Parathyroidectomy Versus Cinacalcet for the Treatment of Secondary Hyperparathyroidism in Hemodialysis Patients

Abstract Background Secondary hyperparathyroidism in patients with end stage renal disease on dialysis is associated with bone pain and fractures in addition to cardiovascular morbidity. Cinacalcet is the most commonly used drug to treat such patients, but it has never been compared to surgery. The goal of this study is to compare the long-term outcomes and survival between cinacalcet and parathyroidectomy in the treatment of secondary hyperparathyroidism in hemodialysis patients. Methods Adult patients on hemodialysis who were treated with cinacalcet or parathyroidectomy in the United States Renal Data System were included. Patients treated with surgery (n = 2023) were compared using 1:1 propensity score matching ratio to a cohort of patients treated with cinacalcet. A Cox regression analysis was conducted to compare the overall mortality. Results The propensity score matching successfully created two groups with similar demographics. Patients in the surgery group had a higher mean peak PTH level prior to therapy (2066.8 vs 1425.4, P < 0.001). No difference was observed in the development of new-onset coronary artery disease (7.7% vs 7.9%, P = 0.8) or cerebrovascular disease (7% vs 6.7%, P = 0.8). Surgical patients had a higher rate of pathologic fractures (27.8% vs 24.9%, P = 0.04). Survival analysis showed that patients undergoing surgery had a better 5-year survival (65.6% vs 57.8%) and were less likely to die within the study period (HR 0.77, 95% CI 0.7–0.85, P < 0.0001). Conclusions Patients on dialysis undergoing parathyroidectomy for the treatment of secondary hyperparathyroidism have a better overall survival than those treated with cinacalcet.

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Real-world evidence and optimization of vocal dysfunction in end-stage renal disease patients with secondary hyperparathyroidism

Scientific Reports ◽

10.1038/s41598-020-79810-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Geng-He Chang ◽

Fong-Fu Chou ◽

Ming-Shao Tsai ◽

Yao-Te Tsai ◽

Ming-Yu Yang ◽

...

Keyword(s):

Renal Disease ◽

Secondary Hyperparathyroidism ◽

Real World ◽

End Stage Renal Disease ◽

Cox Regression ◽

Electrolyte Imbalance ◽

Research Database ◽

Cox Regression Analysis ◽

Stage Renal Disease ◽

End Stage

AbstractPatients with end-stage renal disease (ESRD) may demonstrate secondary hyperparathyroidism (SHPT), characterized by parathyroid hormone oversecretion in response to electrolyte imbalance (e.g., hypocalcemia and hyperphosphatemia). Moreover, this electrolyte imbalance may affect vocal cord muscle contraction and lead to voice change. Here, we explored the effects of SHPT on the voices of patients with ESRD. We used data of 147,026 patients with ESRD from the registry for catastrophic illness patients, a sub-database of Taiwan National Health Insurance Research Database. We divided these patients into 2 groups based on whether they had hyperparathyroidism (HPT) and compared vocal dysfunction (VD) incidence among them. We also prospectively included 60 ESRD patients with SHPT; 45 of them underwent parathyroidectomy. Preoperatively and postoperatively, voice analysis was used to investigate changes in vocal parameters. In the real-world database analysis, the presence of HPT significantly increased VD incidence in patients with ESRD (p = 0.003): Cox regression analysis results indicated that patients with ESRD had an approximately 1.6-fold increased VD risk (p = 0.003). In the clinical analysis, the “jitter” and “shimmer” factors improved significantly after operation, whereas the aerodynamic factors remained unchanged. In conclusion, SHPT was an independent risk factor for VD in patients with ESRD, mainly affecting their acoustic factors.

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Application of regularized regression to identify novel predictors of mortality in a cohort of hemodialysis patients

Scientific Reports ◽

10.1038/s41598-021-88655-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Stanislas Werfel ◽

Georg Lorenz ◽

Bernhard Haller ◽

Roman Günthner ◽

Julia Matschkal ◽

...

Keyword(s):

Statistical Learning ◽

Cox Regression ◽

Serum Levels ◽

Hemodialysis Patients ◽

Derivation Cohort ◽

Predictors Of Mortality ◽

Stage Renal Disease ◽

End Stage ◽

Study Participants ◽

Related Mortality

AbstractCohort studies often provide a large array of data on study participants. The techniques of statistical learning can allow an efficient way to analyze large datasets in order to uncover previously unknown, clinically relevant predictors of morbidity or mortality. We applied a combination of elastic net penalized Cox regression and stability selection with the aim of identifying novel predictors of mortality in a cohort of prevalent hemodialysis patients. In our analysis we included 475 patients from the “rISk strAtification in end-stage Renal disease” (ISAR) study, who we split into derivation and confirmation cohorts. A wide array of examinations was available for study participants, resulting in over a hundred potential predictors. In the selection approach many of the well established predictors were retrieved in the derivation cohort. Additionally, the serum levels of IL-12p70 and AST were selected as mortality predictors and confirmed in the withheld subgroup. High IL-12p70 levels were specifically prognostic of infection-related mortality. In summary, we demonstrate an approach how statistical learning can be applied to a cohort study to derive novel hypotheses in a data-driven way. Our results suggest a novel role of IL-12p70 in infection-related mortality, while AST is a promising additional biomarker in patients undergoing hemodialysis.

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MO757COMPARISON OF ANTI-COAGULATION AND NO ANTI-COAGULATION IN DIALYSIS PATIENTS WITH ATRIAL FIBRILLATION: A SINGLE CENTER RETROSPECTIVE STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab097.0037 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Jun Young Lee ◽

Jae Won Yang ◽

Jae Seok Kim ◽

Seong Ok Choi ◽

Byoung Geun Han

Keyword(s):

Atrial Fibrillation ◽

Cox Regression ◽

Dialysis Patients ◽

Dialysis Therapy ◽

Cox Regression Analysis ◽

Significant Difference ◽

Baseline Characteristics ◽

Stage Renal Disease ◽

End Stage ◽

Risk And Benefit

Abstract Background and Aims Atrial fibrillation (AF) is common arrhythmia in end stage renal disease patients. Although, the need of anticoagulation to prevent stroke and thromboembolism is increasing, the efficacy of anticoagulation is not proven in most of study. We retrospectively analyzed the risk and benefit of anticoagulation in dialysis patients with AF. Method By using medical record, we retrospectively analyzed all data of 99 patients who received dialysis therapy and diagnosed AF. Results Among 99 patients who diagnosed AF with dialysis 36 patients received anticoagulation (17 coumadin, 19 apixaban 2.5mg bid), 63 patients received no anticoagulation. There was no significant difference of baseline characteristics between anticoagulation, and no anticoagulation patients. Although no anticoagulation group experienced more all-cause (39.7% vs 32.4%, p=0.572) and cardiovascular mortality (17.6% vs 10.8%, p=0.197) than anticoagulation group it was not statistically significant. Compared to apixaban 2.5mg bid patients, coumadin anticoagulation patients experienced more frequent mfig ajor adverse cardiovascular events (35.3% vs 15.8%, p=0.109) but it was not statistically significant in multi variate Cox regression analysis (Hazard ratio 1.143, 95% Confidence Interval 0.503-2.597). Conclusion Apixaban 2.5mg bid was not inferior than coumadin considering risk and benefit of anticoagulation in dialysis patients.

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Surgical Resection Significantly Promotes the Overall Survival of Patients with Hepatocellular Carcinoma: A Propensity Score Matching Analysis

10.21203/rs.3.rs-148506/v1 ◽

2021 ◽

Author(s):

Pei-Min Hsieh ◽

Hung-Yu Lin ◽

Chao-Ming Hung ◽

Gin-Ho Lo ◽

I-Cheng Lu ◽

...

Keyword(s):

Risk Factors ◽

Hepatocellular Carcinoma ◽

Overall Survival ◽

Propensity Score ◽

Propensity Score Matching ◽

Surgical Resection ◽

Cox Regression ◽

Survival Rates ◽

Hbv Infection ◽

Cox Regression Analysis

Abstract Background: The benefits of surgical resection (SR) for various Barcelona Clinic Liver Cancer (BCLC) stages of hepatocellular carcinoma (HCC) remain unclear. We investigated the risk factors of overall survival (OS) and survival benefits of SR over nonsurgical treatments in patients with HCC of various BCLC stages.Methods: Overall, 2316 HCC patients were included, and their clinicopathological data and OS were recorded. OS was analyzed by the Kaplan-Meier method and Cox regression analysis. Propensity score matching (PSM) analysis was performed.Results: In total, 66 (2.8%), 865 (37.4%), 575 (24.8%) and 870 (35.0%) patients had BCLC stage 0, A, B, and C disease, respectively. Furthermore, 1302 (56.2%) of all patients, and 37 (56.9%), 472 (54.6%), 313 (54.4%) and 480 (59.3%) of patients with BCLC stage 0, A, B, and C disease, respectively, died. The median follow-up duration time was 20 (range 0-96) months for the total cohort and was subdivided into 52 (8-96), 32 (1-96), 19 (0-84), and 12 (0-79) months for BCLC stages 0, A, B, and C cohorts, respectively. The risk factors for OS were 1) SR and cirrhosis; 2) SR, cirrhosis, and Child-Pugh (C-P) class; 3) SR, hepatitis B virus (HBV) infection, and C-P class; and 4) SR, HBV infection, and C-P class for the BCLC stage 0, A, B, and C cohorts, respectively. Compared to non-SR treatment, SR resulted in significantly higher survival rates in all cohorts. The 5-year OS rates for SR vs non-SR were 44.0% vs 28.7%, 72.2% vs 42.6%, 42.6% vs 36.2, 44.6% vs 23.5%, and 41.4% vs 15.3% (all p-values<0.05) in the total and BCLC stage 0, A, B, and C cohorts, respectively. After PSM, SR resulted in significantly higher survival rates compared to non-SR treatment in various BCLC stages.Conclusion: SR conferred significant survival benefits to patients with HCC of various BCLC stages and should be considered a recommended treatment for select HCC patients, especially patients with BCLC stage B and C disease.

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Abstract 17474: End-Stage Renal Disease is Associated With Increased Complications From Watchman Implantation: A Propensity-Score Matched Analysis From National Readmission Database

Circulation ◽

10.1161/circ.142.suppl_3.17474 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Moghniuddin Mohammed ◽

Amit Noheria ◽

Seth Sheldon ◽

Madhu Reddy

Keyword(s):

Propensity Score ◽

Renal Disease ◽

Propensity Score Matching ◽

End Stage Renal Disease ◽

Early Mortality ◽

Index Hospitalization ◽

Index Hospital ◽

Stage Renal Disease ◽

End Stage ◽

National Readmission Database

Introduction: End-stage renal disease (ESRD) is associated with increased complications due to oral anticoagulation (OAC) use for stroke prevention in atrial fibrillation (AF). Left atrial appendage occlusion (LAAO) is indicated for patients who cannot tolerate or prefer not to use OAC but the outcomes of LAAO in ESRD has not been well studied. Methods: Using National Readmission Database January 2016-December 2017, we identified all adult AF patients who had LAAO performed in the months of January to November with no missing length of stay and/or mortality information. We excluded patients who had ablation, device implantation/revision, other form of LAAO and/or coronary artery bypass graft surgery performed during index hospitalization. 1:1 propensity score matching was performed for patients with and without ESRD based on variables shown in Table 1. The main outcome of interest was early mortality defined as mortality of index hospitalization or 30-day readmissions and index hospital complications. Results: A total of 13,790 procedures were included and of these 370 patients had history of ESRD. The baseline characteristics before and after matching are shown in table 1. After propensity score matching, ESRD group was associated with significantly higher early mortality, 30-day readmissions, systemic embolism and pericardial complications (Table 2). In the matched cohort, none of the patients had postprocedural cerebrovascular accident, transient ischemic attack, device thrombosis and device embolization. After propensity matching 2 (0.5%) developed acute kidney injury requiring hemodialysis. Conclusions: ESRD is associated with higher LOS, index hospital complications and early mortality from LAAO compared to patients without ESRD. Further studies comparing outcomes between OAC use and LAAO are warranted.

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Comparison of overall survival on surgical resection versus transarterial chemoembolization with or without radiofrequency ablation in intermediate stage hepatocellular carcinoma: A propensity score matching analysis

10.21203/rs.2.22284/v2 ◽

2020 ◽

Author(s):

Chih-Wen Lin ◽

Yaw-Sen Chen ◽

Gin-Ho Lo ◽

Yao-Chun Hsu ◽

Chia-Chang Hsu ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Radiofrequency Ablation ◽

Propensity Score ◽

Propensity Score Matching ◽

Surgical Resection ◽

Cox Regression ◽

Cox Regression Analysis ◽

Tace Group ◽

The Impact

Abstract Background: Patients with Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) are recommended to undergo transcatheter arterial chemoembolization (TACE). However, TACE in combination with radiofrequency ablation (RFA) is not inferior to surgical resection (SR), and the benefits of surgical resection (SR) for BCLC stage B HCC remain unclear. Hence, this study aims to compare the impact of SR, TACE+RFA, and TACE on analyzing overall survival (OS) in BCLC stage B HCC. Methods: Overall, 428 HCC patients were included in BCLC stage B, and their clinical data and OS were recorded. OS was analyzed by the Kaplan-Meier method and Cox regression analysis. Results: One hundred forty (32.7%) patients received SR, 231 (53.9%) received TACE+RFA, and 57 (13.3%) received TACE. The OS was significantly higher in the SR group than that in the TACE+RFA group [hazard ratio (HR): 1.78; 95% confidence incidence (CI): 1.15-2.75, p=0.009]. The OS was significantly higher in the SR group than that in the TACE group (HR: 3.17; 95% CI: 2.31-4.36, p<0.0001). Moreover, the OS was significantly higher in the TACE+RFA group than that in the TACE group (HR: 1.82; 95% CI: 1.21-2.74, p=0.004). The cumulative OS rates at 1, 3 and 5 years in the SR, TACE+RFA, and TACE groups were 89.2%, 69.4% and 61.2%, 86.0%, 57.9% and 38.2%, and 69.5%, 37.0% and 15.2%, respectively. After propensity score matching, the SR group still had a higher OS than those of the TACE+RFA and TACE groups. The TACE+RFA group had a higher OS than that of the TACE group. Conclusion: The SR group had higher OS than the TACE+RFA and TACE groups in BCLC stage B HCC. Furthermore, the TACE+RFA group had higher OS than the TACE group.

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Increased urinary miR-196a level predicts the progression of renal injury in patients with diabetic nephropathy

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfy326 ◽

2018 ◽

Vol 35 (6) ◽

pp. 1009-1016 ◽

Cited By ~ 1

Author(s):

Yu An ◽

Changming Zhang ◽

Feng Xu ◽

Wei Li ◽

Caihong Zeng ◽

...

Keyword(s):

Diabetes Mellitus ◽

Diabetic Nephropathy ◽

Renal Injury ◽

Cox Regression ◽

Interstitial Fibrosis ◽

Glomerular Sclerosis ◽

Tubular Atrophy ◽

Cox Regression Analysis ◽

Stage Renal Disease ◽

End Stage

Abstract Background Recent data suggest that miR-196a is predominantly expressed in the kidney and plays an inhibitory role in the progress of renal interstitial fibrosis (IF). However, the predictive value of miR-196a in diabetic nephropathy (DN) remains unknown. We validated the role of urinary miR-196a in the progression of renal injury in a cohort of patients with type 2 diabetes mellitus. Methods Our study included 209 patients with biopsy-proven DN. The mean follow-up time was 54.03 ± 32.94 months. Histological lesions were assessed using the pathological classification established by the Renal Pathology Society. Percentages of IF and tubular atrophy were assessed using the Aperio ScanScope system. We measured the correlation of urinary miR-196a with clinical and pathological parameters using the Spearman’s correlation test. The influence of urinary miR-196a on renal outcomes was assessed using Cox regression analysis. Results Urinary miR-196a levels correlated positively with proteinuria (ρ = 0.385, P < 0.001), duration of diabetes mellitus (ρ = 0.255, P < 0.001) and systolic blood pressure (ρ = 0.267, P < 0.001). The baseline estimated glomerular filtration rate (eGFR) and hemoglobin level showed a negative correlation with urinary miR-196a (ρ = −0.247, P < 0.001 and ρ = −0.236, P = 0.001, respectively). Pathologically, urinary miR-196a levels correlated with glomerular sclerosis and IF in patients with DN. Urinary miR-196a was significantly associated with progression to end-stage renal disease [hazard ratio (HR) 2.03, P < 0.001] and a 40% reduction of baseline eGFR (HR 1.75, P = 0.001), independent of age, gender, body mass index, mean arterial pressure and hemoglobinA1c level. However, urinary miR-196a did not improve predictive power to proteinuria and eGFR in DN patients. Conclusions Increased urinary miR-196a was significantly associated with the progression of renal injury and might be a noninvasive prognostic marker of renal fibrosis in DN patients.

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Efficacy of remdesivir-containing therapy in hospitalized COVID-19 patients: a prospective clinical experience

10.1101/2021.07.01.21259852 ◽

2021 ◽

Author(s):

Alessandro Russo ◽

Erica Binetti ◽

Cristian Borrazzo ◽

Elio Gentilini Cacciola ◽

Luigi Battistini ◽

...

Keyword(s):

Mechanical Ventilation ◽

Propensity Score ◽

Propensity Score Matching ◽

Cox Regression ◽

Large Population ◽

Real Life ◽

Cox Regression Analysis ◽

Non Invasive ◽

High Flow Oxygen ◽

The Impact

Objectives: remdesivir is currently approved for the treatment of COVID-19. The recommendation for using remdesivir in COVID-19 was based on the in vitro and in vivo activity of this drug against SARS-CoV-2. Methods: this was a prospective, observational study conducted on a large population of patients hospitalized for COVID-19. The primary endpoint of the study was to evaluate the impact of remdesivir-containing therapy on 30-day mortality; secondary endpoint was the impact of remdesivir-containing therapy on the need of high flow oxygen therapy (HFNC) or non-invasive ventilation (NIV) or mechanical ventilation. Data were analyzed after propensity score matching. Results: 407 patients with SARS-CoV-2 pneumonia were consecutively enrolled. Out of these, 294 (72.2%) and 113 (27.8%) were respectively treated or not with remdesivir. Overall, 61 (14.9%) patients were treated during hospitalization with non-invasive or mechanical ventilation, while a 30-day mortality was observed in 21 (5.2%) patients. Cox regression analysis, after propensity score matching, showed that therapies, including remdesivir-containing therapy, were not statistically associated with 30-day survival or mortality, while need of HFNC/NIV (HR 17.921, CI95% 0.954-336.73, p=0.044) and mechanical ventilation (HR 3.9, CI95% 5.36-16.2, p=0.003) resulted independently associated with 30-day mortality. Finally, therapies including or not remdesivir were not independently associated with lower or higher risk of HFNC/NIV or mechanical ventilation. Conclusions: this real-life experience about the remdesivir use in hospitalized patients with COVID-19 was not associated with significant increase in rates of survival or reduced use of HFNC/NIV or mechanical ventilation, compared to patients treated with other therapies not including remdesivir.

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Feasibility and Safety of Drug-Coated Balloon-Only Angioplasty for De Novo Ostial Lesions of Left Anterior Descending Artery: Two Center’s Retrospective Study

10.21203/rs.3.rs-817229/v1 ◽

2021 ◽

Author(s):

Chuang Li ◽

Xuebo Ding ◽

Lefeng Wang ◽

Kuibao Li ◽

Xinchun Yang ◽

...

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Propensity Score ◽

Propensity Score Matching ◽

Cox Regression ◽

De Novo ◽

Cox Regression Analysis ◽

Left Circumflex Artery ◽

Left Anterior Descending Artery ◽

Drug Coated Balloon

Abstract Background:There is limited evidence of drug-coated balloon (DCB) only angioplasty in percutaneous treatment of complex de novo ostial coronary lesions. The major objective of our study is to explore the feasibility and test safety of this innovative approach in ostial lesions of left anterior descending artery (LAD). Methods:Patients treated with paclitaxel DCB or second-generation drug-eluting stent (DES) were retrospectively enrolled from two different large centers. The primary endpoints were defined as major adverse cardiovascular events (MACE) composed of cardiovascular death, target lesion revascularization (TLR), target vessel revascularization (TVR), and recurrent myocardial infarction related to target artery occlusion. Cox regression analysis were used to identify risk factors for MACE and propensity score matching is performed to minimize the selection bias.Results:A total of 53 patients were treated with paclitaxel DCB and 336 patients with DES in ostial lesions of LAD were recruited. In accordance with propensity score matching, 49 patients treated with DCB-only coordinated with 49 ones with the strategy of DES. After average follow-up time of 10 months, the rate of MACE trended to lower in DCB-only angioplasty treatment arm and triggered by post-procedure TLR (MACE: 6% vs. 4%, p=0.65; TLR: 2% vs. 4%, p=0.56). Cox regression analysis indicated that not DCB-only angioplasty was considered as an independent risk factor for adverse events after adjustment for cofound risk factors (HR: 1.748, p=0.48).Conclusions:Use of DCB-only approach in treatment of isolated ostial LAD disease could be an innovative and safe strategy without additional risk of aggressive progression of left circumflex artery.

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With versus Without Primary Tumor Radiotherapy in Patients with Unresectable Stage IV Rectal or Rectosigmoid Cancer: A Propensity Score Matching Analysis for Survival

10.21203/rs.3.rs-16443/v1 ◽

2020 ◽

Author(s):

Gang Wang ◽

Ling Wen Wang ◽

Jie Hai Jin ◽

min Hong Dong ◽

wei Wei Chen ◽

...

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Primary Tumor ◽

Cox Regression ◽

Stage Iv ◽

Rectosigmoid Cancer ◽

Cox Regression Analysis ◽

Risk Of Death ◽

Kaplan Meier ◽

The Impact

Abstract Background: To evaluate the impact of primary tumor radiotherapy on survival in patients with unresectable metastatic rectal or rectosigmoid cancer. Methods: Form September 2008 to September 2017, 350 patients with unresectable metastatic rectal or rectosigmoid cancer were retrospectively reviewed in our center. All patients received at least 4 cycles of chemotherapy, and were divided into two groups according to with primary tumor radiotherapy or without. 163 patients received primary tumor radiotherapy, and the median radiation dose was 56.69Gy(50.4-60). Survival curves were estimated from the Kaplan–Meier procedure to roughly compare survival among two groups. Subsequently, 18-month survival was used as the outcome variable for this study. This study mainly evaluated the impact of primary tumor radiotherapy on survival of these patients through a series of multivariate Cox regression analyses after propensity score matching (PSM). Results: The median follow-up time was 21 months. All 350 patients received a median of 7 cycles of chemotherapy (range 4-12), 163 (46.67%) patients received primary tumor radiotherapy for local symptoms. The Kaplan–Meier survival curves showed a significant overall survival (OS) advantage for primary tumor radiotherapy group to without radiotherapy (20.07 vs 17.33 months; P=0.002). In this study, multivariate Cox regression analysis after adjusted covariates, multivariate Cox regression analysis after PSM, and inverse probability of treatment weighting (IPTW) analysis and propensity score (PS)-adjusted model analysis consistently showed that primary tumor radiotherapy could effectively reduce the risk of death for these patients at 18 months (HR: 0.62, 95% CI 0.40-0.98; HR:0.79, 95% CI:0.93-1.45; HR: 0.70, 95% CI 0.55-0.99 and HR: 0.74, 95% CI:0.59-0.94). Conclusion: Compared with patients with stage IV rectal or rectosigmoid cancer who did not receive primary tumor radiotherapy, received primary tumor radiotherapy reduced the risk of death in these patients. The radical doses（59.4Gy/ 33 fractions or 60Gy/ 30 fractions） of radiation for primary tumors might be considered for unresectable metastatic rectal or rectosigmoid cancer, not just for relieve symptoms. Keywords: Stage IV Rectal cancer, primary tumor radiotherapy, propensity score matching.

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