High incidence of left atrial appendage thrombus in end-stage renal disease patients receiving maintenance hemodialysis

Abstract Background and Aims Neutrophil/Lymphocyte Ratio (NLR) and Platelet/Lymphocyte Ratio (PLR) are closely associated with increased inflammation in end-stage renal disease, which often contributes to the severity of anemia in these patients. Erythropoiesis stimulating agents (ESA) have become a standard treatment of anemia in hemodialysis patients. Since some patients do not respond well to erythropoietin therapy (EPO) the aim of this study is to investigate if NLR and PLR as markers of increased inflammation, could be associated with resistance to EPO therapy. Method A total of 90 patients (36 females, 54 males; mean age 60,45 ±11,58) undergoing maintenance hemodialysis and who received recombinant human EPO therapy were examined. Patients' clinical characteristics, laboratory data, dialysis adequacy and the applied doses os EPO were examined in a period of 3 months. EPO hyporesponsiveness index (EHRI) was calculated as the weekly dose of EPO divided by kilograms of body weight divided by the hemoglobin level. Results Obtained results show a statistically significant correlation of moderate-intensity between EHRI and NLR ( r = 0.497, p < 0.01) as well as a negative correlation of moderate-intensity between EHRI and hemoglobin levels (Hgb) (r = -0.403, p < 0.01). When it comes to the connection of NLR and PLR with logarithmically converted EHRI values, the results show that there is no statistically significant correlation between NLR and EHRI. Comparison of PLR among 25th, 50th and 75th percentile of EHRI showed that PLR levels increased going from the 25th towards the 75th percentile (p < 0.01). Post hoc analysis indicated that there is also a statistically strong connection for the 25th i 50th percentile (<0 .05) and furthermore for the 50th and 75th percentile (< 0.05). Conclusion PLR was found to be superior to NLR in terms of evaluating ESA therapy resistance. PLR could be used as a predictor of ESA therapy response.

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Acute Intradialytic Complications in End Stage Renal Disease on Maintenance Hemodialysis

Journal of Nepal Medical Association ◽

10.31729/jnma.358 ◽

2012 ◽

Vol 52 (187) ◽

Author(s):

R K Agrawal ◽

S Khakurel ◽

R Hada ◽

D Shrestha ◽

A Baral

Keyword(s):

Renal Failure ◽

Renal Disease ◽

End Stage Renal Disease ◽

Tertiary Care ◽

Cross Sectional Study ◽

Maintenance Hemodialysis ◽

Care Hospital ◽

Cross Sectional ◽

Stage Renal Disease ◽

End Stage

Introduction: Hemodialysis is the preferred method of treatment for Nepalese patients with End Stage Renal Disease. Despite the technological advances and better understanding of physiology associated with hemodialysis, a number of complications are known to be associated with hemodialysis. This study was undertaken to study the frequency of acute intradialytic complications in patients undergoing hemodialysis. Methods: A cross-sectional study was conducted at Nephrology unit of a tertiary care hospital from 15 June, 2007 to 15 December, 2007. A total of 28 patients were included in the study. Patients with acute renal failure and acute on chronic renal failure were excluded from the study. Results: Total sessions of hemodialysis during the period were 1455. Hypotensive episode were 66 (4.5%) and was the commonest complication and followed by hypertensive episodes were 58 (3.8%). Other problems encountered were transfusion reactions were 23 episodes (1.5%), rigors not related to transfusions were 13 episodes (0.8%), nausea/vomiting were 20 episodes (1.4%), muscle cramps were 12 episodes (0.8%), hypoglycemia were 6 episodes 5(0.4%). Conclusions: The frequency of intradialytic complications is low and many of them are not life threatening. Keywords: complications; end stage renal disease; hemodialysis; hypertension; hypotension.

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