Sex-age-specific handgrip strength and mortality in an incident hemodialysis cohort: The risk explained by nutrition and comorbidities

2018 ◽  
Vol 41 (12) ◽  
pp. 825-832 ◽  
Author(s):  
Marcelo B Lopes ◽  
Luciana F Silva ◽  
Marina AS Dantas ◽  
Cacia M Matos ◽  
Gildete B Lopes ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Cox Regression ◽  
Handgrip Strength ◽  
Sociodemographic Factors ◽  
Hemodialysis Patients ◽  
Hazard Ratio ◽  
Maintenance Hemodialysis ◽  
Mortality Hazard ◽  
Mortality Hazard Ratio ◽  
Maintenance Hemodialysis Patients

Objective: To investigate associations of sex-age-specific handgrip strength by a dynamometer with all-cause mortality and the percent excess risk explained (%ERE) by comorbidities and nutritional indicators in incident maintenance hemodialysis patients. Methods: Prospective cohort of 413 adult patients (165 women, 248 men, 299 <60 years and 114 ⩾60 years) with <6 months (82% <3 months) on dialysis enrolled in PROHEMO in Salvador, Brazil. Low and high handgrip strength groups were based on sex-age-specific cutoffs (17.8 kg for women <60 years, 13.8 kg for women ⩾60 years, 29.5 kg for men <60 years, and 21.9 kg for men ⩾60 years). We used Cox regression to estimate the mortality hazard ratio. The %ERE was determined by the equation (HR1 – HR2)/(HR1 – 1) × 100, in which HR1 represented the hazard ratio in a model with a smaller number of covariates and HR2 represented the hazard ratio in a subsequent model with the inclusion of new covariates plus the variables included in the previous model. Results: The mortality hazard ratio comparing low and high handgrip strength was 2.58 (95% confidence interval: 1.73, 3.85) in the model with sociodemographic factors and vintage and 2.25 (95% confidence interval: 1.49, 3.43) with addition of comorbidities, corresponding to a %ERE of 21%. The hazard ratio was 1.98 (95% confidence interval: 1.29, 3.06) after addition of nutritional indicators corresponding to %ERE of 38%. Results stratified by age and gender followed similar patterns. Conclusion: These results provide support for the assessment of handgrip strength in all maintenance hemodialysis patients for early identification of those who may require special care to improve nutritional status and survival.

P1545LOW SOCIOECONAMIC STATUS INCREASES MORTALITY RISK IN KOREAN MAINTENANCE HEMODIALYSIS PATIENTS: A LONGITUDINAL COHORT STUDY USING HEMODIALYSIS QUALITY ASSESSMENT DATA

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Young-Ki Lee ◽  
Hayne Cho Park ◽  
Ajin Cho ◽  
Do Hyoung Kim ◽  
Juhee Kim ◽  
...  
Keyword(s):  
Health Insurance ◽  
Confidence Interval ◽  
Quality Assessment ◽  
Mortality Risk ◽  
Hemodialysis Patients ◽  
Hazard Ratio ◽  
Maintenance Hemodialysis ◽  
Low Ses ◽  
Assessment Data ◽  
Maintenance Hemodialysis Patients

Abstract Background and Aims The number of hemodialysis (HD) patients and their medical expenses are growing rapidly in Korea due to entry into aging society and accompanying diseases such as diabetes and hypertension. Whether low socioeconomic status (SES) affect poorer HD survival is controversial with most reports come from the USA. Therefore, this study was performed to evaluate the effect of SES upon mortality in Korean maintenance HD patients using periodic HD quality assessment data. Method The HD quality assessment has been performed periodically by Health Insurance review and Assessment Service (HIRA) since 2001. We used 4th and 5th HD quality assessment data from the year of 2013 and 2015 respectively for collecting demographic and clinical data. The 4th survey was a sample survey while the 5th survey was a complete enumeration survey. We also collected data on patient comorbidity using the diagnosis codes from the health insurance claims database. The mortality data was collected until Dec 2017. As a proxy indicator reflecting SES, we classified subjects as a Medical Aid (MA) recipients (“low” SES) or a National Health Insurance (NHI) beneficiary (“middle/high” SES). We analyzed mortality risk based on SES using Cox proportional hazard model. Results A total of 21,786 HD patients from 4th survey and 35,454 HD patients from 5th survey were included in the analysis. The ratio between NHI beneficiary and MA recipient was 76.7% versus 23.3%. Mean age of the subjects was 59.0 years old in 4th survey and 60.3 years old in 5th survey. The MA recipients were younger and showed higher proportion of male, shorter duration of HD, lower body mass index (BMI), higher systolic and diastolic blood pressures before HD compared to the NHI beneficiary. The NHI beneficiary demonstrated higher proportion of diabetes, hypertension, cerebrovascular accidents, and dementia compared to the MA recipients. Two groups did not differ in dialysis efficiency presented as single pool Kt/V. A total of 7,173 deaths occurred in 2013 participants, while 7,306 deaths occurred in 2015 participants. After adjusting for age, gender, Charlson’s comorbidity index, BMI, presence of atrial fibrillation, serum albumin, and serum creatinine, MA recipients showed significantly higher mortality risk compared to the NHI beneficiary (hazard ratio 1.162; 95% confidence interval 1.092-1.237, p&lt;0.001 in 4th survey and hazard ratio 1.078; 95% confidence interval 1.013-1.146, p=0.017 in 5th survey). Conclusion Low SES independently increased mortality risk in Korean maintenance hemodialysis patients.

The Prognostic Value of Soluble ST2 in Maintenance Hemodialysis Patients: A Meta-Analysis

2019 ◽  
Vol 49 (1-2) ◽  
pp. 114-120
Author(s):  
Shuang Wang ◽  
Fang Wei ◽  
Haiyan Chen ◽  
Zhe Wang ◽  
Ruining Zhang ◽  
...  
Keyword(s):  
Large Scale ◽  
Meta Analysis ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Mortality Hazard ◽  
Study Results ◽  
All Cause Mortality ◽  
Mortality Hazard Ratio ◽  
Maintenance Hemodialysis Patients

Background: Much controversy remains in the literature with respect to whether soluble suppression of tumorigenicity 2 (sST2) can serve to predict all-cause death in patients undergoing maintenance hemodialysis (MHD). This meta-analysis therefore sought to analyze extant datasets exploring the association between these 2 variables in MHD patients in order to draw relevant conclusions. Methods: Articles published through December 2018 in PubMed and Embase were independently reviewed by 2 authors to identify relevant articles, and STATA 12.0 was used for statistical analyses of relevant results and study parameters. Results: In total, we identified 4 relevant studies that were incorporated into this meta-analysis. These studies included a total of 1,924 participants (60% male, mean follow-up 911 days). The combined study results suggested that increased levels of sST2 were significantly linked to a 2.23 fold rise in all-cause mortality (hazard ratio [HR] 2.23, 95% CI 1.81–2.75). Subgroup analyses confirmed that this same association was true in patients undergoing hemodialysis (HR 2.17, 95% CI 1.74–2.71), which indicated that the increased levels of sST2 were significantly linked to a 2.17 fold rise in all-cause mortality. Conclusions: This analysis suggests that there is a significant link between elevated levels of sST2 and death in patients undergoing MHD. Further large-scale trials, however, will be needed to fully validate these findings and their clinical relevance.

scholarly journals Lower serum bilirubin is a risk factor for cardiovascular mortality in maintenance hemodialysis patients: a retrospective cohort study

2021 ◽  
Author(s):  
Yu Chen ◽  
Peilei Zhao ◽  
Weifeng Fan ◽  
Hongmei Li ◽  
Xiaojing Zhong ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Serum Bilirubin ◽  
Cox Regression ◽  
Cardiovascular Death ◽  
Hemodialysis Patients ◽  
Cox Proportional Hazards Model ◽  
Maintenance Hemodialysis ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Maintenance Hemodialysis Patients

Abstract Background: Although recent studies showed serum bilirubin, an endogenous antioxidant, is protective against cardiovascular diseases, cancer, and diabetic complications, less information is available its association with cardiovascular mortality in hemodialysis patients. This study aimed to investigate the relationship between serum bilirubin and the cardiovascular mortality in maintenance hemodialysis patients.Methods: This retrospective study included 284 chronic hemodialysis patients who started hemodialysis between January 01, 2003, and May 30, 2019. The endpoint was cardiovascular death and all-cause death. A Cox proportional hazards model was used to evaluate the risk factors for cardiovascular death in the maintenance hemodialysis. The cardiovascular mortality was evaluated by Kaplan-Meier analysis.Results: Up to 2019, the median follow-up time was 53 months. In Kaplan–Meier analysis curves, the risk of cardiovascular death in the patients with serum indirect bilirubin (IBIL) levels＜3.0 μmol/L was significantly higher than those with serum IBIL levels≥3.0 μmol/L(p =0.045). In multivariate Cox regression analysis, the risk of cardiovascular mortality in patients with serum IBIL levels ≥3.0 μmol/L was 0.556 times the risk in patients with serum IBIL levels＜3.0 μmol/L (Hazard ratio=0.556, 95% confidence interval 0.334~0.926, p =0.024). However, there was no significant association between serum IBIL and all-cause mortality (p =0.269). Conclusions: Our findings suggest that low serum IBIL level is independently associated with high risk of cardiovascular death in maintenance hemodialysis patients.

Low handgrip strength is associated with worse functional capacity and inflammation in maintenance hemodialysis patients

Nutrition ◽  
2021 ◽  
pp. 111469
Author(s):  
Lorena Cristina Curado Lopes ◽  
Maria Cristina Gonzalez ◽  
Carla Maria Avesani ◽  
Carla M. Prado ◽  
Maria R.G. Peixoto ◽  
...  
Keyword(s):  
Functional Capacity ◽  
Handgrip Strength ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Maintenance Hemodialysis Patients

scholarly journals When Is Higher Neuroticism Protective Against Death? Findings From UK Biobank

2017 ◽  
Vol 28 (9) ◽  
pp. 1345-1357 ◽  
Author(s):  
Catharine R. Gale ◽  
Iva Čukić ◽  
G. David Batty ◽  
Andrew M. McIntosh ◽  
Alexander Weiss ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Hazard Ratio ◽  
Lower Mortality ◽  
Uk Biobank ◽  
Self Rated Health ◽  
Mortality Hazard ◽  
All Cause Mortality ◽  
Personality Facets ◽  
External Causes ◽  
Mortality Hazard Ratio

We examined the association between neuroticism and mortality in a sample of 321,456 people from UK Biobank and explored the influence of self-rated health on this relationship. After adjustment for age and sex, a 1- SD increment in neuroticism was associated with a 6% increase in all-cause mortality (hazard ratio = 1.06, 95% confidence interval = [1.03, 1.09]). After adjustment for other covariates, and, in particular, self-rated health, higher neuroticism was associated with an 8% reduction in all-cause mortality (hazard ratio = 0.92, 95% confidence interval = [0.89, 0.95]), as well as with reductions in mortality from cancer, cardiovascular disease, and respiratory disease, but not external causes. Further analyses revealed that higher neuroticism was associated with lower mortality only in those people with fair or poor self-rated health, and that higher scores on a facet of neuroticism related to worry and vulnerability were associated with lower mortality. Research into associations between personality facets and mortality may elucidate mechanisms underlying neuroticism’s covert protection against death.

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