Association of cardiovascular morbidity with residual renal function in twice weekly versus thrice weekly hemodialysis patients

2020 ◽  
Vol 8 (6) ◽  
pp. 119-125
Author(s):  
Ahsan MZ ◽  
Faroque MO ◽  
Hossain SMz ◽  
Khan SB ◽  
Ershad SM ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Regression Analysis ◽  
Kidney Disease ◽  
Hemodialysis Patient ◽  
Urine Volume ◽  
Residual Renal Function ◽  
Hemodialysis Patients ◽  
Left Ventricular ◽  
Cardiovascular Morbidity

Background: Chronic kidney disease is a non-communicable global problem. In patients of chronic kidney disease especially in hemodialysis patient mortality and morbidity due to atherosclerosis induced cardiovascular complications is very high despite the advances of hemodialysis procedure. Residual renal function contributes significantly to the overall health and cardiovascular morbidity of dialysis patients. So, the loss of residual renal function, especially in patients on hemodialysis, is a powerful predictor of mortality. Preserving residual renal function is the goal of nephrologists. Objective: To find the association between residual renal function and cardiovascular morbidity in twice weekly and thrice weekly hemodialysis patient. Methodology: This cross sectional study was conducted on 72 hemodialysis patients received dialysis more than three months in the dialysis centre of BSMMU and DMCH, Dhaka, Bangladesh during the period of October 2018 to September 2019. Study populations were divided into two groups on the basis of residual renal function (RRF). RRF was defined by interdialytic 24 hours urine volume and average of urinary urea and creatinine clearance. Preserved RRF was defined 24 hours urine volume more than 100 ml. Chi-square test (χ2), Student’s paired t-test and multiple regression analysis were used to find association between cardiovascular morbidity and RRF. Result: A significant difference of diastolic dysfunction, systolic dysfunction, LVH (p=0.001, p=0.001, p=0.004 respectively) was seen in between preserved RRF and without preserved RRF group but the difference of regional wall motion abnormality and valvular heart disease was found to be non-significant. In regression analysis, loss of RRF was found to be a significant predictor of cardiovascular morbidity. Conclusion: Preserved RRF was significantly associated with less frequent diastolic dysfunction, left ventricular hypertrophy and higher level of left ventricular ejection fraction compared to without preserved residual renal function in both twice weekly and thrice weekly HD patient.

scholarly journals The Relationship of Residual Renal Function with Cardiovascular Morbidity in Twice Weekly and Thrice Weekly Hemodialysis Patient

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Gomes RR
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Regression Analysis ◽  
Kidney Disease ◽  
Diastolic Dysfunction ◽  
Hemodialysis Patient ◽  
Urine Volume ◽  
Residual Renal Function ◽  
Left Ventricular ◽  
Cardiovascular Morbidity

Background: Chronic kidney disease is a non-communicable global problem. In patients of chronic kidney disease especially in Hemodialysis patient mortality and morbidity due to atherosclerosis induced cardiovascular complications is very high despite the advances of Hemodialysis procedure. Residual renal function contributes significantly to the overall health and cardiovascular morbidity of dialysis patients. So, the loss of residual renal function, especially in patients on Hemodialysis, is a powerful predictor of mortality. Preserving residual renal function is the goal of nephrologists. Objective: To find the association between residual renal function and cardiovascular morbidity in twice weekly and thrice weekly Hemodialysis patient. Methodology: This cross sectional study was conducted on 72 Hemodialysis patients received dialysis more than three months in the dialysis centre of BSMMU and DMCH, Dhaka, Bangladesh during the period of October 2018 to September 2019. Study populations were divided into two groups on the basis of residual renal function (RRF). RRF was defined by interdialytic 24 hours urine volume and average of urinary urea and creatinine clearance. Preserved RRF was defined 24 hours urine volume more than 100ml. Chi-square test (χ2), Student’s paired t-test and multiple regression analysis were used to find association between cardiovascular morbidity and RRF. Result: A significant difference of diastolic dysfunction, systolic dysfunction, LVH (p=0.001, p=0.001, p=0.004 respectively) was seen in between preserved RRF and without preserved RRF group but the difference of regional wall motion abnormality and valvular heart disease was found to be non-significant. In regression analysis, loss of RRF was found to be a significant predictor of cardiovascular morbidity. Conclusion: Preserved RRF was significantly associated with less frequent diastolic dysfunction, left ventricular hypertrophy and higher level of left ventricular ejection fraction compared to without preserved residual renal function in both twice weekly and thrice weekly HD patient.

scholarly journals Soluble CD59 in peritoneal dialysis: a potential biomarker for peritoneal membrane function

2020 ◽  
Author(s):  
Bernardo Faria ◽  
Mariana Gaya da Costa ◽  
Carla Lima ◽  
Loek Willems ◽  
Ricardo Brandwijk ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Residual Renal Function ◽  
Hemodialysis Patients ◽  
Healthy Controls ◽  
Peritoneal Membrane ◽  
Membrane Function ◽  
Peritoneal Dialysate

Abstract Introduction Various studies have reported the importance of complement regulators in preventing mesothelial damage during peritoneal dialysis (PD). Its assessment, however, is limited in clinical practice due to the lack of easy access to the peritoneal membrane. Recently, a soluble form of the complement regulatory protein CD59 (sCD59) has been described. We therefore aimed to investigate the role of sCD59 in PD. Methods Plasma sCD59 was measured in 48 PD patients, 41 hemodialysis patients, 15 non-dialysis patients with chronic kidney disease and 14 healthy controls by ELISA (Hycult; HK374-02). Additionally, sCD59 and sC5b-9 were assessed in the peritoneal dialysate. Results sCD59 and sC5b-9 were detectable in the peritoneal dialysate of all patients, and marginally correlated (r = 0.27, P = 0.06). Plasma sCD59 levels were significantly higher in PD patients than in patients with chronic kidney disease and healthy controls, but did not differ from hemodialysis patients. During follow-up, 19% of PD patients developed peritoneal membrane failure and 27% of PD patients developed loss of residual renal function. In adjusted models, increased sCD59 levels in the dialysate (HR 3.44, 95% CI 1.04–11.40, P = 0.04) and in plasma (HR 1.08, 95% CI 1.01–1.17, P = 0.04) were independently associated with the occurrence of peritoneal membrane failure. Higher plasma levels of sCD59 were also associated with loss of residual renal function (HR 1.10, 95% CI 1.04–1.17, P < 0.001). Conclusions Our study suggests that sCD59 has potential as a biomarker to predict peritoneal membrane function and loss of residual renal function in PD, thereby offering a tool to improve patient management. Graphic abstract

scholarly journals Oxidative Balance and Inflammation in Hemodialysis Patients: Biomarkers of Cardiovascular Risk?

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Daniele La Russa ◽  
Daniela Pellegrino ◽  
Alberto Montesanto ◽  
Paolo Gigliotti ◽  
Anna Perri ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Cardiovascular Events ◽  
Cardiovascular Complications ◽  
Hemodialysis Patients ◽  
Healthy Population ◽  
Oxidative Balance

During chronic kidney disease, the progressive deterioration of renal function induces several biological/clinical dysfunctions, including enhancement of synthesis of inflammation/oxidative stress mediators. Impaired renal function is an independent cardiovascular risk factor; indeed, cardiovascular complications dominate the landscape of both chronic kidney disease and end-stage renal disease. The aim of this study is to explore the correlation between the global oxidative balance in hemodialysis patients and both inflammatory markers and cardiovascular events. Using photometric tests, this study explored plasmatic oxidative balance in 97 hemodialysis patients compared to a healthy population. In the hemodialysis patients, we showed that oxidative stress values were significantly lower than in controls while effectiveness in the antioxidant barrier was significantly increased in the hemodialysis group. Furthermore, we highlighted a strong correlation between oxidative index and blood levels of C-reactive protein. When patients were divided into two groups based on previous cardiovascular events, we found that subjects with previous cardiovascular events had higher values of both oxidative stress and antioxidant barrier than patients without cardiovascular events. Our results indicated that in hemodialysis patients, the clinical and prognostic significance of oxidative status is very different from general population. As cardiovascular complications represent a strong negative factor for survival of hemodialysis patients, the research of new cardiovascular risk biomarkers in these patients takes on particular importance in order to translate them into clinical practice/primary care.

scholarly journals Impact of hydrating status on residual renal function in hemodialysis patients (first report)

2019 ◽  
pp. 40-46
Author(s):  
L. Surzhko ◽  
V. Lubashev ◽  
I. Poperechnyj
Keyword(s):  
Renal Function ◽  
Urine Volume ◽  
Residual Renal Function ◽  
Hemodialysis Patients ◽  
Hydration Status ◽  
Significant Difference ◽  
Daily Urine ◽  
The Relationship ◽  
Reliable Correlation ◽  
Influence Of Hydration

 Residual kidney function (RKF) is a powerful indicator of residual renal functional capacity that eliminates uremic toxins and fluid in hemodialysis patients. The purpose of our study was to investigate the influence of hydrating status on residual renal function in patients with CKD 5HD. Methods. A prospective observational study included 60 hemodialysis patients with CKD VD. All patients were examined - taken general and biochemical blood tests, determined the level of urea and creatinine in the daily urine. RKF was evaluated by urine volume, residual KT / V and KRU. Water balance was measured and evaluated using BCM-monitor. Results.During the analysis of BCM data, hyperhydration (OH / ECW above 15%) was revealed in 15 among all patients included in the study, which amounted to 25%. A statistically significant difference between patients who were hyperhydrated and normohydrated was found in relative (OH / ECW) and absolute hydration (OH), ECW, and ultrafiltration rates. Thus, in the group of hyperhydrated patients, the average relative hydration rate was 14.3% lower compared to normohydrated patients (p < 0.001) and absolute hydration by 2.6 l (p < 0.001). In further analysis, no significant difference between two groups was found in the indicators characterizing the RKF, namely, between the level of urine output, KRU, KT / Vren. The level of ultrafiltration in the group with normal hydration is 900 ml lower than that with hyperhydration (p < 0.005). In study the influence of indicators of hydration status such as OH, OH / ECW, TBW, ECW, ICW on RKF indices no reliable correlation of the above mentioned values ​​with diuresis, KRU, KT / Vren (p > 0.05) was found. A positive correlation was found between KRU, diuresis and KT / Vren, indicating that with increasing diuresis the KRU value and KT / Vren increase (p < 0.001). The same relationship was found between diuresis and KT / Vren, p < 0.001. An analysis of the relationship between absolute and relative hydration with dialysis efficacy (eKT / V) revealed that dialysis efficacy decreases with increase of hydratation in CKD 5HD patients (p < 0.05). Conclusions. The results obtained in our study indicate that the indicators of hydration status at baseline do not allow to find out an influence of them on the baseline level of RKF (diuresis, KRU and KT / Vren) in patients with CKD 5HD. Issues of the influence of hydration status on changes in RKF during the observation will be addressed in the following reports.

scholarly journals Diuretics in chronic kidney disease

2020 ◽  
Vol 10 (1) ◽  
pp. 10-20
Author(s):  
A. I. Dyadyk ◽  
G. G. Taradin ◽  
Yu. V. Suliman ◽  
S. R. Zborovskyy ◽  
V. I. Merkuriev
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Diuretic Therapy ◽  
Extracellular Fluid ◽  
Residual Renal Function ◽  
Cardiovascular Complications ◽  
Loop Diuretics ◽  
Stage Renal Disease ◽  
End Stage

The issues of diuretic therapy in patients with chronic kidney disease, pharmacokinetics of diuretics, the problem of diuretic resistance, the tactics of using thiazides and loop diuretics in patients with various stages of chronic kidney disease, according to the recommendations of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative are discussed in the article. Particular attention is paid to the prescription of this group of drugs to patients with end stage renal disease, as well as those undergoing renal replacement therapy (hemodialysis).Diuretics play an important role in the management of patients with chronic kidney disease with the development of hypertension and an increased extracellular fluid volume. In case of impaired renal function leading place is given to loop diuretics. Their combination with thiazide diuretics can increase the diuretic effect. The results of clinical trials assessing the effectiveness of the use of diuretics during decline of residual renal function are provided. It is reported about the effect of potassium-sparing diuretics on the incidence of cardiovascular complications, the development of hyperkalemia in patients undergoing dialysis treatment. The importance of continuation of intensive study about the possibility of antagonists of mineralocorticoid receptors usage, in particular the spironolactone, eplerenone, and finerenone in order to reduce cardiovascular complications and mortality, is indicated.

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