MO528INFLUENCE OF CARDIOVASCULAR DISEASES ON SURVIVAL RATES IN DIALYSIS PATIENTS IN A COHORT OF THE UZBEK POPULATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Olimkhon Sharapov ◽  
Sherzod Abdullaev

Abstract Background and Aims The mortality rate of patients on hemodialysis is 6.3-8.2 times higher than in the general population. The presence of cardiovascular comorbidity worsens the prognosis and survival in this category of patients. According to various sources, the mortality rate in patients with CVD is 3 times higher than in patients without CVD. The aim of our study was to study the effect of comorbidity of the CVD on survival in patients with end-stage CKD receiving programmed hemodialysis among the population of Uzbekistan. Method We conducted a multicenter prospective cohort study of 165 patients among the Uzbek population. The study took place in 3 different dialysis centers in the country for 30 months (from January 2018 to July 2020). All patients received programmed hemodialysis due to ESRD. All patients were of Uzbek nationality, there were 90 men, 75 women. The average age was 48.1 ± 14.1 years. The duration of hemodialysis at the time of inclusion of patients in the study ranged from 6 to 165 months. The main primary diseases were glomerulonephritis (46%), diabetes mellitus (27%) and urolithiasis (8%). 56% (n = 92) of patients (52 men and 40 women) had CVD and 44% (n = 73) of patients (38 men and 35 women) had no CVD. The main CVDs were hypertension, coronary heart disease, heart failure and various arrhythmias. All patients were observed during the observation period, at the end of which the outcome was noted: patients either died or continued to receive hemodialysis. The survival rate was determined using the Kaplan-Meier method. The 95% confidence interval was determined using the Greenwood method. Results After 30 months of follow-up, 43.6% (n = 72) of all observed patients died, 56.4% (n = 93) patients survived (of which 11 underwent kidney transplantation). The average age of the deceased (53.6 ± 1.6) was significantly higher than that of patients continuing to receive HD (45.6 ± 1.5). The average duration of hemodialysis in survivors (33.0 ± 5.4) was higher than in the dead (28.6 ± 3.9). The study of the further fate of patients, depending on the presence or absence of cardiovascular diseases, showed that among the deceased patients, 68.1% (n = 49) of patients were patients who had CVD, while among those who survived, 53.7% ( n = 44) had no CVS pathologies. Among those continuing to receive programmed hemodialysis, there were 31.7% more patients without CVD than among patients with diagnosed CVD. In dialysis patients with CVD who died within the period of 30 months of prospective observation was 39.6% higher than in patients without CVD. The survival rate of patients with CVD was 0.44 [95% CI 0.34-0.55], while in patients without CVD it was 0.67 [95% CI 0.55-0.78]. Conclusion The concomitant pathology of the cardiovascular system affects the survival rate of patients with end-stage CKD on hemodialysis. Dialysis patients of the population of Uzbekistan who do not have concomitant cardiovascular pathology have a 33% higher survival rate than patients without CVD.

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Olimkhon Sharapov

Abstract Background and Aims Until recently, for various reasons in Uzbekistan, it was often necessary to reuse disposable dialyzers for hemodialysis procedures. On June 13, 2018, a Resolution of the President of the Republic of Uzbekistan was issued on measures to improve the effectiveness of the provision of nephrological and dialysis care to the population of our country. Thanks to this, funding and provision of all nephrological and dialysis centers have sharply increased, as well as the country's transplant service has been re-established. Since the end of 2018, dialyzers are used exclusively once in all dialysis centers in our country. We were interested in comparatively studying the survival rate of dialysis patients during one year, before and after the transition to the use of single dialyzers in our center. Method We conducted a prospective observation of 120 (63 men and 57 women) patients with end-stage CKD and receiving programmed hemodialysis at our dialysis center in Tashkent. Our observation took place for 2 years: from the beginning of 2018 to the end of 2019. The study took place in 2 stages, 1 year each: at the first stage, within 1 year (from the beginning to the end of 2018), the survival rate of the observed patients receiving hemodialysis with repeated use of disposable dialyzers was assessed. At the second stage (after the transition to one-time use of dialyzers throughout the country), also for 1 year (from the beginning to the end of 2019), all the patients we observed received hemodialysis sessions with a single use of dialyzers. All patients were diagnosed with end-stage CKD. The average age of the patients was 49.7 ± 14.1 years. The average duration of hemodialysis was 29.4 (6-252) months. All patients underwent hemodialysis sessions with identical apparatus and dialyzers of the same manufacturer. The primary diseases in the patients were glomerulonephritis (n = 44, 36.7%), type 2 diabetes (n = 38, 31.7%), urolithiasis (n = 13, 10.8%), polycystic kidney disease (n = 7, 5.8%), lupus (n = 5, 4.2%) and others (n = 13, 10.8%). Survival was assessed using the Kaplan-Meier method, the confidence interval was determined by Greenwood. Results During the entire period (24 months) of observation, out of 120 patients, 26.7% (n = 32) patients died, 73.3% (n = 88) survived (of which 10 patients underwent kidney transplantation). We will assess the survival rate depending on the periods of dialyzer use. During 1 year of follow-up (the period of repeated use of disposable dialyzers), 19.2% (n = 23) patients died, 80.8% (n = 97) survived and continued to receive hemodialysis, of which 2 (1.7%) patients underwent a kidney transplant and knocked out of observation. The main cause of death was cardiovascular complications (sudden cardiac death, myocardial infarction, stroke, etc.), as a result of which 69.6% (n = 16) of patients died. The survival rate for 1 year was S (t) = 0.815 [95% CI, 0.745-0.885]. Over the next 12 months (single use period), out of 95 patients continuing to receive hemodialysis, 9.5% (n = 9) patients died, 82.1% (n = 78) patients survived. 8.4% (n = 8) of the observed patients underwent kidney transplantation. 55.6% (n = 5) of all deceased patients died from cardiovascular complications. The survival rate at 1 year was S (t) = 0.901 [95% CI, 0.839-0.962]. Conclusion Compliance with the standards for hemodialysis, in particular, the single use of disposable dialyzers for hemodialysis sessions leads to a decrease in the lethality of dialysis patients. The transition from multiple to single use of disposable dialyzers in one dialysis center in Uzbekistan showed a significant increase in survival by 10.6%.


Vascular ◽  
2018 ◽  
Vol 26 (5) ◽  
pp. 509-514 ◽  
Author(s):  
Cemal Kocaaslan ◽  
Tamer Kehlibar ◽  
Mehmet Yilmaz ◽  
Mehmet E Mehmetoglu ◽  
Rafet Gunay ◽  
...  

Introduction Guidelines have been recommending the use of arteriovenous fistula among the hemodialysis population, but no clear conclusion has emerged with regard to the adequate access type in octogenarians. In this paper, the outcomes of arteriovenous fistula in octogenarian cohort were presented for death-censored cumulative patency rate, complications, and patients’ survival rate. Methods A retrospective review of 88 consecutive arteriovenous fistula interventions in 70 octogenarian patients were performed at one referral institution between January 2010 and June 2014. The patients’ records were analyzed and postoperative complications were documented. Death-censored cumulative arteriovenous fistula patency rates were calculated, and Kaplan–Meier method was used to analyze patient survival for 24 months. Findings: Eighty-eight arteriovenous fistula constructions and six salvage procedures were performed in 70 octogenarians. Fifty-four (61.3%) forearm and 34 (38.7%) upper arm fistulas were created. All types of fistulas had 6-, 12-, 18-, and 24-month death-censored cumulative patency rates of 63.6%, 58.3%, 48.8%, and 41.4%, respectively. The primary failure rate was 40.9%. A total of 15 complications were documented as edema, hematoma/bleeding, infection, distal ischemia, and venous aneurysm, all of which had been treated. Patient survival rates for 12 and 24 months were 68.5% and 58.5%, respectively. Discussion and conclusion: This analysis regarding arteriovenous fistula in octogenarian end-stage renal disease patients figured out equal death-censored cumulative patency compared to nonelderly, and two-year survival rate was acceptable. This study strengthens the argument that arteriovenous fistula should be the best proper choice in selected octogenarians; older age only should not be considered as an absolute contraindication for arteriovenous fistula creation in octogenarians; and patient-based approach should be applied.


2021 ◽  
Vol 4 (57) ◽  
pp. 8-11
Author(s):  
Szymon Warwas ◽  
Marta Jagosz ◽  
Beata Średniawa ◽  
Michał Mazurek ◽  
Ewa Jędrzejczyk-Patej

The most common cause of death among dialysis patients with end-stage kidney disease are cardiovascular diseases. It is estimated that 18-27% of all deaths in dialysis patients are sudden cardiac deaths due to arrhythmias and conduction disturbances. The most common arrhythmias in dialysis patients, often leading to sudden death, are not ventricular arrhythmias but bradyarrhythmias. The article below discusses the most common arrhythmias in dialysis patients and methods of preventing sudden cardiac death in this group of patients.


2020 ◽  
Vol 57 (6) ◽  
pp. 1113-1121
Author(s):  
Guido Michielon ◽  
Giovanni DiSalvo ◽  
Alain Fraisse ◽  
Julene S Carvalho ◽  
Sylvia Krupickova ◽  
...  

Abstract OBJECTIVES The interstage mortality rate after a Norwood stage 1 operation remains 12–20% in current series. In-hospital interstage facilitates escalation of care, possibly improving outcome. METHODS A retrospective study was designed for hypoplastic left heart syndrome (HLHS) and HLHS variants, offering an in-hospital stay after the Norwood operation until the completion of stage 2. Daily and weekly examinations were conducted systematically, including two-dimensional and speckle-tracking echocardiography. Primary end points included aggregate survival until the completion of stage 2 and interstage freedom from escalation of care. Moreover, we calculated the sensitivity and specificity of speckle-tracking echocardiographic myocardial deformation in predicting death/transplant after the Norwood procedure. RESULTS Between 2015 and 2019, 33 neonates with HLHS (24) or HLHS variants (9) underwent Norwood stage 1 (31) or hybrid palliation followed by a comprehensive stage 2 operation (2). Stage 1 Norwood–Sano was preferred in 18 (54.5%) neonates; the classic Norwood with Blalock–Taussig shunt was performed in 13 (39.4%) neonates. The Norwood stage 1 30-day mortality rate was 6.2%. The in-hospital interstage strategy was implemented after Norwood stage 1 with a 3.4% interstage mortality rate. The aggregate Norwood stage 1 and interstage Kaplan–Meier survival rate was 90.6 ± 5.2%. Escalation of care was necessary for 5 (17.2%) patients at 2.5 ± 1.2 months during the interstage for compromising atrial arrhythmias (2), Sano-shunt stenosis (1) and pneumonia requiring a high-frequency oscillator (2); there were no deaths. A bidirectional Glenn (25) or a comprehensive-Norwood stage 2 (2) was completed in 27 patients at 4.7 ± 1.2 months with a 92.6% survival rate. The overall Kaplan–Meier survival rate is 80.9 ± 7.0% at 4.3 years (mean 25.3 ± 15.7 months). An 8.7% Δ longitudinal strain 30 days after Norwood stage 1 had 100% sensitivity and 81% specificity for death/transplant. CONCLUSIONS In-hospital interstage facilitates escalation of care, which seems efficacious in reducing interstage Norwood deaths. A significant reduction of longitudinal strain after Norwood stage 1 is a strong predictor of poor outcome.


2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1791-1791
Author(s):  
Domenica De Santis ◽  
Silvia Udali ◽  
Andrea Ruzzenente ◽  
Greta Beschin ◽  
Patrizia Pattini ◽  
...  

Abstract Objectives Recent evidences suggest a principal role of trace elements and metallothioneins (MTs), proteins involved in metal ions homeostasis and detoxification, in hepatocellular carcinogenesis. The study was designed to evaluate whether serum and liver tissue concentrations of the trace elements Cu, Zn and Se are implicated in survival rate of hepatocellular carcinoma (HCC) patients and if promoter DNA methylation is involved in trace elements-related proteins regulation. Methods Cu, Zn and Se levels were determined in serum and liver tissue samples, both HCC and homologous non neoplastic tissue (N) of 27 HCC patients by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Gene expression analysis of MT1G and MT1H, was performed by Real-time qPCR in HCC and N tissue. Promoter DNA methylation of a region overlapping MT1G and MT1H promoters was assessed by bisulfite amplicon sequencing (BSAS) in HCC and N tissues of 23 patients. Kaplan-Meier survival curves were drawn using the log-rank test (Mantel-Cox test) to examine the differences in survival according to serum trace elements and to gene-specific methylation levels. Results Kaplan-Meier analysis according to serum Cu levels showed that subjects within the highest quintile had an increased mortality rate (88.9%) compared with the other four quintiles (P = 0.025). Considering the 80th percentile of Cu levels (1118 μg/L), subjects with Cu concentrations above this value had a significantly decreased survival rate (P < 0.001). Se and Zn content were depleted in HCC tissues as compared to N tissues (P < 0.0001). MT1G and MT1H were strongly repressed in HCC tissues and precisely, MT1H in 24 out of 27 HCC tissues (P = 0.008) and MT1G in 23 out of 27 HCC tissues (P = 0.037). Nine out of 19 HCC tissues showing a down-regulation of MTs with three CpG sites, significantly hypermethylated in HCC tissue as compared to N tissue (P < 0.05). Considering the median methylation level, patients with higher methylation values showed increased mortality rate (P = 0.015). Conclusions The significant repression of MT1G and MT1H in HCC tissue is related to promoter hypermethylation and support the hypothesis of MT1G and MT1H as possible tumor suppressor genes in HCC. The evidence of promoter methylation levels and survival rate association provide new insights for the role of DNA methylation in liver carcinogenesis. Funding Sources N/A.


2019 ◽  
Vol 47 (3) ◽  
pp. 1221-1231 ◽  
Author(s):  
Zhixiang Bian ◽  
Huiyi Gu ◽  
Peihua Chen ◽  
Shijian Zhu

Background The survival rate of patients undergoing hemodialysis and other renal replacement therapies has been extensively studied, but comparative studies of emergency and scheduled hemodialysis are limited. Methods This study included 312 patients who underwent emergency hemodialysis and 274 who received scheduled hemodialysis. We investigated the prognostic differences between these two groups of patients, including the short-term and long-term survival rates. Results The overall survival rate was significantly better among the patients in the scheduled hemodialysis group than emergency hemodialysis group. The mortality rate within 3 months of emergency hemodialysis was 4.8%, while that within 3 months of scheduled hemodialysis was 1.1%. Conclusions Significant differences were present between emergency and scheduled hemodialysis, especially the levels of serum creatinine and hemoglobin.


2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 559-559 ◽  
Author(s):  
Kevin Knopf ◽  
Sheikh Usman Iqbal ◽  
Stephen F Thompson ◽  
Elisabetta Malangone ◽  
Magdaliz Gorritz-Kindu ◽  
...  

559 Background: The increase in survival seen in recent years in patients with mCRC has been attributed to improvements in treatments, including the introduction of targeted biologic agents. The objectives of this retrospective, observational study are to investigate recent treatment patterns in US mCRC patients and examine real-world survival outcomes. Methods: Data were obtained from a large U.S. database (SDI/IMS Health) of mCRC patients diagnosed from January 1, 2004 to June 30, 2011, ≥18 y at diagnosis, and who received chemotherapy and/or biologic treatment. Complete follow-up was defined as those who either died before June 2011 or who had at least 1 claim within 30 days of June 30, 2011. Kaplan-Meier curves were generated to determine overall survival (OS) from the date of mCRC diagnosis. Results: 1,066 stage IV mCRC patients with complete follow-up were identified (57.5% male; mean age, 61.6 y). Approximately 80% were diagnosed with mCRC after 2006; 51.7% had liver metastases. The most common 1L, 2L, and 3L regimens were FOLFOX plus bevacizumab (34.52%), FOLFIRI plus bevacizumab (21.83%), and irinotecan plus cetuximab (15.83%), respectively. A total of 445 patients died during the study period, yielding a mortality rate of 41.74%. Mean time from diagnosis to first treatment was 3.31 months (SD=7.13). All patients received 1L therapy; OS from diagnosis was 35.77 months (95% CI: 32.57-38.10); 5-year survival was approximately 28%. After 1L, 591/1066 (55%) patients went on to receive 2L therapy; for these patients, median survival from diagnosis was 37.13 months (95% CI: 34.07-40.43) and 5-year survival was approximately 25%. After 2L, 278/591 (47%) patients received 3L therapy; for these patients, median survival from diagnosis was 38.10 months (95% CI: 34.83-43.13); 5-year survival was approximately 25%. Conclusions: In this study, OS (35.77 months) was longer than for other mCRC observational studies that have reported survival from start of treatment, but is more comparable when the ~3 months from diagnosis to start of treatment are not included. Addition of targeted agents and novel chemotherapy has prolonged OS in mCRC patients. Because of poor 5-year survival rates, the need for additional agents in later lines of therapy still exists.


2008 ◽  
Vol 36 (04) ◽  
pp. 655-663 ◽  
Author(s):  
Shu-Chuan Lin ◽  
Ming-Feng Chen ◽  
Tsai-Chung Li ◽  
Yu-Ho Hsieh ◽  
Shwu-Jiuan Liu

Yin-Deficiency (YD), representing a status of the human body under lack of nutrition and fluid in traditional Chinese medicine, is commonly seen in late stage of cancer patients. It is not known whether the severity of YD related symptoms/signs can predict the survival rate of cancer patients. This study evaluated the distribution of Yin-deficiency symptoms/signs (YDS) in cancer patients with YD, and investigated whether the severity of YDS can predict the survival rate of cancer patients with YD. From 5 January 2007 to 5 May 2007, we selected 43 cancer patients with diagnosis of YD from hospitalized patients and outpatients. The severity of YD was evaluated by a questionnaire. We further estimated the cumulative probabilities of the survival rates over 4 months since the start of study by the Kaplan-Meier product-limit method, and compared the differences among groups with various severities in each symptom/sign with the use of the log-rank test. The results revealed that, the 3 most common YDS were sleeplessness with annoyance, less or non-coated tongue with or without redness and dry mouth. In the survival rate analysis, only 2 parameters, rapidly small pulse (p = 0.002) and less-or non-coated tongue with paleness (p = 0.017), were found to be related to the decrease of cancer patients with YD. This suggests that, both rapidly small pulse and less-or non-coated tongue without redness may be used as predictors for the estimation of survival rate in cancer patients with YD.


Author(s):  
Fatemeh Gohari-Ensaf ◽  
Zeinab Berangi ◽  
Mohamad Abbasi ◽  
Ghodratollah Roshanaei

Introduction: Gastric cancer is the fourth most common cancer and the second leading cause of death in the world. Despite the recent advances in controlling and treating the disease, the survival rate of this cancer is relatively low. Various factors can affect the survival of the patients with gastric cancer. The aim of this study was to determine the survival rates and the effective factors in the patients with gastric cancer. Methods: The study population included all the patients diagnosed with gastric cancer in Hamadan Province who were referred to Hamadan Imam Khomeini Specialized Clinic between 2004 to 2017. Patients were followed up by periodical referrals and/or telephone contact. The survival rate of the patients was calculated using Kaplan-Meier method and effective survival factors with Cox proportional regression. Data were analyzed using SPSS 23 software at a significance level of 0.05. Results: Out of the 350 patients with gastric cancer, 74.3% were male and 25.7% were female. One-year, three-year and five-year survival rates were 67%, 36% and 27%, respectively. The log -rank test showed that age, type of tumor, stage of disease, type of Surgery and metastasis of the disease were effective on the survival of patients. In Cox's multivariate analysis, the only age variables at the time of diagnosis and chemotherapy were survival variables. (P<0.05). Conclusion: The results of this study showed that age variable is a strong factor in survival, so it is essential to diagnose the disease at the early age and early stages of the disease using a screening program.


2021 ◽  
Vol 48 (1) ◽  
pp. 12-20
Author(s):  
Hyejun Seo ◽  
Soyoung Park ◽  
Eungyung Lee ◽  
Taesung Jeong ◽  
Jonghyun Shin

The purpose of this retrospective study was to evaluate the survival rate by comparing Class II restoration using flowable resin composite with stainless steel crown in primary molars.Electronic medical records and radiographs of 1,504 primary molars with proximal caries of 590 patients from June 2015 to August 2019 were analyzed. With the collected data, survival analysis was performed using the Kaplan-Meier method.The 1-year survival rate of flowable resin composite in the primary molar was 98.5%, 3-year survival rate was 87.7%, and mean survival time was 39 months. There was no statistically significant difference between flowable resin composite and stainless steel crown (<i>p</i> = 0.896).Within the limits of this study, Class II restoration using flowable resin composite can be considered a promising option for the treatment of proximal caries in primary molars.


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