Cardiovascular and non-cardiovascular mortality in dialysis patients: where is the link?

Abstract Background and Aims In dialysis patients, many literatures have shown the association between predialytic hypotension and poor prognosis. Particularly, decrease in diastolic blood pressure (DBP) will be involved myocardial injury because of reduced coronary blood-flow. Such myocardial damage would also be caused by decreased oxygen-supply capacity. Mean corpuscuar hemoglobin-concentration (MCHC) is a hemoglobin concentration per 1% hematocrit (Ht) and could be considered as an indicator of peripheral oxygen-supply. In several literatures, low MCHC had been associated with increased all-cause mortality in non-dialysis patients with congestive heart-failure. In dialysis patients with low Ht between 32 to 35%, low DBP and low MCHC could additively act on myocardial damage. In this study, we examined the relation between the stratified groups by DBP and MCHC and cardiovascular mortality using Yoshikawa clinic dialysis-database (YCD). Method A total of 407 dialysis patients registered in YCD enrolled in this study from April 2006 and on. The cut-off values (COVs) of predialytic DBP and MCHC on cardiovascular death (CVD) were determined from the Receiver Operating Characteristic (ROC) curve. According to these COVs, the whole cohort was divided into 4 groups, group HH (high DBP and high MCHC), group HL (high DBP and low MCHC), group LH (low DBP and high MCHC), and group LL (low DBP and low MCHC). Their survival analysis was estimated by the Kaplan–Meier method, and a log-rank test was used to examine the differences between the survival curves. The prognostic factors for CVD were extracted from background factors, including predialytic DBP, MCHC and above-mentioned grouping, using Cox-regression model. Results In 407 patients, mean predialytic DBP and time-averaged MCHC were 73.3 mmHg and 31.5 % respectively. During observation period of 5.1 years 163 patients died, among that 94 were CVD. The COVs of DBP and MCHC were 79 mmHg and 31.16 %, respectively. According to these COVs, 407 patients were divided into 64 of group HH, 65 of group HL, 171 of group LH and 107 patients of group LL. On the survival curve, the group LL had the highest mortality rate, followed by the group HL. The group HH showed the lowest mortality rate. In multivariate analysis, category variables LL and HL were extracted as prognostic factors for CVD. Their Hazard ratio were 1.960 and 3.863, respectively. Age, intradialytic hypotension, DBP, Kt/V, serum sodium, CRP and blood glucose were extracted as the other prognostic factors. Conclusion These results suggest that low MCHC level would deteriorate prognosis on dialysis patients with predialytic low-DBP. MCHC level could become a new treatment-target in the low DBP group in the future.

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P1166DOES PERITONEAL PROTEIN LOSS AFFECT CARDIOVASCULAR MORTALITY OF PERITONEAL DIALYSIS PATIENTS ?

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1166 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Marios Theodoridis ◽

Stylianos Panagoutsos ◽

Ioannis Neofytou ◽

Konstantia Kantartzi ◽

Efthimia Mourvati ◽

...

Keyword(s):

Regression Analysis ◽

Peritoneal Dialysis ◽

Cardiovascular Mortality ◽

Cox Regression ◽

Dialysis Patients ◽

Protein Loss ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Group A ◽

Group B

Abstract Background and Aims Peritoneal protein loss (PPL) through peritoneal effluent has been a well-recognized detrimental result of peritoneal dialysis (PD). The amount of protein lost will depend on dialysis time, protein size, its serum concentration and other factors including patients’ clinical status. Peritoneal protein loss may be a manifestation of endothelial dysfunction, as with another type of capillary protein leakage, microalbuminuria, a recognized endothelial dysfunction marker. The aim of this study was to retrospectively evaluate the influence of PPL on cardiovascular mortality of peritoneal dialysis patients Method This is a single center retrospective study of 84 PD patients (m=54, f=30) with mean age of 65.2±17 years, mean PD duration of 43.2±24.9 months conducted for the time period from 2006 to 2019 (13 years). The patients were divided into two groups according to the amount of protein excreted during the modified Peritoneal Equilibration Test (PET) procedure using PD solution of 3.86% DW, 2 Lt infusion volume for total time of 4 hours. The total amount of proteins excreted was calculate from PET by multiplying the concentration of proteins at the end of the test with the total volume of PD fluid at the same time. Group A excreted a total amount of proteins < 1.55 gr (median value) at the end of PET test and Group B > 1.55 gr. The cumulative all-cause and cardiovascular survival of the PD patients was calculated by Kaplan Meier while the possible effect of any parameter in survival rates was evaluated by using Cox Regression analysis Results There was not any statistically significant difference between the two groups according to PD duration, age, dialysis adequacy targets, Residual Renal Function(RRF), BMI, ultrafiltration volume during PET and their transport status. The cumulative all-cause survival using Kaplan-Meier analysis revealed no statistically significant deference between the two groups (Log Rank p=0.55) even though mortality risk was adjusted for several factors (Cox Regression). When cardiovascular survival, using Cox Regression analysis, was adjusted for age, sex, Diabetes, PD modality, dialysis Kt/V and RRF we found that Group A (with protein excretion < 1.55 gr) had statistically significant better cardiovascular survival (p=0.029) compared to Group B. We confirm these results while trying to find among the total of our patients the possible risk factors for cardiovascular mortality. Using Cox Regression analysis, the amount of protein excreted during PET procedure and the type of PD solutions (high or low in GDPs) used were statistically significant (p=0.019 and p=0.04 respectively) independent risk factors for cardiovascular survival in our patients. Conclusion These results indicate that protein loss during peritoneal dialysis procedure has negative impact on cardiovascular mortality and survival of PD patients. Additionally, the use of PD solutions with low Glucose Degradation Products (GDPs) and AGEs may improve PD patient’s cardiovascular survival. Randomized interventional studies are encouraged to address the pathological concern of PPL in the future, namely its effects on cardiovascular conditions or its role as marker and effort to reduce PPL using ACE inhibitors or vit D should be considered only if it diminishes cardiovascular morbidity or mortality.

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Blood Pressure and Cardiovascular Mortality in Dialysis Patients With Left Ventricular Systolic Dysfunction

American Journal of Hypertension ◽

10.1093/ajh/hpt190 ◽

2013 ◽

Vol 27 (3) ◽

pp. 401-408 ◽

Cited By ~ 1

Author(s):

A. Losito ◽

L. Del Vecchio ◽

G. Del Rosso ◽

R. Malandra ◽

Keyword(s):

Blood Pressure ◽

Cardiovascular Mortality ◽

Left Ventricular Systolic Dysfunction ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Ventricular Systolic Dysfunction ◽

Dialysis Patients

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B-flow imaging estimation of carotid and femoral atherosclerotic plaques: vessel walls rheological damage or strong predictor of cardiovascular mortality in chronic dialysis patients

International Urology and Nephrology ◽

10.1007/s11255-016-1393-x ◽

2016 ◽

Vol 48 (10) ◽

pp. 1713-1720 ◽

Cited By ~ 3

Author(s):

Petar Avramovski ◽

Maja Avramovska ◽

Aleksandar Sikole

Keyword(s):

Cardiovascular Mortality ◽

Strong Predictor ◽

Chronic Dialysis ◽

Atherosclerotic Plaques ◽

Flow Imaging ◽

Dialysis Patients ◽

Vessel Walls

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Cinacalcet Treatment Significantly Improves All-Cause and Cardiovascular Survival in Dialysis Patients: Results from a Meta-Analysis

Kidney & Blood Pressure Research ◽

10.1159/000504139 ◽

2019 ◽

Vol 44 (6) ◽

pp. 1327-1338 ◽

Cited By ~ 1

Author(s):

Yuan Zu ◽

Xiangxue Lu ◽

Jinghong Song ◽

Ling Yu ◽

Han Li ◽

...

Keyword(s):

Cardiovascular Mortality ◽

Observational Studies ◽

Fixed Effects ◽

Meta Analysis ◽

Controlled Trials ◽

Cochrane Central Register ◽

Fixed Effects Model ◽

Long Term Effects ◽

Dialysis Patients ◽

All Cause Mortality

Objective: To assess the long-term effects including all-cause mortality, cardiovascular mortality, and fracture incidence, of cinacalcet on secondary hyperparathyroidism (SHPT) in patients on dialysis. Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from their inception to October 2018. Randomized controlled trials (RCTs) and cohort design prospective observational studies assessing cinacalcet for the treatment of SHPT in dialysis patients were included. Data extraction was independently completed by 2 authors who determined the methodological quality of the studies and extracted data in duplicate. Study-specific risk estimates were tested by using a fixed effects model. Results: A total of 14 articles with 38,219 participants were included, of which 10 RCTs with 7,471 participants and 4 prospective observational studies with 30,748 participants fulfilled the eligibility criteria. Compared with no cinacalcet, cinacalcet administration reduced all-cause mortality (relative risk [RR] 0.91, 95% CI 0.89–0.94, p < 0.001) and cardiovascular mortality (RR 0.92, 95% CI 0.89–0.95, p < 0.001), but it did not significantly reduce the incidence of fractures (RR 0.93, 95% CI 0.87–1.00, p = 0.05). Conclusions: The results of this meta-analysis indicated that the treatment of SHPT with cinacalcet may in fact reduce all-cause mortality and cardiovascular mortality among patients receiving maintenance dialysis.

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