The Relationship Between Volume Overload in End-Stage Renal Disease and Obstructive Sleep Apnea

Background: Hemodialysis is the main approach for renal replacement therapy in patients with end-stage renal disease (ESRD) in China. The timing of dialysis initiation is one of the key factors influencing patient survival and prognosis. Over the past decade, the relationship between the timing of dialysis initiation and mortality has remained unclear in patients with ESRD in China. Methods: Patients who commenced maintenance hemodialysis from 2009 to 2014 from 24 hemodialysis centers in Mainland China were enrolled in the study (n = 1,674). Patients were divided into 2 groups based on the year they started hemodialysis (patients who started hemodialysis from 2009 to 2011, and patients who started hemodialysis from 2012 to 2014). Analysis of the yearly change in the estimated glomerular filtration rate (eGFR) at the initiation of dialysis was performed for the 2 groups. Meanwhile, the patients were divided into 3 groups based on their eGFR at the initiation of dialysis (<4, 4–8, and >8 mL/min/1.73 m2). For these 3 groups, the relationship between the eGFR at the start of dialysis and mortality were analyzed. Results: The average eGFRs were 5.68 and 5.94 mL/min/1.73 m2 for 2009–2011 and 2012–2014, respectively. Compared with the 2009–2011 group, the proportion of patients with diabetes in 2012–2014 increased from 26.7 to 37.7%. The prognosis of patients with different eGFRs at the start of dialysis was analyzed using Kaplan-Meier survival curves. After adjusting for confounding factors through a Cox regression model, no significant difference was demonstrated among the 3 groups (<4 mL/min/1.73 m2 was used as the reference, in comparison with 4–8 mL/min/1.73 m2 [p = 0.681] and >8 mL/min/1.73 m2 [p = 0.403]). Conclusion: In Mainland China, the eGFR at the start of dialysis did not change significantly over time from 2008 to 2014 and had no association with the mortality of patients with ESRD.

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The relationship between anemia, depression, duration of hemodialysis, and quality of sleep among end-stage renal disease patients

Enfermería Clínica ◽

10.1016/j.enfcli.2019.05.002 ◽

2019 ◽

Vol 29 ◽

pp. 24-29

Author(s):

Alifah Indrarini ◽

Anggri Noorana Zahra ◽

Sri Yona

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Quality Of Sleep ◽

Stage Renal Disease ◽

End Stage ◽

The Relationship

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Altered white matter microstructure mediates the relationship between hemoglobin levels and cognitive control deficits in end‐stage renal disease patients

Human Brain Mapping ◽

10.1002/hbm.24321 ◽

2018 ◽

Vol 39 (12) ◽

pp. 4766-4775 ◽

Cited By ~ 6

Author(s):

Junya Mu ◽

Tao Chen ◽

Peng Li ◽

Dun Ding ◽

Xueying Ma ◽

...

Keyword(s):

White Matter ◽

Cognitive Control ◽

Renal Disease ◽

End Stage Renal Disease ◽

White Matter Microstructure ◽

Stage Renal Disease ◽

End Stage ◽

The Relationship

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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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