scholarly journals In-hospital mortality associated with transcatheter arterial embolization for treatment of hepatocellular carcinoma in patients on hemodialysis for end stage renal disease: a matched-pair cohort study using a nationwide database

BJR|Open ◽  
2019 ◽  
Vol 1 (1) ◽  
pp. 20190004
Author(s):  
Masaya Sato ◽  
Ryosuke Tateishi ◽  
Hideo Yasunaga ◽  
Hiroki Matsui ◽  
Kiyohide Fushimi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
End Stage Renal Disease ◽  
Odds Ratio ◽  
Matched Pair ◽  
Complication Rates ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Objectives: No previous study has evaluated the risks associated with transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma in patients on hemodialysis (HD) for end stage renal disease (ESRD), because invasive treatment is rarely performed for such patients. We used a nationwide database to investigate in-hospital mortality and complication rates following TACE in patients on HD for ESRD. Methods: Using the Japanese Diagnosis Procedure Combination database, we enrolled patients on HD for ESRD who underwent TACE for hepatocellular carcinoma. For each patient, we randomly selected up to four non-dialyzed patients using a matched-pair sampling method based on the patient’s age, sex, treatment hospital, and treatment year. In-hospital mortality and complication rates were compared between dialyzed and non-dialyzed patients following TACE. Results: We compared matched pairs of 1551 dialyzed and 5585 non-dialyzed patients. Although the complication rate did not differ between the dialyzed and non-dialyzed ESRD patients [5.7% vs 5.8%, respectively; odds ratio, 0.99; 95% confidence interval (0.79–1.23); p = 0.90], the in-hospital mortality rate was significantly higher in dialyzed ESRD patients than in non-dialyzed patients [2.2% vs 0.97%, respectively; odds ratio, 2.21; 95% confidence interval (1.44–3.40); p < 0.001]. Among the dialyzed patients, the mortality rate was not significantly associated with sex, age, Charlson comorbidity index, or hospital volume. Conclusions: The in-hospital mortality rate following TACE was 2.2 % and was significantly higher in dialyzed than in non-dialyzed ESRD patients. The indications for TACE in HD-dependent patients should be considered carefully with respect to the therapeutic benefits vs risks. Advances in knowledge: In hospital mortality rate following TACE in dialyzed patients was more than twice compared to non-dialyzed patients. Post-procedural complication following TAE in ESRD onHD patients was 5.7%, and did not differ from that in non dialyzed patients.

Abstract P112: Coronary RevascularizationProcedure Mortality in Coronary Artery Disease Patients With End-Stage Renal Disease: Do Racial Disparities Matter?

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Alexander V Sergeev
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Hospital Mortality ◽  
Racial Disparities ◽  
End Stage Renal Disease ◽  
Post Procedure ◽  
Artery Disease ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background: Studies have demonstrated that chronic kidney disease (CKD), especially its last stage - end-stage renal disease (ESRD) - is not only an independent risk factor for coronary artery disease (CAD), but it also worsens survival prognosis in CAD patients. It remains unclear whether racial disparities affect the outcomes of coronary revascularization procedures - coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) - in CAD patients with ESRD (CAD-ESRD). Study Objectives: (1) to investigate comparative effectiveness of CABG and PCI on in-hospital mortality outcomes in CAD-ESRD patients and (2) to investigate racial disparities in the utilization and in-hospital mortality outcomes of CABG and PCI in CAD-ESRD patients. Methods: We conducted a retrospective cohort study of in-hospital mortality in 23,519 CAD-ESRD patients [mean + SD age: 65.4 + 11.6 years; 62.2% (14,626 of 23,519) males] after CABG and PCI during 2007-2011. Patient race was defined as white, black, Asian, or Native American. In-hospital patient death was a binary outcome of interest. Adjusted odds ratios were obtained from multivariable logistic regression (MLR), adjusted for known clinical, demographic, and socio-economic covariates. Results: In the covariate-adjusted MLR analysis, post-PCI in-hospital mortality in CAD-ESRD patients was significantly lower than post-CABG mortality (adjusted OR = 0.47, 95% CI: 0.41-0.53, p<0.001). Post-procedure mortality was associated with emergency room (ER) admission (adjusted OR 1.62, 95% CI: 1.44-1.83, p<0.001), older age (3.2% increase for each year, 95% CI: 2.6-3.8%, p<0.001), and higher severity of co-existing conditions other than ESRD measured by the Elixhauser Comorbidity Index (8.5% increase for each point increase in the modified Elixhauser-Walraven score, 95% CI: 7.5-9.5%, p<0.001). Blacks were more likely to undergo an ER admission (48.4%) than Asians (46.0%), Native Americans (43.2%) or whites (42.4%, p<0.05, with multiple comparison correction). In the adjusted MLR analysis, race was not a statistically significant independent predictor of post-procedure mortality. C-statistic for the MLR was 0.729. Conclusions: Our results suggest that in-hospital post-PCI mortality in CAD-ESRD patients is lower than post-CABG mortality. Racial disparities in ER admissions - a demonstrated predictor of post-procedure mortality in these patients - may reflect the underlying racial disparities in access to and utilization of primary care. Further studies investigating disparities in CAD-ESRD mortality are warranted.

scholarly journals Impact of serum phosphate changes on in-hospital mortality

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Charat Thongprayoon ◽  
Wisit Cheungpasitporn ◽  
Panupong Hansrivijit ◽  
Sorkko Thirunavukkarasu ◽  
Api Chewcharat ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
End Stage Renal Disease ◽  
Odds Ratio ◽  
Reference Group ◽  
Serum Phosphate ◽  
Hospitalized Patients ◽  
Absolute Difference ◽  
Multivariable Logistic Regression Analysis ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Fluctuations in serum phosphate levels increased mortality in end-stage renal disease patients. However, the impacts of serum phosphate changes in hospitalized patients remain unclear. This study aimed to test the hypothesis that serum phosphate changes during hospitalization were associated with in-hospital mortality. Methods We included all adult hospitalized patients from January 2009 to December 2013 that had at least two serum phosphate measurements during their hospitalization. We categorized in-hospital serum phosphate changes, defined as the absolute difference between the maximum and minimum serum phosphate, into 5 groups: 0–0.6, 0.7–1.3, 1.4–2.0, 2.1–2.7, ≥2.8 mg/dL. Using serum phosphate change group of 0–0.6 mg/dL as the reference group, the adjusted odds ratio of in-hospital mortality for various serum phosphate change groups was obtained by multivariable logistic regression analysis. Results A total of 28,149 patients were studied. The in-hospital mortality in patients with serum phosphate changes of 0–0.6, 0.7–1.3, 1.4–2.0, 2.1–2.7, ≥2.8 mg/dL was 1.5, 2.0, 3.1, 4.4, and 10.7%, respectively (p < 0.001). When adjusted for confounding factors, larger serum phosphate changes were associated with progressively increased in-hospital mortality with odds ratios of 1.35 (95% 1.04–1.74) in 0.7–1.3 mg/dL, 1.98 (95% CI 1.53–2.55) in 1.4–2.0 mg/dL, 2.68 (95% CI 2.07–3.48) in 2.1–2.7 mg/dL, and 5.04 (95% CI 3.94–6.45) in ≥2.8 mg/dL compared to serum phosphate change group of 0–0.6 mg/dL. A similar result was noted when we further adjusted for either the admission or mean serum phosphate during hospitalization. Conclusion Greater serum phosphate changes were progressively associated with increased in-hospital mortality.

scholarly journals THE IGF-1 LEVEL OF ESRD PATIENTS AND ITS RISK FACTORS

2014 ◽  
Vol 21 (1) ◽  
Author(s):  
Titiek Hidayati ◽  
Yuningtyaswari Yuningtyaswari ◽  
Ahmad Hamim Sadewa ◽  
Marsetyawan HNE Soesatyo
Keyword(s):  
Plasma Level ◽  
End Stage Renal Disease ◽  
Odds Ratio ◽  
Smoking Status ◽  
Bivariate Analysis ◽  
Control Groups ◽  
Stage Renal Disease ◽  
End Stage ◽  
And Control ◽  
Esrd Patients

Objective: To identify the Insulin-like Growth Factor–1 (IGF-1) level of End Stage Renal Disease (ESRD) and non ESRD populations, and correlation between IGF-1level and ESRD incidences. Material & Method: This case study was carried out in Yogyakarta with 72 volunteers. The cases involved Chronic Kidney Disease (CKD) patients. The controls were non-CKD patients. CKD parameters were established with PERNEFRI diagnostic criteria. Comparison of IGF-1 levels between case and control groups was performed through ANOVA, with confidence level of 95%. Bivariate analysis to identify the correlation between IGF-1 plasma level, smoking status, illness history and body mass index (BMI) by determining odds ratio (OR) of individual risk factor of p < 0.05. Results: We enrolled 72 volunteers, 45 male and 27 female subjects. Of the 45 male patients, 15 CKD and 30 non CKD patients served as cases and controls, respectively. The difference in plasma IGF-1 level was detected in the case and control groups (42.01 ± 10.66 vs. 56.05 ± 24.91) (p < 0.05). The result of bivariate analysis showed passive smoking status, IGF-1 plasma level, DM history and hypertensive illness history had correlation with ESRD incidence with odds ratios of 7.88 (p < 0.005; CI: 1.6-37.5) for passive smokers, 4.3 (p < 0.05, CI: 1.36 to 13.33) for IGF-1 level, 21.5 (p < 0.05; CI) for DM history and 12.4 (p < 0.05; CI: 3.7 to 41) for hypertensive history. Conclusion: There was difference in IGF-1 plasma level between ESRD and non-ESRD patients. The IGF-1 plasma level, passive smoking status, diabetes history, and hypertensive history have correlation with ESRD incidence.Keywords: Insulin-like Growth Factor–1 level, End Stage Renal Disease, case control, odds ratio.

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 Low Mortality and Key Aspects of Delivery of Care for End-Stage Renal Disease in Italy

2009 ◽  
Vol 9 ◽  
pp. 349-359 ◽  
Author(s):  
Alexander Lauder ◽  
Arrigo Schieppati ◽  
Ferruccio Conte ◽  
Giuseppe Remuzzi ◽  
Daniel Batlle
Keyword(s):  
Mortality Rate ◽  
Renal Disease ◽  
Vascular Access ◽  
End Stage Renal Disease ◽  
Dialysis Patients ◽  
Delivery Of Care ◽  
Stage Renal Disease ◽  
Key Aspects ◽  
End Stage ◽  
Esrd Patients

End-stage renal disease (ESRD) is a global health problem. There are differences in mortality among patients with ESRD amid industrialized countries that may be related to their respective systems of delivery of care. A nationwide survey was completed in Italy, a country with low mortality rate for ESRD patients, in order to help understand key aspects of ESRD delivery of care that contribute to mortality. Survey responses were obtained and analyzed from 131 of 575 dialysis centers (23%), covering data from 13,170 dialysis patients in 2006. The mortality rate was 11.2% and the prevalence of diabetes-associated kidney disease was 21%. Of the patients, 88% were on hemodialysis and 12% were on peritoneal dialysis. Most patients were in the age range of 65–75 years (66.7%), were seen by a nephrologist at CKD stage 3, and began dialysis at mean estimated GFR of 9.6 ml/min/1.73 m2. AV fistulae were the prevailing form of vascular access (83%) and were most frequently placed by a nephrologist (61.2%). In 98% of the dialysis centers, a nephrologist was present during dialysis sessions. The following may explain the low mortality for ESRD patients in Italy: low prevalence of diabetes, high use of AV fistulae, delivery of care by nephrologists beginning in pre-ESRD stages, their involvement in placement of dialysis vascular access, and their physical presence requirement during dialysis sessions. These findings portray key aspects of the contemporary delivery of care for Italian dialysis patients and provide a platform for international comparison of healthcare systems for ESRD.

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.

Iron Chelation Therapy in CAPD: A New and Effective Treatment of Iron Overload Disease in Esrd Patients

1983 ◽  
Vol 3 (2) ◽  
pp. 99-101 ◽  
Author(s):  
Glen H Stanbaugh ◽  
A. W, Holmes Diane Gillit ◽  
George W. Reichel ◽  
Mark Stranz
Keyword(s):  
Peritoneal Dialysis ◽  
Iron Overload ◽  
End Stage Renal Disease ◽  
Chelation Therapy ◽  
Iron Chelation ◽  
Iron Chelation Therapy ◽  
Peritoneal Dialysate ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

A patient with end-stage renal disease on CAPD, and with massive iron overload is reported. This patient had evidence of myocardial and hepatic damage probably as a result of iron overload. Treatment with desferoxamine resulted in removal of iron in the peritoneal dialysate. On the basis of preliminary studies in this patient it would appear that removal of iron by peritoneal dialysis in conjunction with chelation therapy is safe and effective. This finding should have wide-ranging signficance for patients with ESRD.

Adipokines and Gut Hormones in End-Stage Renal Disease

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 298-302
Author(s):  
Robert H. Mak ◽  
Wai Cheung
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Peptide Yy ◽  
Gut Hormones ◽  
Poor Quality ◽  
Mortality And Morbidity ◽  
Novel Therapeutic Strategies ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Cachexia is common in end-stage renal disease (ESRD) patients, and it is an important risk factor for poor quality of life and increased mortality and morbidity. Chronic inflammation is an important cause of cachexia in ESRD patients. In the present review, we examine recent evidence suggesting that adipokines or adipocytokines such as leptin, adiponectin, resistin, tumor necrosis factor α, interleukin-6, and interleukin-1β may play important roles in uremic cachexia. We also review the physiology and the potential roles of gut hormones, including ghrelin, peptide YY, and cholecystokinin in ESRD. Understanding the molecular pathophysiology of these novel hormones in ESRD may lead to novel therapeutic strategies.

Sign in / Sign up

Export Citation Format

Share Document