scholarly journals End-stage renal disease, calcification patterns and clinical outcomes after TAVI

2021 ◽  
Author(s):  
David Grundmann ◽  
Matthias Linder ◽  
Alina Goßling ◽  
Lisa Voigtländer ◽  
Sebastian Ludwig ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Multivariable Analysis ◽  
Clinical Results ◽  
Chronic Hemodialysis ◽  
Vascular Calcifications ◽  
Major Life ◽  
Term Survival ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Patients with chronic hemodialysis due to end-stage renal disease (ESRD) or severely impaired kidney function (CKD) constitute a relevant share of patients undergoing trans-catheter aortic valve implantation (TAVI). However, data on specific challenges and outcomes remain limited. Aim We aimed to characterize this patient population, evaluate clinical results and assess the significance of calcification patterns. Methods This retrospective single-center analysis evaluated 2,712 TAVI procedures (2012–2019) according to baseline renal function: GFR < 30 ml/min/1.73m2 (CKD; n = 210), chronic hemodialysis (ESRD; n = 119) and control (CTRL; n = 2383). Valvular and vascular calcification patterns were assessed from contrast-enhanced multi-detector computed tomography. Outcomes were evaluated in accordance with the VARC-2 definitions. Results Operative risk was higher in ESRD and CKD vs. CTRL (STS-score 8.4% and 7.6% vs. 3.9%, p < 0.001) and patients with ESRD had more severe vascular calcifications (49.1% vs. 33.9% and 29.0%, p < 0.01). Immediate procedural results were similar but non-procedure-related major/life-threatening bleeding was higher in ESRD and CKD (5.0% and 5.3% vs. 1.6%, p < 0.01). 3-year survival was impaired in patients with ESRD and CKD (33.3% and 35.3% vs. 65.4%, p < 0.001). Multivariable analysis identified ESRD (HR 1.60), CKD (HR 1.79) and vascular calcifications (HR 1.29) as predictors for 3-year and vascular calcifications (HR 1.51) for 30-day mortality. Conclusion Patients with ESRD and CKD constitute a vulnerable patient group with extensive vascular calcifications. Immediate procedural results were largely unaffected by renal impairment, yielding TAVI a particularly valuable treatment option in these high-risk operative patients. Mid-term survival was determined by underlying renal disease, cardiovascular comorbidities, and vascular calcifications as a novel risk marker. Graphical abstract

scholarly journals Arterial stiffening and vascular calcifications in end‐stage renal disease

2000 ◽  
Vol 15 (7) ◽  
pp. 1014-1021 ◽  
Author(s):  
Alain P. Guérin ◽  
Gérard M. London ◽  
Sylvain J. Marchais ◽  
Fabien Metivier
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Vascular Calcifications ◽  
Arterial Stiffening ◽  
Stage Renal Disease ◽  
End Stage

Relationship Between Volume Status and Blood Pressure in Children with End Stage Renal Disease on Chronic Hemodialysis

2007 ◽  
Vol 7 (2) ◽  
pp. 210-215
Author(s):  
Fatina I. Fadel ◽  
Samar M. Sabry ◽  
Azza M.O. Abdel Rahm ◽  
Emad Eldin E. Salama ◽  
Marwa M. El-Sonbaty
Keyword(s):  
Blood Pressure ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Chronic Hemodialysis ◽  
Volume Status ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Phase IIa Study of the Immunogenicity and Safety of the Novel Staphylococcus aureus Vaccine V710 in Adults with End-Stage Renal Disease Receiving Hemodialysis

2012 ◽  
Vol 19 (9) ◽  
pp. 1509-1516 ◽  
Author(s):  
Moustafa Moustafa ◽  
George R. Aronoff ◽  
Chandra Chandran ◽  
Jonathan S. Hartzel ◽  
Steven S. Smugar ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Geometric Mean ◽  
Surface Protein ◽  
Chronic Hemodialysis ◽  
Content Type ◽  
Primary Hypothesis ◽  
Stage Renal Disease ◽  
End Stage

ABSTRACTBacteremia is the second leading cause of death in patients with end-stage renal disease who are on hemodialysis. A vaccine eliciting long-term immune responses againstStaphylococcus aureusin patients on chronic hemodialysis may reduce the incidence of bacteremia and its complications in these patients. V710 is a vaccine containing iron surface determinant B (IsdB), a highly conservedS. aureussurface protein, which has been shown to be immunogenic in healthy subjects. In this blinded phase II immunogenicity study, 206 chronic hemodialysis patients between the ages of 18 and 80 years old were randomized to receive 60 μg V710 (with or without adjuvant), 90 μg V710 (with adjuvant), or a placebo in various combinations on days 1, 28, and 180. All 201 vaccinated patients were to be followed through day 360. The primary hypothesis was that at least 1 of the 3 groups receiving 2 V710 doses on days 1 and 28 would have a ≥2.5 geometric mean fold rise (GMFR) in anti-IsdB IgG titers over the baseline 28 days after the second vaccination (day 56). At day 56, all three groups receiving 2 doses of V710 achieved a ≥2.5 GMFR in anti-IsdB antibodies compared to the baseline (Pvalues of <0.001 for all 3 groups), satisfying the primary immunogenicity hypothesis. None of the 33 reported serious adverse experiences were considered vaccine related by the investigators. V710 induced sustained antibody responses for at least 1 year postvaccination in patients on chronic hemodialysis.

Utilization of Peritoneal Dialysis in the Acute Setting

2007 ◽  
Vol 27 (3) ◽  
pp. 328-331 ◽  
Author(s):  
Daniela Ponce Gabriel ◽  
Juan Fernández-Cean ◽  
André Luis Balbi
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
High Volume ◽  
Infectious Complications ◽  
Chronic Hemodialysis ◽  
Attractive Alternative ◽  
Acute Setting ◽  
Stage Renal Disease ◽  
End Stage

Peritoneal dialysis (PD), although classically described and utilized in the treatment of patients with end-stage renal disease, can also be utilized in the acute setting in different clinical situations. Recent studies showed that, in patients with acute renal failure, it is possible to obtain reasonable dialysis doses with adequate metabolic and electrolytic control and low incidence of complications by utilizing continuous PD through a cycler at high volume. In patients with congestive heart failure without end-stage renal disease, PD is capable of promoting clinical improvement with slow removal of liquids, becoming an attractive alternative for situations of rapidly or slowly worsening cardiac function. In patients submitted to chronic hemodialysis but who have vascular access difficulties, PD can also be utilized as a “bridge,” thereby avoiding the use of central venous catheters, which can be associated with infectious complications such as bacterial endocarditis. New studies must be realized showing other indications for PD.

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