MO641IMPACT OF MAGNESIUM AND L-CARNITINE ADMINISTRATION ON 3-YEAR SURVIVAL IN DIABETIC PATIENTS WITH END-STAGE RENAL DISEASE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Oleksandr Susla ◽  
Zoriana Litovkina ◽  
Olha Bushtynska
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Cardiovascular Complications ◽  
Diabetic Patients ◽  
Carnitine Supplementation ◽  
Basic Therapy ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background and Aims According to population registries, the survival of diabetic patients with end-stage-renal disease (ESRD) remains low today. In this context, it is reasonable to develop new therapeutic strategies based on advances in science of the important role of magnesium (Mg) and L-carnitine deficiency (via inflammation and endothelial dysfunction) in mechanisms of cardiovascular remodeling, high morbidity and mortality rates. Thus, the purpose of the present study was to evaluate the effect of Mg and L-carnitine supplementation on 3-year survival and development of the cardiovascular complications in diabetic hemodialysis (HD) patients. Method 48 type 2 diabetic ESRD patients were included in this prospective cohort study (male/female, 29/19; age, 59.9±0.6 years; HD duration, 34.8±4.8 month; diabetes mellitus duration, 174.7±7.1 month). The study was performed in accordance with the provisions of the Declaration of Helsinki last revision. Depending on the treatment programme, patients were divided into two groups: the 1st (main) group (n=24) in addition to basic treatment (hypoglycemic, antihypertensive therapy, according to indications - correction of anemia, hyperparathyroidism, hyperphosphatemia) was treated by combination of magnesium aspartate (0.5 g/day orally) and L-carnitine (1 g/day parenterally after each HD session (three times weekly); the 2nd (comparison) group (n=24) was only on the basic therapy. Complex treatment lasted 12-months; administration of L-carnitine was performed continuously throughout the year, while magnesium aspartate – by three 2-months’ courses/year. The follow up period in both groups was 36 months. Quantitative data are expressed as means±SEM, qualitative ones – as %. Kaplan-Meier method and Log-rank test were used to estimate survival of HD patients, χ2-test – to compare the frequency values. Results The cumulative proportion of survivors at the end of follow-up was 60.4%; however, after 36 months, the survival rate of diabetic HD patients who received a combination of magnesium aspartate and L-carnitine as part of their modified treatment was significantly higher (75 vs. 45.8%; Log-rank=2.07, p=0.038) compared to patients who were on basic therapy (Figure). Survival time in main and comparison groups was 31.9±1.7 and 26.4±2.2 months respectively. It is noteworthy, that throughout the year (from 10 to 22 months), no completed events were recorded in subjects who underwent Mg and L-carnitine supplementation. Conclusion (1) The combined use of magnesium aspartate and L-carnitine in addition to the basic 12-month treatment provides an effective reduction of cardiovascular complications and promotes 3-year survival of diabetic HD patients. (2) The results obtained substantiate the advisability of using repeated courses of Mg and L-carnitine administration 1 years after the end of the primary modified treatment to improve the prognosis in these ESRD patients.

scholarly journals Diabetic nephropathy as a cause of end-stage renal disease in Egypt: a six-year study

2004 ◽  
Vol 10 (4-5) ◽  
pp. 620-626 ◽  
Author(s):  
A. Afifi ◽  
M. El Setouhy ◽  
M. El Sharkawy ◽  
M. Ali ◽  
H. Ahmed ◽  
...  
Keyword(s):  
Diabetic Nephropathy ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Large Scale ◽  
Cross Sectional Study ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

The prevalence of diabetic nephropathy as a cause of end-stage renal disease [ESRD] in Egypt has been examined in small cross-sectional studies, with conflicting results. The need for a large-scale study prompted us to perform this 6-year multiple cross-sectional study. A sample of ESRD patients enrolled in the Egyptian renal data system was evaluated during the period 1996-2001 for the prevalence of diabetic nephropathy. Prevalence gradually increased from 8.9% in 1996, to 14.5% in 2001. The mean age of patients with diabetic nephropathy was significantly higher than that of patients with ESRD from other causes. Mortality was also significantly higher in diabetic patients with ESRD

Hemodialysis Decreases the Etiologically-Related Early Vascular Aging Observed in End-Stage Renal Disease: A 5-Year Follow-Up Study

2016 ◽  
Vol 43 (1-3) ◽  
pp. 18-30 ◽  
Author(s):  
Daniel Bia ◽  
Cintia Galli ◽  
Yanina Zócalo ◽  
Rodolfo Valtuille ◽  
Sandra Wray ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Pulse Wave ◽  
Vascular Aging ◽  
Control Subjects ◽  
Potential Association ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Aims: To analyze the early vascular aging (EVA) in end-stage renal disease (ESRD) patients, attempting to determine a potential association between EVA and the etiology of ESRD, and to investigate the association of hemodialysis and EVA in ESRD patients during a 5-year follow-up period. Methods: Carotid-femoral pulse wave velocity (cfPWV) was obtained in 151 chronically hemodialyzed patients (CHP) and 283 control subjects, and in 25 CHP, who were followed-up after a 5-year lapse. Results: cfPWV increased in ESRD patients compared to control subjects. The cfPWV-age relationship was found to have a steeper increase in ESRD patients. The highest cfPWV and EVA values were observed in patients with diabetic nephropathy. Regression analysis demonstrated a significant reduction of the EVA in HD patients on a 5-year follow-up. Conclusion: Patients in ESRD showed higher levels of EVA. cfPWV and EVA differed in ESRD patients depending on their renal failure etiology. CHP showed an EVA reduction after a 5-year follow-up period.

scholarly journals Worldwide epidemiology of diabetes-related end-stage renal disease, 2000–2015

2020 ◽  
Author(s):  
Hui-Teng Cheng ◽  
Xiaoqi Xu ◽  
Paik Seong Lim ◽  
Kuan-Yu Hung
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Annual Incidence ◽  
Western Pacific ◽  
Diabetic Patients ◽  
Patients With Diabetes ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
The Western Pacific

Objective <p>The annual risk among diabetic patients to reach end-stage renal disease (ESRD) is largely unknown worldwide. This study aimed to compare the incidence of diabetes-related ESRD by creating a global atlas during 2000–2015.</p> <p>Research Design and Methods</p> <p>The annual incidence of ESRD among diabetic patients was calculated as the quotient of the number of incident ESRD patients with diabetes divided by the total number of patients with diabetes after subtracting the number with existing ESRD. The estimated ESRD prevalence and annual incidence were validated using the data provided by Fresenius Medical Care, Germany, and previously reported data, respectively.</p> <p>Results</p> <p>Data were obtained from 142 countries, covering 97·3% of the world population. The global percentage of the prevalent ESRD patients with DM increased from 19·0% in 2000 to 29·7% in 2015 worldwide, while the percentage of incident ESRD patients due to DM increased from 22·1% to 31·3%. The global annual incidence of ESRD among DM patients increased from 375·8 to 1016·0/million with DM during 2000–2015. The highest average rates were observed in the Western Pacific Region. Comparatively, the rates of incident ESRD among European DM patients ranged from half (309·2 vs 544·6) to a third (419·4 vs 1245·2) of the rates of the Western Pacific population during 2000–2015.</p> <p>Conclusions </p> <p>Great and nonrandom geographic variation in the annual rates among diabetic patients to reach ESRD suggests that distinct healthcare, environmental, and/or genetic factors contribute to the progression of diabetic kidney disease. Measures to prevent and treat DM-related ESRD require better patient susceptibility stratification.</p>

Outcomes of Simultaneous Peritoneal Dialysis and Arteriovenous Fistula Placement in End-Stage Renal Disease Patients

2017 ◽  
Vol 37 (6) ◽  
pp. 658-661 ◽  
Author(s):  
Nosratollah Nezakatgoo ◽  
Albert Ndzengue ◽  
Manhunath Ramaiah ◽  
Elvira O. Gosmanova
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Arteriovenous Fistula ◽  
End Stage Renal Disease ◽  
Catheter Insertion ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Peritoneal dialysis (PD) interruption requiring hemodialysis (HD) is not uncommon and its frequently abrupt nature prevents timely creation of permanent HD access and avoidance of central venous catheters (CVC). We retrospectively studied a cohort of 24 end-stage renal disease (ESRD) patients (mean age 50.7 years, 83.3% African-Americans, 58.3% females, time on dialysis interquartile range [IQR] 0 - 65 days) who had simultaneous PD catheter insertion and backup arteriovenous fistula (AVF) creation between January 1, 2012, and December 31, 2013. The primary outcome of interest was the percent of patients receiving HD through the backup AVF at the time of PD interruption. A median (IQR) for PD catheter use after its insertion was 10.5 (2 - 20) days. After the mean follow-up of 19.6 months, 12 patients remained on PD, 2 patients received a kidney transplant, and 1 patient died. The overall AVF patency was 66.7%. A total of 9 (37.5%) patients had PD interruption requiring permanent (8 patients) or temporary (1 patient) HD after the mean (standard deviation [SD]) follow-up of 12.3 (8.2) months. Arteriovenous fistula was used as the initial access in 4 patients, and in 3 patients the original AVF was used after additional surgical revision. Forty-four percent of patients with a backup AVF fistula avoided CVC at the time of PD interruption requiring HD. The simultaneous AVF creation at the time of PD catheter insertion reduced but did not fully eliminate CVC at the time of PD interruption. Larger studies are needed to evaluate the utility of a backup AVF in PD patients.

scholarly journals Worldwide epidemiology of diabetes-related end-stage renal disease, 2000–2015

2020 ◽  
Author(s):  
Hui-Teng Cheng ◽  
Xiaoqi Xu ◽  
Paik Seong Lim ◽  
Kuan-Yu Hung
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Annual Incidence ◽  
Western Pacific ◽  
Diabetic Patients ◽  
Patients With Diabetes ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
The Western Pacific

Objective <p>The annual risk among diabetic patients to reach end-stage renal disease (ESRD) is largely unknown worldwide. This study aimed to compare the incidence of diabetes-related ESRD by creating a global atlas during 2000–2015.</p> <p>Research Design and Methods</p> <p>The annual incidence of ESRD among diabetic patients was calculated as the quotient of the number of incident ESRD patients with diabetes divided by the total number of patients with diabetes after subtracting the number with existing ESRD. The estimated ESRD prevalence and annual incidence were validated using the data provided by Fresenius Medical Care, Germany, and previously reported data, respectively.</p> <p>Results</p> <p>Data were obtained from 142 countries, covering 97·3% of the world population. The global percentage of the prevalent ESRD patients with DM increased from 19·0% in 2000 to 29·7% in 2015 worldwide, while the percentage of incident ESRD patients due to DM increased from 22·1% to 31·3%. The global annual incidence of ESRD among DM patients increased from 375·8 to 1016·0/million with DM during 2000–2015. The highest average rates were observed in the Western Pacific Region. Comparatively, the rates of incident ESRD among European DM patients ranged from half (309·2 vs 544·6) to a third (419·4 vs 1245·2) of the rates of the Western Pacific population during 2000–2015.</p> <p>Conclusions </p> <p>Great and nonrandom geographic variation in the annual rates among diabetic patients to reach ESRD suggests that distinct healthcare, environmental, and/or genetic factors contribute to the progression of diabetic kidney disease. Measures to prevent and treat DM-related ESRD require better patient susceptibility stratification.</p>

scholarly journals Frail phenotype might herald bone health worsening among end-stage renal disease patients

PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e3542 ◽  
Author(s):  
Chia-Ter Chao ◽  
Jenq-Wen Huang ◽  
Ding-Cheng Chan ◽  
Keyword(s):  
Lumbar Spine ◽  
Renal Disease ◽  
Bone Health ◽  
End Stage Renal Disease ◽  
Mineral Density ◽  
One Year ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background Frailty exhibits a high prevalence in end-stage renal disease (ESRD) patients and is associated with adverse health-related outcomes, including falls and fractures. Available studies do not address whether frailty is associated with temporal changes in BMD. We evaluated this issue by analyzing the follow-up dual energy X-ray absorptiometry (DXA) results in an ESRD cohort. Methods In 2015, we enrolled forty-three ESRD patients, divided into frail, pre-frail, and robust ones based on a validated simple FRAIL scale, all receiving DXA at baseline. After one year of follow-up, survivors received another DXA, and we calculated the absolute and percentage changes in area, bone mineral density (BMD), T-, and Z-scores of lumbar spine and femoral neck (FN) between baseline and follow-up examinations. Results Among all, frail individuals with ESRD had significantly lower average lumbar spine area, lower L4, FN, and total BMD and T-scores, lower FN and total Z-scores than non-frail ones, without differences in gender, body mass index, dialysis duration, and comorbidities. Furthermore, we discovered frail ESRD patients had significantly more prominent decrease in average lumbar spine area, percentage changes in L1 Z-scores and average lumbar spine area, and a trend toward more prominent decrease in L4 area than non-frail ones after one year of follow-up. Conclusions Baseline frailty might be associated with deteriorating bone health, including shrinking L-spine areas and a more rapid decrease in L-spine Z scores, among ESRD patients. This frailty-bone association should be highlighted during our care of frail individuals with ESRD.

scholarly journals Evaluation of ischaemia-modified albumin as a marker of myocardial ischaemia in end-stage renal disease

2007 ◽  
Vol 113 (1) ◽  
pp. 25-32 ◽  
Author(s):  
Rajan Sharma ◽  
David C. Gaze ◽  
Denis Pellerin ◽  
Rajnikant L. Mehta ◽  
Helen Gregson ◽  
...  
Keyword(s):  
Renal Disease ◽  
Myocardial Ischaemia ◽  
End Stage Renal Disease ◽  
Area Under The Curve ◽  
Dobutamine Stress ◽  
Transplant Candidates ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

The early diagnosis of myocardial ischaemia is problematic in patients with ESRD (end-stage renal disease). The aim of the present study was to determine whether IMA (ischaemia-modified albumin) increases during dobutamine stress and detects myocardial ischaemia in patients with ESRD. A total of 114 renal transplant candidates were studied prospectively, and all received DSE (dobutamine stress echocardiography). IMA levels were taken at baseline and 1 h after cessation of DSE. A total of 35 patients (31%) had a positive DSE result. Baseline IMA levels were not significantly different in the DSE-positive and -negative groups. The increase in IMA was significantly higher in the DSE-positive group compared with those with no ischaemic response (26.5±19.1 compared with 8.2±9.6 kU/l respectively; P=0.007; where kU is kilo-units). From ROC (receiver operator charactertistic) curve analysis, the optimal IMA increase to predict an ischaemic response was 20 kU/l, with a sensitivity of 81% and a specificity of 72% [area under the curve, 0.80 (95% confidence interval, 0.44–0.94); P=0.03]. There were 18 deaths, ten of which were cardiac in nature over a follow up period of 2.25±0.71 years. An increase in IMA ≥20 kU/l was associated with significantly worse survival (P=0.02). In conclusion, IMA is a moderately accurate marker of myocardial ischaemia in ESRD. Patients with an increase in IMA ≥20 kU/l during DSE had significantly worse survival.

scholarly journals Technology-assisted cognitive-behavioral therapy intervention for end-stage renal disease

2019 ◽  
Vol 10 (3) ◽  
pp. 657-663
Author(s):  
Karen P Jakubowski ◽  
Manisha Jhamb ◽  
Jonathan Yabes ◽  
Swathi Gujral ◽  
Lauren E Oberlin ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Behavioral Therapy ◽  
Preliminary Results ◽  
Patient Reported ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Technology-assisted cognitive-behavioral therapy (CBT) interventions have been conducted for symptoms including depression, pain, and fatigue in patients with chronic illnesses but not in end-stage renal disease (ESRD). The purpose of this study was to pilot the feasibility and acceptability of a technology-assisted CBT intervention in ESRD patients on hemodialysis (HD), share design and implementation lessons learned, and provide preliminary results on changes in select patient-reported symptoms. This was a single-center pilot feasibility study of adult ESRD patients on HD. Study eligibility required clinically elevated levels of at least one symptom (depression, pain, or fatigue). Patients met weekly with a CBT therapist for eight sessions, each 45–60 min, during HD sessions via a video-conferencing platform. Symptom questionnaires were completed at baseline and 3 months follow-up. Of 10 patients screened, 100% screened positive for at least one symptom, 100% of eligible patients consented, and eight (of 10) completed the intervention (mean age 59 years, 50% male, 50% African American). Patient adherence and satisfaction was high, and seven of the eight patients completed all eight prescribed sessions. Minimal interference with HD was reported. Preliminary results indicate no statistically significant changes in depression, fatigue, or pain at follow-up. However, there was small improvement in SF-36 Physical Component score [t(7) = −2.60, p = .035], and four of the six patients (67%) with clinically elevated pain at baseline reported improvement at follow-up. A technology-assisted CBT intervention for ESRD patients was feasible, well-accepted, and required minimal additional resources in the HD setting. Larger, adequately powered clinical trials are needed to evaluate the effect on ESRD patient-reported outcomes.

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