scholarly journals The risk factors associated with COVID-19-Related death among patients with end‐stage renal disease

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hadith Rastad ◽  
Hanieh-Sadat Ejtahed ◽  
Gita Shafiee ◽  
Anis Safari ◽  
Ehsan Shahrestanaki ◽  
...  
Keyword(s):  
Renal Disease ◽  
Hospital Mortality ◽  
Medical History ◽  
End Stage Renal Disease ◽  
Demographic Factors ◽  
Increased Risk ◽  
Significant Difference ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background The extent to which patients with End-stage renal disease (ESRD) are at a higher risk of COVID-19-related death is still unclear. Therefore, the aim of this study was to identify the ESRD patients at increased risk of COVID-19 -related death and its associated factors. Methods This retrospective cohort study was conducted on 74 patients with ESRD and 446 patients without ESRD hospitalized for COVID-19 in Alborz province, Iran, from Feb 20 2020 to Apr 26 2020. Data on demographic factors, medical history, Covid-19- related symptoms, and blood tests were obtained from the medical records of patients with confirmed COVID-19. We fitted univariable and multivariable Cox regression models to assess the association of underlying condition ESRD with the COVID-19 in-hospital mortality. Results were presented as crude and adjusted Hazard Ratios (HRs) and 95% confidence intervals (CIs). In the ESRD subgroup, demographic factors, medical history, symptoms, and blood parameters on the admission of survivors were compared with non-survivors to identify factors that might predict a high risk of mortality. Results COVID-19 patients with ESRD had in-hospital mortality of 37.8% compared to 11.9% for those without ESRD (P value < 0.001). After adjusting for confounding factors, age, sex, and comorbidities, ESRD patients were more likely to experience in-hospital mortality compared to non-ESRD patients (Adjusted HR (95% CI): 2.59 (1.55–4.32)). The Log-rank test revealed that there was a significant difference between the ESRD and non-ESRD groups in terms of the survival distribution (χ2 (1) = 21.18, P-value < 0.001). In the ESRD subgroup, compared to survivors, non-survivors were older, and more likely to present with lack of consciousness or O2 saturation less than 93%; they also had lower lymphocyte but higher neutrophil counts and AST concentration at the presentation (all p –values < 0.05). Conclusions Our findings suggested that the presence of ESRD would be regarded as an important risk factor for mortality in COVID-19 patients, especially in those who are older than age 65 years and presented with a lack of consciousness or O2 saturation less than 93%.

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 Apoprotein(A) Isoforms Risk Factors for Atherogenesis in Esrd Patients on Haemodialysis

2014 ◽  
Vol 68 (1) ◽  
pp. 16-20
Author(s):  
Danica Labudovic ◽  
Katerina Tosheska-Trajkovska ◽  
Sonja Alabakovska
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Renal Disease ◽  
Vascular Disease ◽  
End Stage Renal Disease ◽  
Relative Risks ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Introduction. End-stage renal disease (ESRD) patients undergoing hemodialysis are at an increased risk of arteriosclerotic vascular disease (ASVD). The increased risk is commonly attributed to the traditional risk factors related to ESRD. However, interest for more recent risk factors for ASVD, such as the level of lipoprotein(a) and its specific apoprotein(a) has been promoted. The aim of this paper is to determine whether apo(a) phenotype is a risk factor for arteriosclerotic vascular disease in ESRD patients who are on hemodialysis. Methods. Apo(a) phenotypisation was performed by using the Western Blot Technique of blood samples from 96 end-stage renal disease patients who were undergoing hemodialysis, and from 100 healthy individuals. Results. Frequency distribution of the basic apo(a) isoforms calculated by means of the χ2-test has shown that there was no significant statistical difference in distribution among patients on hemodialysis, and healthy carriers (χ2-0.36, p<0.548-for carriers of single apo(a) isoforms, (χ2-0.10, p<0.7545-for carriers of double apo(a) isoforms). The calculated relative risks have demonstrated that apo(a) phenotype was not a risk factor for ASVD in HD patients. Conclusion. Based on the results obtained, it can be concluded that the apo(a) phenotype is not a risk factor for arteriosclerotic vascular disease in patients undergoing hemodialysis.

scholarly journals Epidemiological Characteristics and Causes of End-stage Renal Disease in Hemodialysis Patients

2020 ◽  
Vol 7 (2) ◽  
pp. 53-57
Author(s):  
Mehdi Khazaei ◽  
Zainab Eslami Hasan Abadi ◽  
Mohammad Keshvari Delavar ◽  
Morteza Shamsizadeh
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Prevalence Rate ◽  
Significant Difference ◽  
Common Causes ◽  
The Common ◽  
Stage Renal Disease ◽  
End Stage ◽  
Epidemiological Characteristics ◽  
Esrd Patients

Background and aims: Hemodialysis (HD) is considered as the main method of renal replacement therapy (RRT) for end-stage renal disease (ESRD) patients in many countries including Iran. Given the limited number of epidemiological studies in this regard at the provincial level across the country, the present study aimed to describe the demographic and clinical characteristics of ESRD patients and determine the most important causes of ESRD in Hamadan Province. Methods: This cross-sectional study was conducted on 508 HD patients in Hamadan province in January 2017. The checklist used to gather information comprised of the patient’s demographic and clinical information. The analysis was carried out using descriptive analysis including frequency tables and charts and the chi-square statistic test was used to compare the groups using Stata software, version 12. Results: The prevalence rate of HD treatment was 288.9 per million population (PMP). Further, most under HD patients were married, illiterate, and urban residents. The mean age of patients at the diagnosis was 47.64 ± 15.17 years. Hypertension (37.4%), diabetes (28.74%), and glomerulonephritis (10.63%) were the common causes of ESRD. Eventually, there was a significant difference between ESRD causes according to gender and residency (P<0.05). Conclusion: In general, the prevalence rate of HD in Hamadan was relatively similar to that of developing countries although it was lower than the national average. Furthermore, hypertension and diabetes were the common causes of ESRD in Hamadan Province. Therefore, preventive strategies should be taken to modify their risk factors.

scholarly journals Sexual Dysfunction Among Patients with End-Stage Renal Disease Undergoing Hemodialysis: Prevalence and Associated Factors

2020 ◽  
Vol 14 (2) ◽  
Author(s):  
Mansour Shakiba ◽  
Nour-Mohammad Bakhshani ◽  
Zohre Soorgi ◽  
Shahab Lotfinia
Keyword(s):  
Sexual Dysfunction ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Pearson Correlation ◽  
Educational Status ◽  
Number Of Patients ◽  
Significant Difference ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background: Chronic renal disease is a worldwide concern. The number of patients on hemodialysis increases every year. These patients have several physiological and psychological problems like sexual dysfunction that can affect their mental health and treatment course. Objectives: This study first aimed to assess the prevalence of sexual dysfunction in end-stage renal disease (ESRD) patients on hemodialysis compared to healthy people. Then, it evaluated factors associated with sexual dysfunction in both groups. Methods: This cross-sectional study recruited a total of 142 participants in two groups selected by a convenience sampling method. Group one included 71 ESRD patients from two hemodialysis centers in Zahedan, Southeast of Iran, recruited between September 2018 and September 2019. Group two included 71 healthy individuals matched for age, weight, and educational status. The two groups were assessed based on psychiatric interviews, the International Index of Erectile Function (IIEF), and the index of female sexual function (IFSF). The SPSS 24 software was used for data analysis. The bivariate Pearson correlation test, Cramer V, and independent-t-test were used to analyze the data. Results: All female patients and 90% of healthy females had various levels of sexual dysfunction, and there was no significant difference between them (P = 0.21). However, 84.6% of male patients and 33.3% of healthy males had various levels of sexual dysfunction and there was a significant difference between the two groups (P < 0.001). The duration of hemodialysis was not correlated with sexual dysfunction. Age, weight, educational status, and marriage duration showed the most correlations with sexual dysfunction, especially in females. Conclusions: As the findings showed, sexual dysfunction had a high prevalence among hemodialysis patients. As many of these patients must be on hemodialysis for long periods, we need to pay attention to sexual dysfunction when assessing and planning for their treatment.

scholarly journals VARIATION IN ADVANCE DIRECTIVES TIMING BETWEEN END-STAGE RENAL DISEASE PATIENTS AND CANCER PATIENTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S275-S275
Author(s):  
Yu-Hsuan Wang ◽  
Susan Enguidanos
Keyword(s):  
Renal Disease ◽  
End Of Life ◽  
Cancer Patients ◽  
End Stage Renal Disease ◽  
The United States ◽  
Completion Rates ◽  
Significant Difference ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract The United States has the third highest prevalence and the second highest incidence of End-Stage Renal Disease (ESRD). ESRD is associated with high mortality and lower quality of end-of-life experiences. Having an advance directive (AD) is associated with better care at the end of life. Although past ACP completion rates in ESRD patients has been studied, little is known about its timing differences between ESRD and cancer patients. This study investigates the timing difference of AD completion between ESRD and cancer patients We conducted logistic regression to analyze data from the Health and Retirement Study, a nationally representative longitudinal survey of older adults. The analytic sample included exit interviews from 2012 to 2016 among 971 proxies of deceased with ESRD or cancer. Among the sample, 47% of decedents completed an AD; 44% of cancer patients and 48% of ESRD patients. Being a racial minority (OR=0.38, p&lt;0.001), and lower education (OR= 0.63, p=0.001) were associated with lower AD completion rates. No significant differences in AD completion rates were found between cancer patients and ESRD patients. Compared to cancer patients, ESRD patients were more likely to complete ADs more than one year before death (OR=3.15, p=0.001). However, there were no significant difference between cancer patients and ESRD patients in AD completion rates in the three months before death. Although both samples had comparable rates of AD completion, compared to cancer patients, ESRD patients tend to document care preferences earlier. Further studies are needed to investigate factors related to early documentation of ADs.

scholarly journals Effect of α-Lipoic Acid on Oxidative Stress in End-Stage Renal Disease Patients Receiving Intravenous Iron

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Arif Showkat ◽  
William R. Bastnagel ◽  
Joanna Q. Hudson
Keyword(s):  
Oxidative Stress ◽  
Renal Disease ◽  
Lipoic Acid ◽  
End Stage Renal Disease ◽  
Transferrin Saturation ◽  
Lipid Hydroperoxide ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Oxidative stress is associated with increased risk of cardiovascular disease in end-stage renal disease (ESRD) patients. Intravenous (IV) iron has been shown to increase oxidative stress. The aim of the study was to evaluate changes in oxidative stress markers following administration of IV sodium ferric gluconate (SFG) to ESRD patients with and without administration of the antioxidant, α-lipoic acid. This is an open-label, crossover study. 125 mg of IV SFG was administered during control (C) and intervention (I) visits. During the I visit, 600 mg of α-lipoic acid was given orally prior to IV SFG. Blood samples were collected at defined time periods for F2-isoprostane (FIP), lipid hydroperoxide (LHP), malondialdehyde (MDA), and iron indices. We recruited ten African-American ESRD subjects: 50% male; mean age 45±9 years; mean hemoglobin 13±1 g/dL; ferritin 449±145 ng/mL; transferrin saturation 27±4%. There were no significant differences in iron indices between the two visits after IV SFG. MDA, FIP, and LHP increased significantly for both C and I visits with a greater increase in the I group. Administration of IV SFG results in an acute rise in oxidative stress in ESRD patients. In contrast to previous studies, administration of α-lipoic acid was associated with a greater increase in oxidative stress.

scholarly journals Evaluation of the Correlation Between Cardiac Troponin I Versus Causes of Admission and In-Hospital Mortality in End-Stage Renal Disease Patients

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Shahram Taheri ◽  
Zahra Tavassoli-Kafrani ◽  
Sayed Mohsen Hosseini
Keyword(s):  
Renal Disease ◽  
Hospital Mortality ◽  
End Stage Renal Disease ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Cardiac Troponin I ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Relationship ◽  
Esrd Patients

Objectives: There are arguments regarding the relationship between the level of cardiac troponin I (cTnI) and presence of cardiac diseases in end-stage renal disease (ESRD) patients. This study aimed to determine the relationship between positivity of cTnI and cause of admission and patients’ outcome in ESRD patients. Methods: In this cross-sectional study, all ESRD patients who had checked cTnI and admitted to two university hospitals in Isfahan, Iran were enrolled. The patients’ demographic characteristics, cause of admission, and outcome were correlated with cTnI positivity. Results: Out of a total of 348 ESRD patients, 100 subjects had positive cTnI. There was a positive correlation between age and admission in Al-Zahra hospital with positive cTnI. In contrast, vascular access complication and hypertension had a negative correlation with positivity of cTnI. The results of multiple logistic regression analysis showed that factors including age (OR: 1.04; 95% CI: 1.01 - 1.07; P: 0.004) and infections (OR: 3.1; 95% CI: 1.3 - 7.3; P: 0.009) were associated with increased risk of in-hospital mortality. In contrary, exit site infection (OR: 0.11; 95% CI: 0.01 - 0.8; P: 0.03) and hypertension (OR = 0.32; 95% CI: 0.14 - 0.77; P = 0.01) were associated with decreased risk of mortality. Although cTnI positivity correlated with patients’ in-hospital mortality (OR = 2.038). Conclusions: Although positive cTnI had a borderline association with in-hospital mortality in ESRD patients, further multicenter studies with larger sample size are required to confirm the results.

scholarly journals Low dialysis potassium bath is associated with lower mortality in end stage renal disease patients admitted to hospital with severe hyperkalemia

2020 ◽  
Author(s):  
Tripti Singh ◽  
Sayee Alagasundaramoorthy ◽  
Andrew Gregory ◽  
Brad C Astor ◽  
Laura Maursetter
Keyword(s):  
Cardiac Arrest ◽  
Renal Disease ◽  
Hospital Mortality ◽  
Serum Potassium ◽  
End Stage Renal Disease ◽  
Lower Mortality ◽  
Severe Hyperkalemia ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background Hyperkalemia is a modifiable risk factor for sudden cardiac death, a leading cause of mortality in hemodialysis patients. The optimal treatment of hyperkalemia in hospitalized end stage renal disease (ESRD) patients is nonexsistent in literature which has prompted studies from outpatient dialysis to be extrapolated to inpatient care. The goal of this study was to determine if low potassium dialysate 1 meq/L is associated with higher mortality in hospitalized ESRD patients with severe hyperkalemia (serum potassium &gt; 6.5 mmol/L). Methods We conducted a retrospective study of all adult ESRD patients admitted with severe hyperkalemia between January 2011- August 2016. Results There were 209 ESRD patients on hemodialysis admitted with severe hyperkalemia during the study period. Mean serum potassium was 7.1 mmol/L. In-hospital mortality or cardiac arrest in ESRD patients with severe hyperkalemia was 12.4%. Median time to dialysis after serum potassium result was 2.0 hours (25, 75 IQR 0.9, 4.2 hours). 47.4% of patients received dialysis with 1mEq/L concentration potassium bath. The use of 1mEq/L potassium bath was associated with significantly lower mortality or cardiac arrest in ESRD patients admitted with severe hyperkalemia (OR 0.27 95% C.I. 0.09-0.80, p = 0.01). Conclusion We conclude that use of 1mEq/L potassium bath for treatment of severe hyperkalemia (&gt;6.5 mmol/L) in hospitalized ESRD patients is associated with decreased in-hospital mortality or cardiac arrest.

scholarly journals Impact of kidney transplantation on the risk of retinal vein occlusion in end-stage renal disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jangwook Lee ◽  
Hye Rim Choe ◽  
Sang Hyun Park ◽  
Kyung Do Han ◽  
Dong Ki Kim ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Renal Disease ◽  
Retinal Vein Occlusion ◽  
End Stage Renal Disease ◽  
Charlson Comorbidity Index Score ◽  
Vein Occlusion ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

AbstractIt has been known that retinal vein occlusion (RVO) is associated with chronic kidney disease, especially end-stage renal disease (ESRD). However, little is known about the effect of kidney transplantation (KT) on RVO incidence in ESRD patients. This study aimed to compare the incidence of RVO in KT recipients (n = 10,498), matched ESRD patients (n = 10,498), and healthy controls (HCs, n = 10,498), using a long-term population-based cohort. The incidence of RVO was 2.74, 5.68, and 1.02 per 1000 patient-years, for the KT group, the ESRD group, and the HCs group, respectively. Adjusted hazard ratios for RVO development compared to the HCs group, were 1.53 and 3.21, in the KT group and the ESRD group, respectively. In the KT group, multivariable regression analysis indicated that an age over 50, a Charlson Comorbidity Index score over 4, and a history of desensitization therapy were associated with an increased risk of RVO. In summary, KT recipients have a lower risk for development of RVO than ESRD patients treated with dialysis. However, the risk is still higher compared to healthy people who have normal kidney functions.

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