Statins as secondary preventives in patients with intracerebral hemorrhage

Background Statins are important components of secondary stroke prevention, but there is a concern they may increase the risk of intracerebral hemorrhage. Although this risk may have been overestimated, there is still an open question whether statin therapy should be continued, or even initiated, in patients who have had a recent intracerebral hemorrhage. Aim Our aim was to investigate the risk of statin use after an intracerebral hemorrhage with respect to recurrent intracerebral hemorrhage, stroke in general, and death. Methods This observational study was based on patients with a first intracerebral hemorrhage in 2004 through 2009. Clinical characteristics, index intracerebral hemorrhage, and recurrent intracerebral hemorrhages were identified by the Swedish Stroke Register; additional data on comorbidities and vital status were retrieved through record linkages to national registers. A propensity score for the likelihood of receiving statins at discharge was developed and used with other established risk factors in a multivariable analysis. Results Of 6082 intracerebral hemorrhage patients (mean age 69.6 years), 1097 (18%) were prescribed statins at discharge. During the follow-up (mean 3.1 years), 1434 (23.6%) deaths and 234 (3.8%) recurrent intracerebral hemorrhages were observed. Statin therapy was associated with a reduced risk of death (adjusted hazard ratio: 0.71; 95% confidence interval: 0.60–0.84) but not with the risk of recurrent intracerebral hemorrhage (adjusted hazard ratio: 0.82; 95% confidence interval: 0.55–1.22). Conclusions This study provides some reassurance that statins may be safe to use, in at least some patients, after an intracerebral hemorrhage. In patients with intracerebral hemorrhage, statin use was associated with a reduced risk of death, without an increased risk of recurrent intracerebral hemorrhage.

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Maternal and child gluten intake and risk of type 1 diabetes: The Norwegian Mother and Child Cohort Study

10.1101/19001883 ◽

2019 ◽

Author(s):

Nicolai A Lund-Blix ◽

German Tapia ◽

Karl Mårild ◽

Anne Lise Brantsaeter ◽

Pål R Njølstad ◽

...

Keyword(s):

Type 1 Diabetes ◽

Cohort Study ◽

Confidence Interval ◽

Population Based ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Pregnancy Cohort ◽

Increased Risk ◽

Mother And Child

ABSTRACTOBJECTIVETo examine the association between maternal and child gluten intake and risk of type 1 diabetes in children.DESIGNPregnancy cohortSETTINGPopulation-based, nation-wide study in NorwayPARTICIPANTS86,306 children in The Norwegian Mother and Child Cohort Study born from 1999 through 2009, followed to April 15, 2018.MAIN OUTCOME MEASURESClinical type 1 diabetes, ascertained in a nation-wide childhood diabetes registry. Hazard ratios were estimated using Cox regression for the exposures maternal gluten intake up to week 22 of pregnancy and child’s gluten intake when the child was 18 months old.RESULTSDuring a mean follow-up of 12.3 years (range 0.7-16.0), 346 children (0.4%) developed type 1 diabetes (incidence rate 32.6 per 100,000 person-years). The average gluten intake was 13.6 grams/day for mothers during pregnancy, and 8.8 grams/day for the child at 18 months of age. Maternal gluten intake in mid-pregnancy was not associated with the development of type 1 diabetes in the child (adjusted hazard ratio 1.02 (95% confidence interval 0.73 to 1.43) per 10 grams/day increase in gluten intake). However, the child’s gluten intake at 18 months of age was associated with an increased risk of later developing type 1 diabetes (adjusted hazard ratio 1.46 (95% confidence interval 1.06 to 2.01) per 10 grams/day increase in gluten intake).CONCLUSIONSThis study suggests that the child’s gluten intake at 18 months of age, and not the maternal intake during pregnancy, could increase the risk of type 1 diabetes in the child.WHAT IS ALREADY KNOWN ON THIS TOPICA national prospective cohort study from Denmark found that a high maternal gluten intake during pregnancy could increase the risk of type 1 diabetes in the offspring (adjusted hazard ratio 1.31 (95% confidence interval 1.001 to 1.72) per 10 grams/day increase in gluten intake). No studies have investigated the relation between the amount of gluten intake by both the mother during pregnancy and the child in early life and risk of developing type 1 diabetes in childhood.WHAT THIS STUDY ADDSIn this prospective population-based pregnancy cohort with 86,306 children of whom 346 developed type 1 diabetes we found that the child’s gluten intake at 18 months of age was associated with the risk of type 1 diabetes (adjusted hazard ratio 1.46 (95% confidence interval 1.06 to 2.01) per 10 grams/day increase in gluten intake). This study suggests that the child’s gluten intake at 18 months of age, and not the maternal intake during pregnancy, could increase the child’s risk of type 1 diabetes.

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Abstract WP167: Effects of Selective Serotonin Reuptake Inhibitors versus Tricyclic Antidepressants on Cerebrovascular Events

Stroke ◽

10.1161/str.44.suppl_1.awp167 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Jou Wei Lin ◽

Chia-Hsuin Chang ◽

Chin-Hsien Lin

Keyword(s):

Confidence Interval ◽

Serotonin Reuptake ◽

Selective Serotonin Reuptake Inhibitors ◽

Tricyclic Antidepressants ◽

Hazard Ratio ◽

Serotonin Reuptake Inhibitors ◽

Adjusted Hazard Ratio ◽

Selective Serotonin ◽

Cerebrovascular Events ◽

Reduced Risk

Background: The objective of this study was to examine the effects of selective serotonin reuptake inhibitors (SSRIs) versus tricyclic antidepressants (TCAs) on cerebrovascular events in patients with depression or anxiety. Methods: We performed a retrospective cohort study in a nationwide population. The patients who started to take SSRIs and TCAs with a diagnosis of depression or anxiety between January 1, 2001 and December 31, 2009 were identified from the Taiwan National Health Insurance claims database. We examined the association between the two types of antidepressants and incidence of stroke using a proportional hazard model adjusted for risk factors for stroke. Results: Among of the 24,662 SSRI and 14,736 TCA initiators, the crude incidence rate for stroke was 10.03 and 13.77 per 100 person-years respectively. SSRI use was associated with a significantly reduced risk as compared with TCAs with the adjusted hazard ratio of 0.67 (95% confidence interval 0.47 to 0.96) in a dose-dependent manner. No significant effect modification was found among subgroups, such as hypertension, diabetes, previous cardiovascular and cerebrovascular diseases. The adjusted hazard ratio was 1.09 (95% confidence interval 0.65 to 1.85) for those aged more than 65 years, suggesting only a potential trend for a higher risk of stroke with SSRIs in the geriatric group. Conclusions: As compared with TCAs, the use of SSRIs was associated with a reduced risk for cerebrovascular events in a clear dose-response manner. Further researches are needed to examine the potential risk and benefit of SSRI use for patients with high risk of stroke.

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Incidence and predictors of venous thromboembolism in post-acute care patients

Thrombosis and Haemostasis ◽

10.1160/th10-03-0169 ◽

2010 ◽

Vol 104 (10) ◽

pp. 734-740 ◽

Cited By ~ 9

Author(s):

Walter Ageno ◽

Andrea Airoldi ◽

Erminio Bonizzoni ◽

Mauro Campanini ◽

Gualberto Gussoni ◽

...

Keyword(s):

Venous Thromboembolism ◽

Confidence Interval ◽

Multivariable Analysis ◽

Hazard Ratio ◽

Term Care ◽

Risk Of Death ◽

Increased Risk ◽

Rehabilitation Facilities ◽

Overall Mortality

SummaryFew studies have addressed the topic of venous thromboembolism (VTE) in patients hospitalised in rehabilitation facilities. This patient population is rapidly growing, and data aimed to better define VTE risk in this setting are needed. Primary aim of this prospective observational study was to evaluate the frequency of symptomatic, objectively confirmed VTE in a cohort of unselected consecutive patients admitted to rehabilitation facilities, after medical diseases or surgery. Further objectives were to assess overall mortality, to identify risk factors for VTE and mortality, and to assess the attitude of physicians towards thromboprophylaxis. A total of 3,039 patients were included in the study, and the median duration of hospitalisation was 26 days. Seventy-two patients (2.4%) had symptomatic VTE. The median time to VTE from admission to the long-term care unit was 13 days. According to multivariable analysis, previous VTE (hazard ratio 5.67, 95% confidence interval 3.30–9.77) and cancer (hazard ratio 2.26, 95% confidence interval 1.36–3.75) were significantly associated to the occurrence of VTE. Overall in-hospital mortality was 15.1%. Age over 75 years, male gender, disability, cancer, and the absence of thromboprophylaxis were significantly associated to an increased risk of death (multivariable analysis). In-hospital antithrombotic prophylaxis was administered to 75.1% of patients, and low-molecular-weight heparin was the most widely used agent. According to our study, patients admitted to rehabilitation facilities remain at substantially increased risk for VTE. Because this applies to the majority of these patients, there is a great need for clinical trials assessing optimal prophylactic strategies.

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Prognostic efficacy of circulating asymmetric dimethylarginine in patients with peripheral arterial disease: A meta-analysis of prospective cohort studies

Vascular ◽

10.1177/1708538117733227 ◽

2017 ◽

Vol 26 (3) ◽

pp. 322-330

Author(s):

Renzhu Chu ◽

Dawei Yu ◽

Junyi Chu ◽

Mingqiang Lin ◽

Hongbo Yu

Keyword(s):

Confidence Interval ◽

Peripheral Arterial Disease ◽

Asymmetric Dimethylarginine ◽

Meta Analysis ◽

Arterial Disease ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Sensitivity Analyses ◽

Increased Risk ◽

Peripheral Arterial

Background Asymmetric dimethylarginine is suggested to be a marker of poor prognosis in patients with atherosclerosis. However, the predictive role of circulating asymmetric dimethylarginine for clinical outcome in patients with peripheral arterial disease has not been determined. Aims To quantitatively assess the predictive value of circulating asymmetric dimethylarginine for clinical outcome in patients with peripheral arterial disease in a meta-analysis of prospective cohort studies. Methods Relevant studies were identified by systematically searching of PubMed and Embase databases. A random-effect model was used to synthesize the results. Sensitivity analyses by omitting one study at a time were performed to evaluate the robustness of the results. Results Six studies with 2535 peripheral arterial disease patients were included. Patients with higher circulating asymmetric dimethylarginine at baseline were associated with higher risk of all-cause mortality (adjusted hazard ratio: 1.63, 95% confidence interval: 1.28–2.06, I2 = 16%), and major adverse cardiovascular events (adjusted hazard ratio: 2.01, 95% confidence interval: 1.08–3.73, I2 = 78%) as compared with those with lower circulating asymmetric dimethylarginine at baseline. Specifically, every increment of 0.1 µmol/l of asymmetric dimethylarginine was associated with 18% (adjusted hazard ratio: 1.18, 95% confidence interval: 1.06–1.31) increased risk for all-cause mortality and 14% (adjusted hazard ratio: 1.14, 95% confidence interval: 1.04–1.25) increased risk for major adverse cardiovascular disease. Sensitivity analyses by omitting one study at a time did not significantly change the results. Conclusion Higher circulating asymmetric dimethylarginine at baseline may be associated with higher incidence of cardiovascular events and mortality in patients with peripheral arterial disease.

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Benzodiazepines, Codispensed Opioids, and Mortality among Patients Initiating Long-Term In-Center Hemodialysis

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.13341019 ◽

2020 ◽

Vol 15 (6) ◽

pp. 794-804 ◽

Cited By ~ 1

Author(s):

Abimereki D. Muzaale ◽

Matthew Daubresse ◽

Sunjae Bae ◽

Nadia M. Chu ◽

Krista L. Lentine ◽

...

Keyword(s):

Confidence Interval ◽

Mortality Risk ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Opioid Prescription ◽

Short Acting ◽

Risk Of Death ◽

Medicare Claims ◽

Long Acting

Background and objectivesMortality from benzodiazepine/opioid interactions is a growing concern in light of the opioid epidemic. Patients on hemodialysis suffer from a high burden of physical/psychiatric conditions, which are treated with benzodiazepines, and they are three times more likely to be prescribed opioids than the general population. Therefore, we studied mortality risk associated with short- and long-acting benzodiazepines and their interaction with opioids among adults initiating hemodialysis.Design, setting, participants, & measurementsThe cohort of 69,368 adults initiating hemodialysis (January 2013 to December 2014) was assembled by linking US Renal Data System records to Medicare claims. Medicare claims were used to identify dispensed benzodiazepines and opioids. Using adjusted Cox proportional hazards models, we estimated the mortality risk associated with benzodiazepines (time varying) and tested whether the benzodiazepine-related mortality risk differed by opioid codispensing.ResultsWithin 1 year of hemodialysis initiation, 10,854 (16%) patients were dispensed a short-acting benzodiazepine, and 3262 (5%) patients were dispensed a long-acting benzodiazepine. Among those who were dispensed a benzodiazepine during follow-up, codispensing of opioids and short-acting benzodiazepines occurred among 3819 (26%) patients, and codispensing of opioids and long-acting benzodiazepines occurred among 1238 (8%) patients. Patients with an opioid prescription were more likely to be subsequently dispensed a short-acting benzodiazepine (adjusted hazard ratio, 1.66; 95% confidence interval, 1.59 to 1.74) or a long-acting benzodiazepine (adjusted hazard ratio, 1.11; 95% confidence interval, 1.03 to 1.20). Patients dispensed a short-acting benzodiazepine were at a 1.45-fold (95% confidence interval, 1.35 to 1.56) higher mortality risk compared with those without a short-acting benzodiazepine; among those with opioid codispensing, this risk was 1.90-fold (95% confidence interval, 1.65 to 2.18; Pinteraction<0.001). In contrast, long-acting benzodiazepine dispensing was inversely associated with mortality (adjusted hazard ratio, 0.84; 95% confidence interval, 0.72 to 0.99) compared with no dispensing of long-acting benzodiazepine; there was no differential risk by opioid dispensing (Pinteraction=0.72).ConclusionsCodispensing of opioids and short-acting benzodiazepines is common among patients on dialysis, and it is associated with higher risk of death.

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Glycemic Control and Risk of Sepsis and Subsequent Mortality in Type 2 Diabetes

10.2337/figshare.16775743 ◽

2021 ◽

Author(s):

Anca Balintescu ◽

Marcus Lind ◽

Mikael Andersson Franko ◽

Anders Oldner ◽

Maria Cronhjort ◽

...

Keyword(s):

Type 2 Diabetes ◽

Regression Analysis ◽

Cox Regression ◽

Cubic Spline ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Cox Regression Analysis ◽

Risk Of Death ◽

Increased Risk

Objective To investigate the nature of the relationship between HbA1c and sepsis among individuals with type 2 diabetes and to assess the association of sepsis and all-cause mortality in such patients. Research design and methods We included 502,871 individuals with type 2 diabetes recorded in the Swedish National Diabetes Register and used multivariable Cox regression and restricted cubic spline analyses to assess the association between time-updated HbA1c values and sepsis occurrence between January 1, 2005 and December 31, 2015. The association between sepsis and death was examined using multivariable Cox regression analysis. Result Overall, 14,534 (2.9%) patients developed sepsis during the study period. On multivariable Cox regression analysis, compared with an HbA1c of 48-52 mmol/mol (6.5-6.9%), the adjusted hazard ratio for sepsis was 1.15 (95% CI 1.07-1.24) for HbA1c <43 mmol/mol (6.1%); 0.93 (0.87-0.99) for HbA1c 53-62 mmol/mol (7.0-7.8%); 1.05 (0.97-1.13) for HbA1c 63-72 mmol/mol (7.9-8.7%); 1.14 (1.04-1.25) for HbA1c 73-82 mmol/mol (8.8-9.7%); and 1.52 (1.37-1.68) for HbA1c >82 mmol/mol (9.7%). In the cubic spline model, a reduction of the adjusted risk was observed within the lower HbA1c range until 53 mmol/mol (7.0%), with a hazard ratio of 0.78 (0.73-0.82) per standard deviation, and increased thereafter (P for non-linearity <0.001). As compared to patients without sepsis, the adjusted hazard ratio for death among patients with sepsis was 4.16 (4.03-4.30). Conclusions In a nationwide cohort of individuals with type 2 diabetes, we found a U-shaped association between HbA1c and sepsis and a four-fold increased risk of death among those developing sepsis.

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Risk of ischemic stroke in patients with acute myocardial infarction and new atrial fibrillation: a nationwide analysis

European Heart Journal ◽

10.1093/ehjci/ehaa946.0514 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L Fauchier ◽

A Bisson ◽

A Bodin ◽

J Herbert ◽

T Genet ◽

...

Keyword(s):

Myocardial Infarction ◽

Atrial Fibrillation ◽

Acute Myocardial Infarction ◽

Ischemic Stroke ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Risk Of Death ◽

Increased Risk ◽

History Of

Abstract Background In patients with acute myocardial infarction (AMI), history of atrial fibrillation (AF) and new onset AF during the early phase may be associated with a worse prognosis. Whether both conditions are associated with a similar risk of stroke and should be similarly managed is a matter of debate. Methods Based on the administrative hospital-discharge database, we collected information for all patients treated with AMI between 2010 and 2019 in France. The adverse outcomes were investigated during follow-up. Results Among 797,212 patients with STEMI or NSTEMI, 146,922 (18.4%) had history of AF, and 11,824 (1.5%) had new AF diagnosed between day 1 and day 30 after AMI. Patients with new AF were older and had more comorbidities than those with no AF but were younger and had less comorbidities than those with history of AF. Both groups with history of AF or new AF had less frequent STEMI and anterior MI, less frequent use of percutaneous coronary intervention but more frequent HF at the acute phase than patients with no AF. During follow-up (mean [SD] 1.8 [2.4] years, median [interquartile range] 0.7 [0.1–3.1] years), 163,845 deaths and 20,168 ischemic strokes were recorded. Using Cox multivariable analysis, compared to patients with no AF, history of AF was associated with a higher risk of death during follow-up (adjusted hazard ratio HR 1.06 95% CI 1.05–1.08) while this was not the case for patients with new AF (adjusted HR 0.98 95% CI 0.95–1.02). By contrast, both history of AF and new AF were associated with a higher risk of ischemic stroke during follow-up compared to patients with no AF: adjusted hazard ratio HR 1.29 95% CI 1.25–1.34 for history of AF, adjusted HR 1.72 95% CI 1.59–1.85 for new AF. New AF was associated with a higher risk of ischemic stroke than history of AF (adjusted HR 1.38 95% CI 1.27–1.49). Conclusion In a large and systematic nationwide analysis, AF first recorded in the first 30 days after AMI was associated with an increased risk of ischemic stroke. Specific management should be considered in order to improve outcomes in these patients after AMI. Funding Acknowledgement Type of funding source: None

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Abstract P439: Mortality After an Arterial Ischemic Event Among Intracerebral Hemorrhage Survivors

Stroke ◽

10.1161/str.52.suppl_1.p439 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Melvin Parasram ◽

Neal S Parikh ◽

Alexander E Merkler ◽

Guido J Falcone ◽

Kevin N Sheth ◽

...

Keyword(s):

Ischemic Stroke ◽

Confidence Interval ◽

Intracerebral Hemorrhage ◽

Medicare Beneficiaries ◽

Ischemic Event ◽

Risk Of Death ◽

Diagnosis Codes ◽

Increased Risk ◽

Secondary Analyses ◽

Ischemic Events

Background and Purpose: Emerging data suggest an increased risk of arterial ischemic events after intracerebral hemorrhage (ICH), but their impact on ICH outcomes is unclear. This study aimed to evaluate the risk of death among ICH survivors with and without an incident arterial ischemic event. Methods: We performed a retrospective cohort study using claims data from Medicare beneficiaries with a non-traumatic ICH from January 2008 to October 2015. Our exposure was an arterial ischemic event, defined as a composite of acute ischemic stroke or myocardial infarction (MI), identified using validated ICD-9-CM diagnosis codes. The outcome was death. After excluding ischemic events and deaths in the first 30 days after ICH discharge to prevent carryover of diagnosis codes from the initial hospitalization, we used marginal structural models to analyze the risk of death among ICH patients with and without an arterial ischemic event, after adjusting for demographics and vascular comorbidities as time-varying covariates. In secondary analyses, we studied the mortality risk separately after an ischemic stroke and MI. Results: Among 8,222 Medicare beneficiaries with an ICH, 2,371 (28.8%) had an arterial ischemic event. During a median follow up time of 2.0 years (interquartile range, 0.8-3.8), the cumulative mortality rate was 7.0% (95% confidence interval [CI], 6.5-7.5%) in patients with an arterial ischemic event and 4.0% (95% CI, 3.8-4.2%) in patients without an arterial ischemic event. In the marginal structural model, the occurrence of an arterial ischemic event was associated with an increased risk of death (hazard ratio [HR], 1.6; 95% confidence interval [CI], 1.5- 1.7). In secondary analyses, the mortality risk was elevated after both an ischemic stroke (HR, 1.5; 95% CI, 1.4-1.6), and a MI (HR, 2.6; 95% CI, 2.1-3.2). Conclusions: In a large population-based cohort, we found that elderly patients who survived an ICH had an increased risk of death after a subsequent ischemic stroke or MI. Careful exploration of secondary cardiovascular and stroke prevention strategies may be warranted in these patients.

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Statins Are Associated With Reduced Mortality in Multiple Myeloma

Journal of Clinical Oncology ◽

10.1200/jco.2016.68.3482 ◽

2016 ◽

Vol 34 (33) ◽

pp. 4008-4014 ◽

Cited By ~ 26

Author(s):

Kristen Marie Sanfilippo ◽

Jesse Keller ◽

Brian F. Gage ◽

Suhong Luo ◽

Tzu-Fei Wang ◽

...

Keyword(s):

Multiple Myeloma ◽

Statin Therapy ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Sensitivity Analyses ◽

Reductase Inhibitors ◽

Specific Mortality ◽

Statin Use

Purpose The 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) have activity in one of the pathways influenced by nitrogen-containing bisphosphonates, which are associated with improved survival in multiple myeloma (MM). To understand the benefit of statins in MM, we evaluated the association between statin use and mortality in a large cohort of patients with MM. Patients and Methods From the Veterans Administration Central Cancer Registry, we identified patients diagnosed with MM between 1999 and 2013. We defined statin use as the presence of any prescription for a statin within 3 months before or any time after MM diagnosis. Cox proportional hazards regression assessed the association of statin use with mortality, while controlling for known MM prognostic factors. Results We identified a cohort of 4,957 patients, of whom 2,294 received statin therapy. Statin use was associated with a 21% decrease in all-cause mortality (adjusted hazard ratio, 0.79; 95% CI, 0.73 to 0.86; P < .001) as well as a 24% decrease in MM-specific mortality (adjusted hazard ratio, 0.76; 95% CI, 0.67 to 0.86; P < .001). This association remained significant across all sensitivity analyses. In addition to reductions in mortality, statin use was associated with a 31% decreased risk of developing a skeletal-related event. Conclusion In this cohort study of US veterans with MM, statin therapy was associated with a reduced risk of both all-cause and MM-specific mortality. Our findings suggest a potential role for statin therapy in patients with MM. The putative benefit of statin therapy in MM should be corroborated in prospective studies.

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P0931PROTEIN ENERGY WASTING ON MORTALITY IN HEMODIALYSIS PATIENTS IN DIFFERENT SERUM ALBUMIN AND CHOLESTEROL LEVELS: A POPULATION STUDY IN TAIWAN

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0931 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

YEN-CHUNG LIN ◽

Cai-Mei Zheng

Keyword(s):

Confidence Interval ◽

Serum Albumin ◽

Cardiovascular Mortality ◽

Dietary Protein ◽

Protein Intake ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Dietary Protein Intake ◽

Increased Risk ◽

Related Mortality

Abstract Background and Aims Protein-energy wasting, hypoalbuminemia and hypercholesterolemia play an important role in mortality among hemodialysis (HD) patients. How hypoalbuminemia and hypercholesterolemia influence the nutrition (normalized protein catabolic rate (nPCR)) related mortality among HD patients is still unclear. Method Using the nationwide data from the Taiwan Renal Registry Data System (TWRDS) between 2005 and 2012, we divided the HD patients into nPCR<1.2 and nPCR≥1.2 groups. The relation of nPCR with three-year all-cause and cardiovascular mortality were determined. The influence of serum albumin (Alb) and cholesterol (TC) on nPCR related mortality were further analysed. Results Of 88,330 HD patients, 58122 (85.6%) patients were among nPCR <1.2 group and 30,208 (14.4%) in nPCR≥1.2 group. Both all-cause and cardiovascular mortality were increased in nPCR <1.2 group. In the nPCR <1.2 subjects, Alb ≥ 3.7 was associated with increased risk of both overall and CV mortality (adjusted hazard ratio [HR]; 95% confidence interval [CI]: 1.16; 1.07–1.25, p=0.0003 and 1.15; 1.02–1.13, p=0.03) compared to the those with Alb < 3.7 (adjusted hazard ratio [HR]; 95% confidence interval [CI]: 1.00; 0.90–1.08, p=0.74 and 1.15; 1.02–1.31, p=0.03). Further analysis revealed that in nPCR < 1.2 and Alb ≥ 3.7 group, TC ≥ 150 had increased risk of both all-cause and CV mortalities (adjusted hazard ratio [HR]; 95% confidence interval [CI]: 1.14; 1.04–1.25, p=0.005 and 1.17; 1.02–1.35, p=0.026). No significant relation was found betweent mortality and nPCR among patients with Alb < 3.7 irrespective of TC levels. Conclusion From this nationwide study, we found the close relation between dietary protein intake and mortality among those with Alb ≥ 3.7 and TC ≥ 150 group. Thus, we need to emphasize the importance of cholesterol control and dietary protein intake even among HD patients with normal serum albumin levels.

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