P1418BONE-DERIVED HORMONES, MINERAL METABOLISM, CARDIOVASCULAR DISEASE AND PATIENT OUTCOME IN END-STAGE RENAL PATIENTS

Abstract Background and Aims Chronic kidney disease-mineral and bone disorder (CKD-MBD) is frequent in end-stage renal disease ESRD (ESRD) patients, increasing morbid-mortality. The aim of this study was to analyse the associations between the new CKD-MBD players [alpha-klotho, fibroblast grow factor (FGF) 23, sclerostin] and the usual markers of the disease [parathyroid hormone (PTH), bone alkaline phosphatase (bAP), vitamin D (vitD), phosphorus (Pi), Calcium (Ca) and Magnesium (Mg)], as well echocardiographic findings [left ventricular mass index (LVMI) measured by Devereux formula, valvular calcifications], vascular calcifications and patients outcomes. Method We performed a prospective cohort study of a sample of ESRD patients listed for renal transplant. All patients were submitted to renal transplant and were followed for 12 months. Patient and graft survival were recorded. At inclusion, demographic and clinical data were collected, laboratorial evaluation, bone biopsy and X-ray of the pelvis and hands (Adragão score) were performed. Continuous variables are presented as medians and categorical variables as frequencies. Associations between variables were performed using Wilcoxon rank sum test and Spearman correlation test. STATA software was used and p < 0.05 was considered statistically significant. Results We included 85 patients. Mean age 50.1±12.7 years, 59 men (69.4%), 66 caucasian (77.6%). The median LVMI was 108.5 (92 – 129) g/m2, with 32 patients presenting LVH and 19 valvular calcifications. Median Adragão score was 1 (0 – 2). At the end of 12 months, 4 patients died and 5 had graft failure (non-primary function). Alpha-klotho correlated with bAP (p=0.0006) and marginally with PTH and absence of valvular calcifications (p=0.05). FGF23 correlated with Pi (p<0.001), Ca (p=0.004), PTH (p=0.003), Mg (p=0.002), and inversely with bAP (p=0.003). There was a marginal association with Adragão score (p=0.06). We didn’t found correlations between FGF23 and alpha-klotho or dialysis vintage or echocardiographic characteristics. Sclerostin correlated negatively with bAP (p=0.007) and PTH (p=0.04). The 3rd sclerostin tertile was associated with high scores of vascular calcifications (p=0.02). Lower levels of sclerostin were associated with patient survival at the end of 12 months (p=0.02). Conclusion From these 3 new bone-derived hormones, sclerostin, a bone formation inhibitor, seems to act as a risk factor for vascular calcifications and worse outcomes.

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MO572BONE BIOPSY AND MINERAL METABOLISM, CARDIOVASCULAR DISEASE AND PATIENT SURVIVAL IN END-STAGE RENAL PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab086.0010 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Ana Carina Ferreira ◽

Patrícia Cotovio ◽

Inês Aires ◽

Marco Mendes ◽

David Navarro ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Renal Transplant ◽

Bone Disease ◽

Patient Survival ◽

Left Ventricular ◽

High Turnover ◽

Vascular Calcifications ◽

End Stage ◽

Esrd Patients

Abstract Background and Aims Chronic kidney disease-mineral and bone disorder (CKD-MBD) is frequent in end-stage renal disease (ESRD) patients, increasing morbid-mortality. The aim of this study was to determine the prevalence and phenotype of bone disease before transplantation; and to correlate FGF23, klotho and sclerostin serum levels with bone histomorphometric parameters and CV disease. The secondary aim was to correlate bone biopsies data with other bone related parameters, as PTH, bone alkaline phosphatase, 25-hidroxivitamin D3, calcitonin, calcium, phosphorus, and magnesium. Method We performed a prospective cohort study of a sample of ESRD patients listed for renal transplant. All patients were submitted to renal transplant and were followed for 12 months. Patient and graft survival were recorded. At inclusion, demographic and clinical data were collected, laboratorial evaluation; bone biopsy and X-ray of the pelvis and hands (Adragão score) were performed. Continuous variables are presented as medians and categorical variables as frequencies. Associations between variables were performed using Wilcoxon rank sum test, Fisher and Kruskal Wallis test. Multivariate analysis was performed using logistic regression. STATA software was used and p < 0.05 was considered statistically significant. Results We included 84 patients. Median age 53.5 (IQ range: 40.5 – 61.5) years, 59 men (70.2%), 65 caucasian (77.4%). The median left ventricular mass index was 108.5 (92 – 129) g/m2, with 32 patients presenting left ventricular hypertrophy and 19 valve calcifications. Median Adragão score was 1 (0 – 2). We diagnosed adynamic bone disease in 15 patients; hyperparathyroid bone disease in 19 patients; osteomalacia in 1 patient and mixed renal osteodystrophy in 3 patients. At the end of 12 months, 4 patients died, 5 had graft failure (non-primary function) and 4 had a cardiovascular event. Sclerostin was found to be a risk factor for low bone volume; whereas low phosphorus, low FGF23 and high bAP risk factors for abnormal mineralization. High turnover was mainly present in patients with high bAP and phosphorus and low sclerostin levels. The presence of valve calcifications was associated with low volume and with low or high turnover disorder. FGF23 appears as an important independent factor for vascular calcifications [as well age (p=0.009), BMI (p=0.02), presence of diabetes (p=0.01)], and for cardiovascular events. Sclerostin emerged as a risk factor for vascular calcifications and lower levels of sclerostin were associated with patient survival at the end of 12 months. Conclusion From the bone-derived hormones, sclerostin and FGF23 seem to act as risk factors for vascular calcifications and worse outcomes.

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MO735INTERPLAY BETWEEN GDF-15 AND LEFT VENTRICULAR HYPERTROPHY IN END-STAGE RENAL DISEASE PATIENTS ON DIALYSIS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab097.0015 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Susana Coimbra ◽

Cristina Catarino ◽

Maria do Sameiro Faria ◽

José Pedro Lopes Nunes ◽

Susana Rocha ◽

...

Keyword(s):

Left Ventricular Hypertrophy ◽

Renal Disease ◽

End Stage Renal Disease ◽

Ventricular Hypertrophy ◽

Tissue Injury ◽

Left Ventricular ◽

Dialysis Vintage ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Abstract Background and Aims Cardiovascular disease (CVD) is the major cause of mortality and morbidity in chronic kidney disease (CKD), especially in end-stage renal disease (ESRD) patients. Left ventricular hypertrophy (LVH) is a common cardiovascular complication in CKD. Growth differentiation factor (GDF)-15 increases in tissue injury and inflammatory states associated with cardiometabolic risk. GDF-15 and N-terminal pro B-type natriuretic peptide (NT-proBNP) are both synthesized by cardiomyocytes and may be associated with cardiorenal dysfunction. Our aim was to study the association of GDF-15 with LVH in ESRD patients on dialysis. Method This study included 196 ESRD patients on dialysis (hemodiafiltration and high-flux hemodialysis). Left ventricular mass (LVM) was evaluated through echocardiographic studies, corrected for body surface area and the values are presented as LVM index (LVMI). LVH was defined by a value of LVMI > 115 g/m2 in men and > 95 g/m2 in women. Patients were divided into two groups - LVH (n=131) and non-LVH (n=65). LVMI, clinical and analytical variables (age, body mass index, dialysis vintage, dialysis adequacy, GDF-15, NT-proBNP and pentraxin (PTX) 3 were evaluated. Results ESRD patients with LVH presented significantly higher levels of NT-proBNP and GDF-15, and a trend towards higher PTX3 values. In LVH patients, GDF-15 correlated positively and significantly with NT-proBNP and PTX3; LVMI correlated positively and significantly with pro-BNP and PTX3 levels; pro-BNP correlated significantly and positively with PTX3. Conclusion Our data show that in ESRD patients on dialysis with LVH, GDF-15 is raised and shows a strong association with NT-proBNP, PTX3 and LVMI. Further studies are needed to clarify if the rise in GDF-15 is a cause or a consequence of LVH development. Acknowledgments This work was supported by Applied Molecular Biosciences Unit-UCIBIO, financed by national funds from FCT/MCTES (UIDB/04378/2020), by North Portugal Regional Coordination and Development Commission (CCDR-N)/NORTE2020/Portugal 2020 (Norte-01-0145-FEDER-000024) and by REQUIMTE-Rede de Química e Tecnologia-Associação in the form of a researcher (S. Rocha) – project Dial4Life co-financed by FCT/MCTES (PTDC/MEC-CAR/31322/2017) and FEDER/COMPETE 2020 (POCI-01-0145-FEDER-031322).

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Treatment with Cinacalcet in Hemodialysis Patients with Severe Secondary Hyperparathyroidism, Influences Bone Mineral Metabolism and Anemia Parameters

Current Drug Therapy ◽

10.2174/1574885514666190802144629 ◽

2020 ◽

Vol 15 (3) ◽

pp. 249-263

Author(s):

Maria Aktsiali ◽

Theodora Papachrysanthou ◽

Ioannis Griveas ◽

Christos Andriopoulos ◽

Panagiotis Sitaras ◽

...

Keyword(s):

Bone Mineral ◽

Mineral Metabolism ◽

Treatment Options ◽

Dry Weight ◽

Chronic Hemodialysis ◽

Protective Agent ◽

Positive Correlation ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Background: Due to the premium rate of Chronic Kidney Disease, we have increased our knowledge with respect to diagnosis and treatment of Bone Mineral Disease (BMD) in End- Stage Renal Disease (ESRD). Currently, various treatment options are available. The medication used for Secondary Hyper-Parathyroidism gives promising results in the regulation of Ca, P and Parathormone levels, improving the quality of life. The aim of the present study was to investigate the relation of cinacalcet administration to not only parathormone, Ca and P but also to anemia parameters such as hematocrit and hemoglobin. Materials and Methods: retrospective observational study was conducted in a Chronic Hemodialysis Unit. One-hundred ESRD patients were recruited for twenty-four months and were evaluated on a monthly rate. Biochemical parameters were related to medication prescribed and the prognostic value was estimated. Cinacalcet was administered to 43 out of 100 patients in a dose of 30-120 mg. Results: Significant differences were observed in PTH, Ca and P levels with respect to Cinacalcet administration. Ca levels appeared to be higher at 30mg as compared to 60mg cinacalcet. Furthermore, a decreasing age-dependent pattern was observed with respect to cinacalcet dosage. A positive correlation was observed between Dry Weight (DW) and cinacalcet dose. Finally, a positive correlation between Hematocrit and Hemoglobin and cinacalcet was manifested. Conclusions: Cinacalcet, is a potential cardiovascular and bone protective agent, which is approved for use in ESRD patients to assist SHPT. A novel information was obtained from this study, regarding the improvement of the control of anemia.

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Contrasting PTH Response of Denosumab Use in Dialysis Patients: A Report of 2 Cases

Pharmacy ◽

10.3390/pharmacy8020059 ◽

2020 ◽

Vol 8 (2) ◽

pp. 59

Author(s):

Soo Min Jang ◽

Smitha Anam ◽

Tara Pringle ◽

Paul Lahren ◽

Sergio Infante

Keyword(s):

Calcium Release ◽

Hemodialysis Patient ◽

Compensatory Mechanism ◽

Normal Range ◽

Mineral And Bone Disorder ◽

Bone Disorder ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients ◽

Pth Level

A common complication of end-stage renal disease (ESRD) is mineral and bone disorder. Yet, many anti-osteoporotic drugs are contraindicated in ESRD patients. Denosumab, a monoclonal antibody, does not require renal dose adjustment. However, its use is uncertain due to a lack of safety and efficacy of data in this population. Two hemodialysis patient cases of contrasting responses in parathyroid hormone (PTH) after denosumab administration were observed. Patient 1, a 62-years-old male received denosumab 60 mg at Day 0. His calcium decreased from 8.8 mg/dL to 6.8 mg/dL on Day 30. The PTH level increased from 265 pg/mL to 372 pg/mL after 30 days. Calcium and PTH levels approached normal range after increasing doses of vitamin D/calcium supplements, and calcitriol. Patient 2, a 72-years-old male on hemodialysis also received denosumab 60 mg on Day 0. His baseline calcium and PTH were 9.2 mg/dL and 420 pg/mL, respectively. On Day 30, his calcium level decreased (6.8 mg/dL) but, PTH level drastically increased (>5000 pg/mL). Denosumab commonly causes hypocalcemia and hyperparathyroidism since it inhibits osteoclast activation, reduces calcium release from bone and increases PTH levels as a compensatory mechanism. With a wait-and-watch approach, Patient 2’s levels approached the normal range (calcium 9.6 mg/dL and PTH 274 pg/mL at Day 90).

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FC 122BONE DENSITOMETRY IN RENAL TRANSPLANTED PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab147.001 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Ana Carina Ferreira ◽

Marco Mendes ◽

Cecília Silva ◽

Patrícia Cotovio ◽

Inês Aires ◽

...

Keyword(s):

Bone Densitometry ◽

Bone Disease ◽

Bone Biopsy ◽

Bone Volume ◽

Categorical Variables ◽

Good Tool ◽

X Ray ◽

Normal Bone ◽

Dialysis Vintage ◽

Significant Difference

Abstract Background and Aims Renal transplant and associated immunosuppression can influence bone volume. The aim of this study was to analyze the relations between bone biopsy data and levels of bone-related molecules [phosphorus (Pi), Calcium (Ca), Magnesium (Mg), parathyroid hormone (PTH), bone alkaline phosphatase (bAP), calcitonin, vitamin D (vitD), alpha-klotho, fibroblast grow factor (FGF) 23, sclerostin], obtained 1-year after transplantation with bone densitometry findings in the same time point in renal transplanted patients. Method We performed a prospective cohort study of a consecutive sample of de novo single renal transplanted patients in our unit. At inclusion, demographic, clinical and transplant-related data were collected, X-ray of the pelvis and hands (Adragão score) and echocardiographic findings were recorded. All patients were submitted to a laboratorial evaluation and a bone biopsy at baseline. Patients were followed for 12 months, after which performed laboratorial evaluation, 2nd bone biopsy, echocardiogram, X-ray of pelvis and hands, bone densitometry (DXA) and non-contrast cardiac CT. For this report we use the information of the 2nd analysis: laboratorial information, bone histology information, as well the densitometry evaluation. Continuous variables were presented as medians and categorical variables as frequencies. Associations between variables were performed using Wilcoxon rank-sum test, Fisher exact test, Kruskal Wallis rank test or Spearman correlation test. Multivariate analysis was performed using linear regression models. STATA software was used and p < 0.05 was considered statistically significant. Results We recruited 84 patients and, at the end of 12 months, we performed a 2nd evaluation in 69 patients. Median age 53 years, 48 men, 53 caucasian (78.8%), median BMI 24.6, median dialysis vintage 55 months. Patients had a median cumulative steroid dose of 5692.5 mg. Analyzing bone biopsies, we found that 28 patients had adynamic bone disease; 6 had hyperparathyroid bone disease; 2 had osteomalacia and 3 other abnormal mineralization; 8 patients presented only with osteoporosis. There was no significant difference between bone volume / total volume pre transplant (18%) and 1 year after transplantation (19%). Using DXA technique, 14 patients were classified has having osteoporosis, and all those had low volume at the bone biopsy. Nevertheless, in 4 patients low bone turnover was also present. The positive predictive value dropped from 100% to 57%, if we add the other abnormalities of bone, in addiction to the volume. DXA exam wasn’t a good tool to detect a normal bone volume, as the negative predicted value dropped from 78% (normal volume, irrespective of turnover and mineralization) to 37% (normal bone biopsy). Nevertheless, overall bone volume assessed by a bone biopsy correlated well with densitometry findings. Conclusion DXA exam isn’t a good tool to identify the bone quality. Nevertheless, once osteoporosis is detected the probability of the patient having low bone volume is high, but we still need a bone biopsy in order to exclude mineralization or turnover deviations.

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MO574MINERAL AND BONE DISORDERS CHANGES IN RENAL TRANSPLANTED PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab086.0012 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Ana Carina Ferreira ◽

Marco Mendes ◽

Cecília Silva ◽

Patrícia Cotovio ◽

Inês Aires ◽

...

Keyword(s):

Renal Transplantation ◽

Renal Transplant ◽

Bone Biopsy ◽

Serum Levels ◽

Agatston Score ◽

Vascular Calcifications ◽

Bone Disorders ◽

X Ray ◽

Bone Disorder ◽

Echocardiographic Findings

Abstract Background and Aims Successful renal transplant restores many physiologic abnormalities, including improvement of chronic kidney disease- mineral and bone disorder (CKD-MBD) syndrome. The primary aims of this study were: analyse the changes and evolution of the 3 components of CKD-MBD pre and 1 year post renal transplantation: the mineral abnormalities, the bone disorders and the vascular calcifications; and to correlate fibroblast grow factor 23 (FGF23), klotho and sclerostin serum levels with bone histomorphometric parameters and CV disease. The secondary aims were to study the evolution of other bone related parameters and correlate those with bone biopsies data, as well as to validate Adragão vascular calcification score in a population of renal transplant patients. Method We performed a prospective cohort study of a consecutive sample of de novo single renal transplanted patients in our unit. At inclusion, demographic, clinical and transplant-related data were collected, X-ray of the pelvis and hands (for Adragão score) and echocardiographic findings were recorded. All patients were submitted to a bone biopsy and laboratorial evaluation at baseline (time 0 – T0). Patients were followed for 12 months (time 1 – T1), after which performed laboratorial evaluation, a 2nd bone biopsy, echocardiogram, X-ray of pelvis and hands, bone densitometry and non-contrast cardiac CT (Agatston score). Continuous variables are presented as medians and categorical variables as frequencies. Differences between T0 and T1 were accessed by Wilcoxon matched-pairs test and paired McNemar test. Correlations between bone histomorphometric findings and severity of vascular calcifications with demographic and laboratorial parameters were obtained with Wilcoxon rank-sum test or Kruskall Wallis test. STATA software was used and p < 0.05 was considered statistically significant. Results We recruited 84 patients in a 28 month-period. At the end of 12 months, 69 patients performed a 2nd evaluation. Median age 53 years, 48 men, 53 caucasian, median dialysis vintage 55 months. We observe a significant reduction on phosphorus, magnesium, PTH, calcitonin, sclerostin, bone alkaline phosphatase and FGF23. Both calcium and alpha-klotho serum levels increase, with no significant changes in vitamin D levels. 68% of the patients presented renal osteodystrophy at the 2nd bone biopsy, and we observed a significant increase in the development of low turnover bone disorder, with no major changes in volume or mineralization. Changes in alpha-klotho, bAP and sclerostin (from T0 to T1) were important determinants of changes in turnover, mineralization and volume, respectively. Despite not being statistically significant, we were able to observe an improvement in the cortical bone porosity. Vascular calcifications and echocardiographic findings weren’t different comparing to the baseline (Median Adragão score was 1 in both evaluations, and valve calcifications were present in 22% and 23% of patients, with no changes in LVMI). The median Agatston score was 48.5, being the median adjusted percentile of 82%. FGF23 and sclerostin were found to be independent risk factors for extra-osseous calcifications, as well as low bone volume, cortical porosity and osteoid volume. Adragão score and valve calcifications correlated well with the increased severity of coronary calcifications determined by Agatston score (absolute and percentile). Conclusion In conclusion, renal transplantation improves two of the three components of CKD-MBD (biochemical and bone disorders), slowing the progression of vascular calcifications. FGF23, sclerostin and bAP seemed to be key parameters in understanding the bone changes observed in post transplant period, and these hormones also interfere with extra osseous calcification severity. Adragão score seems to be a good tool to access vascular calcifications in renal transplanted patients.

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Abstract 289: Hospital Volume of LVAD Procedures Determines Patient Outcome

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.6.suppl_1.a289 ◽

2013 ◽

Vol 6 (suppl_1) ◽

Author(s):

Katherine Feldman ◽

Rami Doukky ◽

Tricia Johnson ◽

David Levine ◽

Sam Hohmann

Keyword(s):

Heart Failure ◽

Hospital Mortality ◽

The United States ◽

Left Ventricular ◽

Policy Implications ◽

Ventricular Assist Devices ◽

Categorical Variables ◽

Procedure Volume ◽

End Stage Heart Failure ◽

End Stage

Background: Left ventricular assist devices (LVADs) provide mechanical circulatory support to patients with end-stage heart failure. The use of these devices in the United States has been increasing since the FDA approved the first device in 1994. There are no published studies that have evaluated the relationship between LVAD procedural volume and hospital mortality, despite large variation across hospitals in the volume of LVAD procedures performed. This study sought to explore whether a correlation exists between hospital and surgeon’s procedural volumes and patient outcomes, and also to identify a critical threshold. Methods: We conducted a retrospective cross-sectional analysis of all patient discharges from UHC member hospitals from January 2008 through June 2012 after an insertion of an LVAD during their hospitalization. Patients were identified from UHC’s Clinical Database/Resource Manager (CDB/RM) on the basis of the principal or secondary International Classification of Diseases Ninth Revision, Clinical Modification ( ICD-9-CM) procedure code 37.66. The primary outcome was all cause mortality. Results: There were 87 hospitals that admitted at least 1 patient for an LVAD procedure during the study period (77.5 percent males, mean age 54.3). The mean length of stay was 42.1 days and a mean total cost of $299,067. We identified variation of in-hospital mortality by hospital LVAD procedure volume quartile. Quartile 1 included hospitals performing 1-9 procedures (38.8% mortality), quartile 2 performed 10-46 procedures (18.1% mortality), quartile 3 performed 55-97 procedures (12.8% mortality), and the fourth quartile performed 107-319 procedures (16.1% mortality) during the study period. Categorical variables were compared with the Chi-Square Test, and continuous variables were compared with t-tests. There was significant variation in the mortality for almost all study variables including age, gender, admission severity of illness, and admission risk of mortality, and the variation persisted by volume quartile. Conclusion: Initial results suggest that there is a correlation between hospital LVAD procedure volume and in-hospital mortality. LVADs are becoming an increasingly common treatment method for patients with end-stage heart failure and are either awaiting transplant or will receive the device as the final method of therapy. Identifying critical volume thresholds could improve outcomes and ultimately improve the efficiency and value of care. Implications: Identifying mortality associated with LVAD procedures at these hospitals will provide patients and physicians with more information when seeking treatment options for heart failure. This study may also have health policy implications for cardiac treatment by implementing guidelines that LVAD hospital and surgeon programs must adhere to.

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Effect of Ultrafiltration on Sleep Apnea and Cardiac Function in End-Stage Renal Disease

American Journal of Nephrology ◽

10.1159/000505445 ◽

2020 ◽

Vol 51 (2) ◽

pp. 139-146 ◽

Cited By ~ 2

Author(s):

Toru Inami ◽

Owen D. Lyons ◽

Elisa Perger ◽

Azadeh Yadollahi ◽

John S. Floras ◽

...

Keyword(s):

Sleep Apnea ◽

Renal Disease ◽

Cardiac Function ◽

End Stage Renal Disease ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Systolic And Diastolic Function ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Rationale: End-stage renal disease (ESRD) patients have high annual mortality mainly due to cardiovascular causes. The acute effects of obstructive and central sleep apnea on cardiac function in ESRD patients have not been determined. We therefore tested, in patients with ESRD, the hypotheses that (1) sleep apnea induces deterioration in cardiac function overnight and (2) attenuation of sleep apnea severity by ultrafiltration (UF) attenuates this deterioration. Methods: At baseline, ESRD patients, on conventional hemodialysis, with left ventricular ejection fraction (LVEF) >45% had polysomnography (PSG) performed on a non-dialysis day to determine the apnea-hypopnea index (AHI). Echocardiography was performed at the bedside, before and after sleep. Isovolumetric contraction time divided by left ventricular ejection time (IVCT/ET) and isovolumetric relaxation time divided by ET (IVRT/ET) were measured by tissue doppler imaging. The myocardial performance index (MPI), a composite of systolic and diastolic function was also calculated. One week later, subjects with sleep apnea (AHI ≥15) had fluid removed by UF, followed by repeat PSG and echocardiography. Results: Fifteen subjects had baseline measurements, of which 7 had an AHI <15 (no–sleep-apnea group) and 8 had an AHI ≥15 (sleep-apnea group). At baseline, there was no overnight change in the LVEF in either the no-sleep-apnea group or the sleep-apnea group. In the no-sleep-apnea group, there was also no overnight change in MPI, IVCT/ET and IVRT/ET. However, in the sleep-apnea group there were overnight increases in MPI, IVCT/ET and IVRT/ET (p = 0.008, 0.007 and 0.031, respectively), indicating deterioration in systolic and diastolic function. Following fluid removal by UF in the sleep-apnea group, the AHI decreased by 48.7% (p = 0.012) and overnight increases in MPI, IVCT/ET and IVRT/ET observed at baseline were abolished. Conclusions: In ESRD, cardiac function deteriorates overnight in those with sleep apnea, but not in those without sleep apnea. This overnight deterioration in the sleep-apnea group may be at least partially due to sleep apnea, since attenuation of sleep apnea by UF was accompanied by elimination of this deleterious overnight effect.

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Impact of parathyroidectomy on left ventricular function in end stage renal disease patients

BMC Nephrology ◽

10.1186/s12882-020-02139-3 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Shaohua Chen ◽

Kaixiang Sheng ◽

Ying Shen ◽

Hua Jiang ◽

Xin Lei ◽

...

Keyword(s):

Left Ventricular Function ◽

Ventricular Function ◽

End Stage Renal Disease ◽

Systolic Function ◽

Left Ventricular Systolic Function ◽

Left Ventricular ◽

Ventricular Systolic Function ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Abstract Background Secondary hyperparathyroidism (SHPT) is a common complication in end-stage renal disease (ESRD) patients, and parathyroidectomy (PTX) is an effective treatment intervention of SHPT. However, the curative impact of PTX on left ventricular function still remains incompletely understood. To evaluate the impact of parathyroidectomy on left ventricular function in ESRD patients, we conducted this retrospective study. Methods Between Oct 1, 2010 and Oct 1, 2016, ESRD patients presented with SHPT who underwent parathyroidectomy were enrolled. We retrospectively collected the ultrasonic cardiogram parameter pre- and 1-year post-PTX, and analyzed the influence factor for the overturn of left ventricular hypertrophy (LVH) and the improvement of ejection fraction% (EF%). Results In all the patients (135), the main ultrasonic cardiogram parameter dramatically improved after PTX. Compared with pre-PTX, the left ventricular mass (LVM) (172.82 (135.90, 212.91) g vs. 192.76 (157.56, 237.97) g, p<0.001) and the left ventricular mass index (LVMI) (107.01 (86.79, 128.42) g/m2 vs. 123.54 (105.49, 146.64) g/m2, p<0.001) significantly declined after 1 year of the PTX. Further, 43.75% patients diagnosed with LVH before the PTX have recovered from LVH. In the subgroup analysis of 35 patients with EF% ≤ 60% pre-PTX, EF% and fractional shortening% (FS%) significantly improved after 1 year of the PTX compared with pre-PTX (EF%: 64.90 ± 7.90% vs. 55.71 ± 4.78%, p<0.001; FS% 35.48 ± 6.34% vs. 29.54 ± 2.88%, p<0.001), and 82.86% patients underwent an improvement of left ventricular systolic function post 1year of the PTX. Conclusions tPTX+AT is an effective curative intervention of secondary hyperparathyroidism and can significantly overturn the LVH and increase the left ventricular systolic function.

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Clinical Manifestations of Cardiac Disease in Patients with End Stage Renal Disease Under Maintenance Hemodialysis in a Tertiary Level Hospital of Nepal

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v15i1.15017 ◽

2016 ◽

Vol 15 (1) ◽

pp. 61-65

Author(s):

Kumar Roka ◽

Pratibha Bista Roka

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Low Voltage ◽

Clinical Manifestations ◽

Left Ventricular Diastolic Dysfunction ◽

Left Ventricular ◽

Maintenance Hemodialysis ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Introduction: End stage renal disease presents with multiple clinical and systemic manifestations. The aim of the present study was to identify the early cardiac and other morbidities in end stage renal disease (ESRD) patients who were under maintenance hemodialysis.Methods: This was an observational, prospective study conducted in fifty established ESRD patients of 20 to 74 years under maintenance hemodialysis in Nephrology unit of Shree Birendra Hospital. Clinical examination, laboratory parameters, electrocardiogram and echocardiography findings were used to identify the morbidities. Results: Among all patients enrolled in the study 88.7% had anemia, 64.2 % systolic murmurs, 62.26 % pedal edema, 73.6 % fatiguability, 71.7 % angina, 24.4 % palpitations and 13.2 % had breathlessness on exertion. 62.26% of the patients had hypertension and 13.20 % had diabetes. In the electrocardiogram, prolonged QTc was observed in 10.4%, followed by T wave inversion in 9.4 % and finally low voltage complex comprised 7.6 %. The echocardiogram showed left ventricular diastolic dysfunction in 58.5 %, left ventricular hypertrophy (overall type) 49 % and valvular lesion like mitral regurgitation and tricuspid regurgitation 83 % and 58.5 % respectively. Conclusion: Cardiac co-morbidities are common in patients diagnosed with ESRD on maintenance hemodialysis.

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