scholarly journals P1414THE PREDICTORS OF PARATHYROID HORMONE VARIABILITY IN HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Vasilije Tomanoski ◽  
Gordana Gjorgjievska ◽  
Vasiliki Krecova ◽  
Aleksandar Andonoski ◽  
Margarita Nakovska ◽  
...  

Abstract Background and Aims KDIGO Clinical Practice Guidelines suggest in hemodialysis (HD) patients using a dialysate calcium concentration between 1,25 and 1,5 mmol/L and maintaining serum intact parathyroid hormone (sPTH) levels in the range of approximately 2 to 9 times the upper normal limit for the assay. The aim of the study was to evaluate the predictors of PTH variability in HD patients over a 12 months period. Method The multicenter restrospective study encompassed 398 patients (256M and 142F) with the average age 59,64±13,29 years and the average HD vintage 78,63±64,26 months. Over a 12 months (M0-M12) period: serum calcium (sCa), serum phosphorus (sPi), serum alkaline phosphatase (sAPh), oral calcium-carbonate daily dose, oral calcitriol weekly dose, and dialysate Ca concentration (dCa) were monitored monthly, and sPTH at 6 months. According to PTH assay reference level (18,4-80,1 pg/ml) 3 groups of patients were categorized: patients with low sPTH<160, with target range sPTH =160-721, and with high sPTH>721. For statistical analysis chi-square test, analysis of variance with repeated measures and logistic regression analysis were performed by softver SPSS. Results Over a 12 months period the number of patients with low sPTH significantly decreased, but the number of patients with target range sPTH and high sPTH increased (Chi square=269,45; p<0.001). On the basis of overall pattern of sPTH fluctuation over a 12 months period six subgroups of patients were observed: consistently low in 20,6% of patients, consistently within the target range in 22,1%, consistently high in 14,07%, low-amplitude fluctuation with low and target range sPTH levels (LAL) in 31,4%, low-amplitude fluctuation with target range and high sPTH levels (LAH) in 10,55%, and high-amplitude fluctuation (HA) subgroup with low, target range and high sPTH levels in 1,25%. In 35 patients constantly hemodialyzed over a 12 months period with dCa=1,25 mmol/L due to high sCa the significant increase of sPTH (M0=797±657 vs M12=1030±740 pg/ml; p=0.001) and no significant changes of sCa (M0=2,44± vs M12=2,34± mmol/L; n.s.), sPi (M0=1,81±0,49 vs M12=1,68±0,49 mmol/L; n.s.), Ca-carbonate daily dose (M0=1,88±1,54 vs M12=2,22±1,53 g/d; n.s.) and calcitriol weekly dose (M0=0,84±1,38 vs M12=1,1±1,41 ucg/w; n.s.) were observed. In 24 patients constantly hemodialyzed with dCa=1,75 mmol/L due to low sCa the significant decrease of sPTH (M0=518±582 vs M12=391±530 pg/ml; p=0.037) and no significant changes of sCa (M0=2,17±0,19 vs M12=2,18±0,17 mmol/L; n.s.), sPi (M0=1,3±0,34 vs M12=1,36±0,52 mmol/L; n.s.), Ca-carbonate daily dose (M0=2,53±1,58 vs M12=2,1±1,91 g/d; n.s.) and calcitriol weekly dose (M0=1,33±1,23 vs M12=1,42±1,69 ucg/w; n.s.) were observed. In 195 patients constantly hemodialyzed with dCa=1,5 mmol/L no significant changes of sPTH (M0=388±421 vs M12=434±459 pg/ml; n.s.), sCa (M0=2,29±0,18 vs M12=2,27±0,15 mmol/L; n.s.), sPi (M0=1,48±0,41 vs M12=1,52±0,41 mmol/L; n.s.), Ca-carbonate daily dose (M0=2,42±1,4 vs M12=2,57±1,2 g/d; n.s.) and calcitriol weekly dose (M0=0,47±0,72 vs M12=0,38±0,68 ucg/w; n.s.) were observed. By model of logistic regression analysis dCa=1,75 (OR=8,33), increased sCa (OR=7,7), and presence of diabetes mellitus (OR=2,44) were the most significant predictors of low sPTH<160 (Chi square=116,27; p<0.001), but the increased sCa (OR=6,88), dCa=1,25 (OR=5,08), and the increased sPi (OR=2,72) were the most significant predictors of high sPTH>721 (Chi square=72,475; p<0.001). Conclusion The prolonged use of dCa=1,25 in patients with high sCa led to significant sPTH increase likely due to net negative calcium balance, but prolonged use of dCa=1,75 in patients with low sCa led to significant sPTH decrease likely due to net positive calcium balance.

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Zeynep Bal ◽  
Bahar Gurlek Demirci ◽  
Suleyman Karakose ◽  
Emre Tutal ◽  
Mehtap Erkmen Uyar ◽  
...  

Purpose. We aimed to investigate the factors influencing hemoglobin variability with inflammatory and nutritional parameters and its associations with all-cause mortality among hemodialysis patients. Methods. One hundred and sixty-nine patients during the entire 12 months were enrolled into the study. Fasting plasma glucose, creatinine, calcium, phosphorus, alkaline phosphatase, parathyroid hormone (PTH), C-reactive protein (CRP), serum iron, serum iron-binding capacity, and transferrin saturation were analyzed. We defined six groups: low, target range, high, low-amplitude fluctuation with low hemoglobin levels, low-amplitude fluctuation with high hemoglobin levels, and high-amplitude fluctuation. Body mass index (BMI), malnutrition-inflammation score (MIS), and Charlson Comorbidity Index were evaluated. Results. Hemoglobin variability was significantly correlated with age, platelet count, and number of hospitalization instances and inversely correlated with erythropoietin dose per body surface area. The coefficient of variation of hemoglobin showed a correlation with MIS and ferritin. The absolute level of hemoglobin showed a negative correlation between PTH, CRP, MIS, number of hospitalization instances and a positive correlation with albumin and BMI. High, low, and target-range groups showed survival advantage compared to the other three groups. In regression analysis, age, CRP levels, MIS, and BMI were the predictors of mortality. Conclusion. Inflammation and duration of anemia were the major predictors of hemoglobin variability. High-amplitude fluctuation predicts high mortality; on the contrary low-amplitude fluctuations is related to better survival. MIS was independently associated with mortality. This trial is registered with NCT03454906.


2021 ◽  
Vol 12 ◽  
pp. 204201882110251
Author(s):  
Dishan Li ◽  
Wenhu Liu ◽  
Hongdong Huang ◽  
Wang Guo ◽  
Zongli Diao ◽  
...  

Background: The number of patients ⩾65 years who require maintenance hemodialysis (MHD) is increasing. Although reduced bone turnover in older patients receiving hemodialysis, as reflected by lower serum intact parathyroid hormone (iPTH) and phosphate (P) levels, has been reported, focus on the association between abnormal bone metabolism and the risk of death in older patients receiving MHD has been limited. Methods: We retrospectively examined data from the Beijing Hemodialysis Quality Control and Improvement Center for 1410 older patients who underwent hemodialysis from 1 January 2012 to 31 December 2016. Baseline, time-dependent (TD) Cox proportional hazards models and Kaplan–Meier analyses were used to evaluate the association between the markers of mineral and bone disorder (MBD) [calcium (Ca), P, and iPTH] and survival. The Kidney Disease: Improving Global Outcomes (KDIGO) target ranges were included as reference values. Results: Serum P levels >2.49 mmol/l increased the risk of all-cause death [hazard ratio (HR): 1.46; 95% confidence interval (CI): 1.04–2.07; p = 0.030] and cardiovascular death (HR: 2.01; 95%CI: 1.21–3.34; p = 0.007); iPTH levels >600 pg/ml increased the risk of cardiovascular death (HR: 1.95; 95%CI: 1.20–3.15; p = 0.007). Baseline results and TD Cox analyses were similar. All three MBD parameters were within the respective target ranges at least once during the follow-up period in 399 (28.3%) patients, and these patients had better survival rates than those who achieved two of the three target ranges (715/1410 patients; 50.7%); those who achieved one or no target range (296/1410; 21.0%) had the lowest survival rate (all-cause death: log-rank chi square = 83.96, p < 0.001; cardiovascular death: log-rank chi square = 47.06, p < 0.001). Conclusion: Older patients undergoing MHD who achieved the KDIGO target levels for any two or three MBD parameters had lower risks of all-cause and cardiovascular death.


2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e42-e44
Author(s):  
Frédérique Armellin-Ducharme ◽  
Olivier Drouin

Abstract Primary Subject area Respirology Background Children with asthma from lower socioeconomic status (SES), and those with poor adherence to controller medications have worse health outcomes, including higher rates of exacerbations and hospitalizations. Simpler medication regimens could potentially improve medication adherence and asthma control. Objectives We aimed to determine if: (1) medication adherence (proportion of prescribed days covered [PPDC]) and primary non-adherence (PPDC = 0%) varied by SES; and if (2) there was an interaction between SES and daily dose frequency on adherence. Design/Methods This retrospective cohort study included children 2-17 years old followed at the asthma clinic of a large Canadian pediatric hospital between 2011 and 2020. Patients were prescribed one of five medication regimens that included one or more of the following medication classes: inhaled corticosteroids (ICS), long-acting beta-agonists (LABA) and leukotriene receptor antagonists (LTRA). Primary outcome was medication adherence, using the PPDC: the number of days for which a medication was dispensed divided by the number of days for which it was prescribed. For regimens with two different medications, total PPDC was the average of the PPDCs for each medication. The main predictor was SES, measured by the Pampalon’s material deprivation index, a compounded index of income, employment, and education, based on postal codes. It is divided in quintiles, with quintile 1 being the least materially deprived. Comparison of PPDC between quintiles of SES was achieved by a Kruskal-Wallis test. Chi-square testing was used to assess the relationship between the proportion of patients with primary non-adherence (PPDC=0) and quintiles of SES. In the subset of patients who did not have primary non-adherence (n = 462), interaction between SES and daily dose frequency on log transformed PPDC was examined using linear regression models. Results Among 551 patients, mean age was 7.1 years (SD 3.8) (Table1), and there was a similar number of patients in each quintile of SES based on a chi-square goodness of fit test (p=0.61). For the overall sample, mean PPDC was 38.1% (SD 27.6). PPDC was not statistically different between quintiles of SES (p=0.57) (Figure 1). Distribution of primary non-adherence (PPDC = 0) in the cohort was independent of the quintiles of SES (p=0.57). Keeping SES constant, twice-daily dose frequency was associated with a 1.1% decrease in PPDC (p=0.85). The interaction between daily dose frequency and SES was not statistically significant (p=0.66). Conclusion Medication adherence (PPDC) and primary non-adherence (PPDC = 0) did not vary significantly by SES, but twice-daily dose frequency was associated with a small decrease in mean PPDC. Quebec’s mandatory medication insurance could potentially explain the absence of difference in medication adherence across SES quintiles.


2018 ◽  
Vol 2 (2) ◽  
pp. 137
Author(s):  
Muhammad Abi Berkah Nadi

Radin Inten II Airport is a national flight in Lampung Province. In this study using the technical analysis stated preference which is the approach by conveying the choice statement in the form of hypotheses to be assessed by the respondent. By using these techniques the researcher can fully control the hypothesized factors. To determine utility function for model forecasting in fulfilling request of traveler is used regression analysis with SPSS program. The analysis results obtained that the passengers of the dominant airport in the selection of modes of cost attributes than on other attributes. From the result of regression analysis, the influence of independent variable to the highest dependent variable is when the five attributes are used together with the R square value of 8.8%. The relationship between cost, time, headway, time acces and service with the selection of modes, the provision that states whether or not there is a decision. The significance of α = 0.05 with chi-square. And the result of Crame's V test average of 0.298 is around the middle, then the relationship is moderate enough.


Angiology ◽  
2021 ◽  
pp. 000331972199334
Author(s):  
Sema Hepsen ◽  
Davut Sakiz ◽  
Hilal Erken Pamukcu ◽  
Ismail Emre Arslan ◽  
Hakan Duger ◽  
...  

Levothyroxine suppression therapy (LST) can cause some unfavorable effects on the cardiovascular system in patients with differentiated thyroid cancer (DTC). The aim of this study was to evaluate ventricular arrhythmia predictors based on electrocardiography (ECG) in patients with DTC with LST. The ECG parameters including QT, corrected QT (QTc), Tp-e intervals, Tp-e/QT, and Tp-e/QTC ratios of 265 patients with DTC who met the inclusion criteria were compared with 100 controls. No difference was observed in the number of patients with DTC and controls with prolonged and borderline QTc interval ( P = .273). Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were significantly higher in patients ( P = .002, P = .02, P = .003; respectively). Linear regression analysis suggested that male gender was a predictor of higher Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios (β = 4.322, R 2 = 0.024, P = .042; β = 0.016, R 2 = 0.048, P = .005; β = 0.015, R 2 = 0.044, P = .006, respectively). A higher serum fT4 level was found to be associated with a higher Tp-e/QT ratio (β = 0.018, R 2 = 0.089, P = .007). Ventricular arrhythmia indicators were found to be higher in patients with DTC with LST. Defining ventricular arrhythmia predictors through ECG, an easily accessible cardiac diagnostic tool, can be potentially useful in raising awareness of the possible cardiac harm of LST.


2021 ◽  
Vol 11 (5) ◽  
pp. 2006
Author(s):  
Jai-Chang Park ◽  
Seongbeom Kim ◽  
Je-Hoon Lee

Diabetes mellitus is a severe chronic disease, and the number of patients has increased. To manage blood glucose levels, patients should frequently measure their blood glucose and analyze which lifestyle habits affect blood glucose levels. However, it is hard to record and analyze the relationship between their blood glucose levels and lifestyle. The internet of things (IoT) is useful to interconnect, monitor, obtain, and process data between various devices used in everyday life to fulfill a common objective. This paper proposes an intelligent self-care platform using IoT technology that helps patients with chronic diabetes manage their blood glucose levels in their target range. In particular, we developed various devices called the self-care IoT pack. It consists of five different types of devices to obtain blood glucose levels, physical activities, food intake, medication, sleeping, and so on. They can collect blood glucose levels with lifestyles that automatically impact the patient’s blood glucose level. We also devised a self-care application to display and analyze the data obtained from the IoT pack. Consequently, the proposed self-care IoT platform collects the blood glucose levels and the lifestyles without any burden of record. By reviewing the accumulated information, the patients can find bad habits in blood glucose management and improve their lifestyle.


2020 ◽  
Vol 185 (7-8) ◽  
pp. e944-e951
Author(s):  
Hwi Jun Kim ◽  
Sarah So Yeon Oh ◽  
Dong Woo Choi ◽  
Sun Yeong Won ◽  
Hae Jung Kim ◽  
...  

Abstract Introduction The National Statistical Yearbook of Defense 2018 issued by the Republic of Korea (ROK) Ministry of National Defense reported that the number of patients using military hospitals steadily increased from 2008 to 2017. However, in the outpatient clinic statistics for years 2015–2017 from the ROK Armed Forces Medical Command, the amount of medical care received from some medical departments, such as the infection medicine, surgery, and anesthesiology departments, decreased. Therefore, the purpose of this study was to observe the differences in incidence of military personnel’s unmet healthcare needs according to number of diseases by type. Materials and Methods The study used data from the Military Health Survey, which was conducted from 2014 to 2015 and included 5162 responses from ROK military personnel. The number of diseases by type and unmet healthcare needs were self-reported. A multiple logistic regression analysis was used to examine the validity of the annual disease experience by type and correlations with unmet healthcare needs. Results Of the 5162 military personnel, 25.2% experienced unmet healthcare needs, and the more people with the number of disease by type, the more likely they were to experience unmet healthcare needs (1: 13.4%, 2: 22.9%, 3: 29.2%, 4: 34.5%, 5: 41.4%). The logistic regression analysis also revealed significant differences (1 = REF, 2 odds ratio (OR) = 1.83, 95% confidence interval (CI): 1.50–2.24; 3 OR = 2.53, 95% CI: 2.05–3.11, 4 OR = 3.10, 95% CI = 2.49–3.85; ≥5 OR = 3.85, 95% CI = 3.08–4.81). In addition, subgroup analysis showed that female military personnel are more likely to experience unmet healthcare needs than are male military personnel. We have also confirmed that working areas and private insurance can affect unmet healthcare needs. Conclusion This study suggests that unmet healthcare needs are influenced by the number of disease by the type of ROK military personnel. It is therefore necessary to strive to reduce the number of military personnel who experience unmet healthcare needs through this data.


2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Yulianti Wulandari ◽  
Siska Afri Nofita

In health service, nurses are at the forefront of providing health care, if the nurses don’t provide the care and not accompanied by EPEEP implementation (Explain, Pain, Elimination, Environment and Plan Of Return) it will have an impact on decreasing client satisfaction. From the results of the preliminary survey the nurses have not done EPEEP implementation method (Explain, Pain, Elimination, Environment and Plan Of Return) properly. And the achievement of patient satisfaction in the pandoria room of Awal Bros Batam Hospital from the results of satisfaction survey in September 2018, very satisfied category was 46%, satisfied category was 54% and less satisfied category was 2%. Therefore , it is necessary to implement EPEEP (Explain, Pain, Elimination, Environment and Plan Of Return) in providing services to clients. This study aimed to determine the Relation between EPEEP Implementation Methods (Explain, Pain, Elimination, Environment and Plan Of Return) With Patient Satisfaction at Pandoria Inpatient Awa Bros Batam in 2019. This type of research was descriptive correlation with cross sectional approach, 129 respondents selected using purposive sampling technique. Data were obtained by observation sheets on nurses about EPEEP implementation (Explain, Pain, Elimination, Environment and Plan Of Return) and provide satisfaction questionnaires to clients. The study was conducted in February until March 2019 in the Pandoria room. Analysis of the data used Chi square. There was a relationship between EPEEP implementation method (Explain, Pain, Elimination, Environment and Plan Of Return) with patient satisfaction and with nurses inpatient at Pandoria Awal Bros Batam Hospital, and the p-value was 0.00 (p <0.05). It can be concluded that the implementation of EPEEP (Explain, Pain, Elimination, Environment and Plan Of Return) can affect client satisfaction. Suggestions for future researchers can conduct research related to how long the nurse responds if there are patients who call or press the bell (Patient Calls) and for the Home Pain as an input to perform research related to nurse daily activity, because Pandoria Room compared to other inpatient rooms was the room with the highest number of patients and the highest mobile patients.


2019 ◽  
Vol 13 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Amr Sobhy ◽  
Doaa M. K. Eldin ◽  
Hany V. Zaki

Background and Aims: In our study, we investigated the effectiveness of intravenous milrinone in life-threatening bronchial asthma as compared to conventional treatment. Methods: Fifty patients aged 18-50 years, presenting with life-threatening asthma were enrolled in a Randomised Controlled Trial (RCT). They were randomly allocated into Group C (25 patients): who received the standard pharmacotherapy and placebo, and Group M (25 patients): who in addition to the standard therapy, received 25 μg milrinone as an initial slow IV bolus diluted in 10 ml of normal saline. The following data were recorded: PEFR (Peak Expiratory Flow Rate) expressed as a percentage of the patient’s previous value, Respiratory Rate (RR), MABP (Mean Arterial Blood Pressure), arterial blood gases, and the number of patients requiring mechanical ventilation. Differences between groups were tested using Analysis of Variance (ANOVA) for quantitative variables with post hoc using the Least Significant Difference (LSD) test, and Chi square test for categorical variables. Results: Group M showed marked improvement in PEFR that was highly significant (P < 0.001) 10 min after injection and significant after one hour from the start of treatment in comparison to Group C. There was also an improvement in RR and PO2 that was significant in group M. Milrinone was associated with a reduction in MABP only after 10 min from injection, and showed a statistically significant decrease in the number of patients requiring mechanical ventilator support (P ˂ 0.05). Conclusion: Milronine is a promising agent as a rescue drug in the treatment of life-threatening bronchial asthma.


2019 ◽  
Vol 7 (1) ◽  
pp. 276-296
Author(s):  
Anwesha Chattopadhyay ◽  
Priyanka Khanzode

Last 5 years have seen lots of changes in the consumption pattern of individuals with concerns rising constantly on the quality of climate conditions, individuals have become aware about change in climate, increasing pollution, deteriorating air quality, excessive use of chemicals in the farms, increase of carbon particles in environment and impact on population. Consumers now-a-days are very particular about the products they are consuming, Thus the concept of organic food product come into picture. This concept is gaining impetus in society especially after increase in health problems in individuals. It refers to using such food product which are eco-friendly and safe. The paper is a humble attempt to understand the level of awareness about organic food products in Bengaluru. This paper also aims at understanding the consumption pattern of individuals in Bengaluru. Statistical tools like ANOVA, Regression analysis, Chi-square tests and different charts are used to analyse the data obtained from a primary survey conducted in Bengaluru. On the basis of analysis done in the paper, it is concluded that the consumption has increased lately although more awareness should be created to make the consumption more popular among consumers.


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