The impact of hyporesponsiveness to erythropoietin-stimulating agents on time-dependent mortality risk among CKD stage 5D patients: a single-center cohort study

Abstract Background and Aims Hyperkalemia (HK) is a common and dangerous complication of CKD because of impaired kidneýs ability for potassium elimination. On the other hand, HK is a common complication of extremely beneficial therapeutic agents acting on the renin–angiotensin–aldosterone system (RAAS). Its initiation at early CKD stages is even more benefic but HK could lead to stop it. We wonder if there is a possible relation between HK, therapeutic changes in RAAS inhibition (not initiating or stopping it) and mortality. Our goal was to investigate incidence, prevalence and clinical outcomes of at least one episode of HK in a CKD population outpatient setting. Additionally, we investigated the association of HK with changes in RAAS inhibition and mortality risk. Method We conducted a patient-level, retrospective, cohort analysis of all adult patients referred to a nephrology clinic over a 6 years period. We included CKD stage 3 patients with at least 24 months of follow up and three or more serum potassium determinations. The prevalence of HK (blood potassium level ≥ 5,5mmol/L) at first consultation and incidence during follow up were accessed. Patients were spited in two groups prior to analysis: A) Patients without any HK episode and B) Patients with at least one HK episode. Baseline and follow up covariates included demographics, comorbid conditions, laboratory values, HK-associated drugs [ACEis, ARBs, potassium-sparing diuretics and diuretics]. The impact of HK and therapeutic changes on mortality was evaluated through a logistic regression. Results Out of the 3008 patients referred to the nephrology clinic, 575 (19.1%) met the inclusion criteria (mean age: 70.4 years; 63.7% male and 94.0% caucasians). Mean follow-up was 4.1±1.8 years. Important cardiovascular comorbidities included hypertension (HTN) (90.3%); overweigh (67.4%), DM (49.0%) and Heart Failure (31.4%). CKD stage progression was present in 122 (21.2%). The prevalence of HK at first consultation was 8.7% and follow up incidence 21.7%. From this cohort, 164 (28.5%) had at least on episode of HK (Group B) and 101 (17.6%) died. During the follow up, RAAS inhibition drugs was removed or not started in 200 (34.8%) patients and diuretic was initiated in 165 (28.7%). In univariate analysis, at least one HK episode was associated with Diabetes (65.9 vs 42.3%, p<0.001), Heart failure (36.6 vs 28.0%, p=0.007), Macroalbuminuria (34.1 vs 21.2%, p=0.001), CKD progression (33.5 vs 16.3. p<0.001) higher frequency of diuretic initiation (38.4 vs 24.8%, p<0.001) and higher mortality (27.6 vs 13.7%, p<0.001). In multivariate logistic regression analysis, the independent predictors of mortality were: At least one HK episode (OR 1.82, 95% CI 1.08-3.04, p=0.02); Heart Failure (OR 1.97, 95% CI 1.16-3.35, p=0.01); Older age (OR per 1 year increase 1.04, 95% CI 1.02-1.07, p=0.001); CKD progression (OR 4.18, 95% CI 2.43-7.19, p<0.001). Predictors of lower mortality risk were: Patients who maintained RAAS inhibition during follow up (OR 0.50, 95% CI 0.26-0.96, p=0.03); Patients who started RAAS inhibition during follow up (OR 0.38, 95% CI 0.16-0.88, p=0.02). Conclusion Our study confirms that RAAS inhibition had a protector and independent impact in mortality when prescribed in CKD early stages. On the other hand, patients with at least one episode of HK have a higher risk of mortality. All efforts should be made to maintain these therapeutic agents, looking for other ways to control hyperkalemia rather than stop it.

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Diagnostic usefulness of bone mineral density and biochemical markers of bone turnover in predicting fracture in CKD stage 5D patients--a single-center cohort study

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfr317 ◽

2011 ◽

Vol 27 (1) ◽

pp. 345-351 ◽

Cited By ~ 171

Author(s):

S. Iimori ◽

Y. Mori ◽

W. Akita ◽

T. Kuyama ◽

S. Takada ◽

...

Keyword(s):

Bone Mineral Density ◽

Cohort Study ◽

Bone Turnover ◽

Bone Mineral ◽

Biochemical Markers ◽

Single Center ◽

Mineral Density ◽

Markers Of Bone Turnover ◽

Ckd Stage ◽

Diagnostic Usefulness

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Three-month functional outcomes following endovascular thrombectomy during the first wave of the COVID-19 pandemic: a Canadian single-center cohort study

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017664 ◽

2021 ◽

pp. neurintsurg-2021-017664

Author(s):

Joel Neves Briard ◽

Gabrielle Dufort ◽

Grégory Jacquin ◽

Walid Alesefir ◽

Olena Bereznyakova ◽

...

Keyword(s):

Cohort Study ◽

Acute Stroke ◽

Functional Status ◽

Functional Outcomes ◽

High Volume ◽

Stroke Care ◽

Single Center ◽

Acute Stroke Care ◽

Baseline Characteristics ◽

The Impact

BackgroundThe COVID-19 pandemic has disrupted acute stroke care logistics, including delays in hyperacute management and decreased monitoring following endovascular therapy (EVT). We aimed to assess the impact of the pandemic on 90-day functional outcome among patients treated with EVT.MethodsThis is an observational cohort study including all patients evaluated for an acute stroke between March 30, 2020 and September 30, 2020 (pandemic cohort) and 2019 (reference cohort) in a high-volume Canadian academic stroke center. We collected baseline characteristics, acute reperfusion treatment and management metrics. For EVT-treated patients, we assessed the modified Rankin score (mRS) at 90 days. We evaluated the impact of the pandemic on a 90-day favourable functional status (defined as mRS 0–2) and death using multivariable logistic regressions.ResultsAmong 383 and 339 patients included in the pandemic and reference cohorts, baseline characteristics were similar. Delays from symptom onset to evaluation and in-house treatment were longer during the early first wave, but returned to reference values in the subsequent months. Among the 127 and 136 EVT-treated patients in each respective cohort, favourable 90-day outcome occurred in 53/99 (53%) vs 52/109 (48%, p=0.40), whereas 22/99 (22%) and 28/109 (26%, p=0.56) patients died. In multivariable regressions, the pandemic period was not associated with 90-day favourable functional status (aOR 1.27, 95% CI 0.60 to 2.56) or death (aOR 0.74, 95% CI 0.33 to 1.63).ConclusionIn this single-center cohort study conducted in a Canadian pandemic epicenter, the first 6 months of the COVID-19 pandemic did not impact 90-day functional outcomes or death among EVT-treated patients.

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Trajectories of Serum Sodium on In-Hospital and 1-Year Survival among Hospitalized Patients

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.12281019 ◽

2020 ◽

Vol 15 (5) ◽

pp. 600-607 ◽

Cited By ~ 4

Author(s):

Api Chewcharat ◽

Charat Thongprayoon ◽

Wisit Cheungpasitporn ◽

Michael A. Mao ◽

Sorkko Thirunavukkarasu ◽

...

Keyword(s):

Cohort Study ◽

Hospital Mortality ◽

Mortality Risk ◽

Serum Sodium ◽

Odds Ratio ◽

Reference Group ◽

High Serum ◽

Single Center ◽

Outcome Comparison ◽

One Year

Background and objectivesThis study aimed to investigate the association between in-hospital trajectories of serum sodium and risk of in-hospital and 1-year mortality in patients in hospital.Design, setting, participants, & measurementsThis is a single-center cohort study. All adult patients who were hospitalized from years 2011 through 2013 who had available admission serum sodium and at least three serum sodium measurements during hospitalization were included. The trend of serum sodium during hospitalization was analyzed using group-based trajectory modeling; the five main trajectories were grouped as follows: (1) stable normonatremia, (2) uncorrected hyponatremia, (3) borderline high serum sodium, (4) corrected hyponatremia, and (5) fluctuating serum sodium. The outcome of interest was in-hospital mortality and 1-year mortality. Stable normonatremia was used as the reference group for outcome comparison.ResultsA total of 43,539 patients were analyzed. Of these, 47% had stable normonatremia, 15% had uncorrected hyponatremia, 31% had borderline high serum sodium, 3% had corrected hyponatremia, and 5% had fluctuating serum sodium trajectory. In adjusted analysis, there was a higher in-hospital mortality among those with uncorrected hyponatremia (odds ratio [OR], 1.33; 95% CI, 1.06 to 1.67), borderline high serum sodium (OR, 1.66; 95% CI, 1.38 to 2.00), corrected hyponatremia (OR, 1.50; 95% CI, 1.02 to 2.20), and fluctuating serum sodium (OR, 4.61; 95% CI, 3.61 to 5.88), compared with those with the normonatremia trajectory. One-year mortality was higher among those with uncorrected hyponatremia (hazard ratio [HR], 1.28; 95% CI, 1.19 to 1.38), borderline high serum sodium (HR, 1.18; 95% CI, 1.11 to 1.26), corrected hyponatremia (HR, 1.24; 95% CI, 1.08 to 1.42), and fluctuating serum sodium (HR, 2.10; 95% CI, 1.89 to 2.33) compared with those with the normonatremia trajectory.ConclusionsMore than half of patients who had been hospitalized had an abnormal serum sodium trajectory during hospitalization. This study demonstrated that not only the absolute serum sodium levels but also their in-hospital trajectories were significantly associated with in-hospital and 1-year mortality. The highest in-hospital and 1-year mortality risk was associated with the fluctuating serum sodium trajectory.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_03_25_CJN.12281019.mp3

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Hyponatremia and mortality risk: a Danish cohort study of 279 508 acutely hospitalized patients

Acta Endocrinologica ◽

10.1530/eje-15-0111 ◽

2015 ◽

Vol 173 (1) ◽

pp. 71-81 ◽

Cited By ~ 56

Author(s):

Louise Holland-Bill ◽

Christian Fynbo Christiansen ◽

Uffe Heide-Jørgensen ◽

Sinna Pilgaard Ulrichsen ◽

Troels Ring ◽

...

Keyword(s):

Internal Medicine ◽

Cohort Study ◽

Mortality Risk ◽

Serum Sodium ◽

Survival Function ◽

Underlying Disease ◽

Population Based ◽

Continuous Variable ◽

Probability Of Death ◽

The Impact

ObjectiveWe aimed to investigate the impact of hyponatremia severity on mortality risk and assess any evidence of a dose–response relation, utilizing prospectively collected data from population-based registries.DesignCohort study of 279 508 first-time acute admissions to Departments of Internal Medicine in the North and Central Denmark Regions from 2006 to 2011.MethodsWe used the Kaplan–Meier method (1 – survival function) to compute 30-day and 1-year mortality in patients with normonatremia and categories of increasing hyponatremia severity. Relative risks (RRs) with 95% CIs, adjusted for age, gender and previous morbidities, and stratified by clinical subgroups were estimated by the pseudo-value approach. The probability of death was estimated treating serum sodium as a continuous variable.ResultsThe prevalence of admission hyponatremia was 15% (41 803 patients). Thirty-day mortality was 3.6% in normonatremic patients compared to 7.3, 10.0, 10.4 and 9.6% in patients with serum sodium levels of 130–134.9, 125–129.9, 120–124.9 and <120 mmol/l, resulting in adjusted RRs of 1.4 (95% CI: 1.3–1.4), 1.7 (95% CI: 1.6–1.8), 1.7 (95% CI: 1.4–1.9) and 1.3 (95% CI: 1.1–1.5) respectively. Mortality risk was increased across virtually all clinical subgroups, and remained increased by 30–40% 1 year after admission. The probability of death increased when serum sodium decreased from 139 to 132 mmol/l. No clear increase in mortality was observed for lower concentrations.ConclusionsHyponatremia is highly prevalent among patients admitted to Departments of Internal Medicine and is associated with increased 30-day and 1-year mortality risk, regardless of underlying disease. This risk seems independent of hyponatremia severity.

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