < 0.05]. Binary Logistic regression analysis showed that serum CRP was an independent risk factor for poor prognosis in MHD patients with CRBSI [odds ratio (OR) = 1.020, 95% confidence interval (95%CI) was 1.002-1.038, P = 0.025]. ROC curve analysis showed that the area under the curve (AUC) of serum CRP in predicting poor prognosis of MHD patients with CRBSI was 0.711; when the optimal cut-off value was 104.65 mg/L, the sensitivity was 64.3% and the specificity was 85.0%, indicating that it has good predictive value. Gram-positive bacteria are the main pathogens of CRBSI in MHD patients during non-hospital period. The poor prognosis is mainly related to the high level of serum CRP. Serum CRP level can effectively screen the high-risk group of MHD patients with CRBSI with poor prognosis.

The Predictive Value of Atherogenic Index of Plasma, Non- High Density Lipoprotein Cholesterol (Non-HDL-C), Non-HDL-C/HDL-C, and Lipoprotein Combine Index for Stroke Incidence and Prognosis in Maintenance Hemodialysis Patients.

The serum lipid level is strongly associated with atherosclerosis. However, research on the relationship between lipid-derived indices and acute ischemic stroke (AIS) occurrence in hemodialysis populations is limited. This study aimed to explore the predictive value of lipid-derived indices, including atherogenic index of plasma (AIP), Non- high density lipoprotein cholesterol (Non-HDL-C), Non-HDL-C/HDL-C, and lipoprotein combine index (LCI) in clinical practice for the occurrence and prognosis of AIS in hemodialysis patients. A total of 451 patients undergoing maintenance hemodialysis were screened and 350 were enrolled in this study. The lipid parameters exhibit a progressive increase across the tertiles, with values rising from Q1 through Q3. Enrolled patients were divided into three groups (Q1, Q2, and Q3) based on tertiles of AIP, Non-HDL-C, Non-HDL-C/HDL-C, and LCI values. Kaplan-Meier curves were performed to investigate the association between the AIP, Non-HDL-C, Non-HDL-C/HDL-C, LCI and AIS-free survival in hemodialysis patients. Chi-square analysis was used to explore the association between the AIP, Non-HDL-C, Non-HDL-C/HDL-C, LCI and AIS outcomes in hemodialysis patients. AIS outcomes were assessed using the modified Rankin Scale (mRS). Kaplan-Meier analysis revealed that the AIS-free survival rates were significantly higher in the Q1 group compared to Q2 and Q3 groups for AIP, Non-HDL-C, Non-HDL-C/HDL-C, and LCI. Log rank tests showed statistically significant differences between the Q1 group and the Q2 and Q3 groups (p < 0.05 for all). The proportion of patients with a good outcome mRS was higher in the Q1 group compared to the Q2-Q3 groups (AIP: 0.818 vs 0.792; Non- HDL-C: 0.866 vs 0.767; Non- HDL-C/HDL-C: 0.867 vs 0.767; LCI: 0.938 vs 0.750). The four lipid-derived parameters are effective predictors of AIS in patients undergoing hemodialysis, and AIP has a strongest correlation with the risk of AIS. Hemodialysis patients with elevated levels of the four lipid-derived indices had a higher incidence of AIS and poorer functional outcomes compared to those with lower levels. Our conclusions may require confirmation by further research in the future.

A high platelet-to-lymphocyte ratio predicts all-cause mortality and cardiovascular mortality in maintenance hemodialysis patients

Purpose The aim of this study was to further assess whether the platelet-to-lymphocyte ratio (PLR) is independently associated with all-cause mortality and cardiovascular mortality in maintenance hemodialysis (MHD) patients. Methods From January 1, 2014, to December 31, 2014, patients undergoing regular hemodialysis in the Blood Purification Center of the General Hospital of Northern Theatre Command were retrospectively selected. A total of 303 MHD patients were enrolled in accordance with the inclusion and exclusion criteria. For each patient, the endpoint of follow-up was either death or December 31, 2021. The primary endpoints were all-cause and cardiovascular death. A receiver operating characteristic (ROC) curve was drawn to detect the predictive ability of PLR, and the optimal critical value of PLR was determined to be 107.57. Kaplan–Meier curves and Cox proportional analysis were used to assess the prognostic value of PLR. We used the same method to evaluate the correlation between the neutrophil-to-lymphocyte ratio (NLR) and the prognosis of MHD patients. Results At the end of follow-up, 128 MHD patients had progressed to all-cause death, and 73 MHD patients had progressed to cardiovascular death. In multivariate Cox regression, both the high PLR group and the high NLR group were independently associated with all-cause mortality (HR 2.608, 95% CI 1.579–4.306, p < .001 vs. HR 1.634, 95% CI 1.023–2.610, p = .04). Only high PLR expression was associated with cardiovascular mortality (HR 3.379, 95% CI 1.646–6.936, p = .001). Conclusions High PLR levels can independently predict all-cause and cardiovascular mortality in MHD patients.

#3846 MALNUTRITION RISK IN HEMODIALYSIS PATIENTS AND SCREENING TOOLS PROGNOSIS: GNRI, CREATININE INDEX AND SPEW

Abstract Background and Aims nutritional status clearly has a great impact on the prognosis of maintenance hemodialysis patients. Therefore, its management should be a priority and risk screening frequent and easily implemented, based on the biochemical and clinical routine parameters already available. Many tools fit these simple criteria, namely simple Protein Energy Wasting score (sPEW), Geriatric Nutritional Risk Index (GNRI) and Creatinine Index (Cr Index). These scores are associated with a high mortality and morbidity risk in hemodialysis (HD) patients. The objective of this study was to assess the performance of these tools regarding the estimation of all-cause mortality, in a 45-months follow-up of a large patient cohort. Method Historical cohort study of HD pts from 25 outpatient clinics. sPEW, GNRI and Cr Index were estimated. Kaplan-Meier estimator and univariable Cox regression models to analyze time until death were used. To compare survival curves the log-rank test or Tarone test were used, as appropriate. The level of significance α = .05 was considered. All data were analyzed using SPSS 22.0 (IBM Corp. Released 2013. IBM SPSS Statistics for Windows. Armonk, NY, USA: IBM Corp). Results We analyzed 2322 pts, 59% males, 31.7% diabetic, with a median age of 70 years (P25 = 60, P75 = 79) followed up for a maximum of 45-month (P25 = 31; P75 = 45). All-cause mortality was observed in 778 pts (33.5%). To assess the mortality risk, the exposures GNRI and CR Index, were discretized using quartiles. GNRI The median was 106.6 (P25 = 99.4, P75 = 114.2). The log-rank test results showed a significantly lower survival for patients in GNRI Q1 category (GNRI ≤ 99.4). A p-value &amp;lt;0.001 was obtained when comparing patients in Q4, Q3 and Q2 with patients in Q1. The univariable Cox regression model showed that patients in Q1 had a 2-fold increased risk of death, when compared with Q4 (HR = 2.1, 95% CI: 1.7-2.6, p&amp;lt;0.001). Creatinine Index The median was 12.648 (P25 = 11.908, P75 = 13.406). The log-rank test for the equality of survival functions for the different levels was considered statistically significant and showed a significantly lower survival for patients in CR Index Q1 category, when compared with the remaining categories (p&amp;lt;0.001). The univariable Cox regression model showed that comparatively with Q4, patients in Q1 had a 5-fold increased risk of death (HR = 4.8, 95% CI: 3.7-6.0, p&amp;lt;0.001), patients in Q2 a 3-fold increased risk of death (HR = 3.1, 95% CI:2.4– 3.9, p&amp;lt;0.001), and patients in Q3 a 2-fold increased risk of death (HR = 1.9, 95% CI: 1.4 – 2.4, p&amp;lt;0.001). sPEW The frequency of each score from 0 to 4 was 306, 380, 111, 1369 and 156, respectively. The log-rank test for the equality of survival functions corresponding to the different levels showed a significantly higher survival for patients with a sPEW score of 4 when comparing with the remaining levels (p&amp;lt;0.001). The univariable Cox regression model showed that comparatively with a score of 4, patients with a: score of 0 had an 8-fold increased risk of death (HR = 7.7, 95% CI: 4.5-13.3, p&amp;lt;0.001), score of 1 a 6-fold increase risk of death (HR = 5.6, 95% CI: 3.3– 9.7, p&amp;lt;0.001), score of 2 a 4-fold increase risk of death (HR = 4.1, 95% CI: 2.2– 7.7, p&amp;lt;0.001), and a score of 3, almost a 4-fold increased risk of death (HR = 3.7, 95% CI: 2.2– 6.3, p&amp;lt;0.001). Conclusion In this exploratory analysis, the three tools showed a significant association with mortality during follow-up. These tools, if adequately validated in future studies, may select patients for further intervention to modify the outcome.

Antiviral treatment and prognosis in patients undergoing maintenance hemodialysis due to hepatitis C virus.

Maintenance hemodialysis (MHD) is one of the important renal replacement therapies for patients with end-stage renal disease. Hepatitis C virus (HCV) infection is a serious global public health problem. The proportion of MHD patients complicated with HCV infection and the risk of adverse prognosis are higher than those in the general population. Active antiviral treatment and prevention of reinfection is a combined treatment by nephrology and infection physicians. It is a widely accepted preventive measure to set hemodialysis buffer area for patients in treating HCV infection, but its effectiveness and safety still need to be further explored. Thus, the aim of this study is to explore the antiviral treatment and prognosis of MHD patients with HCV infection during hemodialysis. A retrospective analysis for renal disease patients at 10 end-stage with long-term hemodialysis in the HCV area of the Blood Purification Center of Xiangya Hospital, Central South University. After standard antiviral drug treatment, the patient reached the cure standard for HCV infection. The buffer zone was set up in the Blood Purification Center by the Department of Nephrology of Xiangya Hospital since April 2017. Patients cured of HCV infection were transferred from the HCV area to the buffer zone for continuous dialysis, accompanied by monitoring serum HCV-RNA, anti-HCV antibody levels and changes in clinical biochemical indicators following the status of reinfection. Ten patients with HCV infection were finally cured after antiviral treatment, and there were no significant changes in clinical biochemical indicators before and after treatment. In the followed-up period after the transfer, the patient continued to be negative for HCV-RNA and positive for anti-HCV antibody. Direct antiviral therapy is safe and effective in MHD patients with HCV infection. Active antiviral therapy and transferring to the buffer area for dialysis are new and effective treatment modes for HCV patients during MHD.

The assessment of cognitive impairment in maintenance hemodialysis patients and the relationship between cognitive impairment and depressive symptoms.

Cognitive impairment and depression are common mental health problems in chronic kidney disease (CKD) patients with maintenance hemodialysis (MHD). Previous studies have proven that cognitive impairment and depression were risk factors for poor prognosis in MHD patients. However, the related factors of cognitive function and the association between cognitive impairment and depression in MHD patients are still unclear. The purpose of this study is to explore the related factors affecting the cognitive function of MHD patients and evaluate the relationship between cognitive function and depression in MHD patients. This single-center, cross-sectional study enrolled 160 MHD patients. Cognitive function and depressive symptoms were measured using Montreal Cognitive Assessment (MoCA) and Patient Health Questionnaire-9 (PHQ-9), respectively. Cognitive impairment was detected in 58.1% of 160 MHD patients. Multivariate linear regression analysis showed that age, level of education and homocysteine (HCY) were independent influencing factors of MoCA scores and the scores of attention and abstract thinking were independently correlated with PHQ-9 score after adjusting for confounding factors CONCLUSIONS: These findings indicated that age, level of education and HCY were independently associated with cognitive function, and attention and abstract thinking could independently affect depressive symptoms in MHD patients.

Serum leptin concentration can predict cardiovascular outcomes and all-cause death in maintenance hemodialysis patients

BackgroundWe explored the associations between serum leptin concentration and cardiovascular prognosis in maintenance hemodialysis patients. MethodsIn our prospective study with no intervention, demographics data at baseline were collected from electronic medical records. Serum leptin concentration was determined by ELISA. Patients underwent body composition assessment and echocardiographic measurements after hemodialysis. The primary endpoints were defined as cardiovascular events (CVEs), cardiovascular death (CVD) and all-cause death. ResultsA total of 165 eligible patients aged 51(43–65) y were enrolled and the mean serum leptin concentration was 35.49 (29.98) ng/ml. During a median follow-up of 18 (12–22) months, CVEs occurred in 37 (22.42%) patients and the cardiovascular and all-cause mortality was 10.91% and 21.82%. Serum leptin concentration was associated with CVEs (HR = 0.982, p = 0.003), CVD (HR = 0.934, p = 0.002) and all-cause death (HR = 0.943, p < 0.001). Decreased serum leptin concentration was an independent risk factor for the development of left ventricular hypertrophy (LVH, OR = 0.98, p = 0.007) and peripheral vascular disease (PVD, OR = 0.974, p = 0.007). ConclusionSerum leptin concentration can independently predict cardiovascular outcomes and all-cause death in MHD patients. The effects that serum leptin concentration on development of LVH and PVD maybe the potential mechanism.

维持性血液透析患者预后的相关影响因素及预测方式概述

维持性血液透析患者预后的相关影响因素及预测方式概述

Usefulness of a Simple Protein-Energy Wasting Score for Predicting Hospitalization in Maintenance Hemodialysis Patients: A Prospective Cohort Study

Background: Malnutrition is a strong predictor of prognosis in maintenance hemodialysis patients (MHD). We previously proposed a new and simple protein-energy wasting (PEW) score that appears to be useful for assessing the risk of mortality in patients on MHD. Objectives: In the present study, we evaluated the reliability of this PEW score as a predictor of hospitalization in Japanese patients on MHD. Methods: In this single-center, prospective cohort study conducted in Japan, PEW score was calculated for 180 MHD patients. PEW score ranged from 0 (best: S1) to 4 (worst: S4) and was calculated based on nutritional indicators including serum albumin, body mass index, serum creatinine level, and protein intake. The outcome was the number of hospitalizations during the 2-year study period. Results: Thirty-six patients were hospitalized during the study period. Kaplan-Meier curves showed there were fewer hospitalizations in the group with a PEW score of 0/1 than in the group with a score of 3/4. Multivariate analysis revealed a hazard ratio for hospitalization of 3.109 for S3/4 versus S0, 2.777 for S3/4 versus S1, and 2.048 for S3/4 versus S2. Conclusion: The new and simple PEW score is a useful predictor of hospitalization in MHD patients and is also useful for identifying subgroups of MHD patients with a high risk of mortality.

Clinical course of patients on maintenance hemodialysis and COVID-19: a retrospective longitudinal study.

Coronavirus Disease 2019 (COVID-19) emerges as a global pandemic and there is a lack of evidence about the clinical course and outcome of patients on maintenance hemodialysis (MHD). Here we conducted a retrospective longitudinal study aimed to analyze the clinical features and outcome of MHD patients hospitalized with COVID-19. Of 3126 inpatients with COVID-19 at 3 Branches of Wuhan Tongji Hospital from Jan 18th to Mar 9th, 2020, 19 patients were undergoing maintenance hemodialysis. Among the 19 MHD patients with COVID-19, 6 patients (31.6%) died, and 13 patients (68.4%) were able to be discharged. Baseline characteristics, clinical courses, laboratory findings, and dynamic trajectories of major laboratory markers were compared between survivors and nonsurvivors. According to our findings, MHD patients with COVID-19 who experienced non-surviving outcome had more elevated CRP, IL6 and procalcitonin as well as fibrinogen levels at various points compared to survivors. Thus the dysregulation of immune response as well as coagulation abnormalities might be highly involved in the pathological process of COVID-19, contributing to the poor prognosis in MHD patients.

Association between serum lipids, polyunsaturated fatty acids, and prognosis in maintenance hemodialysis patients.

Risks of mortality and cardiovascular disease (CVD) are significantly higher in hemodialysis (HD) patients than in the general population, where dyslipidemia is an established risk factor for CVD and mortality. There is no clear conclusion, however, whether dyslipidemia is a significant risk factor for CVD and mortality in HD patients. Similarly, the association between the polyunsaturated fatty acids (PUFAs) and the mortality is not clear in HD patients. We retrospectively investigated mortality and CVD events in 420 HD patients. We classified patients into high- and low-lipid groups depending on their lipid levels. Survival rates were calculated using the Kaplan-Meier analysis and evaluated by the log-rank test. The risk estimates were computed using a multivariate Cox proportional hazard analysis. During their follow-up (June 2011 to June 2016), 151 patients died (37 of CVD), and 112 patients experienced new CVD events. On Kaplan-Meier analysis, the number of all-cause deaths and CVD events were significantly higher in the low HDL-cholesterol group (P < 0.01, log-rank test). Similarly, the number of all-cause deaths was significantly higher in the high eicosapentaenoic acid/arachidonic acid ratio group (P < 0.01, log-rank test). Multivariate Cox proportional analysis showed that HDL-cholesterol was a significant prognostic indicator for new onset of CVD events (low: 0, high: 1, hazard ratio 0.66, 95% confidence interval 0.44-0.97; P = 0.04). In HD patients, LDL-cholesterol and non-HDL-cholesterol levels are not associated with mortality or CVD events. The HDL-cholesterol level, however, is an independent predictor of new CVD events even in HD patients.

Nutritional Status and Mortality Predictability for Time-Varying Serum Alkaline Phosphatase in Hemodialysis Patients: A Longitudinal Study

Higher serum alkaline phosphatase (sALP) levels associate with a poor prognosis in maintenance hemodialysis patients. However, little is known about the meaning of lower sALP in this population. We hypothesized that lower sALP concentrations may express nutritional status and survival accordingly. A retrospective, longitudinal cohort study of a clinical database containing the medical records of 554 patients (367 men and 187 women, mean age 67.6±14.2years) receiving maintenance hemodialysis from November 2007 to July 2018 in a single center was conducted. sALP, nutritional, bone turnover, and inflammatory marker levels were recorded at 0, 6, 12, 18, 24, 30,and 36months followed by 58 additional months of clinical observations. The median sALP level was 90.0 (71.0-125.8) U/L. In a linear mixed effects model adjusted for baseline demographics and clinical parameters, each 1.0 U/L increase above the mean sALP at baseline was associated with 0.7% slower rate of decline in geriatric nutritional risk index per 3years (P=.02 for sALP×time interaction). sALP remained associated with the rate of change in geriatric nutritional risk index, even after controlling for C-reactive protein and intact parathyroid hormone levels. For each 1.0 U/L increase in sALP over time, the fully adjusted all-cause mortality hazard ratio using Cox models with the time-varying risk effect was 0.996 (95% confidence interval 0.993-1.000, P=.04). Increasing longitudinal levels of sALP associate with improved nutritional status and lower mortality rates. sALP can be used as an integrated marker, combining the properties of the nutritional marker, the marker of mineral-bone disease and inflammation, according to its levels.

Handgrip Strength and Mortality in Maintenance Hemodialysis Patients

Background: Muscle strength assessment is a convenient clinical test that has shown to correlate with the nutritional status of dialysis patients. Articles written in English to investigate the association between Handgrip Strength (HGS) and mortality in Maintenance Hemodialysis (MHD) patients are mainly from Brazil and several other non-Asian countries. Objectives: This study aimed to examine the association of HGS with all-cause mortality in Chinese MHD patients. Methods: The current multicenter observational longitudinal study enrolled MHD patients from June 2015 to June 2016. The study setting was seven dialysis centers of tertiary general hospitals in Guizhou province, China. Patients were followed up until June 2018. The ROC curves were plotted to seek the best cutoffs for HGS to predict mortality in men and women. Survival analysis was done using the Kaplan-Meier survival curve and the Cox proportional hazard model. Results: We enrolled 857 MHD patients and followed up for 24.9 ± 10.2 months. During the follow-up, 204 (23.8%) patients died, 39 (4.6%) received renal transplantation, 18 (2.1%) switched to peritoneal dialysis, and 118 (11.7%) were transferred to nonparticipating dialysis units. The cutoff value of HGS to predict all-cause mortality was 12.4 kg for women and 25 kg for men. Utilizing the cutoffs to fit the survival curve of Kaplan-Meier, the correlation of HGS with mortality was verified for both genders. After adjustment for demographic and biochemical variables, HGS remained an independent predictor of all-cause mortality. Conclusions: Handgrip strength was strongly associated with all-cause mortality in patients receiving MHD. The cutoff values to predict all-cause mortality were 12.4 kg for women and 25 kg for men. Handgrip strength may be incorporated into clinical practice for assessing functional status and predicting prognosis in MHD patients.

Association of mineral content outside of bone with coronary artery calcium and 1-year cardiovascular prognosis in maintenance hemodialysis patients.

Coronary artery calcifications (CACs) are common among maintenance hemodialysis (MHD) patients and associated with increased morbidity and mortality due to cardiovascular events. The insight into chronic kidney disease‐mineral and bone disorder (CKD‐MBD) established a correlation between dysregulated mineral metabolism and CACs. This study aimed to identify the association of mineral content outside of bone (MCOB) with CACs and cardiovascular events in MHD patients. In the pilot prospective study with no intervention, patients underwent body composition assessment by body composition monitor after hemodialysis and computed tomography examination using the Agatston scoring method simultaneously within a week. The primary end point included cardiovascular events and cardiovascular death. Correlations and receiver operating characteristic analysis elucidated the associations of MCOB with CACs; multivariate analysis assessed the cardiovascular risk for groups with different MCOB. One hundred three eligible patients with an average age of 48 (35‐63) years old were enrolled and followed up to 12 (11‐12.5) months, among which 52.4% had detectable CACs at baseline. MCOB showed an inverse correlation with Agatston score and significantly discriminated the patients with Agatston score > 0 (AUC = 0.737; P < 0.001) and 400 (AUC = 0.733; P < 0.001). MCOB ≤ 9.2657 mg/kg was an independent risk factor for CACs (OR = 4.853; P = 0.044) and strong predictor for cardiovascular morbidity and mortality (HR = 10.108; P = 0.042), as well as rehospitalization (HR = 2.689; P = 0.004). MCOB inversely correlated with the presence and extent of CACs, and could discriminate Agatston score > 0 and 400, which also presented as an independent indicator for CKD‐MBD and 1‐year cardiovascular prognosis in adult MHD patients. Additional studies are required for identifying this issue.

Research on the relationship of serum sclerostin level and bone density in maintenance hemodialysis patients

Objective To investigate whether serum sclerostin level is an indicator of the prognosis in patients with maintenance hemodialysis (MHD). Methods The clinical data of MHD patients treated in Yan′an University Affiliated Hospital in recent 3 years were collected to record their basic information and routine blood biochemical indexes.Serum Sclerostin levels were measured by ELISA calcaneus, while bone mineral density (BMD) was measured by quantitative ultrasound (QUS); correlation analysis was applied to screen the indicators affecting BMD.Logiest regression was used to look for protective factors and risk factors of low bone density; The correlation between serum sclerostin level and bone mineral density was analyzed, and ROC curve was used to explore whether serum sclerostin level could be used to predict low level bone mineral density. Results The median serum sclerostin concentration of 62 patients was 166.74(105.87, 311.90)pmol/L.Spearman correlation analysis showed that serum sclerostin levels were positively correlated with BMI, serum calcium and 25(OH) VitD levels(r=0.327, 0.323, 0.257, P=0.010, 0.049, 0.044), while negatively correlated with lg[iPTH], spKt/v, triglyceride(TG), low density lipoprotein cholesterol (LDL-C) (r=-0.254, -0.279, -0.186, -0.314, P=0.046, 0.012, 0.027, 0.031). Serum Sclerostin level was not related with serum phosphorus, alkaline phosphatase (AKP), high density lipoprotein cholesterol (HDL-C) and LDL (P>0.05). Correlation analysis showed serum sclerostin levels were significantly and positively correlated with BMD(r=0.328, P=0.009). Logistic regression showed that serum sclerostin level was a risk factor for BMD (OR=1.17, 95%CI(0.928~1.474); P=0.008). The ROC curve was established, and the area under the curve of serum sclerostin diagnosis was 87.9%. Conclusion Serum sclerostin levels are positively correlated with bone mineral density.And serum sclerostin levels may become a marker to predict the prognosis in MHD patients. Key words: Hemodialysis; Sclerostin; Bone Density; Calcium and Phosphorus Metabolism

Serum hepcidin level and its clinical significance in maintenance hemodialysis patients.

Hepcidin is a key protein of iron metabolism, which may play an important role in the prognosis of patients with chronic renal failure on maintenance hemodialysis. The purpose of this study was to investigate the relationship between the prognosis of maintenance hemodialysis patients and serum hepcidin level. We enrolled 60 patients on maintenance hemodialysis and 30 healthy controls from March 2012 to December 2012 in our hospital. Peripheral blood samples were collected to determine hepcidin by an ELISA method. Hepcidin levels of hemodialysis patients were significantly higher than those of the healthy control group. Hepcidin level was positively correlated with the degree of anemia in the dialysis group. Therefore, we conclude that hepcidin level is significantly increased in patients with chronic renal failure on maintenance hemodialysis and that increased hepcidin seriously affects the prognosis of chronic renal failure.