scholarly journals Association between Serum Soluble Klotho Levels and Mortality in Chronic Hemodialysis Patients

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Naoko Otani-Takei ◽  
Takahiro Masuda ◽  
Tetsu Akimoto ◽  
Sumiko Honma ◽  
Yuko Watanabe ◽  
...  
Keyword(s):  
Transmembrane Protein ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Soluble Form ◽  
Ectodomain Shedding ◽  
Dialysis Patients ◽  
Complex Phenotypes ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
The Relationship

Klotho is a single-pass transmembrane protein predominantly expressed in the kidney. The extracellular domain of Klotho is subject to ectodomain shedding and is released into the circulation as a soluble form. Soluble Klotho is also generated from alternative splicing of theKlothogene. In mice, defects in Klotho expression lead to complex phenotypes resembling those observed in dialysis patients. However, the relationship between the level of serum soluble Klotho and overall survival in hemodialysis patients, who exhibit a state of Klotho deficiency, remains to be delineated. Here we prospectively followed a cohort of 63 patients with a mean duration of chronic hemodialysis of6.7±5.4years for a median of 65 months. Serum soluble Klotho was detectable in all patients (median 371 pg/mL, interquartile range 309–449). Patients with serum soluble Klotho levels below the lower quartile (<309 pg/mL) had significantly higher cardiovascular and all-cause mortality rates. Furthermore, the higher all-cause mortality persisted even after adjustment for confounders (hazard ratio 4.14, confidence interval 1.29–13.48). We conclude that there may be a threshold for the serum soluble Klotho level associated with a higher risk of mortality.

scholarly journals P1259RELATIONSHIP BETWEEN NT-PROBNP AND ELECTROCARDIOGRAPHIC FINDINGS IN PREVALENT HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Shouichi Fujimoto ◽  
Yuji Sato ◽  
Masao Kikuchi ◽  
Hiroko Inagaki ◽  
Toshihide Hayashi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hemodialysis Patients ◽  
Left Ventricular ◽  
Dialysis Patients ◽  
Cross Sectional ◽  
T Wave ◽  
Dialysis Vintage ◽  
All Cause Mortality ◽  
Two Factors ◽  
The Relationship

Abstract Background and Aims There are several reports showing on the relationship between electrocardiographic (ECG) findings and prognosis in dialysis patients. We recently reported that among various ECG findings, T-wave of lead aVR (aVRT) amplitude revealed the strongest and significant association with cardiovascular disease (CVD) events and all-cause mortality in prevalent dialysis patients (Ther Apher Dial, 2017). We also reported that BNP level was significantly associated with CVD-related mortality and all-cause mortality in our cohort study (Ren Fail, 2018; Sci Rep, 2019). On the other hand, BNP levels have been reported to be higher among elderly and women and lower in people with higher body mass index. However, there is no report showing the correlation between NT-proBNP and ECG findings. Method From our Miyazaki Dialysis Cohort, we extracted patients who had both ECG findings and NT-proBNP data and did not have atrial fibrillation. We examined the relationship between log NT-proBNP level and various ECG findings using Spearman analysis as a cross-sectional study. Results We analyzed 519 hemodialysis patients (44.1% women, mean age was 66.1 years old, median dialysis vintage was 105 months) without atrial fibrillation. Diabetes mellitus was the underlying disease in 25.0% and a history of CVD was found in 25.2% of all patients. Median and IQR (25-75 percentile) of NT proBNP was 4150 (1980-8960). Log NT-proBNP level was significantly correlated with aVRT magnitude (mV), electrical left ventricular high voltage (mV), QTc time (ms), and T-wave amplitude of I lead (mV) (r=0.289, p&lt;0.01; r=0.248, p&lt;0.01; r=0.271, p&lt;0.01; r=-0.282, p&lt;0.01, respectively). However, log NT-proBNP did not show significant correlation with heart rate, PR interval and QRS duration. These significant correlations between these ECG findings and log NT-proBNP were higher in men compared with women. Conclusion Although some ECG findings and BNP level are factors associated with CVD events and death, there was also a significant correlation between these two factors. There has been no report showing the relationships between these two factors, and it may be useful in considering BNP levels in dialysis patients.

scholarly journals Prescription characteristics of phosphate binders in a high pill burden for hemodialysis patients

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Nobuo Nagano ◽  
Kyoko Ito ◽  
Takashi Ono ◽  
Yuichi Ariyoshi ◽  
Soichiro Masima ◽  
...  
Keyword(s):  
Significant Negative Correlation ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Phosphate Binders ◽  
Pill Burden ◽  
Dialysis Patients ◽  
Oral Drugs ◽  
Dialysis Vintage ◽  
The Mean ◽  
The Relationship

Abstract Background Dialysis patients have to take many oral drugs, causing a high pill burden. Phosphate binders (PBs) account for a large proportion of daily pill burden; however, the relationship between patient background and prescription status of PBs is not clear. Methods We clarified the characteristics of PBs in the total daily pill burden by analyzing the drugs prescribed for 533 chronic hemodialysis patients in our facility. Results An average of nine different types of oral drugs was prescribed for each patient. The mean and median values of total pill burden were 15.1 and 14.1 pills/day/patient, respectively. The total pill burden showed a significant negative correlation with age and a significant positive correlation with dialysis vintage. In addition, the total pill burden was significantly higher in males than in females. However, there was no difference in the pill burden between patients with and without diabetes mellitus (DM). PBs were prescribed to 409 patients (76.7%), and the mean pill burden derived from PBs was 6.44 pills/day/patient. This was by far the highest of all 35 different drug categories and accounted for 32.84% of all pills. Multiple regression analysis demonstrated that independent predictors of total pill burden were age, dialysis vintage, DM, and serum phosphorus (P) levels, and all these variables, except DM, were also independent predictors of pill burden from PBs. These variables were also selected when considering the use of calcimimetics. Conclusions A high pill burden is more likely to occur in younger patients with longer dialysis vintage, DM, higher serum P levels, and prescription of calcimimetics. In addition, PB was the single largest contributor to the total pill burden that positively and linearly linked to serum P levels. Therefore, P management is a high-priority issue in the mitigation of high pill burdens in dialysis patients.

scholarly journals N-terminal Pro-B–Type Natriuretic Peptide (NT-proBNP) Concentrations in Hemodialysis Patients: Prognostic Value of Baseline and Follow-up Measurements

2008 ◽  
Vol 54 (8) ◽  
pp. 1339-1348 ◽  
Author(s):  
Orlando M Gutiérrez ◽  
Hector Tamez ◽  
Ishir Bhan ◽  
James Zazra ◽  
Marcello Tonelli ◽  
...  
Keyword(s):  
Natriuretic Peptide ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Longitudinal Changes ◽  
Fractional Polynomial ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
Unit Increase ◽  
Multivariable Adjustment

Abstract Background: Increased N-terminal pro-B–type natriuretic peptide (NT-proBNP) concentrations are associated with increased cardiovascular mortality in chronic hemodialysis patients. Previous studies focused on prevalent dialysis patients and examined single measurements of NT-proBNP in time. Methods: We measured NT-proBNP concentrations in 2990 incident hemodialysis patients to examine the risk of 90-day and 1-year mortality associated with baseline NT-proBNP concentrations. In addition, we calculated the change in concentrations after 3 months in a subset of 585 patients to examine the association between longitudinal changes in NT-proBNP and subsequent mortality. Results: Increasing quartiles of NT-proBNP were associated with a monotonic increase in 90-day [quartile 1, referent; from quartile 2 to quartile 4, hazard ratio (HR) 1.7–6.3, P &lt; 0.001] and 1-year (quartile 1, referent; from quartile 2 to quartile 4, HR 1.7–4.9, P &lt; 0.001) all-cause mortality. After multivariable adjustment, these associations remained robust. When examined using a multivariable fractional polynomial, increased NT-proBNP concentrations were associated with increased 90-day (HR per unit increase in log NT-proBNP 1.5, 95% CI 1.3–1.7) and 1-year (HR per unit increase in log NT-proBNP 1.4, 95% CI 1.3–1.5) all-cause mortality. In addition, patients with the greatest increase in NT-proBNP after 3 months of dialysis had a 2.4-fold higher risk of mortality than those with the greatest decrease in NT-proBNP. Conclusions: NT-proBNP concentrations are independently associated with mortality in incident hemodialysis patients. Furthermore, the observation that longitudinal changes in NT-proBNP concentrations were associated with subsequent mortality suggests that monitoring serial NT-proBNP concentrations may represent a novel tool for assessing adequacy and guiding therapy in patients initiating hemodialysis.

The Relationship between Serum Ferritin Levels and 5-Year All-Cause Mortality in Hemodialysis Patients

2021 ◽  
pp. 1-7
Author(s):  
Emre Erdem ◽  
Ahmet Karatas ◽  
Tevfik Ecder
Keyword(s):  
Serum Ferritin ◽  
Hemodialysis Patients ◽  
Rank Test ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Group 3 ◽  
Group 2 ◽  
The Relationship ◽  
Group 1

<b><i>Introduction:</i></b> The effect of high serum ferritin levels on long-term mortality in hemodialysis patients is unknown. The relationship between serum ferritin levels and 5-year all-cause mortality in hemodialysis patients was investigated in this study. <b><i>Methods:</i></b> A total of 173 prevalent hemodialysis patients were included in this study. The patients were followed for up to 5 years and divided into 3 groups according to time-averaged serum ferritin levels (group 1: serum ferritin &#x3c;800 ng/mL, group 2: serum ferritin 800–1,500 ng/mL, and group 3: serum ferritin &#x3e;1,500 ng/mL). Along with the serum ferritin levels, other clinical and laboratory variables that may affect mortality were also included in the Cox proportional-hazards regression analysis. <b><i>Results:</i></b> Eighty-one (47%) patients died during the 5-year follow-up period. The median follow-up time was 38 (17.5–60) months. The 5-year survival rates of groups 1, 2, and 3 were 44, 64, and 27%, respectively. In group 3, the survival was lower than in groups 1 and 2 (log-rank test, <i>p</i> = 0.002). In group 1, the mortality was significantly lower than in group 3 (HR [95% CI]: 0.16 [0.05–0.49]; <i>p</i> = 0.001). In group 2, the mortality was also lower than in group 3 (HR [95% CI]: 0.32 [0.12–0.88]; <i>p</i> = 0.026). No significant difference in mortality between groups 1 and 2 was found (HR [95% CI]: 0.49 [0.23–1.04]; <i>p</i> = 0.063). <b><i>Conclusion:</i></b> Time-averaged serum ferritin levels &#x3e;1,500 ng/mL in hemodialysis patients are associated with an increased 5-year all-cause mortality risk.

Sarcopenia and Frailty in PD: Impact on Mortality, Malnutrition, and Inflammation

2018 ◽  
Vol 38 (6) ◽  
pp. 447-454 ◽  
Author(s):  
Yuka Kamijo ◽  
Eiichiro Kanda ◽  
Yoshitaka Ishibashi ◽  
Masayuki Yoshida
Keyword(s):  
Muscle Mass ◽  
Secondary Outcome ◽  
Related Factors ◽  
Clinical Frailty Scale ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
Comorbidity Index ◽  
The Relationship ◽  
Worse Prognosis

Background It is known that sarcopenia is related to malnutrition-inflammation-atherosclerosis (MIA) syndrome and is an important problem in dialysis patients. The notion of frailty includes various physical, psychological, and social aspects. Although it has been reported that sarcopenia is associated with poor prognosis in patients with hemodialysis, reports on peritoneal dialysis (PD) patients are rare. In this study, we examined the morbidity and mortality of sarcopenia and frailty in PD patients. We also investigated the MIA-related factors. Methods We evaluated 119 patients cross-sectionally and longitudinally. The Asian Working Group for Sarcopenia criteria and the Clinical Frailty Scale (CFS) were used to diagnose sarcopenia and frailty. The primary outcome is all-cause mortality with sarcopenia and frailty. The secondary outcome is the relationship between various MIA-related factors. Results Morbidity of sarcopenia and frailty in PD patients was 8.4% and 10.9%, respectively. Old age, high values of Barthel Index, Charlson Comorbidity Index, CFS, and low values of body mass index (BMI), muscle strength, muscle mass, and slow walking were associated with sarcopenia. Interleukin-6, albumin, and prealbumin were significantly correlated with muscle mass. During follow-up, the presence of sarcopenia or frailty was associated with the risk of mortality. In multivariate analysis, CFS was related to the mortality rate of PD patients. Conclusions The presence of sarcopenia or frailty was associated with a worse prognosis.

MO752EVALUATION AND ANALYSIS OF CHRONIC PAIN IN HEMODIALYSIS PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Sanae Ezzaki ◽  
Imane Failal ◽  
Rania Elafifi ◽  
Salma siham Elkhayat ◽  
Ghizlane Medkouri ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cross Sectional Study ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Advanced Age ◽  
Dialysis Patients ◽  
Cross Sectional ◽  
High Prevalence ◽  
Significant Intensity

Abstract Background and Aims Despite progress these recent years in support the hemodialysis, chronic pain remains a problem concern that ultimately affect the quality of life and psycho-emotional state, even among dialysis patients already psychologically fragile. However, it is often overlooked and its characteristics in chronic hemodialysis (HDC) are poorly understood. The purpose of this study was to evaluate the prevalence, features, impact and treatment of pain in our population of chronic hemodialysis patients and to determine the factors associated with it. Method cross-sectional study conducted in January 2020 including 71 chronic hemodialysis patients from the nephrology department of the CHU ibn rochd CASABLANCA. They were subjected to a questionnaire on socio-demographic characteristics, the characteristics of the pain, its impact on daily life, the various treatments performed. The pain is chronic if it persists for more than 3 months. The intensity was assessed using a visual analog scale. Results Of the 71 patients, 64.4% report chronic pain, the average age of our patients was 46.5 years, ranging from 16 to 93 years, with a sex ratio M/F 1.1, seniority hemodialysis was 17.3 years. The pain is continuous, frequent, intermittent and rare in respectively 55.5%, 27.5%, 13.7%, 3.44% of cases, it is a weak, moderate, severe, very severe in respectively: 13.7%, 58.6%, 17.24%, 10.3%, causing musculoskeletal was predominant in 75.8% of cases, the most common sites are: shoulders (47,23%), knees (34.5%), the head (41.2%) and the back (19.65%). It resounded on the patient's daily activity in 55.17%, and sleep in 41.3%, the treatment was essentially based analgesics in 58.6% of cases, these analgesics were level 1 in 47.1% cases and level 2 in 52.9% of cases. This is taken daily in 28.5% of patients, common in 42.8% and 28.5% rare among of them, the disappearance of pain was achieved in 65.51% of cases. In perdialyse, the intensity of the pain does not change in 79.4% of patients. Pain was favored by advanced age and age dialysis (advanced age (p = 0.043) and age dialysis (p = 0.01).) Conclusion Chronic pain is a major problem in hemodialysis by its high prevalence, its significant intensity and its impact on life daily patient. However its management remains inadequate. Regular assessment of pain using a well-codified questionnaire is necessary to improve the care of dialysis patients.

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 Cardiac Troponin T Predicts Long-Term Outcomes in Hemodialysis Patients

2001 ◽  
Vol 47 (3) ◽  
pp. 412-417 ◽  
Author(s):  
Daylily S Ooi ◽  
Deborah Zimmerman ◽  
Janet Graham ◽  
George A Wells
Keyword(s):  
Troponin I ◽  
Troponin T ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Peripheral Vascular ◽  
Long Term Outcomes ◽  
All Cause Mortality ◽  
End Stage

Abstract Background: Increased plasma troponin T (cTnT), but not troponin I (cTnI), is frequently observed in end-stage renal failure patients. Although generally considered spurious, we previously reported an associated increased mortality at 12 months. Methods: We studied long-term outcomes in 244 patients on chronic hemodialysis for up to 34 months, correlating the outcomes to plasma cTnT in routine predialysis samples. In addition, subsequent plasma samples at least 1 year later and within 6 months of data analysis were available in 97 patients and were used to identify patients with increasing plasma cTnT. The endpoints used were death and new or worsening coronary, cerebro-, and peripheral vascular disease and neuropathy. Results: Transplantation occurred more frequently in patients with low initial cTnT: 31%, 13%, and 3% in the groups with cTnT &lt;0.010, 0.010–0.099, and ≥0.100 μg/L, respectively. In the same groups, total deaths occurred in 6%, 43%, and 59% and cardiac deaths in 0%, 14%, and 24% of patients. In patients with follow-up samples, the group with increasing cTnT had a significantly increased death (relative risk, 2.0; P = 0.028). The increase was mainly in cardiac and sudden deaths. Conclusions: Higher plasma cTnT predicts long-term all-cause mortality in hemodialysis patients, even at concentrations &lt;0.100 μg/L, as does an increasing cTnT concentration over time.

Arteriosclerosis in Dialysis Patients

1996 ◽  
Vol 19 (11) ◽  
pp. 638-644 ◽  
Author(s):  
J. Bommer ◽  
E. Strohbeck ◽  
J. Goerich ◽  
M. Bahner ◽  
I. Zuna
Keyword(s):  
Calcium Phosphate ◽  
Hdl Cholesterol ◽  
Cross Sectional Study ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Maintenance Hemodialysis ◽  
Time Interval ◽  
Dialysis Patients ◽  
Cross Sectional ◽  
Vldl Cholesterol

Arteriosclerosis is a constant problem in long-term hemodialysis patients. Computer tomography of the abdominal aorta allows a well-defined and reproducible evaluation of aortosclerosis. In the cross-sectional study, aortosclerosis was significantly accelerated in 84 chronic hemodialysis patients and was comparable to the results found in 20-year older control patients without renal disease. The increase of aortosclerosis correlated significantly with age of the patient, smoking, and duration of dialysis therapy. Furthermore, increased VLDL cholesterol and decreased HDL cholesterol seem to enhance aortosclerosis in our dialysis patients. In the longitudinal study (two CT scans with a time interval of 87 ± 62.7 months) in 36 dialysis patients, progressed aortosclerosis correlated significantly with the long duration of hypertriglyceridemia, VLDL cholesterol, uric acid, and calcium phosphate products. Progression of aortosclerosis was reduced in parathyroidectomized patients. The study suggests that premature aortosclerosis is found in dialysis patients. In addition to the common risk factor of aortosclerosis, disturbed calcium phosphate and parathyroid hormone metabolism seem to enhance aortosclerosis in patients under maintenance hemodialysis.

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