Regular Hemodialysis Patients Research Articles

Study of depression, anxiety and sleep quality as possible predictors of fatigue in regular hemodialysis patients

Study of depression, anxiety and sleep quality as possible predictors of fatigue in regular hemodialysis patients

Assessment of the prevalence of pulmonary hypertension and volume status in Regular hemodialysis patients

Assessment of the prevalence of pulmonary hypertension and volume status in Regular hemodialysis patients

The impact of predictability of coronary flow reserve for non-cardiovascular mortality, all-cause mortality, cardiovascular mortality in dialysis population

Abstract Background In the clinical setting, ischemic heart disease (IHD) is a major problem not only in general patients but also in regular hemodialysis (HD) patients. 13N-ammonia positron emission tomography (13NH3PET) is an established and excellent diagnostic test for IHD. We have reported about the predictability of coronary flow reserve (CFR) in poor prognosis in HD population. Some prior studies show that low CFR predicts poor prognosis for not only cardiovascular event but also all-cause mortality. Although it is well-known that CFR is an important predictor, there are limited data about predictability of CFR for non-cardiovascular (non-CV) mortality. We investigated the prognostic predictability of all-cause mortality, cardiovascular (CV) mortality and non-CV mortality. Methods In total 1020, patients who underwent NH3+PET suspected of ischemic heart disease from May 2013 to May 2022 were included. They are divided into two groups according to CFR cut off value (CFR=2.0). 465 patients were included into low CFR group and 555 patients were included into high CFR group. We collected all-cause mortality, cardiovascular (CV) mortality and non-CV mortality. CV mortality was defined death from myocardial infarction, sudden death, stroke, heart failure, arrhythmia and ischemic colitis. We have followed them in 1282 days (median, 1st-3rd quartile was 510-2116). Results We found any cause death were 285 cases (the high CFR group vs the low CFR group; 165 (35.5%) vs 118 (21.3%), p<0.001), CV death were 121 cases (52 (9.4%) vs 68 (14.6%), p=0.010) and non-CV death were 164 cases (66(11.9%) vs 97 (20.9%, p<0.001)). Kaplan-Meier curve analysis and Cox regression model shows the low CFR groups shows poor prognosis for all-cause mortality (log rank; p<0.001, hazard ratio (HR); 1.9964, 95% confidential interval (CI); 1.576-2.529), CV mortality (log rank; p=0.0009, HR; 1.834, 95%CI; 1.278-2.633) and non-CV mortality (log rank; p<0.0001, HR; 2.213, 95%CI; 1.555-2.907). Furthermore, multivariate cox regression model shows the continuous value of CFR is an independent predictor for both all-cause mortality (HR0.180, 95%CI 0.074-0.435, p=0.0001) and non-CV mortality (HR0.553, 95% CI0.397-0.769, p=0.0004). Conclusion In dialysis population, CFR is an important predictor for all-cause mortality, CV mortality and non-CV mortality. In addition, CFR would predict non-CV death in HD population even though CFR is an index for IHD.

Impact of coronary flow reserve on the mortality and major adverse cardiac and cerebrovascular event in hemodialysis patients, regardless of diabetes

Abstract Background Ischemic heart disease (IHD) is still a major problem not only in general patients but also in regular hemodialysis (HD) patients. We have reported about prognostic value of coronary flow reserve (CFR) derived from N13-ammonia PET in HD population for all-cause mortality and major adverse cardiac event (MACE) in prior studies. We investigated the impact of diabetes and low CFR on the mortality in HD population. Methods A total 1,027 HD patients who undergone 13N-ammonia PET for suspected IHD were enrolled. We divided them into four groups according to CFR (cut off value = 2.0) and whether DM or not. We collected and evaluated their all-cause mortality, cardiovascular (CV) mortality and MACE, and analyzed using Kaplan-Meier methods and uni/multivariate cox regression model. Results The number of DM with better CFR group was 194, DM with worse CFR was 244, non-DM with better CFR was 361 and non-DM with worse CFR was 221. We found 285 case of all-cause mortality, 121 case of CV mortality, 164 case of CV mortality and 424 case of MACCE. Whether DM or not, CFR predicts HD patients’ prognosis precisely (See figure). Furthermore, multivariate Cox regression model showed CFR (continuous value) was an independent predictor for all-cause mortality (hazard ratio (HR); 0.774, 95% confidential interval (CI) 0.606-0.979, p value=0.037) and MACCE (HR0.769, 95%CI0.630-0.932, p=0.009) in DM and HD population. Furthermore, CFR predicted all-cause mortality (HR0.731, 95%CI 0.569-0.940, p=0.015) and non-CV death (HR0.636, 95%CI0.451-0.896, p=0.010) in non-DM and HD population. Conclusion The HD patients with DM and low CFR had worst prognosis in all-cause mortality, CV death, non-CV death and MACCE.

Role of reticulocyte hemoglobin equivalent in early detection of iron deficiency anemia in regular hemodialysis patients

Role of reticulocyte hemoglobin equivalent in early detection of iron deficiency anemia in regular hemodialysis patients

Identification of Cell-Cell Communications by Single-Cell RNA Sequencing in End Stage Renal Disease Provides New Insights into Immune Cell Heterogeneity.

Impaired immune system characterized by low-grade inflammation is closely associated with kidney chronic kidney disease (CKD) progression. To reveal the alterations of the function, component, and intercellular communication of immune cells during the progression of CKD. We conducted a case-control study enrolling regular hemodialysis patients and healthy controls. Clinical data, serum and peripheral blood mononuclear cell (PBMC) samples were collected. Flow cytometry and single-cell RNA sequencing were performed to quantitatively analyze the immune cell subsets and T-cell subsets of PBMCs. scRNA data of GSE140023 containing mouse unilateral ureteral obstruction (UUO) models were analyzed the heterogeneity of immune cells. Overall reduction in peripheral blood lymphocyte subsets in patients with end-stage renal disease (ESRD) was observed. A higher ratio of Th17/Treg, Th1/Treg, and b-cell/Treg in the ESRD group was associated with a decrease in eGFR, PTH, and ferritin. Among T cell subsets identified by scRNA analysis, Th17 cells were significantly increased in the ESRD and UU0 group. TFH, Th1, and Th2 cells are located at the final stage in the developmental tree, while Treg and memory CD8+ T cells are at the beginning site. Early developmental differentiation of Th17, Th1, and Tfh cells was observed in the ESRD and UUO group. Analysis of intercellular communication between t-cell subpopulations identified two major input and output signaling pathways: the CD40 and macrophage inhibitory factor (MIF) pathways. The MIF signaling pathway primarily mediates intercellular communication among th17 effects, CD8+ t-cell, and Th17-Treg in the ESRD group, the serum level of MIF showed significant upregulation, which was closely related to Th17/Treg cells. A global immune imbalance was closely associated with the deterioration in renal function and complication development. The MIF signaling pathway mediates Th17/Treg communication and promotes the trans-differentiation of Treg cells to Th17 cells in CKD progression.

Comparative Study Evaluating the Effect of the Administration of Vitamin K2 versus Placebo on Vascular Calcification in Haemodialysis Patients

Abstract Background Vitamin K deficiency serves as risk factor for vascular calcification in CKD patients. Vitamin K family includes phylloquinone (vitamin K1) and several menaquinones (vitamin K2). Until trials are designed to compare the effects of phylloquinone and menaquinone on CAC and other cardiovascular outcomes, it is not known if one form of vitamin K is superior to any other form of vitamin in terms of cardiovascular health. Objective To evaluate the effect of supplementation of vitamin K2 (menaquinone, MK-7) on circulating levels of calcification regulators and to assess their safety in patients on regular hemodialysis patients. Patients and Methods The study was conducted on 84 ESRD patient on regular Hemodialysis recruited from Ain shams university Hospitals hemodialysis unit, their age ranged from 18 to 75 years This study was conducted from June 2020 to September 2020 in Hemodialysis Unit of Ain Shams University Hospitals, each participant signed informed consent. The study was approved by the Research Ethical Committee of Faculty of Medicine, Ain Shams University in April 2020. Patients were equally divided into two groups: Vitamin K2 group: 42 patients will receive 90 ug per day orally in addition to their standard treatment for 3 months period. Placebo group: 42 patients will receive placebo orally in addition to their standard treatment for 3 months period. Results In our study there was no statistically significant difference between the two groups according to their risk factors regarding smoking, HTN, HCV, DM, and ISHD. In this work only 22.5 % of patients were diabetic in 1st group and 35% were diabetic in placebo group, but their diabetes was well controlled and there was no significant difference between groups regarding incidence of There was no significant difference between groups regarding vascular access (AVF, Permicath) and duration of dialysis this study did not find a significant difference in blood pressure, BMI, serum levels of calcium, phosphorus, hemoglobin%, PTH, between group I and group II at the start of the study and after 3 months. Conclusion The study are that it is a pilot study with a small sample size, no funding was present., also carotid duplex was not done so effect of vitamin k2 administration and rise in serum MGP level on vessels calcification and atherosclerotic changes couldn’t be assessed.

Prevalence of Hepatitis B Virus, Hepatitis C Virus, and HIV Infections in Hemodialysis Patients at Kano Kidney Center.

Background Hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections are more prevalent in hemodialysis patients compared to the general population. The objective of this study was to evaluate the prevalence of HBV, HCV, and HIV infections in hemodialysis patients dialyzing regularly at Kano Kidney Center (KKC) in the Eastern Health Cluster of Saudi Arabia in 2022. Methods This retrospective study included all hemodialysis patients who were dialyzed regularly at KKC during 2022. Their electronic medical records were reviewed for the results of HBV, HCV, and HIV along with the patient's demographics, comorbid conditions, and dialysis history. The study was approved and monitored by the Institutional Review Board of Dammam Medical Complex. Results A total of 239 regular hemodialysis patients were included, consisting of 142 males and 97 females (59.41% and 40.59%, respectively), with a mean age of 52.71±15.83 years. Most of the patients were Saudis (156 patients, 65.27%) with the non-Saudi patients being composed mostly of Arabian patients.Nine patients (3.77%) tested positive forhepatitis B surface antigen (HBsAg), the serologic hallmark of HBV infection. Two patients (0.84%) had resolved HBV infections as evidenced by positive hepatitis B core antibody (anti-HBc) and hepatitis B surface antibody (anti-HBs). However, the majority (226 patients, 94.56%) were never tested for anti-HBc. Anti-HBs, which can imply long-term immunity against HBV from prior immunizations or infections, were positive in 165 patients (69.04%). A protective anti-HBs level of ≥ 10 IU/L was detected in 158 patients (66.11%) including 104 patients (43.51%) having ≥ 100 IU/L. Eighteen patients (7.53%) had reactive HCV antibodies. Four patients (1.67%) had chronic HCV infection as they had detectable HCV RNA. The remaining 14 patients (5.86%) cleared HCV either spontaneously (seven patients, 2.93%) or by medications (seven patients, 2.93%). HIV screening tests were negative in all 239 patients (100%). HBsAg-positive patients did not have any statistically significant differences from HBsAg-negative patients. On the other hand, the patients who were positive for HCV antibodies were older than the patients who were negative for HCV antibodies (60.66 vs 52.05 years on average, p-value <0.05). They also contained a statistically larger proportion of non-Saudi patients than the patients with no evidence of prior infections (61.11% vs 32.13%, p-value <0.05). Conclusions The study found that the prevalence of HBV and HCV infections among hemodialysis patients in KKC at 3.77% and 1.67%, respectively, is higher than that reported in the general populationin Saudi Arabia, with non-Saudis having a higher prevalence rate of HCV infection than Saudis.However, the current prevalence rate is lower compared to the previous studies that were conducted in Saudi Arabia in the first decade of the 21st century, and there were no cases of HIV infections. Nevertheless, a significant proportion of patients had unprotective or negative anti-HBs antibody titers, indicating the need for strict vaccination protocols and monitoring of antibody titers to ensure optimal protection.

Correlation between Erythropoietin Resistance Index and Mortality in Regular Hemodialysis Patients at Haji Adam Malik General Hospital Medan

Correlation between Erythropoietin Resistance Index and Mortality in Regular Hemodialysis Patients at Haji Adam Malik General Hospital Medan

Neutrophil-Lymphocyte Ratio as Predictor of Mortality in Regular Hemodialysis Patients at Tabanan General Hospital

The risk of mortality in chronic kidney disease (CKD) patients is higher than in normal population. Inflammation has an important role in the high mortality in CKD patients undergoing hemodialysis (HD). The neutrophil lymphocyte ratio (NLR) is a simple parameter and has been widely associated with poor outcomes in HD patients but has not been widely implemented in Indonesia, especially in Bali. This research prospectively analyzed survival of 186 patients aged 18-90 years undergoing regular HD 2x/week for at least 3 months. NLR was calculated by dividing the absolute number of neutrophils and lymphocytes. The Survival test was performed by the Kaplan-Meier method and compared with the log-rank test. Univariate and multivariate tests were performed to assess the prognostic impact of NLR and other clinical factors on all-cause mortality in HD patients. Mortality was found higher in the group with high NLR values (p-value 0.003). High NLR was significantly associatedwith all-causemortality (HR 3.206; 95% CI 1.467 – 7.004; p value 0.003) and remained an independent factor on mortality in routine HD patients after adjustment toothervariables(aHR 2.696, 95% CI 1.176 –6.182, p-value: 0.019). Inconclusion, HighNLR is independently associated with all-cause mortality in CKD patients undergoing regular HD. NLR can be used as an inflammation marker that is considered easy and affordable and can be used to help determine populations that require special attention in order to reduce the mortality of patients with HD.

The cardiovascular mononeuropathy in Hemodialysis Patients analysed by a combination with reactivity tests to noninvasively evaluate skin sympathetic nerve activity and skin microvascular function by (LDF)

Aim: Although several patients with kidney disease have simultaneous dysfunction of the parasympathetic and sympathetic nervous systems, orthostatic hypotension during a hemodialysis (HD) procedure impacts not only the form of treatment but overall comfort of life for patients with HD. Despite a number of methods that are not invasive and have already been used to assess autonomous functioning, a system for monitoring malfunction throughout filtration of blood therapy which has yet to be discovered. Methods: Regarding the purpose of monitoring the autonomous function of stable 40 regular HD patients and 35 healthy controls, we examined the clinical application of the laser-Doppler blood flow meter (LDF). By detecting the periflux blood flow decreasing velocity (PDV) while combined with the Valsalva manoeuvre, the LDF device which was used for an autonomous test. We also looked at the relationship between PDV and traditional atherosclerosis testing. Results: The baseline PDV (5.30 ± 2.93), comparative to subjects who were in excellent condition (9.65 ± 7.10), was substantially decreased in the HD populace. Furthermore, we discovered a substantial connection between PDV and established parameters like heart rate fluctuation and ankle-brachial blood pressure indexing. Conclusion: Regarding assessing autonomous functioning in hemodialysis patients, evaluation of PDV by LDF is just as effective as the standard approach. The benefit from regular and recurring assessments of autonomous dysfunction is made possible by the device's ease.

60. Prevalence and Management of Hypertension in Regular Hemodialysis Patients at Sanjiwani Gianyar Hospital

Background: Hypertension is a condition in which blood pressure is more than equal to 140/90 mmHg. Hypertension is often found in CKD patients undergoing regular hemodialysis (HD). The mechanism of hypertension in CKD is multifactorial, so it is difficult to control and is associated with cardiovascular complications. Methods: This study is a cross-sectional study to determine the prevalence and management of hypertension in regular hemodialysis patients at Sanjiwani Gianyar Hospital in 2021. Patients included in the study were over 18 years of age, who underwent regular hemodialysis twice a week, and were willing to participate in the study by signing an informed consent. Results: In this study, 108 regular HD patients consisted of 61.1% men with the mean age of 53.70 years, mean length of HD of 43.04 months. The mean of URR is 75.6% and KT/V is 1.73. Hypertension was found in 68.5%, in which 29.7% of them with comorbid DM. The mean systolic blood pressure was 130.37 ± 20.37 mmHg and the mean diastolic blood pressure was 79.17 ± 9.87 mmHg. Controlled hypertension &lt;140/90 mmHg, was found in 51.4% of cases, where the majority of patients (65.8%) took 2 types of antihypertensive drugs, however 34.2% of patients used 3 types of antihypertensive drugs or more. Conclusion: The prevalence of hypertension in regular HD patients is high, however most of them can be controlled with 2 types of antihypertensive drugs. Reference: Unger T., Borghi C., Charchar F,. et al. International Society of Hypertension Global Hypertension Practice Guidelines 2020;75:1334-1357.

Study The Effect of Na concentration, Dialysate Temperature on Intra Dialytic Hypotension on Regular Hemodialysis Patients

Study The Effect of Na concentration, Dialysate Temperature on Intra Dialytic Hypotension on Regular Hemodialysis Patients

Study of some biochemical and hematological parameters in continuously hemodialysis patients in Kirkuk city

Introduction: The severity of chronic renal failure (CRF) classified by professional guidelines in five stages, stage 5 is a severe illness often called end stage kidney failure or end stage renal disease (ESRD), dialysis may be used for this stage. Dialysis treatments replace some of these functions through diffusion (waste removal) and ultrafiltration (fluid removal). Hemodialysis, is a process of purifying the blood, when the kidneys are not working normally. It is one of three renal replacement therapies (the other two being peritoneal dialysis and renal transplant).&#x0D; Materials and Methods: The samples of this study consists of 80 patients (42 males, 38 females) and 85 healthy individuals (43 males, 42 females) from (20 - 70) years old of age. Serum paraoxonase-1 (PON1), `5-nucleatidase, blood urea ( BU), serum creatinine Cr, serum iron (Fe), serum total iron binding capacity (TIBC), Serum feritin, serum amylase activity and serum lipase activity were determined. Some hematological parameters includes packed cell volume (PCV), hemoglobin (Hb), white blood cells count (WBCs), red blood cell count (RBCs) were measured, the erythrocyte sedimentation rate (ESR), Body mass index (BMI) and creatinine clearance Ccl were also measured.&#x0D; Results: Decreased levels of some enzymes activity and some biochemical and hematological parameters and increased others in continuous and regular hemodialysis patients in Kirkuk city. Blood urea and serum creatinine showed significant increased (P˂0.05) in their levels, while the creatinine clearance was significantly decreased (P˂0.05) in patients with continuous hemodialysis patients when compared to those of controls. In the present study; there was significant decreased (P˂0.05) in PON-1 in patients when compared to those of controls. However, the serum`5-NT, amylase and lipase activities were significantly increased (P ˂ 0.05) in these patients when compared with serum of normal individuals. In the present study; there was significant decreased in Fe and TIBC concentrations in the serum of patients when compared to those of healthy control individuals (P˂0.05). While the serum ferritin was significantly increased (P˂0.05) in these patients as compared to the controls. In the present study; there was significant decreased (P ˂ 0.05) in Hb and PCV and RBCs concentrations inthese patients when compared to those of controls. While WBCs and ESR was significantly increased (P˂0.05) in these patients as compared to the controls.&#x0D; Conclusion: Serum paraoxonase PON -1 activity is the most commonly affected than other biochemical parameters in continuous hemodialysis patients. Anemia, pancreatitis are the common and often an early complication of chronic renal diseases

NUTRITIONAL STATUS PROFILE OF CKD PATIENTS THAT ARE REGULARLY HEMODIALYSIS IN UNIVERSITAS AIRLANGGA HOSPITAL

CKD patients, especially those undergoing hemodialysis, often have poor nutritional status. This condition can increase morbidity and mortality and decrease the patients quality of life, therefore an assessment of nutritional status in hemodialysis patients is important. This study aims to determine the nutritional status of CKD patients undergoing hemodialysis at the Universitas Airlangga Hospital. This research is a quantitative research using a descriptive method. The sample was taken by total sampling technique and obtained from a sample of 50 people who are regular hemodialysis patients at the Universitas Airlangga Hospital. The nutritional status of patients was assessed based on Body Mass Index (BMI), serum albumin levels, body fat percentage and skeletal muscle percentage. The data obtained were analyzed descriptively and presented in the form of a table containing the percentage, mean, and standard deviation. The results showed the characteristics of the subjects such as gender, age, BMI, serum albumin levels, body fat percentage, and skeletal muscle percentage. From the results of this study, it was found that the characteristics of the research subjects were the same between the sexes of male (50%) and female (50%) with the highest age group between 50-59 years (36%). The largest proportion of subjects had a normal BMI (56%), 36% of subjects had hypoalbuminemia, the majority of body fat percentages were high (34%) and the majority of subjects had low muscle mass (52%).

Transferrin as A Marker of Malnutrition in Regular Hemodialysis Patients

Transferrin as A Marker of Malnutrition in Regular Hemodialysis Patients

SERUM CALCIUM LEVEL AND THE ASSOCIATED FACTORS ON REGULAR HEMODIALYSIS PATIENTS

Chronic kidney disease-mineral bone disorder (CKD-MBD) is a chronic complication of regular hemodialysis (HD) patients. Previously, several study had found that serum calcium in regular hemodialysis patients can be low, normal or high level. However, there is a lack of data in our region. This study is a cross-sectional descriptive analytic study to obtain serum calcium level and the associated factors. Serum calcium were measured by calorimetric methods using Arsenazo III then it was classified into low, normal, and high serum calcium level according to Indonesian Society of Nephrology consensus. This study collected 100 patients who perfomed chronic hemodialysis at Sanjiwani Gianyar and Ari Canti hospital which consisted of male (67%) and female (33%). The mean age was 52.52 years with 44.6 months of mean dialysis vintage. Most of the subjects underwent hemodialysis twice a week (96 %) with total HD duration of 9 hours a week. Sixty six percent of the subjects used arterio-venous fistula for vascular access. This study showed that most chronic hemodialysis patients (60%) had low serum calcium level (&lt;8.4 mg/dL). Linier regression test indicated that serum calcium is significantly influenced by serum phosphate, however, serum urea has less powerful effect to serum calcium concentration with r = -0.371 and r= -0.013 respectively with r2= 0.313. This study obtained that most of the subjects had low serum calcium level and the serum calcium associated with serum phosphate and serum urea. Keywords: CKD-MBD; Hemodialysis; Serum Calcium.

Hippocampal subfield morphology in regular hemodialysis patients.

Hippocampal alterations have been implicated in the pathophysiology of cognitive impairment in hemodialysis patients. The hippocampus consists of several distinct subfields, and the molecular mechanisms underlying cognition might be associated with specific hippocampal subfield volume changes. However, this has not yet been investigated in hemodialysis patients. This study aimed to explore volumetric abnormalities in hippocampal subfields in regular hemodialysis patients. High-resolution T1-weighted structural images were collected in 61 subjects including 36 hemodialysis patients and 25 healthy controls. A state-of-the-art hippocampal segmentation approach was adopted to segment the hippocampal subfields. Group differences in hippocampal subfield volumes were assessed in Python with a statsmodels module using an ordinary least squares regression with age and sex as nuisance effects. Hemodialysis patients had significantly smaller volumes in the bilateral hippocampus (P<.05/2, Bonferroni corrected), cornu ammonis 1 (CA1), CA4, granule cell and molecular layer of the dentate gyrus, hippocampus-amygdala transition area and molecular layer of the hippocampus than healthy controls (P<.05/24, Bonferroni corrected). Hemodialysis patients also had lower volumes in the left hippocampal tail and right fimbria than healthy controls (P<.05/24, Bonferroni corrected). Hippocampal subfield volumes were associated with neuropsychological test scores, the duration of disease and hemoglobin levels. We found smaller hippocampal subfield volumes in hemodialysis patients, which were associated with impaired cognition, supporting their role in memory disturbance in the hemodialysis population. However, multiple clinical factors may have confounded the results, and therefore, the interpretation of these results needs to be cautious.

Role of malnutrition inflammation score and interleukin-6 on quality of life of regular hemodialysis patients

Background: Malnutrition, systemic inflammation, and atherosclerosis known as MIA syndrome occurs in patients who have undergone regular hemodialysis (HD) and can lower their quality of life (QoL). Current study aimed to determine the interrelation of malnutrition and inflammation to QoL. Methods: A cross-sectional analytic study was conducted in our hemodialysis installation. We performed Malnutrition Inflammation Score (MIS) and measure serum IL-6 to determine malnutrition and inflammation conditions in regular HD patients and utilized ‘Kidney Disease Quality of Life-Short Form (KDQOL-SF) to assess QoL MIS. IL-6 cut-off point were determined by the Receiver Operating Curves (ROC) then we performed linear regression to analyze the relationship level of MIS and IL-6 with level of QoL. We also used path analysis to prove the mechanism model of MIS and IL-6 to QoL on regular HD patients. Results: This study consisted of 60 regular HD patients, 40 (66.7%) of men with mean age of 51.8 years and 78 months average of dialysis vintage. Good QoL was obtained ≥60 overall health (above the median value) and high level of MIS was obtained ≥5 with 75% sensitivity and 21.8% specificity, while high IL-6 level were ≥47.21 pg/mL, with 62.2% sensitivity and specificity of 78.3%. This study found the prevalence of protein-energy wasting (PEW) in regular HD patients was 81.7% by using high level of MIS. MIS were significantly correlated to IL-6 (r = 0.376, p = 0.003) however high level of MIS were uncorrelated to poor QoL. The mechanism of the interrelation of MIS, IL-6, and QoL showed on path analysis that MIS was 15% directly correlated to QoL, however, IL-6 indirectly correlated to QoL on regular hemodialysis patients. Conclusion: MIS and IL-6 were correlated to QoL and MIS also correlated to IL-6. Malnutrition inflammatory score directly affected QoL but IL-6 indirectly affected QoL in regular HD patients.

High C-Terminal Fibroblast Growth Factor-23, Intact Parathyroid Hormone, and Interleukin-6 as Determinants of Valvular Calcification in Regular Hemodialysis Patients.

PurposeBiggest cause of death in chronic kidney disease-hemodialysis (CKD-HD) patients is cardiovascular disease (CVD). Cardiovascular disease is often associated with mineral bone disorders (MBD), especially vascular and valvular calcification. Biomarkers such as C-terminal-fibroblast growth factor-23 (FGF-23), intact parathyroid hormone (iPTH), and interleukin-6 (IL-6) were investigated. Only few studies have focused on valvular calcification in CKD-HD patients, with controversial results. The present study aimed to investigate whether high C-terminal-FGF-23, iPTH, and IL-6 can be used as determinants of valvular calcification in CKD-MBD patients undergoing regular HD.Patients and MethodsThis was an analytical cross-sectional study which involved CKD-HD patients aged 18–60 years with no history of CVD, malignancy, and diabetes mellitus. C-terminal FGF-23 was measured using enzyme-linked immunosorbent assay (ELISA) kit, iPTH using chemiluminescent immunometric method, and IL-6 using sandwich enzyme immunoassay technique. Valvular calcification on aortic and mitral valves was examined with echocardiography. Data analysis was done using Chi-squared test or Fisher’s exact test as appropriate and multivariate logistic regression analysis.ResultsBivariate analysis with Fisher’s exact test showed significant association of prevalence ratio (PR) of C-terminal FGF-23 (PR = 1.33; p = 0.003; CI (1.017–1.748)), iPTH (PR = 1.361; p = 0.002; CI (1.02–1.816)), and IL-6 (PR = 1.2; p = 0.019; CI (1.000–1.446)) with valvular calcification. Multivariate analysis with logistic regression showed high C-terminal FGF-23 (exp (B) value of 16.44; p = 0.045; CI (1.07–252.75)), iPTH (exp (B) value of 33.312; p = 0.016; CI (1.94–571.71)), and IL-6 (exp (B) value of 21.58; p = 0.0381; CI (1.18–394.87)) were determinants of valvular calcification in CKD-MBD patients undergoing regular HD.ConclusionThis study demonstrated that high C-terminal FGF-23, iPTH, and IL-6 were determinants of valvular calcification in CKD-MBD patients undergoing regular HD.