scholarly journals Predicting factors of intradialytic hypotension in the last half of hemodialysis therapy

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yumi Aoyama ◽  
Katsuya Kajimoto ◽  
Maiko Hori ◽  
Shigeru Otsubo ◽  
Kosaku Nitta
Keyword(s):  
Serum Level ◽  
Roc Curve ◽  
Strong Association ◽  
Laboratory Data ◽  
Vena Cava ◽  
Cutoff Point ◽  
Intradialytic Hypotension ◽  
Mitral Inflow ◽  
Hemodialysis Session ◽  
Predicting Factors

Abstract Background Intradialytic hypotension (IDH) is one of the most frequent complications of hemodialysis. IDH alters a patient’s quality of life and has a strong association with mortality. IDH mainly occurs when ultrafiltration during hemodialysis exceeds the pace of the plasma refill. Ultrasonography has been used to evaluate the intravascular volume status. We evaluated the association between IDH and baseline laboratory data or ultrasound findings during IDH during the latter half of a hemodialysis session. Methods Sixty-two patients who underwent hemodialysis were enrolled in this study. The peak early mitral inflow wave velocity (peak E-velocity), the inferior vena cava (IVC) dimensions, and number of B-lines were estimated at two time points (just after the start and at the midpoint of the hemodialysis session). We compared the parameters between the patients without IDH throughout the hemodialysis session (non-IDH group) and patients with IDH only during the latter half of the hemodialysis session (IDH in the latter half group). Results Of the 62 study participants, 28 patients were in non-IDH group, and 16 patients were in IDH in the latter half group. The serum sodium level was significantly lower in the IDH in the latter half group (135 ± 4 mEq/L) than in the non-IDH group (138 ± 4 mEq/L) (P = 0.015). The rate of decrease of the peak E-velocity was significantly higher in the IDH in the latter half group (0.33 ± 0.13) than in the non-IDH group (0.24 ± 0.14) (P = 0.037). The best cutoff point of the serum level of sodium was 137 mEq/L, with a sensitivity of 68.8% and specificity of 64.3%. The area under the receiver operating characteristic (ROC) curve was 0.71. The best cutoff point of the rate of decrease of the peak E-velocity was 0.295, with a sensitivity of 73.3% and a specificity of 71.4%. The area under the ROC curve was 0.71. Conclusions A low serum level of sodium at baseline and an early decrease in the peak E-velocity during hemodialysis may be related to intradialytic hypotension in the latter half of a hemodialysis session. Careful observation may be needed in the hemodialysis patients in whom the serum level of sodium is below 137 mEq/L or the rate of decrease of the peak E-velocity is over 0.295.

Budd-Chiari syndrome due to segmental obstruction of the inferior vena cava successfully managed with endovascular stenting

MedPharmRes ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. 22-26
Author(s):  
Uyen Vo ◽  
Duc Quach ◽  
Luan Dang ◽  
Thao Luu ◽  
Luan Nguyen
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Laboratory Data ◽  
Transaminase Level ◽  
Vena Cava ◽  
Budd Chiari Syndrome ◽  
Endovascular Stenting ◽  
Massive Ascites ◽  
Chiari Syndrome ◽  
History Of

Budd–Chiari syndrome (BCS), a rare and life-threatening disorder due to hepatic venous outflow obstruction, is occasionally associated with hypoproteinemia. We herein report the first case of BCS with segmental obstruction of the intrahepatic portion of inferior vena cava (IVC) and hepatic veins (HVs) successfully treated by endovascular stenting in Vietnam. A 32-year-old female patient presented with a 2-month history of massive ascites and leg swelling. She refused history of oral contraceptives use. Hepatosplenomegaly without tenderness was noted. Laboratory data showed polycythemia, mild hypoalbuminemia and hypoproteinemia, slightly high total bilirubin and normal transaminase level. The serum ascites albumin gradient was 1.9 g/dL and ascitic protein level was 1.1 g/dL. The other data were normal. BCS was suspected because of the discrepancy between mild liver failure and massive ascites; and the presence of hepatosplenomegaly and polycythemia. On abdominal magnetic resonance imaging, the segmental obstruction of three HVs and IVC was 2-3 cm long without thrombus. Cavogram revealed the severe segmental stenosis of intrahepatic portion of IVC with no visualized HV and extensive collateral veins. A Protégé stent was deployed to IVC. Leg swelling and ascites were completely resolved within 3 days after stenting. During 1-year follow-up, edema was not recurred and repeated laboratory results were all normal.

The Association of Two Rare Diseases is Not Rare: Primary Immunodeficiencies and Autoimmune Liver Diseases

2021 ◽  
Author(s):  
Şefika Nur Ayar ◽  
Elif Soyak ◽  
Cem Şimşek ◽  
Deniz Çağdaş ◽  
Yasemin Balaban
Keyword(s):  
Rare Diseases ◽  
Liver Diseases ◽  
Strong Association ◽  
Laboratory Data ◽  
Tertiary Hospital ◽  
Iga Deficiency ◽  
Primary Biliary Cholangitis ◽  
Cross Sectional ◽  
Autoimmune Liver Diseases ◽  
Igm Deficiency

Abstract Purpose: PIDs associates with autoimmune diseases include autoimmune liver diseases (AILD); however, the frequency of PIDs among patients with AILD is unknown. This study aimed to evaluate the strength of the association between AILD and PIDs. Methods: We conducted this single-center, cross-sectional, and descriptive study in a tertiary hospital. We evaluated eighty-two patients with AILD (39 autoimmune hepatitis (AIH), 32 with primary biliary cholangitis (PBC), seven with variant syndromes (VS), and four with primary sclerosing cholangitis (PSC) for the presence of PIDs. We obtained a detailed history of infections, comorbidities, family history, and laboratory data from the files. All patients were evaluated in the immunology department for further examination, and PID diagnoses were made according to ESID (The European Society for Immunodeficiencies) criteria. Results: Out of 82 patients with AILD, PIDs were diagnosed in 18% (15 patients); there were four patients with common variable immunodeficiency (CVID), four with partial IgA deficiency (PIgAD), four with selective IgM deficiency (SIgMD), and three with combined immunodeficiency (CID). PIDs were present in 29% of patients with VS, 25 % of patients with PSC, 23% of patients with AIH, and 9% of patients with PBC. Conclusion: Although PIDs are rare diseases in the general population, they have a strong association with AILD and were detected in one-fifth of the patients. Further research with larger patient groups is needed to evaluate the diagnostic and prognostic impacts of PIDs on AILD.

scholarly journals Evaluation of peripheral perfusion index and heart rate variability as early predictors for intradialytic hypotension in critically ill patients

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Hanan Mostafa ◽  
Mohamed Shaban ◽  
Ahmed Hasanin ◽  
Hassan Mohamed ◽  
Shymaa Fathy ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Pulmonary Oedema ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Perfusion Index ◽  
Intradialytic Hypotension ◽  
Peripheral Perfusion ◽  
Hemodialysis Session ◽  
Prophylactic Measures

Abstract Background Intradialytic hypotension is a serious complication during renal replacement therapy in critically ill patients. Early prediction of intradialytic hypotension could allow adequate prophylactic measures. In this study we evaluated the ability of peripheral perfusion index (PPI) and heart rate variability (HRV) to predict intradialytic hypotension. Methods A prospective observational study included 36 critically ill patients with acute kidney injury during their first session of intermittent hemodialysis. In addition to basic vital signs, PPI was measured using Radical-7 (Masimo) device. Electrical cardiometry (ICON) device was used for measuring cardiac output, systemic vascular resistance, and HRV. All hemodynamic values were recorded at the following time points: 30 min before the hemodialysis session, 15 min before the start of hemodialysis session, every 5 min during the session, and 15 min after the conclusion of the session. The ability of all variables to predict intradialytic hypotension was assessed through area under receiver operating characteristic (AUROC) curve calculation. Results Twenty-three patients (64%) had intradialytic hypotension. Patients with pulmonary oedema showed higher risk for development of intradialytic hypotension {Odds ratio (95% CI): 13.75(1.4–136)}. Each of baseline HRV, and baseline PPI showed good predictive properties for intradialytic hypotension {AUROC (95% CI): 0.761(0.59–0.88)}, and 0.721(0.547–0.857)} respectively. Conclusions Each of low PPI, low HRV, and the presence of pulmonary oedema are good predictors of intradialytic hypotension.

Common Genetic Variants of MUTYH are not Associated with Cutaneous Malignant Melanoma: Application of Molecular Screening by Means of High-Resolution Melting Technique in a Pilot Case-Control Study

2011 ◽  
Vol 26 (1) ◽  
pp. 37-42 ◽  
Author(s):  
Concetta Santonocito ◽  
Andrea Paradisi ◽  
Rodolfo Capizzi ◽  
Eleonora Torti ◽  
Sara Lanza-Silveri ◽  
...  
Keyword(s):  
High Resolution ◽  
High Resolution Melting ◽  
Direct Sequencing ◽  
Strong Association ◽  
Laboratory Data ◽  
Gene Mutations ◽  
Case Control ◽  
Common Genetic Variants ◽  
Mutyh Gene ◽  
Embryonic Origin

MUTYH glycosylase recognizes the 8-oxoG:A mismatch and is able to excise the adenine base using proofreading mechanisms. Some papers have reported a strong association between cancer development or aggressiveness and MUTYH gene mutations. The aim of this study was to find a possible association between the most frequent MUTYH mutations and melanoma in the context of a case-control pilot study. One hundred ninety-five melanoma patients and 195 healthy controls were matched for sex and age. Clinical and laboratory data were collected in a specific database and all individuals were analyzed for MUTYH mutations by high-resolution melting and direct sequencing techniques. Men and women had significantly different distributions of tumor sites and phototypes. No significant associations were observed between the Y165C, G382D and V479F MUTYH mutations and risk of melanoma development or aggressiveness. Our preliminary findings therefore do not confirm a role for MUTYH gene mutations in the melanoma risk. Further studies are necessary for the assessment of MUTYH not only in melanoma but also other cancer types with the same embryonic origin, in the context of larger arrays studies of genes involved in DNA stability or integrity.

scholarly journals Growth of hypoplastic mitral valves in hypoplastic left heart complex and similar constellations after anatomical left superior vena cava correction

2020 ◽  
Vol 59 (1) ◽  
pp. 236-243
Author(s):  
Robert A Cesnjevar ◽  
Frank Harig ◽  
Moritz Dietz ◽  
Muhannad Alkassar ◽  
Wolfgang Waellisch ◽  
...  
Keyword(s):  
Superior Vena Cava ◽  
Coronary Sinus ◽  
Superior Vena ◽  
Vena Cava ◽  
Innominate Vein ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Mitral Inflow ◽  
Z Scores ◽  
Hypoplastic Left Heart Complex

Abstract OBJECTIVES Left superior vena cava (LSVC)-related obstruction of mitral inflow is a rare finding in patients with complex cardiac anomalies like hypoplastic left heart complex. We report our experience by establishing a left superior to right superior caval vein continuity (innominate vein creation by direct LSVC–right superior vena cava end-to-side-anastomosis), and coronary sinus unroofing if indicated for LSVC-related mitral inflow obstruction. METHODS Nineteen patients (median age: 1.0 ± 0.3 years; range: 7 days–4.8 years) underwent anatomical correction of LSVC without the use of foreign material in conjunction with repair or palliation of congenital anomalies in a single centre between April 2015 and November 2019. Indications for the procedure were LSVC-related obstruction of left ventricular inflow due to a dilated coronary sinus. Additional procedures included mitral (n = 7) or atrioventricular (n = 3) valve surgery, right ventricular to pulmonary artery conduit (n = 3), first stage palliation (n = 3) or biventricular repair (n = 5) of hypoplastic left heart complex. Three patients needed secondary mitral valve replacement (n = 3). RESULTS All LSVC or coronary sinus-related obstructions were effectively relieved. No patient died early, 2 patients died late after the procedure. One patient needed stenting of the superior vena cava below the unobstructed cephalad vein anastomosis at the former right superior vena cava-cannulation-site. Follow-up was complete and demonstrated an 89.5% survival after 2.5 ± 0.4 years. Innominate vein patency was 100% documented by echocardiography (n = 19), cardiac catheterization (n = 6) or both. Mean mitral valve z-scores before the operation were −1.7 ± 0.2 (range −3.8 to 0.3) and increased to 0.7 ± 0.2 (range −0.7 to 1.9) after LSVC repair. CONCLUSIONS Anatomical correction by surgical creation of an innominate vein is an effective method to relieve LSVC-related obstructions and promotes mitral valvar growth. Mitral ring sizes were at least normalized after surgery at the time of discharge. Further prospective follow-up studies to evaluate the growth potential of left-sided heart structures by reporting cardiac z-scores are needed to evaluate the true impact of coronary sinus unroofing.

scholarly journals Change in Postprandial Level of Remnant Cholesterol After a Daily Breakfast in Chinese Patients With Hypertension

2021 ◽  
Vol 8 ◽  
Author(s):  
Jin Xu ◽  
Peiliu Qu ◽  
Xiao Du ◽  
Qunyan Xiang ◽  
Liling Guo ◽  
...  
Keyword(s):  
Roc Curve ◽  
Serum Levels ◽  
Cholesterol Content ◽  
Curve Analysis ◽  
Cutoff Point ◽  
Chinese Patients ◽  
Roc Curve Analysis ◽  
Hypertensive Patients ◽  
Remnant Cholesterol ◽  
Postprandial Lipids

Background: Hypertension (HBP) is usually accompanied by hypertriglyceridemia that represents the increased triglyceride-rich lipoproteins and cholesterol content in remnant lipoproteins [i.e., remnant cholesterol (RC)]. According to the European Atherosclerosis Society (EAS), high RC (HRC) is defined as fasting RC ≥0.8 mmol/L and/or postprandial RC ≥0.9 mmol/L. However, little is known about postprandial change in RC level after a daily meal in Chinese patients with HBP.Methods: One hundred thirty-five subjects, including 90 hypertensive patients (HBP group) and 45 non-HBP controls (CON group), were recruited in this study. Serum levels of blood lipids, including calculated RC, were explored at 0, 2, and 4 h after a daily breakfast. Receiver operating characteristic (ROC) curve analysis was used to determine the cutoff point of postprandial HRC.Results: Fasting TG and RC levels were significantly higher in the HBP group (P < 0.05), both of which increased significantly after a daily meal in the two groups (P < 0.05). Moreover, postprandial RC level was significantly higher in the HBP group (P < 0.05). ROC curve analysis showed that the optimal cutoff point for RC after a daily meal to predict HRC corresponding to fasting RC of 0.8 mmol/L was 0.91 mmol/L, which was very close to that recommended by the EAS, i.e., 0.9 mmol/L. Fasting HRC was found in 31.1% of hypertensive patients but not in the controls. According to the postprandial cutoff point, postprandial HRC was found in approximately half of hypertensive patients and ~1-third of the controls.Conclusion: Postprandial RC level increased significantly after a daily meal, and hypertensive patients had higher percentage of HRC at both fasting and postprandial states. More importantly, the detection of postprandial lipids could be helpful to find HRC.

scholarly journals Handgrip strength accuracy as discriminator of functional independence in centenarian women

2020 ◽  
Vol 22 ◽  
Author(s):  
Artur Rodrigues Fortunato ◽  
Raquel Ester Lima da Silva ◽  
Giovana Zarpellon Mazo
Keyword(s):  
Sensitivity And Specificity ◽  
Roc Curve ◽  
Daily Living ◽  
Handgrip Strength ◽  
Roc Curves ◽  
Functional Independence ◽  
Cutoff Point ◽  
Left Hand ◽  
The Right ◽  
Hearing Difficulties

Abstract The aim of this study was to verify and compare handgrip strength (HS) with activities of the daily living (ADL) and to identify the cutoff point of HGS in the prediction of independence in ADL of centenarians. Twenty-four centenarians with mean age of 101.67 ± 2.80 years participated in the study. Subjects were asked about marital status, schooling (years), diseases, hearing difficulties and activities of the daily living (Katz scale), to classify functional independence. Handgrip strength of the right hand (HSR) and left hand (HSL) (mean of the three measures of each hand) was evaluated by means of manual dynamometer. The U Mann Whitney test was applied to compare HSR and HSL with functions of ADL. To identify the cutoff point (sensitivity and specificity) of the right and left HGS of centenarians in the prediction of independence in functions of ADL, the Received Operating Characteristic (ROC) Curves were used. The following cutoff points were used: 11 Kgf for HSR (sensitivity = 66.7%, specificity = 100%, ROC curve = 0.778) and 9 Kgf for HSL (sensitivity = 66.7%, specificity = 77.8%, curve ROC = 0.730) to predict independence in performing the "bathing" function; 11 Kgf for HSR for the "continence" function (sensitivity = 83.3%, specificity = 66.7%, ROC curve = 0.712); and 9 Kgf for HSL for "transfer" function (sensitivity = 80%, specificity = 71.4%, ROC curve = 0.786). For these functions, sensitivity and specificity presented values greater than 66%. On all these functions, sensitivity showed values higher than 46% and specificity 77%. Minimum HSR is required to perform functions of ADL independently. The best HSR cutoff point to predict independence of subjects differs according to functions of activities of the daily living and hand evaluated.

scholarly journals Evaluation of peripheral perfusion index and heart rate variability as early predictors for intradialytic hypotension in critically ill patients.

2019 ◽  
Author(s):  
Mohamed Shaban ◽  
Ahmed Hasanin ◽  
Akram El-adawy ◽  
Hanan Mostafa ◽  
Shymaa Fathy ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Pulmonary Oedema ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Perfusion Index ◽  
Intradialytic Hypotension ◽  
Peripheral Perfusion ◽  
Hemodialysis Session ◽  
Prophylactic Measures

Abstract Background Intradialytic hypotension is a serious complication during renal replacement therapy in critically ill patients. Early prediction of intradialytic hypotension could allow adequate prophylactic measures. In this study we evaluated the ability of peripheral perfusion index (PPI) and heart rate variability (HRV) to predict intradialytic hypotension. Methods A prospective observational study included 36 critically ill patients with acute kidney injury during their first session of intermittent hemodialysis. In addition to basic vital signs, PPI was measured using Radical-7 (Masimo) device. Electrical cardiometry (ICON) device was used for measuring cardiac output, systemic vascular resistance, and HRV. All hemodynamic values were recorded at the following time points: 30 minutes before the hemodialysis session, 15 minutes before the start of hemodialysis session, every 5 minutes during the session, and 15 minutes after the conclusion of the session. The ability of all variables to predict intradialytic hypotension was assessed through area under receiver operating characteristic (AUROC) curve calculation. Results Twenty-three patients (64%) had intradialytic hypotension. Patients with pulmonary oedema showed higher risk for development of intradialytic hypotension {Odds ratio (95% CI): 13.75(1.4-136)}. Each of baseline HRV, and baseline PPI showed good predictive properties for intradialytic hypotension {AUROC (95% CI): 0.761(0.59-0.88)}, and 0.721(0.547-0.857)} respectively. Conclusions Each of low PPI, low HRV, and the presence of pulmonary oedema are good predictors of intradialytic hypotension.

scholarly journals Role of inferior vena cava collapsibility index in the prediction of hypotension associated with general anesthesia: an observational study

2019 ◽  
Author(s):  
Marcell Szabó ◽  
Anna Bozó ◽  
Katalin Darvas ◽  
Alexandra Horváth ◽  
Zsolt Dániel Iványi
Keyword(s):  
Observational Study ◽  
Inferior Vena Cava ◽  
General Anesthesia ◽  
Roc Curve ◽  
Inferior Vena ◽  
Vena Cava ◽  
Systolic Pressure ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Collapsibility Index

Abstract Background: Intraoperative hypotension increases 30-day mortality and the risks of myocardial injury and acute renal failure. Patients with inadequate volume reserve before the induction of anesthesia are highly exposed. The identification of latent hypovolemia is therefore crucial. Ultrasonographic measurement of the inferior vena cava collapsibility index (IVCCI) is able to detect volume responsiveness in circulatory shock. No current evidence is available regarding whether preoperative measurement of the IVCCI could identify patients at high risk for hypotension associated with general anesthesia. Methods: A total of 102 patients undergoing elective general surgery under general anesthesia with standardized propofol induction were recruited for this prospective observational study. The IVCCI was measured under spontaneous breathing. A collapsing (IVCCI≧50%) (CI+) and a noncollapsing (CI-) group were formed. Immediate postinduction changes in systolic and mean blood pressure were compared. The performance of the IVCCI as a diagnostic tool for predicting hypotension (systolic pressure <90 mmHg or a ≥30% drop from the baseline) was evaluated by ROC curve analysis. Results: A total of 83 patients were available for analysis, with 20 in the CI+ and 63 in the CI- group, we excluded 19 previously eligible patients due to inadequate visualization of the IVC (7 cases), lack of adherence to the protocol (8 cases), missing data (2 cases) or change in anesthesiologic management (2 cases). The mean decrease in systolic pressure in the CI+ group was 53.8±15.3 compared to 35.8±18.1 mmHg in CI- patients (P=0.0001). The relative mean arterial pressure change medians were 34.1% (IQR 23.2%-43.0%) and 24.2% (IQR 17.2%-30.2%), respectively (P=0.0029). The ROC curve analysis for IVCCI showed an AUC of 64.8% (95%CI 52.1-77.5%). The selected 50% level of the IVCCI had a sensitivity of only 45.5% (95%CI 28.1-63.7%), but the specificity was high at 90.0% (78.2-96.7%). The positive predictive value was 75.0% (95%CI 50.9-91.3%), and the negative predictive value was 71.4% (95%CI 58.7-82.1%). Conclusion: In spontaneously breathing preoperative noncardiac surgical patients, preoperatively detected IVCCI≧50% can predict postinduction hypotension with high specificity but low sensitivity. Despite moderate performance, IVCCI is an easy, noninvasive and attractive option to identify patients at risk and should be explored further.

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