Hyperkalemia excursions and risk of mortality and hospitalizations in hemodialysis patients: results from DOPPS-Italy

AbstractWomen have a longer life expectancy than men in the general population. However, it has remained unclear whether this advantage is maintained in patients undergoing maintenance hemodialysis. The aim of this study was to compare the risk of mortality, especially infection-related mortality, between male and female hemodialysis patients. A total of 3065 Japanese hemodialysis patients aged ≥ 18 years old were followed up for 10 years. The primary outcomes were all-cause and infection-related mortality. The associations between sex and these outcomes were examined using Cox proportional hazards models. During the median follow-up of 8.8 years, 1498 patients died of any cause, 387 of whom died of infection. Compared with men, the multivariable-adjusted hazard ratios (95% confidence interval) for all-cause and infection-related mortality in women were 0.51 (0.45–0.58, P < 0.05) and 0.36 (0.27–0.47, P < 0.05), respectively. These findings remained significant even when propensity score-matching or inverse probability of treatment weighting adjustment methods were employed. Furthermore, even when the non-infection-related mortality was considered a competing risk, the infection-related mortality rate in women was still significantly lower than that in men. Regarding all-cause and infection-related deaths, women have a survival advantage compared with men among Japanese patients undergoing maintenance hemodialysis.

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The Impact of Comorbidity Burden on The Association between Vascular Access Type and Clinical Outcomes among Elderly Patients Undergoing Hemodialysis

Scientific Reports ◽

10.1038/s41598-019-54191-1 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Jong Hyun Jhee ◽

Seun Deuk Hwang ◽

Joon Ho Song ◽

Seoung Woo Lee

Keyword(s):

Vascular Access ◽

Survival Rates ◽

Hemodialysis Patients ◽

Korean Society ◽

Hospitalization Rates ◽

Risk Of Mortality ◽

Increased Risk ◽

Comorbidity Burden ◽

The Impact ◽

Elderly Hemodialysis Patients

AbstractThe optimal vascular access type for elderly hemodialysis patients is controversial. We evaluated the impact of comorbidity burden on the association between vascular access type and mortality risk among 23,100 hemodialysis patients aged ≥65 years from the Korean Society of Nephrology End-Stage Renal Disease registry data. Subjects were stratified into tertiles according to the simplified Charlson comorbidity index (sCCI), and the survival and hospitalization rates were compared with respect to vascular access type: arteriovenous fistula (AVF), arteriovenous graft (AVG), and central venous catheter (CVC). Among all tertiles of sCCI, CVC use showed highest risk of mortality than AVF use. In the lowest to middle tertile, no difference was observed in survival rates between the use of AVF and AVG. However, in the highest tertile, AVG use showed higher risk of mortality than AVF use. When subjects were classified according to a combination of sCCI tertile and access type (AVF vs. AVG), patients with the highest CCI with AVG showed 1.75-folded increased risk of mortality than those with the lowest sCCI with AVF. Hospitalization rates due to access malfunction were highest in patients with CVC in all sCCI tertiles. In the highest tertile, patients with AVG showed increased rates of hospitalization compared to those with AVF due to access malfunction. However, hospitalization rates due to access infection were highest in patients with AVG in all tertiles. The use of AVF may be of benefit and switching to AVF should be considered in elderly hemodialysis patients with a high burden of comorbidity.

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SP763ROMA ETNICITY AND HIGH RISK OF MORTALITY AT YOUNG AGES IN HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfv200.82 ◽

2015 ◽

Vol 30 (suppl_3) ◽

pp. iii629-iii629

Author(s):

Florica Gadalean ◽

Oana Schiller ◽

Bogdan Timar ◽

Flaviu Bob ◽

Emilia Barzuca ◽

...

Keyword(s):

High Risk ◽

Hemodialysis Patients ◽

Risk Of Mortality

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Effect of exercise based renal rehabilitation training in improving the quality and exercise capacity in haemodialysis patients - A systematic review

Medpusle International Journal of Medicine ◽

10.26611/102119313 ◽

2021 ◽

Vol 19 (3) ◽

pp. 144-149

Author(s):

Muralidharan C K ◽

Keyword(s):

Quality Of Life ◽

Exercise Capacity ◽

Aerobic Capacity ◽

Functional Disability ◽

Disease Patient ◽

Hemodialysis Patients ◽

Rehabilitation Training ◽

Risk Of Mortality ◽

Therapeutic Exercises

Background: The end-stage renal disease patient receives hemodialysis. The objective was to provide physical therapy interventions to the patients receiving hemodialysis. This study aimed to briefly review the evaluation and exercise based renal rehabilitation training in hemodialysis patients. Methods: In this study, the library research method was used, which took online and offline data sources referring to book, journals and articles related to the topic evaluation and exercise based renal rehabilitation training in hemodialysis patients as a data source to answer the research objective. Results: Some researchers commonly assess the risk of mortality, kidney and physical functioning, aerobic capacity, exercise capacity, vo2 max, blood pressure and quality of life. As a regular treatment some authors suggest that general therapeutic exercises helps to release the risk of mortality and improve the exercise capacity and quality of life in hemodialysis patients. Conclusion: Physiotherapist can evaluate the hemodialysis patients based on their complaints like decreasing aerobic capacity, exercise capacity and functional disability. Physiotherapist can use any methods of therapeutic exercise to improve the exercise capacity and quality of life in hemodialysis patient. The study has designed a structured exercise program for hemodialysis patients in improving the exercise capacity and quality of life.

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Association between Serum Soluble Klotho Levels and Mortality in Chronic Hemodialysis Patients

International Journal of Endocrinology ◽

10.1155/2015/406269 ◽

2015 ◽

Vol 2015 ◽

pp. 1-10 ◽

Cited By ~ 21

Author(s):

Naoko Otani-Takei ◽

Takahiro Masuda ◽

Tetsu Akimoto ◽

Sumiko Honma ◽

Yuko Watanabe ◽

...

Keyword(s):

Transmembrane Protein ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Soluble Form ◽

Ectodomain Shedding ◽

Dialysis Patients ◽

Complex Phenotypes ◽

Risk Of Mortality ◽

All Cause Mortality ◽

The Relationship

Klotho is a single-pass transmembrane protein predominantly expressed in the kidney. The extracellular domain of Klotho is subject to ectodomain shedding and is released into the circulation as a soluble form. Soluble Klotho is also generated from alternative splicing of theKlothogene. In mice, defects in Klotho expression lead to complex phenotypes resembling those observed in dialysis patients. However, the relationship between the level of serum soluble Klotho and overall survival in hemodialysis patients, who exhibit a state of Klotho deficiency, remains to be delineated. Here we prospectively followed a cohort of 63 patients with a mean duration of chronic hemodialysis of6.7±5.4years for a median of 65 months. Serum soluble Klotho was detectable in all patients (median 371 pg/mL, interquartile range 309–449). Patients with serum soluble Klotho levels below the lower quartile (<309 pg/mL) had significantly higher cardiovascular and all-cause mortality rates. Furthermore, the higher all-cause mortality persisted even after adjustment for confounders (hazard ratio 4.14, confidence interval 1.29–13.48). We conclude that there may be a threshold for the serum soluble Klotho level associated with a higher risk of mortality.

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