scholarly journals A Nationwide Analysis of Outcomes of Stroke in Hospitalized Patients with Essential Thrombocythemia: 2006 to 2014

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4293-4293
Author(s):  
Germame Ajebo ◽  
Kristine Badin ◽  
William Forehand ◽  
Achuta Kumar Guddati ◽  
Vamsi Kota
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Essential Thrombocythemia ◽  
Age Groups ◽  
Hospitalized Patients ◽  
Age Group ◽  
National Inpatient Sample ◽  
Medical Comorbidities ◽  
Significant Difference

Abstract Background: Essential thrombocythemia (ET) is a chronic myeloproliferative neoplasm which is associated with an increased risk of thrombohemorrhagic complications as well as progression to myelofibrosis and frank leukemia. Patients with ET are at an elevated risk for stroke. However, studies of prevalence and outcomes of stroke in hospitalized patients with ET have been limited to case series. The median survival of patients with ET is comparable to normal population but the quality of life may be significantly altered due to the occurrence of thrombotic events in the cerebrovascular and cardiovascular systems. By conducting a retrospective analysis of nationwide data from hospitalized ET patients between the years of 2006 and 2014, we sought to identify if there are any statistically significant associations between stroke and/or in-hospital mortality with respect to patients' gender, age group, race, and comorbidities like hypertension, diabetes atrial fibrillation and chronic kidney disease. Methods: Data from the National Inpatient Sample was utilized to identify outcomes in hospitalized patient with ET who were admitted for stroke. The National Inpatient sample is a database maintained by the Agency for Healthcare Quality and Research. Utilizing the current procedural terminology code (CPT) for ET, outcomes of patients with ET who were hospitalized with stroke were studied for the year 2006 to 2014. Patient demographics of age, gender and race were collected and hospital characteristics of location and size were correlated to outcomes. The extent of common medical comorbidities such as hypertension, diabetes, chronic kidney disease and atrial fibrillation was studied in ET patients who died with and without stroke. Chi square test was used to determine odds ratios and multiple logistic regression was used to determine independent predictors of mortality. Results: Between 2006 to 2014, 552422 hospitalizations involved patients with a diagnosis of ET of which 20650 hospitalizations were due to stroke. Of these patients with stroke there was a preponderance of prevalence in females (13400 vs. 7251). The percentage of stroke in these hospitalizations varied between 3.64 to 4.29 over 15 years and mortality in these patients did not significantly change during this time period. The prevalence of stroke was highest amongst Asians and Caucasians (4.7% and 3.86%) with a statistically significant difference (p=0.0000). The age group of 80+ years and the difference in prevalence between different age groups (18-34 vs. 35-49 vs, 50-64 vs. 75-79) was statistically significant (p=0.0000) with Medicare being the insurance for most of these patients (p=0.000)). Notably, mortality was highest in the same group but was not significantly different from other age groups. Large sized hospitals were noted to have a higher proportion of ET patients with stroke compared to smaller and medium sized hospitals (p=0.0002). No difference in such proportions was noted in hospitals varying by region (Northeast vs. Midwest vs. South vs. West). Burden of medical comorbidities as measured by Charlson's comorbidity index was noted to be in the 4-6 range. Similarly, hypertension, hyperlipidemia, diabetes, atrial fibrillation, smoking status were also found to be more frequent in ET patients with stroke. A majority of ET patients with stroke were discharged to skilled nursing facilities. Multiple regression showed that female gender, atrial fibrillation, stroke, higher Charlsons comorbidity score and 80+ age were independent predictors of mortality (OR: 0.75, 1.35, 1.8, 2 to 5.7, 13.9 respectively). Conclusions: Patients with ET who are hospitalized with stroke have significantly worse outcomes. This study demonstrated that a statistically significant difference exists among different age groups of patients with ET and stoke who died during hospitalization when stratification is made using age groups and Charlson Score. This study may serve as an initial point to include new risk factors for further risk stratification. Early identification of patients at higher risk may reduce the incidence and decrease the morbidity of stroke in patients with ET. Disclosures Kota: BMS: Honoraria; Novartis: Honoraria; Xcenda: Honoraria; Incyte: Honoraria; Pfizer: Honoraria.

scholarly journals Clinico-biochemical profile of chronic kidney disease patients in elderly age group in a tertiary care centre

2019 ◽  
Vol 7 (11) ◽  
pp. 4227
Author(s):  
Atul V. Rajkondawar ◽  
Amit Yele
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Elderly Patients ◽  
Tertiary Care ◽  
P Value ◽  
Age Group ◽  
Elderly Age ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Significant Difference

Background: Chronic kidney disease (CKD) remains one of the major health problems in India. Renal function steadily deteriorates as age advances and advancing age has been indicted to have adverse implications in the disease progression to end stage renal disease (ESRD). With the present study, clinico-biochemical profiling of chronic kidney disease patients in geriatric age group as well as comparison with non-elderly patients was undertaken.Methods: In this cross-sectional observational study, 100 patients of CKD admitted in the tertiary care study centre were enrolled consecutively and assessed for symptoms, signs and biochemical parameters over two years. Study subjects were divided into two groups:- Group 1: Elderly patients- aged 60 years or more, and Group 2: Non-elderly patients- less than 60 years of age. Relevant comparisons were drawn statistically and tested for significance.Results: Pallor and pedal edema were observed to be the commonest clinical features across groups. Elderly group shows higher prevalence of severe anaemia (mean hemoglobin- 7.4 gm%). Higher prevalence of clinical and biochemical derangement was found in patients with relatively lower GFR. Elderly age group also had more prevalence of electrolyte abnormalities compared with non-elderly population, with statistically significant difference observed for hyponatremia (p value- 0.023), hypoproteinemia (p value- 0.0078) and blood urea level (p value- 0.0054).Conclusions: Understanding beforehand the biochemical abnormalities associated with old age in CKD patients helps in appropriate modifications in patient management.

scholarly journals Association between breed and renal biomarkers of glomerular filtration rate in dogs

2020 ◽  
Vol 187 (10) ◽  
pp. e82-e82
Author(s):  
Michael Coyne ◽  
Donald Szlosek ◽  
Celeste Clements ◽  
Donald McCrann ◽  
Lauren Olavessen
Keyword(s):  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Age Groups ◽  
Age Group ◽  
Serum Chemistry ◽  
Symmetric Dimethylarginine ◽  
Renal Biomarkers

BackgroundKidney disease, especially chronic kidney disease (CKD), is common in older dogs. The biomarkers symmetric dimethylarginine (SDMA) and creatinine (Cr) are indicators of glomerular filtration rate (GFR). This retrospective study used these biomarkers to identify groups at risk of decreased GFR at the breed level.MethodsData from dogs with a single serum chemistry result that included Cr and SDMA submitted between July 2015 through December 2017 were included. Dogs were identified by breed and age group. Decreased GFR was defined as Cr above 1.9 mg/dl or SDMA above 18 µg/dl.ResultsFourteen breeds had a significantly higher percentage of dogs with increased SDMA or Cr for one or more age groups. Geriatric and senior Shetland sheepdogs, Yorkshire terriers and Pomeranians were significantly more likely to have increased renal biomarkers. Boxers were identified with significantly increased renal biomarkers in the age groups spanning two months to 10 years of age.ConclusionEvidence of decreased GFR occurred commonly in older dogs of most breeds, especially geriatric dogs greater than 10 years of age, but there were some exceptions, with more significant changes affecting younger animals of several breeds. The combination of SDMA and Cr identified more cases of decreased GFR than either SDMA or Cr alone.

Secondary stroke prophylaxis in atrial fibrillation patients with chronic kidney disease: a nationwide cohort study

EP Europace ◽  
2019 ◽  
Vol 22 (5) ◽  
pp. 716-723
Author(s):  
Mathias Aagaard Christensen ◽  
Emil Loldrup Fosbøl ◽  
Anders Nissen Bonde ◽  
Jonas Bjerring Olesen ◽  
Gunnar H Gislason ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Ischaemic Stroke ◽  
Antiplatelet Therapy ◽  
Oral Anticoagulation ◽  
Multivariable Analysis ◽  
Thromboembolic Events ◽  
Post Stroke ◽  
Significant Difference

Abstract Aims Oral anticoagulation (OAC) therapy as secondary stroke prophylaxis in atrial fibrillation (AF) patients with chronic kidney disease (CKD) remains unexplored and poses a clinical treatment dilemma. We assessed the long-term risk of thromboembolic events according to post-stroke OAC therapy in AF patients with CKD after their first ischaemic stroke. Methods and results We identified Danish AF patients with CKD who presented with first-time ischaemic stroke from 2005 to 2014. Chronic kidney disease was defined as a diagnosis code for CKD before baseline, defined as 100 days after stroke discharge. Post-stroke antithrombotic therapy (OAC therapy and antiplatelet therapy) was identified from prescription claims from discharge to baseline. Cumulative incidences and adjusted hazard ratios (HRs) of thromboembolic events according to post-stroke OAC therapy were examined. Of 1252 AF patients with CKD presenting with ischaemic stroke, 631 (50.4%) patients were on OAC therapy and 621 (49.6%) were on antiplatelet therapy alone at baseline [median age 76 (interquartile range, IQR 71–83) and 80 (IQR 72–86), respectively]. The median follow-up period was 1.9 years (IQR 0.8–3.6). Cumulative incidence rates of thromboembolic events and bleeding showed no significant difference between those on OAC therapy and antiplatelet therapy. The results from the multivariable analysis revealed similar results: thromboembolic risk was not modified by OAC treatment [adjusted HR 0.89, 95% confidence interval (CI) 0.73–1.09] nor was the risk of bleeding (adjusted HR 0.88, 95% CI 0.67–1.17). Conclusion Oral anticoagulation in patients with CKD and prior stroke was not associated with a reduced risk of recurrent thromboembolic events compared with antiplatelet therapy.

scholarly journals AGE AND EFFECTIVENESS AND SAFETY OF VARIOUS ANTITHROMBOTIC THERAPY VARIANTS IN PATIENTS WITH NONVALVULAR ATRIAL FIBRILLATION

2013 ◽  
Vol 12 (1) ◽  
pp. 46-53 ◽  
Author(s):  
V. I. Shevelev ◽  
S. G. Kanorskyi
Keyword(s):  
Atrial Fibrillation ◽  
Antithrombotic Therapy ◽  
Age Groups ◽  
Age Group ◽  
Nonvalvular Atrial Fibrillation ◽  
Old Patients ◽  
Therapy Strategy ◽  
Group I ◽  
Significant Difference ◽  
Clopidogrel Therapy

Aim. To compare effectiveness and safety of warfarin, dabigatran, and clopidogrel therapy as thromboembolism (TE) prevention strategy across the age groups in patients with nonvalvular atrial fibrillation (AF).Material and methods. The study included 189 patients (110 men and 79 women), aged 65–80 years, with nonvalvular AF. All participants were divided into two groups: Group I (n=126) included patients aged 65–74 years. They were administered warfarin (n=43), in the dose providing the INR levels of 2,0–3,0; dabigatran (n=41) in the dose of 110 mg twice a day; and clopidogrel (n=42) in the dose of 75 mg/d. Group II (n=63) included patients aged 75–80 years. They were administered warfarin (n=22), dabigatran (n=20), and clopidogrel (n=21) in identical doses.Results. In the younger age group, the 6-month treatment with dabigatran (110 mg twice a day), compared to the warfarin treatment, was associated with a similar incidence of ischemic stroke, but a lower risk of major bleeding (4,8% vs. 27,9%; p<0,05). The treatment with clopidogrel prevented stroke as effectively as the therapy with warfarin or dabigatran, and was reasonably safe. In the older age group, there was no significant difference in the incidence of TE and hemorrhagic complications between dabigatran and warfarin groups.Conclusion. While selecting the antithrombotic therapy strategy in 65–74-year-old patients with nonvalvular AF, dabigatran and clopidogrel could be regarded as an acceptable alternative to warfarin.

scholarly journals Study on Correlation of Carotid Artery Intima–Media Thickness and Dyslipidemia in Chronic Kidney Disease in a Bangladeshi Population

2020 ◽  
Vol 4 (4) ◽  
pp. 271
Author(s):  
Amir Mohammad Kaiser ◽  
Rafi Nazrul Islam ◽  
Miliva Mozaffor ◽  
Salahuddin Feroz ◽  
Md Mustafizur Rahman
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Carotid Artery ◽  
Total Cholesterol ◽  
Negative Correlation ◽  
Intima Media Thickness ◽  
Age Group ◽  
Cross Sectional ◽  
Media Thickness ◽  
Significant Difference

Background: In chronic kidney disease (CKD) patients,measuring carotid artery intima– media thickness (CIMT) canpredict coronary heart disease and stroke, resulting from systemic atherosclerosis.Objective: To find out correlation of carotid artery intima–media thickness and dyslipidemia in chronic kidney disease in a Bangladesh population.Methods: A cross-sectional analytic study was conducted in the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladeshi, between July 2014 and June 2015, on 80 CKD patients. Standard laboratory techniques were followed to estimate all biochemical parameters. CIMT measurement was done by duplex study of carotid vessels through high resolution B-mode ultrasound technique.Results: Among 80 patients, 29 (36%) were in 18-30 age group, 18 were (23%) 31-40 age group and 33 (41%) were between 41-50 age group; mean age was 36.1±9.5 years. 51 (64%) patients were male and 29 (36%) were female. Though mean CIMT was found markedly increased in all CKD patients, the differences among stage 3, 4 and 5 was not significant. Mean CIMT was found more in dyslipidemic patients in comparison those with normal lipid profile, which was statistically significant (p<0.05). Positive correlations were found between total cholesterol (TC) and CIMT (r=+0.295; p=0.008), triglyceride (TG) and CIMT (r=+0.238; p=0.034), and lowdensity lipoprotein (LDL) and CIMT (r=+0.231; p=0.039). However, there was negative correlation between high-density lipoprotein (HDL) and CIMT (r=–0.242; p=0.030).Conclusion: Our data suggest that the mean carotid intima-media thickness was markedly high in patients with CKD in comparison to normal expected value; however, there was no significant difference in thickness among CKD stages 3, 4 and 5. It was also observed that carotid artery intima-media thickness showed significant positive correlation with total cholesterol, triglyceride and LDL, but negative correlation with HDL.International Journal of Human and Health Sciences Vol. 04 No. 04 October’20 Page : 271-276

Sarcopenia is an actual problem in chronic kidney disease of the 5d stage

2020 ◽  
Vol 24 (1) ◽  
pp. 60-66
Author(s):  
I. V. Lavrishcheva ◽  
A. Sh. Rumyantsev ◽  
M. V. Zakharov ◽  
N. N. Kulaeva ◽  
V. M. Somova
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Muscle Mass ◽  
Chronic Kidney Disease Stage ◽  
Age Groups ◽  
Disease Stage ◽  
Actual Problem ◽  
European Working ◽  
Low Performance ◽  
6 Minute Walk Test

BACKGROUND. The lack of data on the epidemiology of presarcopenia/sarcopenia leads to an underestimation of the role of this condition in the structure of morbidity and mortality of haemodialysis patients in theRussian Federation. THE AIM: to study the epidemiological aspects of presarcopenia /sarcopenia in patients with chronic kidney disease stage 5d. PATIENTS AND METHODS. This study comprised 317 patients receiving programmed bicarbonate haemodialysis for 8.2 ± 5.1 years, among them 171 women and 146 men, the average age was 57.1 ± 11.3 years. The assessment of the presence of sarcopenia was performed using the method recommended by the European Working Group on Sarcopenia in Older People. RESULTS. The prevalence of presarcopenia was 0.7 % and sarcopenia 29.6 %. The incidence of skeletal muscle mass deficiency according to muscle mass index (IMM) was 30.3 %, 48.7 % showed a decrease in muscle strength according to dynamometry, and low performance of skeletal muscles according to 6 minute walk test was determined in 42.8 %. Sarcopenia patients were significantly characterized by lower body mass index, as well as higher body fat mass values. The duration of haemodialysis (χ2 = 22.376, p = 0.0001) and the patient's age (χ2 = 10.545 p = 0.014) were an independent risk factors for the development of sarcopenia. CONCLUSION. Sarcopenia is recorded more frequently in hemodialysis patients than presarcopenia. Its prevalence increases among patients of older age groups and with a hemodialysis duration of more than 5 years. The age and experience of dialysis make their independent contribution to the development of this syndrome.

The Problem of Atrial Fibrillation in Patients with Chronic Kidney Disease

2016 ◽  
Vol 14 (3) ◽  
pp. 260-265 ◽  
Author(s):  
Beata Franczyk ◽  
Anna Gluba-Brzózka ◽  
Aleksandra Cia|kowska-Rysz ◽  
Maciej Banach ◽  
Jacek Rysz
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease

Seroprevalence of anti-SARS-CoV-2 IgG antibodies in hospitalized patients at a tertiary referral center in North India (Preprint)

2020 ◽  
Author(s):  
Dr. Animesh Ray ◽  
Dr. Komal Singh ◽  
Souvick Chattopadhyay ◽  
Farha Mehdi ◽  
Dr. Gaurav Batra ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Age Groups ◽  
Hospitalized Patients ◽  
North India ◽  
P Value ◽  
Care Hospital ◽  
Igg Antibodies ◽  
Igg Antibody ◽  
Increased Risk ◽  
Significant Difference

BACKGROUND Seroprevalence of IgG antibodies against SARS-CoV-2 is an important tool to estimate the true extent of infection in a population. However, seroprevalence studies have been scarce in South East Asia including India, which, as of now, carries the third largest burden of confirmed cases in the world. The present study aimed to estimate the seroprevalence of anti-SARS-CoV-2 IgG antibody among hospitalized patients at one of the largest government hospital in India OBJECTIVE The primary objective of this study is to estimate the seroprevalence of SARS-CoV-2 antibody among patients admitted to the Medicine ward and ICU METHODS This cross-sectional study, conducted at a tertiary care hospital in North India, recruited consecutive patients who were negative for SARS-CoV-2 by RT-PCR or CB-NAAT. Anti-SARS-CoV-2 IgG antibody levels targeting recombinant spike receptor-binding domain (RBD) protein of SARS CoV-2 were estimated in serum sample by the ELISA method RESULTS A total of 212 hospitalized patients were recruited in the study with mean age (±SD) of 41.2 (±15.4) years and 55% male population. Positive serology against SARS CoV-2 was detected in 19.8%patients(95% CI 14.7-25.8). Residency in Delhi conferred a higher frequency of seropositivity 26.5% (95% CI 19.3-34.7) as compared to that of other states 8% (95% CI 3.0-16.4) with p-value 0.001. No particular age groups or socio-economic strata showed a higher proportion of seropositivity CONCLUSIONS Around, one-fifth of hospitalized patients, who were not diagnosed with COVID-19 before, demonstrated seropositivity against SARS-CoV-2. While there was no significant difference in the different age groups and socio-economic classes; residence in Delhi was associated with increased risk (relative risk of 3.62, 95% CI 1.59-8.21)

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