scholarly journals Higher one-year achievement rate of serum phosphate associated with lower cardiovascular mortality in hemodialysis patients

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Weichen Zhang ◽  
Guoxin Ye ◽  
Zhaori Bi ◽  
Weisheng Chen ◽  
Jing Qian ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Cox Regression ◽  
Hemodialysis Patients ◽  
Serum Phosphate ◽  
Target Range ◽  
Maintenance Hemodialysis ◽  
Phosphate Binding ◽  
Achievement Rate ◽  
Individual Achievement ◽  
One Year

Abstract Background Estimation of phosphate load in hemodialysis patients is always controversial in clinical practice. The aim of this study was to verify individual achievement rate of serum phosphate as the evaluation of phosphate load through investigating its impact on cardiovascular mortality in hemodialysis patients. Methods This was a single-center, retrospective cohort study. A total of 251 maintenance hemodialysis patients were enrolled. The individual achievement rate of serum phosphate was defined as the times of tests within the target range divided by total times of tests over a period of time. Cox regression model was used to examine the relationship between individual achievement rate of serum phosphate and cardiovascular mortality. Results The mean age of the study population was 61 ± 13 years old. A total of 44 (17.5%) patients died from cardiovascular disease (CVD) during a median follow-up of 65 months. Multivariable Cox analysis showed that one-year serum phosphate achievement rate of 0% (HR = 4.117, P = 0.016) and 25% (HR = 3.343, P = 0.023) increased the risk of cardiovascular mortality while the achievement rate of 50% (HR = 2.129, P = 0.162) and 75% (HR = 1.080, P = 0.902) did not, compared to the rate of 100%. Urea reduction ratio (URR) was positively, while serum intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), normalized protein catabolic rate (nPCR), and total phosphate-binding capacity of drug were negatively associated with achievement in target of serum phosphate. Conclusions Keeping one-year achievement rate of serum phosphate higher than 50% provides significant clinical benefits in reducing cardiovascular mortality.

scholarly journals Higher One-year Achievement Rate of Serum Phosphate Associated with Lower Cardiovascular Mortality in Hemodialysis Patients

2021 ◽  
Author(s):  
Weichen Zhang ◽  
Guoxin Ye ◽  
Zhaori Bi ◽  
Weisheng Chen ◽  
Jing Qian ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Cox Regression ◽  
Hemodialysis Patients ◽  
Serum Phosphate ◽  
Target Range ◽  
Maintenance Hemodialysis ◽  
Phosphate Binding ◽  
Achievement Rate ◽  
Individual Achievement ◽  
One Year

Abstract Background: Estimation of phosphate load in hemodialysis patients is always controversial in clinical practice. The aim of this study was to verify individual achievement rate of serum phosphate as the evaluation of phosphate load through investigating its impact on cardiovascular mortality in hemodialysis patients.Methods: This was a single-center, retrospective cohort study. A total of 251 maintenance hemodialysis patients were enrolled. The individual achievement rate of serum phosphate was defined as the times of tests within the target range divided by total times of tests over a period of time. Cox regression model was used to examine the relationship between individual achievement rate of serum phosphate and cardiovascular mortality. Results: The mean age of the study population was 61±13 years old. A total of 44 (17.5%) patients died from cardiovascular disease (CVD) during a median follow-up of 65 months. Multivariable Cox analysis showed that one-year serum phosphate achievement rate of 0% (HR=4.117, P=0.016) and 25% (HR=3.343, P=0.023) increased the risk of cardiovascular mortality while the achievement rate of 50% (HR=2.129, P=0.162) and 75% (HR=1.080, P=0.902) did not, compared to the rate of 100%. Urea reduction ratio (URR) was positively, while serum intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), normalized protein catabolic rate (nPCR), and total phosphate-binding capacity of drug were negatively associated with achievement in target of serum phosphate.Conclusions: Keeping one-year achievement rate of serum phosphate higher than 50% provides significant clinical benefits in reducing cardiovascular mortality.

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.

scholarly journals P1493CORRELATION BETWEEN END-DIALYSIS OVER-WEIGHT IN INITIAL STAGE OF HEMODIALYSIS AND PROGNOSIS IN INCIDENT HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ping Zhang ◽  
Ying Wang ◽  
Xi Yao ◽  
Shaohua Chen ◽  
Chunping Xu ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cardiovascular Mortality ◽  
Multivariate Regression ◽  
Independent Risk Factor ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Interdialytic Weight Gain ◽  
The Relationship

Abstract Background and Aims The volume factor of maintenance hemodialysis patients is closely related to the prognosis. We hypothesized that the excess weight after dialysis (end-dialysis over-weight, edOW) is an important factor of volume impact survival in hemodialysis (HD) patients. The purpose of this study was to analyze the relationship between edOW and long-term prognosis of patients with maintenance hemodialysis. Method This retrospective study observed incident hemodialysis patients who treated in Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University from January 1, 2008 to April 30, 2017, three times a week for at least one year. The end point of follow-up was death, abdominal dialysis, kidney transplantation, transfer or until April 30, 2018. The general data of the patients included age, gender, BMI, primary renal disease, CVD, first hemodialysis access, albumin(Alb), Haemoglobin(Hb), blood pressure, heart rate, ultrafiltration rate(UFR), interdialytic weight gain IDWG, end -dialysis overweight (edOW). Cox multivariate regression was used to analyze the relationship between edow and all-cause mortality and cardiovascular mortality. Results Totally 469 patients male, 64% were enrolled, with an average age of 56.9 ± 17.1 years. During the follow-up period, 102 patients died. The main cause of death was cardiovascular and cerebrovascular events, accounting for 44.7%. The mean value of edow was 0.28 ± 0.02 kg. Kaplan-Meier(Log-rank test) survival analysis showed that the long-term survival rate of the group with edow ≤ 0.28kg was better than that of the group with edow > 0.28kg (P = 0.042), and the cardiovascular mortality of the group with edow > 0.28kg was significantly higher than that of the group with edow ≤ 0.28kg (P = 0.001). Cox multivariate regression analysis showed that edow was an independent risk factor for all-cause death in hemodialysis patients (P = 0.025, AhR = 1.541, 95% CI 1.057-2.249), and also an independent risk factor for CVD death in hemodialysis patients (P = 0.007, AhR = 1.929, 95% CI 1.198-3.107). Conclusion EdOW is an independent risk factor of long-term all-cause and cardiovascular death in hemodialysis patients.

scholarly journals High Erythropoiesis Resistance Index Is a Significant Predictor of Cardiovascular and All-Cause Mortality in Chinese Maintenance Hemodialysis Patients

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Xiangxue Lu ◽  
Jialing Zhang ◽  
Shixiang Wang ◽  
Qian Yu ◽  
Han Li
Keyword(s):  
Cardiovascular Mortality ◽  
Resistance Index ◽  
High Sensitivity ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
All Cause Mortality ◽  
Correlated Factors ◽  
Maintenance Hemodialysis Patients

Background. Renal anemia is a common complication of hemodialysis patients. Erythropoietin (EPO) hyporesponsiveness has been recognized as an important factor to poor efficacy of recombinant human erythropoietin in the treatment of renal anemia. More importantly, increased erythropoiesis resistance index (ERI) may be associated with inflammation and increased mortality. Objective. The objective of this research was to investigate correlated factors of EPO responsiveness and to clarify the relationships between EPO hyporesponsiveness and cardiovascular mortality and all-cause mortality among maintenance hemodialysis patients. Methods. This prospective cohort study enrolled 276 maintenance hemodialysis patients for a 55-month follow-up to investigate the factors related to ERI and its relationship to all-cause mortality and cardiovascular mortality. Results. ERI was positively correlated with predialysis serum high-sensitivity C-reactive protein ( r = 0.234 , p < 0.001 ), alkaline phosphatase ( r = 0.134 , p = 0.028 ), and ferritin ( r = 0.155 , p = 0.010 ) and negatively correlated with albumin ( r = − 0.206 , p < 0.001 ) and creatinine ( r = − 0.232 , p < 0.001 ). As multiple linear regression showed, predialysis serum albumin, high-sensitivity C-reactive protein, ferritin, and creatinine were independent correlated factors of ERI ( p < 0.05 ). Kaplan–Meier curves showed that the cumulative incidences of both cardiovascular mortality and all-cause mortality were significantly higher in patients with ERI > 11.04   IU / kg / w / g / dL (both p < 0.01 ). The high ERI group was significantly associated with higher risk for all-cause mortality (OR 1.781, 95% CI 1.091 to 2.910, p = 0.021 ) and cardiovascular mortality (OR 1.972, 95% CI 1.139 to 3.417, p = 0.015 ) after adjusting for confounders. Conclusions. Predialysis serum albumin, high-sensitivity C-reactive protein, ferritin, and creatinine were independent correlated factors of EPO responsiveness among maintenance hemodialysis patients. Patients with higher ERI values had a higher all-cause mortality rate and cardiovascular mortality rate.

Comparison of 24-hour and Office Pulse Wave Velocity for Prediction of Mortality in Hemodialysis Patients

2019 ◽  
Vol 49 (4) ◽  
pp. 317-327 ◽  
Author(s):  
Julia Matschkal ◽  
Christopher C. Mayer ◽  
Pantelis A. Sarafidis ◽  
Georg Lorenz ◽  
Matthias C. Braunisch ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Cardiovascular Mortality ◽  
Pulse Wave ◽  
Cox Regression ◽  
Hemodialysis Patients ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
All Cause Mortality

Background: Mortality in hemodialysis patients still remains unacceptably high. Enhanced arterial stiffness is a known cardiovascular risk factor, and pulse wave velocity (PWV) has proven to be a valid parameter to quantify risk. Recent studies showed controversial results regarding the prognostic significance of PWV for mortality in hemodialysis patients, which may be due to methodological issues, such as assessment of PWV in the office setting (Office-PWV). Method: This study cohort contains patients from the “Risk stratification in end-stage renal disease – the ISAR study,” a multicenter prospective longitudinal observatory cohort study. We examined and compared the predictive value of ambulatory 24-hour PWV (24 h-PWV) and Office-PWV on mortality in a total of 344 hemodialysis patients. The endpoints of the study were all-cause and cardiovascular mortality. Survival analysis included Kaplan-Meier estimates and Cox regression analysis. Results: During a follow-up of 36 months, a total of 89 patients died, 35 patients due to cardiovascular cause. Kaplan-Meier estimates for tertiles of 24 h-PWV and Office-PWV were similarly associated with mortality. In univariate Cox regression analysis, 24 h-PWV and Office-PWV were equivalent predictors for all-cause and cardiovascular mortality. After adjustment for common risk factors, only 24 h-PWV remained solely predictive for all-cause mortality (hazard ratio 2.51 [95% CI 1.31–4.81]; p = 0.004). Conclusions: Comparing both measurements, 24 h-PWV is an independent predictor for all-cause-mortality in hemodialysis patients beyond Office-PWV.

Predictive value of ankle–brachial index for long-term events of ischemic stroke in hemodialysis patients

Vascular ◽  
2020 ◽  
pp. 170853812092595
Author(s):  
Kai-Ni Lee ◽  
Li-Ping Chou ◽  
Chi-Chu Liu ◽  
Tsang-Shan Chen ◽  
Eric Kim-Tai Lui ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Cox Regression ◽  
Ankle Brachial Index ◽  
Hemodialysis Patients ◽  
Serum Phosphate ◽  
Cox Regression Analysis

Objectives The ankle–brachial index is a noninvasive modality to evaluate atherosclerosis and is a predictive role for future cardiovascular events and mortality. However, few studies have evaluated its relation to long-term future ischemic stroke in hemodialysis patients. Therefore, we examined the relationship between ankle–brachial index and ischemic stroke events among hemodialysis patients in a seven-year follow-up. Methods A total of 84 patients were enrolled. Ankle–brachial index was assessed in January 2009. Primary outcomes included ischemic stroke. An ankle–brachial index < 0.9 was considered abnormal and 1.4 ≥ ankle–brachial index ≥ 0.9 to be normal ankle–brachial index. Results Mean values for ankle–brachial index were 0.98 ± 0.21at study entrance. In addition, 28 patients encountered ischemic stroke in the seven-year follow-up. In univariate Cox regression analysis, old age (hazard ratio (HR): 1.065, 95% confidence interval (CI): 1.030–1.102, p < 0.001), low seven-year averaged serum phosphate levels (HR: 0.473, 95% CI: 0.306–0.730, p = 0.001), and abnormal ankle–brachial index (HR: 0.035, 95% CI: 0.009–0.145, p < 0.001) were risk factors for ischemic stroke. In multivariate Cox regression analysis for significant variables in univariate analysis, abnormal ankle–brachial index (HR: 0.058, 95% CI: 0.012–0.279, p < 0.001) and low seven-year averaged serum phosphate levels (HR: 0.625, 95% CI: 0.404–0.968, p = 0.035) remained the risk factors for ischemic stroke. The risk of ischemic stroke was 3.783-fold in patients with abnormal ankle–brachial index compared with patients with normal ankle–brachial index (HR: 3.783, 95% CI: 1.731–8.269, p = 0.001). Conclusions These findings suggest that ankle–brachial index is an impressive predictor of future ischemic stroke among hemodialysis patients.

A 3-day diary of dietary protein and calorie intake by serum phosphate concentration and binder use in hemodialysis patients

2017 ◽  
Vol 41 (2) ◽  
pp. 94-99
Author(s):  
Meiry J.S. Araújo ◽  
Luciana F. Silva ◽  
Maria T.S. Martins ◽  
Cacia M. Matos ◽  
Marcelo B. Lopes ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Serum Phosphate ◽  
Phosphate Binders ◽  
Calorie Intake ◽  
Maintenance Hemodialysis ◽  
Dietary Intakes ◽  
Cross Sectional ◽  
Low Serum

Introduction: The use of phosphate binders to control hyperphosphatemia may allow diets less restricted in protein and calories for maintenance hemodialysis (MHD) patients. The study compared intakes of protein, calorie and phosphate among MHD patients with different serum phosphate concentrations, taking into account binder use. The hypothesis was that low serum phosphate would be associated with low intakes of protein and calories only in patients not on binders. Methods: A cross-sectional study of 443 patients enrolled in the Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO) in Salvador, Brazil, with stratified sampling on serum phosphate: ≤3.0 (n = 41), 3.5-5.5 (n = 328) and ≥7.0 mg/dL (n = 74). A 3-day diet diary was used to determine dietary intakes. Results: Approximately 49.0% confirmed binder use. Covariate-adjusted linear regression showed that associations between dietary intakes and serum phosphate were modified by the binder use. In patients not on binders, protein intake was >20% lower for serum phosphate ≤3.0 mg/dL compared to higher concentrations. Also in those not on binders, calorie intake was >30% lower for serum phosphate ≤3.0 mg/dL compared to ≥7.0 mg/dL. Differences in dietary intakes by serum phosphate were virtually absent in patients on binders. Conclusions: The results are consistent with the hypothesis that low serum phosphate is associated with low protein and calorie intake only among MHD patients not on binders. This study supports recommendations to prevent hyperphosphatemia in MHD patients by adequate combination of binder use and selection of foods restricted in phosphors but not severely restricted in protein and calories.

Sign in / Sign up

Export Citation Format

Share Document