scholarly journals MO824PREDICTORS OF MORTALITY OF COVID-19 IN CHRONIC HEMODIALYSIS PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Catarina Almeida ◽  
Marina Sofia Rodrigues Reis ◽  
Daniela Alferes ◽  
Catarina Isabel Ribeiro ◽  
Sara Daniela Rodrigues ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Logistic Regression ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Dialysis Patients ◽  
Hospitalization Time ◽  
Bacterial Superinfection

Abstract Background and Aims Coronavirus disease 2019 (COVID-19) has affected the care of patients on chronic hemodialysis (HD). It has been reported that older adults and those with comorbidities, such as diabetes mellitus, hypertension, cardiovascular disease and chronic kidney disease are prone to develop severe disease and poorer outcomes. By virtue of their average old age, multiple comorbidities, immunosuppression and frequent contact with other patients in dialysis facilities, chronic HD patients are at particular risk for severe COVID-19 infection. The aim of this study was to compare clinical presentation, laboratory and radiologic data and outcomes between HD and non-HD COVID-19 patients and find possible risk factors for mortality on HD patients. Method A single center retrospective cohort study including patients on HD hospitalized with a laboratory confirmed COVID-19 infection, from March 1st to December 31st of 2020 and matched them to non-dialysis patients (non-HD) (1:1). Data regarding patient baseline characteristics, symptoms, laboratory and radiologic results at presentation were collected, as well as their outcomes. Categorical variables are presented as frequencies and percentages, and continuous variables as means or medians for variables with skewed distributions. A paired Student’s t-test was performed on parametric continuous values or Mann-Whitney for non-parametric continuous variables. Chi-squared test was performed for comparing categorical variables. Logistic regression was used to identify risk factors for mortality on HD patients. A p-value of less than 0,05 indicated statistical significance. Results A total of 34 patients HD patients were included, 70,6% male, mean age of 76,5 years, median time of dialysis of 3,0 years. Among them 85,3% were hypertensive, 47,1% diabetic, 47,1% had cardiovascular disease, 30,6% pulmonary chronic disease and 23,5% cancer. The most frequent symptoms were fever (67,6%), shortness of breath (61,8%) and cough (52,9%). At admission, 55,9% of patients needed oxygen supply, one required mechanic ventilation and was admitted to intensive care unit. Regarding laboratory data, the most common features were lymphopenia in 58,9% (median- 795/uL), elevated LDH in 64,7% (median- 255 U/L), raised C-reactive protein in 97,1% (median-6,3 mg/dlL, raised D-dimer in 95,8% (median 1,7 ng/mL), and all patients presented high ferritin (median 1658 ng/mL) and elevated Troponin T (median 130ng/mL). The majority presented with radiologic changes, particularly bilateral infiltrates in 29,4%. Concerning clinical outcomes, the median hospitalization time was 11 days and 13 patients (38,2%) developed bacterial superinfection. Mortality rate was 32,4%. When matched to 34 non-HD patients there was no statistical significant differences in sex, age and comorbidities. The HD group had a tendency to more ventilator support need (p=0,051), higher ferritin and troponin levels (p=<0,001 for both), whereas the non-HD group presented with greater levels of transaminases (p= 0,017). There was o significant difference in hospitalization time (median of 11 vs 7 days, p=0,222) neither in mortality (median of 32,4 vs 35,3%, p=0,798). When the logistic regression was performed, only bacterial superinfection was a predictor for mortality on hemodialysis patients (p=0,004). Conclusion Our study compared outcomes for COVID-19 patients on chronic HD to non-dialysis patients and showed no difference in hospitalization time nor in death rate. In spite of these results, the mortality in patients on chronic HD is still not negligible, with up to 32% of in-hospital mortality. Bacterial superinfection is a predictive risk factor for mortality. Hence the importance of interventions to mitigate the burden of COVID-19 in these patients, by preventing its spread, particularly in hemodialysis centers.

scholarly journals Associations of Cardiovascular and All-Cause Mortality with Metabolic Syndrome in Hemodialysis Patients: A Prospective Single-Center Study

Medicina ◽  
2019 ◽  
Vol 55 (10) ◽  
pp. 694
Author(s):  
Zorica Dimitrijevic ◽  
Andriana Jovanovic ◽  
Mina Cvetkovic ◽  
Tamara Vrecic ◽  
Emina Kostic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Metabolic Syndrome ◽  
Metabolic Disorders ◽  
Cardiometabolic Risk ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Single Center Study ◽  
All Cause Mortality

Background and objectives: Metabolic syndrome (MetS) is a cluster of risk factors, such as abdominal obesity, insulin resistance, dyslipidemia and hypertension, that together increase the risk of cardiovascular disease. Chronic hemodialysis (HD) patients have multiple comorbidities and many metabolic disorders, causing the frequent occurrence of metabolic syndrome. The goal of this study was to assess the prevalence of MetS in HD patients, and its association with all-cause and cardiovascular (CV) mortality. Patients and methods: A total of 138 HD patients were included in this prospective study. We analyzed demographic, anthropometric and biochemical data. Outcome measures were all-cause and CV mortality during the three-year follow-up. Results: MetS was diagnosed in 57.24% of enrolled patients. During the 36 months of follow-up, 33 patients died. MetS patients showed a significantly higher mortality rate than non-MetS (30.4% versus 16.36%, p < 0.001). The association of different MetS components with cardiovascular mortality reached significance when a minimum of three components were present (1.81 (95% confidence interval CI = 1.21–2.33)), with a grouped increase in effect size for subjects with four or five MetS components. Subjects with MetS exhibited nearly twice as high risk for all-cause (hazard ratio HR = 1.99 (95%CI) = 1.42–2.97) and 2.5 times for CV (HR = 2.51 (95%CI) = 1.25–3.83) mortality compared with those without MetS, after adjustment for age, gender, and cardiovascular disease. Conclusions: The study demonstrates that MetS is widespread in HD patients. In future, the focus must be on an active screening approach, and treatment of cardiometabolic risk factors, aiming to reduce mortality.

scholarly journals Practical ways to deal with the high burden of cardiovascular disease in hemodialysis patients

2006 ◽  
Vol 124 (1) ◽  
pp. 36-41 ◽  
Author(s):  
José Jayme Galvão de Lima
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
General Population ◽  
Cardiovascular Risk Factors ◽  
Ventricular Hypertrophy ◽  
Significant Proportion ◽  
Hemodialysis Patients ◽  
Left Ventricular ◽  
Dialysis Patients

Cardiovascular disease is the main cause of death among hemodialysis patients. Although uremia by itself may be considered to be a cardiovascular risk factor, a significant proportion of dialysis patients die because of cardiovascular disease not directly attributable to uremia. Indeed, many of the cardiovascular diseases and cardiovascular risk factors in these patients are common to those occurring in the general population and are amenable to intervention. Lack of proper medical care during the early stages of renal insufficiency and present-day dialysis routines, by failing to correct hypertension, hypervolemia and left ventricular hypertrophy in many patients, may also add to the cardiovascular burden. The author suggests that, in addition to early treatment and referral to a specialist, chronic renal failure patients should undergo intensive cardiovascular screening and treatment, and correction of cardiovascular risk factors based on guidelines established for the general population.

scholarly journals An analysis of clinical risk factors for adolescent scoliosis caused by spinal cord abnormalities in China: Proposal for a selective whole-spine MRI examination scheme

2020 ◽  
Author(s):  
Wei Xu ◽  
Xiangyang Zhang ◽  
Ying Zhu ◽  
Xiaodong Zhu ◽  
zhikun li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Abdominal Wall ◽  
Incidence Rates ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Ankle Clonus ◽  
Adolescent Patients ◽  
Whole Spine ◽  
Spine Mri

Abstract Objective This study examined the risk factors for non-idiopathic scoliosis with intramedullary abnormalities(IA). Method The clinical data of adolescent patients between July 1, 2013, and December 31, 2018, were reviewed. According to the whole-spine MRI results, the patients were divided into either the idiopathic group or the intramedullary abnormality group. 12 data were compared between the two groups. Student’s t test and the chi-square test were used to evaluate the differences in the continuous variables and categorical variables. Logistic regression was used to evaluate the correlation between the multivariate risk factors and intramedullary abnormalities. Result A total of 714 adolescent patients with scoliosis with a mean age of 13.5 (10-18 years) were included in the study, and IA were found in 68 (9.5%) patients. There were statistically significant differences in the incidence rates of intramedullary abnormalities between males and females, left and right thoracic curvatures, angular scoliosis and smooth scoliosis, and abnormal abdominal wall reflex and ankle clonus (P<0.01). Logistic regression showed that the ratios for sex, scoliosis direction, scoliosis type, abdominal wall reflex and ankle clonus were 2.987, 3.493, 4.823, 3.94 and 8.083, respectively. The ROC curve showed a sensitivity of 66.18% and a specificity of 89.01%(0.5519). Conclusion The incidence of scoliosis caused by IA was approximately 9.5%.The risk factors associated with AS caused by abnormal IA included the male sex, thoracic scoliosis on the left side, a sharp curvature of the spine, an abnormal abdominal wall reflex and ankle clonus.

scholarly journals Risk factors of mortality for intensive care COVID-19 patients: A retrospective cohort study.

2020 ◽  
Author(s):  
Yanli Gu ◽  
Donghui Wang ◽  
Cen Chen ◽  
Wanjun Lu ◽  
Hongbing Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Intensive Care ◽  
Multivariate Logistic Regression Analysis ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Laboratory Findings ◽  
Chi Square Test ◽  
Student’S T

Abstract Aims: To identify the risk factors of mortality for coronavirus disease 19 (COVID-19) patients admitted to intensive care units (ICU), we conducted a retrospective analysis.Methods: The demographic characteristics, laboratory findings and chest X-ray data of COVID-19 patients admitted to ICU of Huoshenshan Hospital from February 10 to April 10, 2020 were retrospectively analyzed. Student's t test and chi-square test were used to compare continuous variables, categorical variables respectively. Logistic regression model was used to seek risk factors of mortality.Results: A total of 57 patients (38 males and 19 females) were included in this retrospective study, including 20 patients in deceased group and 37 patients in surviving group. Leukocyte count, neutrophil count, lymphocyte count, eosinophil count, neutrophil-to-lymphocyte ratio (NLR), urea nitrogen, lactate dehydrogenase (LDH), interleukin-6 (IL-6), C-reactive protein (CRP), arterial partial pressure of oxygen/oxygen concentration (PaO2/FiO2) and imaging findings were statistically different between the two groups. The multivariate logistic regression analysis identified IL-6 and PaO2/FiO2 as independent risk factors of mortality. The area of under curves (AUC) of IL-6 and PaO2/FiO2 were 0.9 (95%CI:0.823-0.977, p<0.0001) and 0.865 (95%CI:0.774-0.956, p<0.0001) respectively. The cut-off value of IL-6 was 25.69 pg/mL, the sensitivity was 95% and the specificity was 75.7%, while the cut-off value of PaO2/FiO2 was 167.79 mmHg, the sensitivity was 75.7% and the specificity was 85%.Conclusion: Clinicians should pay enough attention to IL-6 and PaO2/FiO2, especially when IL-6>25.69 pg/ml and PaO2/FiO2<167.79 mmHg, and take active intervention measures as early as possible.

scholarly journals Risk Factors of Arterial Damage Assessed by ABI and baPWV among Hemodialysis Patients in Macau

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Mingxin Li ◽  
Jing Xin ◽  
Ding-Wei Kuang ◽  
Un-I Kuok ◽  
Chiu-Leong Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Chronic Dialysis ◽  
Clinical Value ◽  
Mortality And Morbidity ◽  
Arterial Damage ◽  
Conventional Risk Factors

Cardiovascular disease (CVD) is the leading cause of mortality and morbidity among patients with ESRD on chronic dialysis. Arterial damage is one of the characteristics of CVD. But the association between arterial damage and conventional risk factors for CVD has not yet been fully highlighted in chronic hemodialysis patients. Here we validate the clinical value of assessment of arterial damage by ABI and PWV in chronic hemodialysis patients in Macau.

scholarly journals Subclavian vascular access stenosis in dialysis patients: natural history and risk factors.

1998 ◽  
Vol 9 (8) ◽  
pp. 1507-1510
Author(s):  
D Hernández ◽  
F Díaz ◽  
M Rufino ◽  
V Lorenzo ◽  
T Pérez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Natural History ◽  
Vascular Access ◽  
Collateral Circulation ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Dialysis Patients ◽  
The Third ◽  
Mechanical Factors

Stenosis of the subclavian vein (SVS) after cannulation occurs in 15 to 50% of chronic hemodialysis patients, and impedes the placement of an arteriovenous fistula in the ipsilateral arm. Its natural history and pathogenic mechanisms are not well established. This study examined 42 consecutive chronic renal failure patients (28 men and 14 women; 46+/-19 yr) in whom subclavian catheters had been placed as the initial vascular access for hemodialysis. All patients underwent sequential venography studies: at baseline (24 to 48 h after removal of the catheter) and 1, 3, and 6 mo thereafter. Venograms were considered abnormal when there was evidence of unequivocal strictures (more than 30% narrowing), with or without collateral circulation. At baseline, 52.4% (n=22) of patients showed stenotic vein lesions (n=19) or total thrombosis (n=3), and identical lesions were also observed after 1 mo. Surprisingly, 10 of 22 patients with initial SVS (45.4%) showed spontaneous recanalization of venous lesions in the venographies performed 3 mo after removal. The patients with normal baseline venograms (n=20) showed no change during follow-up. Patients with definitive stenosis at 6 mo (n=12) had a higher number of inserted catheters (1.58+/-0.6 versus 1.2+/-0.48; P < 0.05), longer time in place (49.08+/-32.2 versus 29.03+/-26.6 d; P < 0.05), and higher number of dialysis sessions (21+/-13.8 versus 12.4+/-11.4; P < 0.05) than those without SVS or with spontaneous recanalization of venous lesions during follow-up. Furthermore, a higher number of catheter-related infections were observed in patients with definitive SVS (66.6% versus 33.3%; P < 0.05). In summary, SVS is observed in more than half of patients 24 to 48 h after catheter removal and 1 mo later. Even when recanalization occurs in many cases, a definitive stenosis is seen in 28% of patients by the third month. Thus, the creation of an ipsilateral vascular access is possible provided that venography is normal at this time. Finally, mechanical factors and catheter-related infections are the major risk factors for the development of late SVS.

scholarly journals An analysis of clinical risk factors for adolescent scoliosis caused by spinal cord abnormalities in China: Proposal for a selective whole-spine MRI examination scheme

2020 ◽  
Author(s):  
Wei Xu ◽  
Xiangyang Zhang ◽  
Ying Zhu ◽  
Xiaodong Zhu ◽  
zhikun li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Abdominal Wall ◽  
Incidence Rates ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Ankle Clonus ◽  
Adolescent Patients ◽  
Whole Spine ◽  
Spine Mri

Abstract Objective This study examined the risk factors for non-idiopathic scoliosis with intramedullary abnormalities(IA). Method The clinical data of adolescent patients between July 1, 2013, and December 31, 2018, were reviewed. According to the whole-spine MRI results, the patients were divided into either the idiopathic group or the intramedullary abnormality group. 12 data were compared between the two groups. Student’s t test and the chi-square test were used to evaluate the differences in the continuous variables and categorical variables. Logistic regression was used to evaluate the correlation between the multivariate risk factors and intramedullary abnormalities. Result A total of 714 adolescent patients with scoliosis with a mean age of 13.5 (10-18 years) were included in the study, and IA were found in 68 (9.5%) patients. There were statistically significant differences in the incidence rates of intramedullary abnormalities between males and females, left and right thoracic curvatures, angular scoliosis and smooth scoliosis, and abnormal abdominal wall reflex and ankle clonus (P<0.01). Logistic regression showed that the ratios for sex, scoliosis direction, scoliosis type, abdominal wall reflex and ankle clonus were 2.987, 3.493, 4.823, 3.94 and 8.083, respectively. The ROC curve showed a sensitivity of 66.18% and a specificity of 89.01%(0.5519). Conclusion The incidence of scoliosis caused by IA was approximately 9.5%.The risk factors associated with AS caused by abnormal IA included the male sex, thoracic scoliosis on the left side, a sharp curvature of the spine, an abnormal abdominal wall reflex and ankle clonus.

scholarly journals Age and multimorbidities as poor prognostic factors for COVID-19 in hemodialysis: a Lebanese national study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mabel Aoun ◽  
Rabab Khalil ◽  
Walid Mahfoud ◽  
Haytham Fatfat ◽  
Line Bou Khalil ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Coronary Artery Disease ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Death Rate ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
National Study ◽  
Artery Disease

Abstract Background Hemodialysis patients with COVID-19 have been reported to be at higher risk for death than the general population. Several prognostic factors have been identified in the studies from Asian, European or American countries. This is the first national Lebanese study assessing the factors associated with SARS-CoV-2 mortality in hemodialysis patients. Methods This is an observational study that included all chronic hemodialysis patients in Lebanon who were tested positive for SARS-CoV-2 from 31st March to 1st November 2020. Data on demographics, comorbidities, admission to hospital and outcome were collected retrospectively from the patients’ medical records. A binary logistic regression analysis was performed to assess risk factors for mortality. Results A total of 231 patients were included. Mean age was 61.46 ± 13.99 years with a sex ratio of 128 males to 103 females. Around half of the patients were diabetics, 79.2% presented with fever. A total of 115 patients were admitted to the hospital, 59% of them within the first day of diagnosis. Hypoxia was the major reason for hospitalization. Death rate was 23.8% after a median duration of 6 (IQR, 2 to 10) days. Adjusted regression analysis showed a higher risk for death among older patients (odds ratio = 1.038; 95% confidence interval: 1.013, 1.065), patients with heart failure (odds ratio = 4.42; 95% confidence interval: 2.06, 9.49), coronary artery disease (odds ratio = 3.27; 95% confidence interval: 1.69, 6.30), multimorbidities (odds ratio = 1.593; 95% confidence interval: 1.247, 2.036), fever (odds ratio = 6.66; 95% confidence interval: 1.94, 27.81), CRP above 100 mg/L (odds ratio = 4.76; 95% confidence interval: 1.48, 15.30), and pneumonia (odds ratio = 19.18; 95% confidence interval: 6.47, 56.83). Conclusions This national study identified older age, coronary artery disease, heart failure, multimorbidities, fever and pneumonia as risk factors for death in patients with COVID-19 on chronic hemodialysis. The death rate was comparable to other countries and estimated at 23.8%.

scholarly journals Long term prognostic implication of newly detected abnormal glucose tolerance among patients with stable cardiovascular disease: a population-based cohort study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Maryam Kabootari ◽  
Samaneh Asgari ◽  
Seyedeh Maryam Ghavam ◽  
Hengameh Abdi ◽  
Fereidoun Azizi ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Glucose Tolerance ◽  
Plasma Glucose ◽  
Population Based ◽  
World Health ◽  
Incident Diabetes ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Diabetes Status ◽  
Adjusted Model

Abstract Background Fasting plasma glucose (FPG) and 2-h post challenge plasma glucose (2 h-PCPG), whether as continuous or categorical variables, are associated with incident cardiovascular disease (CVD) and diabetes; however, their role among patients with existing CVD is a matter of debate. We aimed to evaluate associations of different glucose intolerance states with recurrent CVD and incident diabetes among subjects with previous CVD. Methods From a prospective population-based cohort, 408 Iranians aged  ≥  30 years, with history of CVD and without known diabetes were included. Associations of impaired fasting glucose (IFG) according to the American Diabetes Association (ADA) and World Health Organization (WHO) criteria, impaired glucose tolerance (IGT), newly diagnosed diabetes (NDM) with outcomes of interest were determined by multivariable Cox proportional hazard models after adjustment for traditional risk factors. Furthermore, FPG and 2 h-PCPG were entered as continuous variables. Results Over a decade of follow-up, 220 CVD events including 89 hard events (death, myocardial infarction and stroke) occurred. Regarding prediabetes, only IFG-ADA was associated with increased risk of hard CVD [hazard ratio(HR), 95%CI: 1.62,1.03–2.57] in the age-sex adjusted model. In patients with NDM, those with FPG ≥ 7 mmol/L were at higher risk of incident CVD/coronary heart disease(CHD) and their related hard outcomes (HR ranged from 1.89 to 2.84, all P < 0.05). Moreover, those with 2 h-PCPG ≥ 11.1 mmol/L had significant higher risk of CVD (1.46,1.02–2.11), CHD (1.46,1.00–2.15) and hard CHD (1.95:0.99–3.85, P = 0.05). In the fully adjusted model, each 1 SD increase in FPG was associated with 20, 27, 15 and 25% higher risk of CVD, hard CVD, CHD and hard CHD, respectively; moreover each 1 SD higher 2 h-PCPG was associated with 21% and 16% higher risk of CVD, and CHD, respectively. Among individuals free of diabetes at baseline (n = 361), IFG-ADA, IFG-WHO and IGT were significantly associated with incident diabetes (all P < 0.05); significant associations were also found for FPG and 2 h-PCPG as continuous variables (all HRs for 1-SD increase > 2, P < 0.05). Conclusions Among subjects with stable CVD, NDM whether as high FPG or 2 h-PCPG, but not pre-diabetes status was significantly associated with CVD/CHD and related hard outcomes.

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