scholarly journals Erythropoietin Use and the Risk of Stroke in Patients on Hemodialysis: A Retrospective Cohort Study in Taiwan

2021 ◽  
Author(s):  
Peir‐Haur Hung ◽  
Chih‐Ching Yeh ◽  
Chih‐Yen Hsiao ◽  
Chih‐Hsin Muo ◽  
Kuan‐Yu Hung ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Proportional Hazards Regression ◽  
Defined Daily Doses ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage

Background Targeting higher hemoglobin levels with erythropoietin to treat anemia in patients with chronic kidney disease is associated with increased cardiovascular risk, including that of stroke. The risks of the subtypes of stroke, ischemic, hemorrhagic, and unspecified, following the administration of erythropoietin in patients with end‐stage renal disease receiving hemodialysis remain unclear. Methods and results Overall, 12 948 adult patients with end‐stage renal disease treated during 1999 to 2010 who had undergone hemodialysis were included. The study end points were the incidences of stroke and its subtypes. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) of stroke and its subtypes in erythropoietin recipients compared with nonrecipients. Patients in the erythropoietin cohort did not have an increased risk of stroke compared with those in the nonerythropoietin cohort (adjusted HR, 1.03; 95% CI, 0.92–1.15). Compared with patients in the nonerythropoietin cohort, the risks of ischemic, hemorrhagic, or unspecified stroke were not higher in patients in the erythropoietin cohort (adjusted HRs, 1.08 [95% CI, 0.93–1.26], 0.96 [95% CI, 0.78–1.18], and 1.03 [95% CI, 0.80–1.32], respectively). Increased risks of stroke and its subtypes were not observed with even large annual defined daily doses of erythropoietin (>201). Conclusions Erythropoietin in patients receiving hemodialysis is not associated with increased risk of stroke or any of its subtypes.

Increased risk of tuberculosis in patients with end-stage renal disease: a population-based cohort study in Taiwan, a country of high incidence of end-stage renal disease

2013 ◽  
Vol 142 (1) ◽  
pp. 191-199 ◽  
Author(s):  
H. Y. HU ◽  
C. Y. WU ◽  
N. HUANG ◽  
Y. J. CHOU ◽  
Y. C. CHANG ◽  
...  
Keyword(s):  
Cohort Study ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Chronic Obstructive ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage

SUMMARYThis nationwide population-based cohort study investigated the risk of tuberculosis (TB) in patients with end-stage renal disease (ESRD) and receiving dialysis. The evaluations included 4131 incident ESRD patients receiving dialysis and 16 524 age- and gender-matched controls, recruited between 1998 and 2009. We used Cox proportional hazards regression analysis to measure the association between TB and ESRD. Compared to the controls, the ESRD cohort had a significantly higher risk of TB within 1 year [incident rate ratio (IRR) 4·13], and 1–2 years (IRR 2·12), of occurrence of ESRD. The Cox proportional hazards model revealed that ESRD [hazard ratio (HR) 2·40], age >65 years (HR 2·41), male sex (HR 1·94), diabetes mellitus (HR 1·36), silicosis (HR 7·70) and chronic obstructive pulmonary disease (HR 1·61) are independent risk factors for TB. Patients with ESRD are associated with an increased risk of TB, and should thus be monitored more carefully for TB, especially within 2 years of onset of ESRD.

Could Antioxidant Supplementation Delay Progression of Cardiovascular Disease in End-Stage Renal Disease Patients?

2020 ◽  
Vol 19 (1) ◽  
pp. 41-54 ◽  
Author(s):  
Stefanos Roumeliotis ◽  
Athanasios Roumeliotis ◽  
Xenia Gorny ◽  
Peter R. Mertens
Keyword(s):  
Oxidative Stress ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Close Association ◽  
Omega 3 ◽  
Endstage Renal Disease ◽  
Increased Risk ◽  
Underlying Mechanisms ◽  
Stage Renal Disease ◽  
End Stage

In end-stage renal disease patients, the leading causes of mortality are of cardiovascular (CV) origin. The underlying mechanisms are complex, given that sudden heart failure is more common than acute myocardial infarction. A contributing role of oxidative stress is postulated, which is increased even at early stages of chronic kidney disease, is gradually augmented in parallel to progression to endstage renal disease and is further accelerated by renal replacement therapy. Oxidative stress ensues when there is an imbalance between reactive pro-oxidants and physiologically occurring electron donating antioxidant defence systems. During the last decade, a close association of oxidative stress with accelerated atherosclerosis and increased risk for CV and all-cause mortality has been established. Lipid peroxidation has been identified as a trigger for endothelial dysfunction, the first step towards atherogenesis. In order to counteract the deleterious effects of free radicals and thereby ameliorate, or delay, CV disease, exogenous administration of antioxidants has been proposed. Here, we attempt to summarize existing data from studies that test antioxidants for CV protection, such as vitamins E and C, statins, omega-3 fatty acids and N-acetylcysteine.

scholarly journals Sex-Specific Associations between Blood Pressure and Risk of Atrial Fibrillation Subtypes in the Tromsø Study

2021 ◽  
Vol 10 (7) ◽  
pp. 1514
Author(s):  
Hilde Espnes ◽  
Jocasta Ball ◽  
Maja-Lisa Løchen ◽  
Tom Wilsgaard ◽  
Inger Njølstad ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Pressure Management ◽  
Reference Models ◽  
Proportional Hazards Regression ◽  
Hazard Ratios ◽  
Increased Risk

The aim of this study was to explore sex-specific associations between systolic blood pressure (SBP), hypertension, and the risk of incident atrial fibrillation (AF) subtypes, including paroxysmal, persistent, and permanent AF, in a general population. A total of 13,137 women and 11,667 men who participated in the fourth survey of the Tromsø Study (1994–1995) were followed up for incident AF until the end of 2016. Cox proportional hazards regression analysis was conducted using fractional polynomials for SBP to provide sex- and AF-subtype-specific hazard ratios (HRs) for SBP. An SBP of 120 mmHg was used as the reference. Models were adjusted for other cardiovascular risk factors. Over a mean follow-up of 17.6 ± 6.6 years, incident AF occurred in 914 (7.0%) women (501 with paroxysmal/persistent AF and 413 with permanent AF) and 1104 (9.5%) men (606 with paroxysmal/persistent AF and 498 with permanent AF). In women, an SBP of 180 mmHg was associated with an HR of 2.10 (95% confidence interval [CI] 1.60–2.76) for paroxysmal/persistent AF and an HR of 1.80 (95% CI 1.33–2.44) for permanent AF. In men, an SBP of 180 mmHg was associated with an HR of 1.90 (95% CI 1.46–2.46) for paroxysmal/persistent AF, while there was no association with the risk of permanent AF. In conclusion, increasing SBP was associated with an increased risk of both paroxysmal/persistent AF and permanent AF in women, but only paroxysmal/persistent AF in men. Our findings highlight the importance of sex-specific risk stratification and optimizing blood pressure management for the prevention of AF subtypes in clinical practice.

scholarly journals Anticoagulation in Patients with End-Stage Renal Disease and Atrial Fibrillation: Confusion, Concerns and Consequences

2020 ◽  
Vol 22 (3) ◽  
pp. 306-316
Author(s):  
Narender Goel ◽  
Deepika Jain ◽  
Danny B. Haddad ◽  
Divya Shanbhogue
Keyword(s):  
Atrial Fibrillation ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Clinical Decision Making ◽  
Controlled Trial ◽  
Oral Anticoagulants ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

End-stage renal disease (ESRD) patients have a higher prevalence of diabetes mellitus, hypertension, congestive heart failure and advanced age, along with an increased incidence of non-valvular atrial fibrillation (AF), thereby increasing the risk for cerebrovascular accidents. Systemic anticoagulation is therefore recommended in patients with ESRD with AF to reduce the risk and complications from thromboembolism. Paradoxically, these patients are at an increased risk of bleeding due to great degree of platelet dysfunction and impaired interaction between platelet and endothelium. Currently, CHA2DS2-VASc and Hypertension, Abnormal liver/kidney function, Stroke, Bleeding, Labile INR, Elderly, Drugs or alcohol (HAS-BLED) are the recommended models for stroke risk stratification and bleeding risk assessment in patients with AF. There is conflicting data regarding benefits and risks of medications such as antiplatelet agents, warfarin and direct oral anticoagulants in ESRD patients with AF. Moreover, there is no randomized controlled trial data to guide the clinical decision making. Hence, a multi-disciplinary approach with annual re-evaluation of treatment goals and risk-benefit assessment has been recommended. In this article, we review the current recommendations with risks and benefits of anticoagulation in patients with ESRD with AF.

scholarly journals Increased Risk of End-Stage Renal Disease in Familial IgA Nephropathy

2002 ◽  
Vol 13 (2) ◽  
pp. 453-460
Author(s):  
Francesco Paolo Schena ◽  
Giuseppina Cerullo ◽  
Michele Rossini ◽  
Salvatore Giovanni Lanzilotta ◽  
Christian D’Altri ◽  
...  
Keyword(s):  
Renal Disease ◽  
Iga Nephropathy ◽  
End Stage Renal Disease ◽  
Upper Respiratory Tract ◽  
Renal Survival ◽  
First Degree Relatives ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
Tract Infections ◽  
End Stage

ABSTRACT. Primary IgA nephropathy (IgAN) is characterized by recurrent episodes of macroscopic hematuria accompanied by upper respiratory tract infections or persistent asymptomatic microscopic hematuria with or without proteinuria. IgAN may involve one or more members of a family. Three generations of a cohort of 110 patients with biopsy-proven IgAN, living in Southern Italy, were checked for urinalysis, and the relative risk (RR) of developing the disease was evaluated. A total of 19 unrelated familial, 37 suspected, and 54 sporadic cases of IgAN were identified. Renal survival was estimated by the Kaplan-Meier method for censored data and compared by use of the log-rank test. More than 50% of the patients with IgAN clustered in kindred with more than two probably affected relatives. In 19 unrelated IgAN families, 8 had single-generation (SG) and 11 multigenerational (MG) involvement showing a prevalent vertical transmission of the trait. The RR was 16 times higher in first-degree relatives (odds ratio [OR], 16.4; 95% confidence interval [CI], 5.7 to 47.8; P < 0.0001) and >2 times higher, even if NS, in second-degree relatives (OR, 2.4; 95 % CI, 0.7 to 7.9; P = 0.145). The clinical and histologic picture of familial and sporadic IgAN appeared to be similar. The 20-yr renal survival rate from the apparent onset of the disease was significantly poorer in patients with familial (41%) than in patients with sporadic (94%) IgAN (P = 0.003). Furthermore, 15-yr renal survival from the time of renal biopsy was significantly worse in familial IgAN (P = 0.02); end-stage renal disease was present in 64% of familial and only in 8% of patients with sporadic IgAN. Finally, renal survival was significantly worse in patients belonging to families with SG rather than with MG involvement (P = 0.03). These data show, for the first time, that familial IgAN may be considered a nonbenign disease that occurs frequently in first-degree relatives. Familial IgAN has a poorer outcome than sporadic IgAN. Therefore, an accurate family history and urinalysis in all family members is urgently recommended in clinical practice. This procedure might avoid late referral of subjects with persistent and underestimated urinary abnormalities and late diagnosis of the disease.

Abstract P218: Carotid Intima-media Thickness and Incident End-stage Renal Disease: The Atherosclerosis Risk in Communities Study

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Yuanjie Pang ◽  
Yingying Sang ◽  
Shoshana Ballew ◽  
Morgan Grams ◽  
Gerardo Heiss ◽  
...  
Keyword(s):  
Renal Disease ◽  
Kidney Function ◽  
End Stage Renal Disease ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Carotid Imt ◽  
Media Thickness ◽  
Hazard Ratios ◽  
Stage Renal Disease ◽  
End Stage

Introduction: Carotid intima-media thickness (IMT) has been reported to predict kidney function decline. However, whether carotid IMT is associated with a hard kidney endpoint, end-stage renal disease (ESRD), has not been investigated. Hypothesis: We assessed the hypothesis that increased carotid IMT is associated with ESRD risk. Methods: We studied 13,197 ARIC participants at visit 1 (1987-1989) without history of cardiovascular disease including coronary heart disease, stroke and heart failure and assessed whether carotid IMT measured by B-mode ultrasound is associated with ESRD risk using Cox proportional-hazards models. Regarding carotid IMT parameters, we investigated the mean and maximum values of overall and segment-specific (common, bifurcation and internal carotid arteries) measurements. Results: Mean age was 54.0 (SD 5.7) years, and there were 3,373 (25.6%) blacks and 7,370 (55.8%) women. During a median follow-up of 22.7 years, 433 participants developed ESRD (1.4/1,000 person-years). After adjusting for shared risk factors for atherosclerosis and kidney disease, including baseline kidney function, carotid IMT was significantly associated with ESRD risk (hazard ratios between quartiles 4 and 1, 1.43 [95%CI: 1.01-2.04] for overall mean IMT and 1.73 [95%CI: 1.22-2.44] for overall maximum IMT). The associations were largely consistent in demographic and clinical subgroups. When we explored segment-specific IMTs, the associations with ESRD were most robust for bifurcation carotid. The adjusted hazard ratios between quartiles 4 and 1 were 1.48 (95%CI: 1.04-2.11) for mean bifurcation IMT and 1.42 (95%CI: 0.99-2.03) for maximum bifurcation IMT. Conclusions: Carotid IMT was independently associated with incident ESRD in the general population. Our findings suggest the shared etiology between atherosclerosis and ESRD and highlight the importance of monitoring kidney function over time in individuals with subclinical atherosclerosis.

CLINICAL CHARACTERISTICS AND SHORT-TERM OUTCOMES IN COVID-19 POSITIVE PATIENTS REQUIRING HEMODIALYSIS AT A TERTIARY HOSPITAL IN A DEVELOPING COUNTRY

2021 ◽  
pp. 38-40
Author(s):  
Subashri Mohanasundaram ◽  
Sujit S. ◽  
Edwin Fernando ◽  
Lakshmi Balasundaram
Keyword(s):  
Intensive Care ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Tertiary Care ◽  
Chest Imaging ◽  
Invasive Ventilation ◽  
Hospital Outcomes ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage

Background: The presence of comorbidities and relative immunosuppression in chronic kidney disease patients on hemodialysis raises concerns that these patients may have an increased risk of severe COVID-19. We aimed to examine the presentation and in-hospital outcomes of COVID-19 patients with end stage renal disease requiring hemodialysis. Methods:To examine presentation and in-hospital outcomes of COVID-19 in patients with end stage renal disease requiring hemodialysis. The study was conducted in a tertiary care centre from June 2020 to December 2020. We collected clinical & laboratory data of 126 COVID-19 positive in-patients requiring hemodialysis. CKD patients referred to our centre for hemodialysis patients were also included. Patients requiring invasive ventilation and management in intensive care units were excluded. Patients were categorised into two groups based on their outcomes; survivors and non-survivors. Detailed history & biochemistry results were recorded and analysed using SPSS 20.0. Results: A total of 126 patients were included in our study, with male predominance, n=91(72.2%). The median age of our study population was 53 years. The main presenting complaints were fever, n=78(61.9%); cough, n=69(54.8%), dyspnea, n= 62(49.2%), fatigue, n=102(81%) and myalgia, n=51(40.5%). Eighty nine(70.6%) patients were hypertensives, 48 (38.1%) known diabetics and 13 (10.3%) had pre-existing chronic obstructive pulmonary disease. Lung involvement in CT imaging at the time of admission, were found in 93(85.5%) patients. On comparison between survivor and non-survivors, there was no statistical difference in the biochemical prole, however there was signicant chest imaging ndings (p<0.001) and requirement of ventilator (p<0.001) in the non-survivor group. Conclusion: In our study, mortality was high in patients showing chest imaging ndings and also in those requiring non-invasive ventilation even in non-intensive care setting, at admission. The high mortality in CKD patients on hemodialysis emphasizes the need of dedicated COVID hemodialysis units,to prevent interruption in routine outpatient stable dialysis patients.

Sign in / Sign up

Export Citation Format

Share Document