Optimal blood pressure for the minimum all-cause mortality in Chinese ESRD patients on maintenance hemodialysis

Abstract Blood pressure (BP) is a known prognostic marker for mortality in patients on maintenance hemodialysis (MHD). However, definition of the BP and its optimal values vary essentially among different MHD populations. Our purpose was to clarify these important clinical parameters in a Chinese MHD cohort. Accordingly, we reviewed the available records of patients on regular MHD during the past 10 years and made a comparison between the deceased (n=81) and survival ones (n=131). Multiple logistic regression and Kaplan–Meier survival analysis were used to examine the effect of BP on mortality and long-term survival, respectively. The all-cause mortality in our patients was 38.2%, in which 49.4% was from cardio-cerebrovascular deaths. Using the multiple logistic regression, we found that the sitting (the same definition hereafter) pre-dialysis systolic BP (SBP) was significantly associated with both the all-cause mortality and cardio-cerebrovascular deaths exclusively in patients of 60–80 years. Moreover, a pre-dialysis SBP of 140–160 mmHg in these patients had the minimum all-cause mortality (23.5%) against that conferred by either a lower (42.1%) or higher SBP value (61.5%). This observation was further confirmed by the Kaplan–Meier survival analysis. As fresh gain to the practice of hemodialysis, our report revealed that BP worked in a time-dependent way among a Chinese MHD cohort and highlighted a U-shaped association between the pre-dialysis SBP and all-cause mortality. These findings may hence help to obtain optimal BP control for better survival and lend some prognostic insight into mortality in these MHD patients.

Download Full-text

Individualized Hemodialysis Treatment: A Perspective on Residual Kidney Function and Precision Medicine in Nephrology

Cardiorenal Medicine ◽

10.1159/000494808 ◽

2018 ◽

Vol 9 (2) ◽

pp. 69-82 ◽

Cited By ~ 4

Author(s):

Inkyong Hur ◽

Yong Kyu Lee ◽

Kamyar Kalantar-Zadeh ◽

Yoshitsugu Obi

Keyword(s):

Blood Pressure ◽

Precision Medicine ◽

Kidney Function ◽

Hemodialysis Patients ◽

Maintenance Hemodialysis ◽

Clinical Aspects ◽

Patient Centeredness ◽

Mineral And Bone Disorder ◽

Term Survival ◽

Residual Kidney Function

Background: Residual kidney function (RKF) is often expected to inevitably and rapidly decline among hemodialysis patients and, hence, has been inadvertently ignored in clinical practice. The importance of RKF has been revisited in some recent studies. Given that patients with end-stage renal disease now tend to initiate maintenance hemodialysis therapy with higher RKF levels, there seem to be important opportunities for incremental hemodialysis by individualizing the dose and frequency according to their RKF levels. This approach is realigned with precision medicine and patient-centeredness. Summary: In this article, we first review the available methods to estimate RKF among hemodialysis patients. We then discuss the importance of maintaining and monitoring RKF levels based on a variety of clinical aspects, including volume overload, blood pressure control, mineral and bone metabolism, nutrition, and patient survival. We also review several potential measures to protect RKF: the use of high-flux and biocompatible membranes, the use of ultrapure dialysate, the incorporation of hemodiafiltration, incremental hemodialysis, and a low-protein diet, as well as general care such as avoiding nephrotoxic events, maintaining appropriate blood pressure, and better control of mineral and bone disorder parameters. Key Message: Individualized hemodialysis regimens may maintain RKF, lead to a better quality of life without compromising long-term survival, and ensure precision medicine and patient-centeredness in nephrology practice.

Download Full-text

Abstract P128: Serum Lipid Levels at Adolescence can Predict Adult Dyslipidemia in South Korea - The Kangwha Study

Circulation ◽

10.1161/circ.135.suppl_1.p128 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Jung H Lee ◽

Hyeon C Kim ◽

Dae R Kang ◽

Il Suh

Keyword(s):

Blood Pressure ◽

Body Mass Index ◽

Logistic Regression ◽

South Korea ◽

Lipid Profile ◽

Total Cholesterol ◽

Serum Lipid ◽

Hdl Cholesterol ◽

Multiple Logistic Regression ◽

Auc Value

Introduction: Several studies have examined tracking pattern of lipid profile level during long follow-up periods in Western countries. However, there have been few such studies in East Asia. Hypothesis: We assessed the hypothesis that there exists tracking pattern of lipid profile level from adolescence to adulthood, and lipid measurements in adolescence can predict adult dyslipidemia in South Korea. Methods: The Kangwha Study was a community-based prospective cohort study that started in 1986 in Kangwha County, South Korea . A total of 400 participants (54% women) whose serum total cholesterol, triglyceride, and high density lipoprotein (HDL) cholesterol level were measured at least once during adolescence (1992-1996), and repeatedly measured at least once during adulthood (2005-2015) were enrolled in our study. Body mass index, waist circumstance, and blood pressure were measured at all measurements. Family history of cardiovascular disease, smoking history, and presence of adult dyslipidemia were checked at adulthood. The tracking pattern of lipid profile level was determined by tracking coefficients (low: <0.30; moderate: 0.30-0.59; moderately high: 0.60-0.89; high: ≥0.90). The tracking coefficients were calculated by Generalized Estimating Equation. The predictability of adult dyslipidemia was assessed by multiple logistic regression and area under curve (AUC) value. Additional analyses were performed to find out whether repeated lipid measurements during adolescence can enhance the predictability of adult dyslipidemia or not. Results: The presence of adult dyslipidemia was 26.3% (105 of 400). Mean age of study participants at enrollment is 13.8 years (SD, 1.6 years), and that at adulthood is 30.1 years (SD, 3.7 years). When adjusted for age, body mass index, waist circumstance, and blood pressure, the tracking coefficient of total cholesterol was 0.59 (95% confidence interval (CI), 0.54-0.63), that of triglyceride was 0.39 (95% CI, 0.28-0.49), and that of HDL cholesterol was 0.51 (95% CI, 0.46-0.55). The AUC value of our multiple logistic regression model on adult dyslipidemia without lipid profile levels at adolescence was 0.77 (95% CI, 0.72-0.83), and that with lipid profile levels at adolescence was 0.80 (95% CI, 0.75-0.85). P value for AUC comparison was significant (p=0.02). In additional analyses, using the average lipid profile levels in multiple lipid measurements at adolescence did not significantly improve the AUC value (p>0.09). Conclusion: In conclusion, moderate tracking patterns of serum lipid profile level were shown in this study. Serum lipid profile measurements at adolescence could help the prediction of adult dyslipidemia. The results of this study supported the need of lipid profile screening at adolescence.

Download Full-text

Relationship between obesity indices and hypertension among middle-aged and elderly populations in Taiwan: a community-based, cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2019-031660 ◽

2019 ◽

Vol 9 (10) ◽

pp. e031660 ◽

Cited By ~ 1

Author(s):

Yen-An Lin ◽

Ying-Jen Chen ◽

Yu-Chung Tsao ◽

Wei-Chung Yeh ◽

Wen-Cheng Li ◽

...

Keyword(s):

Blood Pressure ◽

Logistic Regression ◽

Cross Sectional Study ◽

Multiple Logistic Regression ◽

Sectional Study ◽

Community Based ◽

Cross Sectional ◽

Elderly Populations ◽

Obesity Indices ◽

Northern Taiwan

ObjectiveObesity and hypertension (HTN) have become increasingly prevalent in Taiwan. People with obesity are more likely to have HTN. In this study, we evaluated several anthropometric measurements for the prediction of HTN in middle-aged and elderly populations in Taiwan.DesignCross-sectional observational study.SettingCommunity-based investigation in Guishan Township of northern Taiwan.ParticipantsA total of 396 people were recruited from a northern Taiwan community for a cross-sectional study. Anthropometrics and blood pressure were measured at the annual health exam. The obesity indices included body mass index (BMI), body fat (BF) percentage and waist circumference (WC).Outcome measuresStatistical analyses, including Pearson’s correlation, multiple logistic regression and the area under ROC curves (AUCs) between HTN and anthropometric measurements, were used in this study.ResultsOf the 396 people recruited, 200 had HTN. The age-adjusted Pearson’s coefficients of BMI, BF percentage and WC were 0.23 (p<0.001), 0.14 (p=0.01) and 0.26 (p<0.001), respectively. Multiple logistic regression of the HTN-related obesity indices showed that the ORs of BMI, BF percentage and WC were 1.15 (95% CI 1.08 to 1.23, p<0.001), 1.07 (95% CI 1.03 to 1.11, p<0.001) and 1.06 (95% CI 1.03 to 1.08, p<0.001), respectively. The AUCs of BMI, BF percentage and WC were 0.626 (95% CI 0.572 to 0.681, p<0.001), 0.556 (95% CI 0.500 to 0.613, p=0.052) and 0.640 (95% CI 0.586 to 0.694, p<0.001), respectively.ConclusionsWC is a more reliable predictor of HTN than BMI or BF percentage. The effect of abdominal fat distribution on blood pressure is greater than that of total BF amount.

Download Full-text

O10 Effect of hemodialysis dose (spKt/V) on survival in patients on maintenance hemodialysis since childhood – a retrospective analysis

Archives of Disease in Childhood ◽

10.1136/archdischild-2019-esdppp.10 ◽

2019 ◽

Vol 104 (6) ◽

pp. e4.3-e5

Author(s):

V Gotta ◽

A Atkinson ◽

O Marsenic ◽

M Pfister

Keyword(s):

Retrospective Analysis ◽

Rank Test ◽

Maintenance Hemodialysis ◽

Nephrol Dial Transplant ◽

List Type ◽

Dialysis Dose ◽

Term Survival ◽

Kaplan Meier ◽

Urea Distribution Volume

BackgroundHemodialysis (HD) prescription significantly differs between pediatric and adult patients on maintenance HD, resulting in greater difference between prescribed and delivered HD dose.1,2 HD dose targets have formally not been evaluated for children, hence targets are mainly derived from adults (spKt/V >1.4; sp: single-pool model of urea distribution, K: urea clearance, t: duration of HD session, V: urea distribution volume). This analysis aimed to evaluate the relationship between delivered dialysis dose and survival in a large cohort of patients having started HD therapy in childhood.MethodsThis retrospective analysis included a cohort of patients < 30 years (y) on chronic HD treatment since childhood, having received thrice-weekly HD between 2004 and 2016 in outpatient DaVita dialysis centers. Survival while on HD (death from any cause) was investigated using Kaplan-Meier analysis stratified by age at start of HD (0–2, >2–6, >6–12, and >12–18 y), and three mean delivered dialysis dose levels (spKt/V < 1.4, 1.4–1.6, >1.6). Survival curves between subgroups were compared using the Log-rank test.Results1773 patients were included in the analysis, among n=34 having started HD at age of 0–2y, n=57 at >2–6y, n=244 at >6–12y, and n=1438 at >12–18y. Median follow-up on HD ranged between 1.5 (>2–6y) to 4.7 years (>6–12y) with maximal follow-up of 23 years. Death while on HD occurred in 1/34, 6/57, 26/244, and 101/1438 patients during recorded follow-up (p=0.075, n.s.). Patients with mean spKt/V < 1.4 had lower survival on HD than those with spKt/V >1.4–1.6 (p=0.019) and those with spKt/V >1.6 (p=0.035), with 10-year survival estimated to 75% (65.2–86.2%) versus 84.5% (78.5–90.9%) and 85.0% (80.8–89.5%), respectively.ConclusionsThis is the first study to report long term survival and its relationship with delivered HD dose in patients starting HD in childhood. Our results support targeting spKt/V(urea)>1.4 in children on chronic HD treatment.ReferencesGotta V, Marsenic O, Pfister M. Age- and weight-based differences in haemodialysis prescription and delivery in children, adolescents and young adults. Nephrol Dial Transplant 2018 Apr 18.Gotta V, Marsenic O, Pfister M. Understanding urea kinetic factors that enhance personalized hemodialysis prescription in children. ASAIO J 2019 Jan 14.Disclosure(s)M Pfister is a consultant at Quantitative Solutions a Certara Company. V Gotta has been supported for this project by the Research Fund for Junior Researchers, University of Basel, Switzerland. O Marsenic and A Atkinson declare no financial conflict of interest.

Download Full-text

Impact of Transferrin Saturation on All-Cause Mortality in Patients on Maintenance Hemodialysis

Blood Purification ◽

10.1159/000499758 ◽

2019 ◽

Vol 48 (2) ◽

pp. 158-166

Author(s):

Madoka Sato ◽

Norio Hanafusa ◽

Ken Tsuchiya ◽

Hiroshi Kawaguchi ◽

Kosaku Nitta

Keyword(s):

Mortality Rate ◽

Reference Group ◽

Binding Capacity ◽

Iron Status ◽

Transferrin Saturation ◽

Japanese Patients ◽

Maintenance Hemodialysis ◽

Kaplan Meier ◽

Significant Independent Risk Factor ◽

All Cause Mortality

Background: Transferrin saturation (TSAT) is an index that represents the iron-binding capacity of transferrin, which is the main transport protein for iron, and is widely used to evaluate iron status. Objective: To evaluate the prognostic importance of TSAT in Japanese patients on maintenance hemodialysis (MHD). Methods: A total of 398 patients on MHD were recruited and divided into 3 groups on the basis of their baseline TSAT levels (<20, 20–40, and >40%). Results: There was no difference in the proportion of patients on erythropoiesis-stimulating agents or iron supplements between the 3 groups. During a mean follow-up period of 52.2 ± 1 6.3 months, 130 patients died of cardiovascular causes (n = 63, 15.8%) or infection (n = 47, 11.8%). Compared with the reference group (TSAT 20–40%), patients with a TSAT <20% had a significantly higher all-cause mortality rate (6.44 vs. 9.55 events per 100 patient-years, p = 0.0452). Kaplan-Meier analysis showed that all-cause mortality rate was significantly higher in patients with TSAT <20% than in the other 2 groups (p = 0.0353). Conclusions: Low TSAT was a significant independent risk factor for all-cause mortality in a cohort of Japanese patients on MHD. The findings of this study suggest that the adverse clinical outcomes in patients with low TSAT can be partly attributed to infection-related iron deficiency.

Download Full-text

Characteristics and Survival of 29 Patients with Sezary Syndrome.

Blood ◽

10.1182/blood.v106.11.5587.5587 ◽

2005 ◽

Vol 106 (11) ◽

pp. 5587-5587

Author(s):

Francesca Sampogna ◽

Marina Frontani ◽

Giannandrea Baliva ◽

Damiano Abeni ◽

Giuseppe A. Lombardo ◽

...

Keyword(s):

Survival Analysis ◽

Survival Time ◽

White Blood Cells ◽

Clinical History ◽

Sézary Syndrome ◽

Sezary Syndrome ◽

Term Survival ◽

Kaplan Meier

Abstract We created a relational database of patients with cutaneous T-cell lymphoma (CTCL) to collect in a standardised fashion, anagraphic variables, clinical history, clinical, histological, haematological, and immunological information on CTCL patients hospitalised at IDI-IRCCS, Rome, Italy. At present, there are data on 424 patients, hospitalised from 1983 to July 2005. Active follow-up is performed yearly to ensure a standardised ascertainment of survival time. For deceased patients, the actual date of death (for all causes) is recorded, while surviving patients are censored at the date of last contact. The database includes 29 patients with Sezary syndrome (SS). Follow-up times ranged from 0 to 105 months. At first hospitalisation the median values of cells/mL were: white blood cells (WBC) 8750, neutrophils 4250, eosinophils 140, basophils 120, lymphocytes 2760, monocytes 500, CD3+ 2780, CD4+ 2431, CD8+ 192, CD19+ 96. Seventeen patients were deceased. We included in the Kaplan-Meier survival analysis only patients who were diagnosed before July 2004 (n=26). Median survival time from diagnosis was 52 months. No significant differences were observed in mortality for WBC (cutoff 9000 cells/uL), neutrophils (cutoff 4500 cells/uL), basophils (cutoff 200 cells/uL), lymphocytes (cutoff 3000 cells/uL), monocytes (cutoff 500 cells/uL), CD3+ (cutoff 2000 cells/uL), CD4+ (cutoff 2000 cells/uL), CD8+ (cutoff 200 cells/uL), CD19+ (cutoff 70 cells/uL). A lower survival was observed for patients with eosinophils <200 cells/uL (p=.08). Survival in patients with SS does not seem to be influenced by haemathologic parameters. However, patients with long-term survival (>90 months) are observed, and their characteristics should be further investigated. Survival analysis of 26 patients with Sézary syndrome, Rome, Italy, 1991–2004. Survival analysis of 26 patients with Sézary syndrome, Rome, Italy, 1991–2004.

Download Full-text

Predictors of long-term survival in patients with metastatic renal cell carcinoma in the cytokine era: An analysis of 473 patients treated between 1995 and 2005.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.7_suppl.335 ◽

2011 ◽

Vol 29 (7_suppl) ◽

pp. 335-335

Author(s):

N. Shinohara ◽

S. Maruyama ◽

T. Abe ◽

A. Sazawa ◽

K. Nonomura ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Logistic Regression ◽

Regression Analysis ◽

Renal Cell ◽

Multiple Logistic Regression Analysis ◽

Multiple Logistic Regression ◽

Term Survival ◽

Long Term Survivors ◽

Metastatic Rcc

335 Background: Based on the clinical data in Japanese renal cell carcinoma (RCC) patients who underwent cytokine therapy (Naito et al, Eur Urol 2010), the overall survival (OS) of these patients has been considered to be better than that of Caucasian patients. We identified long-term survivors among a cohort of 473 metastatic RCC patients, and explored clinical predictors of OS in these patients. Methods: Between 1995 and 2005, 473 patients with metastatic RCC were the subjects of this retrospective analysis. Three hundred sixty-one (76%) patients received IFN-α and no patient did molecular-targeted drugs. The patients with survival times of greater than 5 years after the development of metastases were identified as long-term survivors. Multiple logistic regression analysis was performed to evaluate the impact of clinical variables potentially influencing OS. Results: Median OS for all patients was 22.3 months (95%CI 18.7-27.6), the estimated 5-year survival rate was 27.4% (95% CI 22.9-31.9). Sixty-eight patients (14.4%) among 473 patients were identified as long-term survivors. Twenty-six (38%) had metastases at diagnosis of kidney cancer, 3 (4%) and 11 (16%) had liver mets and bone mets, respectively. According to MSKCC risk classification, 19 (28%), 28 (41%), and 6 (9%) were classified as favorable, intermediate, and poor risk, respectively. All patients had undergone prior nephrectomy, and 40 (59%) underwent metastatectomy. Multiple logistic regression analysis from all patients identified metastatectomy (HR 5.0; 95%CI 2.7-9.5) and MSKCC risk group (HR 3.7; 95%CI 1.5-9.1) as adverse prognostic factors for long-term OS. Conclusions: Selected patients with metastatic RCC who can undergo metastatectomy have a good opportunity for long-term survival, especially those with favorable or intermediate risk classified by MSKCC risk classification. No significant financial relationships to disclose.

Download Full-text

Circulating miR-30d Predicts Survival in Patients with Acute Heart Failure

Cellular Physiology and Biochemistry ◽

10.1159/000459899 ◽

2017 ◽

Vol 41 (3) ◽

pp. 865-874 ◽

Cited By ~ 22

Author(s):

Junjie Xiao ◽

Rongrong Gao ◽

Yihua Bei ◽

Qiulian Zhou ◽

Yanli Zhou ◽

...

Keyword(s):

Heart Failure ◽

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Multivariate Logistic Regression Analysis ◽

Multivariate Logistic Regression ◽

Univariate Logistic Regression Analysis ◽

Kaplan Meier ◽

All Cause Mortality

Background/Aims: Identification of novel biomarkers to identify acute heart failure (AHF) patients at high risk of mortality is an area of unmet clinical need. Recently, we reported that the baseline level of circulating miR-30d was associated with left ventricular remodeling in response to cardiac resynchronization therapy in advanced chronic heart failure patients. However, the role of circulating miR-30d as a prognostic marker of survival in patients with AHF has not been explored. Methods: Patients clinically diagnosed with AHF were enrolled and followed up for 1 year. Quantitative reverse transcription polymerase chain reactions were used to determine serum miR-30d levels. The univariate logistic regression analysis and multivariate logistic regression analysis were used to determine the predictors for all-cause mortality in AHF patients. Kaplan–Meier survival analysis was used to analyze the role of miR-30d in prediction of survival. Results: A total of 96 AHF patients were enrolled and followed up for 1 year. Serum miR-30d was significantly lower in AHF patients who expired in the one year follow-up period compared to those who survived. Univariate logistic regression analysis yielded 18 variables that were associated with all-cause mortality in AHF patients, while the multivariate logistic regression analysis identified 4 variables including heart rate, hemoglobin, serum sodium, and serum miR-30d level associated with mortality. ROC curve analysis showed that hemoglobin, heart rate and serum sodium displayed poor prognostic value for AHF (AUCs not higher than 0.700) compared to miR-30d level (AUC = 0.806). Kaplan–Meier survival analysis confirmed that patients with higher serum miR-30d levels had significantly lower mortality (P=0.001). Conclusion: In conclusion, this study shows evidence for the predictive value of circulating miR-30d as 1-year all-cause mortality in AHF patients. Large multicentre studies are further needed to validate our findings and accelerate the transition to clinical utilization.

Download Full-text

Association of Hypertension and Hypertriglyceridemia on Incident Hyperuricemia: An 8-year Prospective Cohort Study

10.21203/rs.3.rs-60991/v1 ◽

2020 ◽

Author(s):

Yuan Zhang ◽

Miaomiao Zhang ◽

Xiawen Yu ◽

Fengjiang Wei ◽

Chen Chen ◽

...

Keyword(s):

Blood Pressure ◽

Cohort Study ◽

Survival Analysis ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Cox Regression ◽

Target Organ Damage ◽

Organ Damage ◽

Combined Effect ◽

Kaplan Meier

Abstract BackgroundHypertension and high triglyceride are two of the most important risk factors for hyperuricemia. Epidemiological records show that hypertension and dyslipidemia often coexist and may significantly increase the risk of target organ damage. However, their combined effect on incident hyperuricemia is poorly understood. Thus, we aimed to investigate the separate and combined effect of hypertension and hypertriglyceridemia on the incidence of hyperuricemia.MethodsA prospective cohort study of 6424 hyperuricemia-free participants aged 20 to 94 years between August 2009 and October 2017 was performed at Tianjin General Hospital of China. Participants were categorized into four groups by combining hypertension and hypertriglyceridemia status at baseline. The restricted cubic spline fitting Cox regression model was used to evaluate the relationship between blood pressure and triglyceride and hyperuricemia. Cox regression models were performed to calculate hazard ratios (HRs) and 95% confident intervals (CIs) to estimate baseline factors and their association with the incidence of hyperuricemia. A Kaplan–Meier survival analysis was performed to compare the incidence of hyperuricemia among subjects in each separate and combined hypertension and hypertriglyceridemia group.ResultsDuring the 8-year follow-up period, 1,259 subjects developed hyperuricemia (20.6%). There existed positive relationships between blood pressure and triglyceride levels and hyperuricemia. This risk factor arising from a combination of the two (HR, 3.02; 95% CI: 2.60-3.50) is greater than that from hypertension (HR, 1.48; 95% CI: 1.28-1.71) or hypertriglyceridemia (HR, 1.84; 95% CI: 1.55-2.18) separately. The Kaplan–Meier survival analysis indicated that combined effect of hypertension and hypertriglyceridemia may predict higher onset of hyperuricemia.ConclusionThe combined effect of hypertension and hypertriglyceridemia on the risk of hyperuricemia is much stronger than that by hypertension or hypertriglyceridemia separately. Hypertension combined with hypertriglyceridemia may be an independent and powerful predictor for hyperuricemia.

Download Full-text

Determinants of the intensity of uremic pruritus in patients receiving maintenance hemodialysis: A cross-sectional study

PLoS ONE ◽

10.1371/journal.pone.0245370 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245370

Author(s):

Jian-Hui Zhao ◽

Qiu-Shuang Zhu ◽

Yi-Wen Li ◽

Li-Li Wang

Keyword(s):

Logistic Regression ◽

Multiple Logistic Regression Analysis ◽

Cross Sectional Study ◽

Maintenance Hemodialysis ◽

Multiple Logistic Regression ◽

Sectional Study ◽

Cross Sectional ◽

Urea Nitrogen ◽

Uremic Pruritus ◽

Hs Crp

Background Uremic pruritus (UP) is a common and frustrating symptom in patients receiving hemodialysis (HD). The majority of patients have mild to moderate itching of the skin, and a small percentage have severe itching, which seriously affects their quality of life and survival rate. However, little is known about factors that influence the intensity of itching in patients. Methods A cross-sectional study on uremic pruritus in male and female patients receiving HD was conducted in September 2019. This study included 148 eligible patients who received HD at the Blood Purification Center of Xinchang County People’s Hospital, Zhejiang Province, China from March 2019 to June 2019. We collected general data consisted of age, sex, body mass index (BMI), place of residence, educational level, diabetes mellitus status and duration of HD; as well as clinical, biochemical indicators, including serum calcium (Ca), serum phosphorus (P), serum albumin (ALB), haemoglobin (Hb), serum intact parathyroid hormone (iPTH), pre-dialysis serum urea nitrogen (BUN), normalized protein catabolic rate (nPCR), urea nitrogen clearance index (KT/V), ferritin (FER) and pre-dialysis serum creatinine (sCR). We also assayed the inflammatory cytokine serum high sensitivity C-reactive protein (hs-CRP). The Five-Dimensional Itching Scale (5DIS) was used to evaluate the degree of skin itching (none, mild, moderate, or severe). We used multiple logistic regression to analyze influencing factors on the degree of skin itching in patients with UP. Results Of the 148 patients, 60 had uremic pruritus (incidence rate, 40.54%). These included 22 cases of mild skin itching (14.86%), 30 of moderate skin itching (20.27%), and 8 of severe skin itching (5.41%). Compared with uremia patients without skin pruritus, patients with UP had higher levels of iPTH, Hb, BUN, nPCR, and hs-CRP. The composition ratio showed significant differences between urban and rural patients with different degrees of skin itching (P = 0.017); moreover, the difference of iPTH and hs-CRP levels were statistically significant (P = 0.009 and < 0.001, respectively). Using no itching as a reference, multiple logistic regression analysis showed that as hs-CRP level increased, the patient’s risks of mild skin itching (odds ratio [OR] = 1.740; 95% confidence interval [CI], 1.061–2.854; P = 0.028), moderate skin itching (OR = 2.8838 95% CI, 1.744–4.718; P < 0.001), and severe skin itching (OR = 9.440; 95% CI, 3.547–25.124; P < 0.001) all increased as well. Compared with urban residents, rural residents have a higher risk of moderate itching (OR = 3.869; 95% CI, 1.099–13.622; P = 0.035). Conclusion Levels of hs-CRP were associated with the intensity of skin itching in patients with UP. Higher hs-CRP levels were closely related to severe skin itching. The relationship between the intensity of skin itching and the environment in maintenance hemodialysis patients needs further clarification.

Download Full-text