Physical Function and Clinical Outcomes in Hemodialysis Patients: The China Dialysis Outcomes and Practice Pattern Study

Abstract Background: Hemodialysis (HD) patients usually have impaired physical function compared with general population. Self-reported physical function is a simple method to implement in daily dialysis care. This study aimed to examine the association of self-reported physical function with clinical outcomes of HD patients.Methods: Dialysis Outcomes and Practice Patterns Study (DOPPS) is a prospective cohort study. Data on 1427 HD patients in China DOPPS5 were analyzed. Self-reported physical function was characterized by 2 items of ‘moderate activities limited level’ and ’climbing stairs limited level’. Demographic data, comorbidities, hospitalization and death records were collected from patients’ records. Associations between physical function and outcomes were analyzed using COX regression models. The generalized linear mixed models were used to examine correlates of physical function limited level.Results: Compared to ‘limited a lot’ in moderate activities, ‘limited a little’ and ‘not limited at all’ groups were associated with lower all-cause mortality after adjusted for covariates (HR: 0.652, 95% CI: 0.435-0.977 and HR: 0.472, 95% CI: 0.241-0.927, respectively). And not limited in moderate activities was associated with lower risk of hospitalization compared with ‘limited a lot’ group after adjusted for covariates (HR: 0.747, 95% CI: 0.570-0.978). Meanwhile, compared to ‘limited a lot’ in climbing stairs, ‘limited a little’ and ‘not limited at all’ groups were associated with lower all-cause mortality (HR: 0.574, 95% CI: 0.380-0.865 and HR: 0.472, 95% CI: 0.293-0.762, respectively) but not hospitalization after fully adjusted. Factors including old age, female gender, longer dialysis vintage, catheter use, low serum albumin and combining with diabetes, coronary artery disease and cerebrovascular disease were related to higher limited levels of physical function (P < 0.05).Conclusion: Higher limited levels in self-reported physical function were associated with higher risk of all-cause mortality and hospitalization in HD patients.

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Physical Function and Clinical Outcomes in Hemodialysis Patients: China Dialysis Outcomes and Practice Patterns Study

Kidney Diseases ◽

10.1159/000513897 ◽

2021 ◽

pp. 1-8

Author(s):

Qingyu Niu ◽

Xinju Zhao ◽

Liangying Gan ◽

Xinling Liang ◽

Zhaohui Ni ◽

...

Keyword(s):

Physical Function ◽

Clinical Outcomes ◽

Practice Patterns ◽

Cox Regression ◽

Demographic Data ◽

Simple Method ◽

Daily Dialysis ◽

All Cause Mortality ◽

Dialysis Outcomes ◽

Climbing Stairs

Background: Hemodialysis (HD) patients usually have impaired physical function compared with the general population. Self-reported physical function is a simple method to implement in daily dialysis care. This study aimed to examine the association of self-reported physical function with clinical outcomes of HD patients. Methods: The Dialysis Outcomes and Practice Patterns Study (DOPPS) is a prospective cohort study. Data on 1,427 HD patients in China DOPPS5 were analyzed. Self-reported physical function was characterized by 2 items of “moderate activities limited level” and “climbing stairs limited level.” Demographic data, comorbidities, hospitalization, and death records were collected from patients’ records. Associations between physical function and outcomes were analyzed using COX regression models. Results: Compared to “limited a lot” in moderate activities, “limited a little” and “not limited at all” groups were associated with lower all-cause mortality after adjusted for covariates (HR: 0.652, 95% CI: 0.435–0.977, and HR: 0.472, 95% CI: 0.241–0.927, respectively). And, not limited in moderate activities was associated with lower risk of hospitalization than the “limited a lot” group after adjusted for covariates (HR: 0.747, 95% CI: 0.570–0.978). Meanwhile, compared to “limited a lot” in climbing stairs, “limited a little” and “not limited at all” groups were associated with lower all-cause mortality (HR: 0.574, 95% CI: 0.380–0.865 and HR: 0.472, 95% CI: 0.293–0.762, respectively) but not hospitalization after fully adjusted. Conclusion: Higher limited levels in self-reported physical function were associated with higher risk of all-cause mortality and hospitalization in HD patients.

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Serum total indoxyl sulfate and clinical outcomes in hemodialysis patients: results from the Japan Dialysis Outcomes and Practice Patterns Study

Clinical Kidney Journal ◽

10.1093/ckj/sfaa121 ◽

2020 ◽

Cited By ~ 2

Author(s):

Suguru Yamamoto ◽

Douglas S Fuller ◽

Hirotaka Komaba ◽

Takanobu Nomura ◽

Ziad A Massy ◽

...

Keyword(s):

Clinical Outcomes ◽

Practice Patterns ◽

Large Cohort ◽

Indoxyl Sulfate ◽

Study Phase ◽

Uremic Toxin ◽

Dialysis Vintage ◽

All Cause Mortality ◽

Large Cohort Study ◽

Dialysis Outcomes

Abstract Background Uremic toxins are associated with various chronic kidney disease-related comorbidities. Indoxyl sulfate (IS), a protein-bound uremic toxin, reacts with vasculature, accelerating atherosclerosis and/or vascular calcification in animal models. Few studies have examined the relationship of IS with clinical outcomes in a large cohort of hemodialysis (HD) patients. Methods We included 1170 HD patients from the Japan Dialysis Outcomes and Practice Patterns Study Phase 5 (2012–15). We evaluated the associations of serum total IS (tIS) levels with all-cause mortality and clinical outcomes including cardiovascular (CV)-, infectious- and malignancy-caused events using Cox regressions. Results The median (interquartile range) serum tIS level at baseline was 31.6 μg/mL (22.6–42.0). Serum tIS level was positively associated with dialysis vintage. Median follow-up was 2.8 years (range: 0.01–2.9). We observed 174 deaths (14.9%; crude rate, 0.06/year). Serum tIS level was positively associated with all-cause mortality [adjusted hazard ratio per 10 μg/mL higher, 1.16; 95% confidence interval (CI) 1.04–1.28]. Association with cause-specific death or hospitalization events, per 10 μg/mL higher serum tIS level, was 1.18 (95% CI 1.04–1.34) for infectious events, 1.08 (95% CI 0.97–1.20) for CV events and 1.02 (95% CI 0.87–1.21) for malignancy events after adjusting for covariates including several nutritional markers. Conclusions In a large cohort study of HD patients, serum tIS level was positively associated with all-cause mortality and infectious events.

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Hyperkalemia excursions are associated with an increased risk of mortality and hospitalizations in hemodialysis patients

Clinical Kidney Journal ◽

10.1093/ckj/sfaa208 ◽

2020 ◽

Author(s):

Angelo Karaboyas ◽

Bruce M Robinson ◽

Glen James ◽

Katarina Hedman ◽

Carol P Moreno Quinn ◽

...

Keyword(s):

Clinical Outcomes ◽

Cox Regression ◽

Target Range ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

Using Data ◽

Dialysis Outcomes ◽

Mortality Hazard Ratio ◽

New Strategies

Abstract Background Hyperkalemia is common among hemodialysis (HD) patients and has been associated with adverse clinical outcomes. Previous studies considered a single serum potassium (K) measurement or time-averaged values, but serum K excursions out of the target range may be more reflective of true hyperkalemia events. We assessed whether hyperkalemia excursions lead to an elevated risk of adverse clinical outcomes. Methods Using data from 21 countries in Phases 4–6 (2009–18) of the Dialysis Outcomes and Practice Patterns Study (DOPPS), we investigated the associations between peak serum K level, measured monthly predialysis, over a 4-month period (‘peak K’) and clinical outcomes over the subsequent 4 months using Cox regression, adjusted for potential confounders. Results The analysis included 62 070 patients contributing a median of 3 (interquartile range 2–6) 4-month periods. The prevalence of hyperkalemia based on peak K was 58% for >5.0, 30% for >5.5 and 12% for >6.0 mEq/L. The all-cause mortality hazard ratio for peak K (reference ≤5.0 mEq/L) was 1.15 [95% confidence interval (CI) 1.09, 1.21] for 5.1–5.5 mEq/L, 1.19 (1.12, 1.26) for 5.6–6.0 mEq/L and 1.33 (1.23, 1.43) for >6.0 mEq/L. Results were qualitatively consistent when analyzing hospitalizations and a cardiovascular composite outcome. Conclusions Among HD patients, we identified a lower K threshold (peak K 5.1–5.5 mEq/L) than previously reported for increased risk of hospitalization and mortality, with the implication that a greater proportion (>50%) of the HD population may be at risk. A reassessment of hyperkalemia severity ranges is needed, as well as an exploration of new strategies for effective management of chronic hyperkalemia.

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Thrombocytopenia predicts mortality in Chinese hemodialysis patients- an analysis of the China DOPPS

BMC Nephrology ◽

10.1186/s12882-021-02579-5 ◽

2022 ◽

Vol 23 (1) ◽

Author(s):

Xinju Zhao ◽

Qingyu Niu ◽

Liangying Gan ◽

Fan Fan Hou ◽

Xinling Liang ◽

...

Keyword(s):

Logistic Regression ◽

Cerebrovascular Disease ◽

Cox Regression ◽

Demographic Data ◽

White Blood Cells ◽

Impact Factors ◽

Multivariate Logistic Regression ◽

Platelet Counts ◽

All Cause Mortality ◽

Dialysis Outcomes

Abstract Background Hemodialysis (HD) patients have a higher mortality rate compared with general population. Our previous study revealed that platelet counts might be a potential risk factor. The role of platelets in HD patients has rarely been studied. The aim of this study is to examine if there is an association of thrombocytopenia (TP) with elevated risk of all-cause mortality and cardiovascular (CV) death in Chinese HD patients. Methods Data from a prospective cohort study, China Dialysis Outcomes and Practice Patterns Study (DOPPS) 5, were analyzed. Demographic data, comorbidities, platelet counts and other lab data, and death records which extracted from the medical record were analyzed. TP was defined as the platelet count below the lower normal limit (< 100*109/L). Associations between platelet counts and all-cause and CV mortality were evaluated using Cox regression models. Stepwise multivariate logistic regression was used to identify the independent associated factors, and subgroup analyses were also carried out. Results Of 1369 patients, 11.2% (154) had TP at enrollment. The all-cause mortality rates were 26.0% vs. 13.3% (p < 0.001) in patients with and without TP. TP was associated with higher all-cause mortality after adjusted for covariates (HR:1.73,95%CI:1.11,2.71), but was not associated with CV death after fully adjusted (HR:1.71,95%CI:0.88,3.33). Multivariate logistic regression showed that urine output < 200 ml/day, cerebrovascular disease, hepatitis (B or C), and white blood cells were independent impact factors (P < 0.05). Subgroup analysis found that the effect of TP on all-cause mortality was more prominent in patients with diabetes or hypertension, who on dialysis thrice a week, with lower ALB (< 4 g/dl) or higher hemoglobin, and patients without congestive heart failure, cerebrovascular disease, or hepatitis (P < 0.05). Conclusion In Chinese HD patients, TP is associated with higher risk of all-cause mortality, but not cardiovascular mortality. Platelet counts may be a useful prognostic marker for clinical outcomes among HD patients, though additional study is needed.

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Prognostic Significance of Fragmented QRS in Patients with Hypertrophic Cardiomyopathy

Cardiology ◽

10.1159/000471845 ◽

2017 ◽

Vol 138 (1) ◽

pp. 26-33 ◽

Cited By ~ 3

Author(s):

Xili Lu ◽

Wei Wang ◽

Ling Zhu ◽

Yilu Wang ◽

Kai Sun ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Clinical Outcomes ◽

Cox Regression ◽

Prognostic Significance ◽

Cox Regression Analysis ◽

Fragmented Qrs ◽

All Cause Mortality ◽

The Relationship ◽

Cvd Mortality

Objectives: The relationship between a fragmented QRS (fQRS) and clinical outcomes in patients with hypertrophic cardiomyopathy (HCM) remains unclear. This study aimed to investigate the prognostic significance of fQRS in patients with HCM. Methods: Between 2000 and 2012, 326 unrelated patients with HCM (72% male with a mean age of 52 years) were included and were divided into 2 groups: those with fQRS and those without fQRS. Results: A total of 105/326(32.2%) patients with HCM presented with fQRS at enrollment. During a follow-up of 5.3 ± 2.4 years, 33 patients died, 30 of cardiovascular disease (CVD). Cox regression analysis revealed that fQRS predicted a higher risk of all-cause mortality (adjusted hazard ratio [HR] 2.24; 95% confidence interval [CI] 1.08-4.64; p = 0.030) and CVD mortality (adjusted HR 2.68; 95% CI 1.22-5.91; p = 0.014). Our study also showed that fQRS increased the risk of heart failure-related death (adjusted HR 3.75; 95% CI 1.24-11.30; p = 0.019). Conclusions: Our results indicate that fQRS is associated with adverse clinical outcomes in patients with HCM.

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Abstract P274: Kidney Filtration Markers and the Risk of Clinical Outcomes in Individuals With Type 2 Diabetes in the Advance Trial

Circulation ◽

10.1161/circ.141.suppl_1.p274 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Hyunju Kim ◽

Dan Wang ◽

John Chalmers ◽

Mark Woodward ◽

Elizabeth Selvin ◽

...

Keyword(s):

Type 2 Diabetes ◽

Clinical Outcomes ◽

Regression Models ◽

Cox Regression ◽

All Cause Mortality ◽

Baseline Levels ◽

Controlled Evaluation ◽

Egfr Decline

Introduction: Creatinine-based estimated glomerular filtration rate (eGFR) is biased in the setting of obesity and other conditions. Alternative kidney filtration markers may be particularly useful in adults with diabetes, but few studies examined the risk of clinical outcomes associated with filtration markers in adults with type 2 diabetes. Objective: We evaluated whether baseline levels and change in eGFR based on creatinine (Cr), cystatin C (Cys), and B 2 -microglobulin (B2M) were associated with the risk of clinical outcomes among individuals with type 2 diabetes. Methods: In the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial, Cr, Cys, and B2M were measured in 7,217 participants at baseline and a random sample of 640 participants at the 1 year visit. We categorized baseline eGFR Cr , eGFR Cys , eGFR B2M , and the average across the 3 eGFR estimates (eGFR avg ) into quarters, and examined associations with major macrovascular and microvascular events together, and separately, and all-cause mortality using Cox regression models, adjusting for established risk factors. We also examined associations with continuous eGFR decline and increase (per 30%). Results: Over a median follow-up of 5 years, 1,313 combined major macrovascular (n=748) and microvascular events (n=637), and 743 deaths occurred. Lower levels of eGFR based on all three filtration markers individually and combined were associated with 1.5 to 2.2 times higher risk of combined major macrovascular and microvascular events, with similar patterns for other outcomes ( Table ). Per 30% decline in eGFR Cys and eGFR avg were associated with a >2-fold higher risk of all clinical outcomes, after additional adjustment of baseline eGFR. Conclusions: In adults with type 2 diabetes, baseline levels of eGFR based on alternative filtration markers and per 30% decline in eGFR Cys and eGFR avg were consistently associated with all clinical outcomes.

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Meta-analysis of the association between sclerostin level and adverse clinical outcomes in patients undergoing maintenance haemodialysis

Therapeutic Advances in Chronic Disease ◽

10.1177/2040622320967148 ◽

2021 ◽

Vol 12 ◽

pp. 204062232096714

Author(s):

Sha-Sha Li ◽

Zhi-Qin Zhang ◽

Da-Wei He ◽

Ao-Lin He ◽

Qi-Feng Liu

Keyword(s):

Clinical Outcomes ◽

Cardiovascular Events ◽

Fixed Effects ◽

Meta Analysis ◽

Cochrane Library ◽

Maintenance Haemodialysis ◽

Dialysis Vintage ◽

All Cause Mortality ◽

Predictive Role

Background: Studies regarding the relationship of sclerostin (Scl) with clinical outcomes in patients undergoing maintenance haemodialysis have yielded controversial findings. This meta-analysis was performed to investigate the predictive role of Scl in this patient population. Methods: Several electronic medical databases (e.g. PubMed, Embase, Web of Science and Cochrane Library) were searched for eligible studies through December 20, 2019. Summary hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated based on Scr level (high or low) using a random or fixed effects model. Results: From among 641 initially screened publications, 16 eligible studies were included in this meta-analysis. A high Scl level was not associated with cardiovascular events [HR = 0.8 (95% CI, 0.42–1.35)] or all-cause mortality [HR = 0.93 (95% CI, 0.56–1.54)]. There was high heterogeneity, but no evidence of publication bias. Interestingly, a high Scl level was associated with reduced cardiovascular events [HR = 0.44 (95% CI, 0.29–0.69)] in the subgroup by shorter follow-up period or all-cause mortality [pooled HR = 0.58 (95% CI, 0.36–0.91)] by shorter dialysis vintage. Conclusion: This meta-analysis indicated that a high Scl level did not predict total clinical outcomes in patients undergoing maintenance haemodialysis despite survival benefits in the subgroups. The predictive role of Scl in these patients should be further evaluated in large prospective studies.

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Citric Acid-Containing Dialysate and Survival Rate in the Dialysis Outcomes and Practice Patterns Study

Kidney360 ◽

10.34067/kid.0006182020 ◽

2021 ◽

pp. 10.34067/KID.0006182020

Author(s):

Pablo Ureña-Torres ◽

Brian Bieber ◽

Fitsum Guebre Egziabher ◽

Rim Ossman ◽

Michel Jadoul ◽

...

Keyword(s):

Citric Acid ◽

Practice Patterns ◽

Cox Regression ◽

Hemodialysis Patients ◽

Hemodynamic Stability ◽

Patient Demographics ◽

Dependent Relationship ◽

All Cause Mortality ◽

Dialysis Outcomes ◽

Dose Dependent

Background: Metabolic acidosis is a common threat for hemodialysis patients, managed by alkaline dialysate. The main base is bicarbonate, to which small amounts of acetic, citric, or hydrochloric acid are added. The first two ones are metabolized to bicarbonate, mostly by the liver. Citric acid-containing dialysate might improve dialysis efficiency, anticoagulation, calcification propensity score, and intradialytic hemodynamic stability. However, a recent report from the French dialysis registry suggested that this dialysate increases mortality risk. This prompted us to assess whether citric acid-containing bicarbonate-based dialysate was associated with mortality in the international Dialysis Outcomes and Practice Patterns Study (DOPPS). Methods: Detailed patient-based information on dialysate composition was collected in DOPPS phases 5 and 6 (2012 to 2017). Cox regression was used to model the association between baseline bicarbonate dialysate containing citric acid versus not containing citric acid and mortality among DOPPS country/phases where citric acid-containing dialysate was used. Results: Citrate-containing dialysate was most commonly used in Japan, Italy, and Belgium (25%, 25%, 21% of DOPPS phase 6 patients) and used in < 10% of patients in other countries. Among 11,306 patients in DOPPS country-phases with at least 15 patients using citrate-containing dialysate, patient demographics, comorbidities, and labs were similar among patients using (14%) vs. not using (86%) citrate-containing dialysate. After accounting for case mix, we did not observe a directional association between citric acid-containing dialysate use (any vs. none) and mortality [HR (95% CI) = 1.14 (0.97-1.34)], nor did we find evidence of a dose-dependent relationship when parameterizing the citrate concentration in the dialysate as 1, 2, and 3+ mEq/L. Conclusions: The use of citric acid-containing dialysate was not associated with greater risk of all-cause mortality in hemodialysis patients participating in DOPPS. Clinical indications for the use of citric acid-containing dialysate deserve further investigation.

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MO820INTRACELLULAR WATER BEFORE HEMODIALYSIS PREDICTS ALL-CAUSE MORTALITY IN HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab098.0012 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Robert Ekart ◽

Gasper Keber ◽

Nina Vodošek Hojs ◽

Eva Jakopin ◽

Nejc Piko ◽

...

Keyword(s):

Blood Pressure ◽

Regression Analysis ◽

Cox Regression ◽

Volume Status ◽

Dialysis Patients ◽

Cox Regression Analysis ◽

Dialysis Vintage ◽

All Cause Mortality ◽

Before And After

Abstract Background and Aims Several factors may be responsible for the increased mortality in dialysis patients, but volume overload is considered among the main mechanisms of this association. Volume status is usually estimated using clinical criteria, i.e., patien's signs and symptoms, peridialytic blood pressure measurements, and intradialytic hemodynamic instability. Bioimpedance analysis (BIA) is another way to measure volume status in dialysis patients. BIA can measure overhydration (OH), extracellular water (ECW), intracellular water (ICW) and ECW/ICW ratio. The aim of our study was to analyze the role of BIA parameters before and after hemodialysis (HD) on all-cause mortality. Method Eighty-three patients (mean age 64.2 years; 51 men) on maintenance HD were included. BIA was performed and blood pressure was measured before and after the HD session. Patients were followed for assigned time, until transplantation or death. The mean follow-up time was 1181±564 days. Results Descriptive statistics of our patients are shown in Table 1. During the follow-up period, 6 (7.2%) patients were transplanted and 39 (47%) patients died. Univariate Cox regression analysis showed that only ICW before HD was a significant predictor of all-cause mortality (HR=1.089; 95%CI: 1.01-1.17, p=0.018). OH, ECW, ECW/ICW ratio before and after HD and ICW after HD were not associated with survival. In multivariate Cox regression analysis including ICW before dialysis, age, dialysis vintage, pulse pressure before HD, hemoglobin, CRP and serum albumin, ICW before dialysis was an independent predictor of all-cause mortality (HR=1.102; 95%CI: 1.01-1.20, p=0.029) (Table 2). Conclusion ICW before HD predicts all-cause mortality in HD patients.

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Plasma syndecan-1 in hemodialysis patients associates with survival and lower markers of volume status

AJP Renal Physiology ◽

10.1152/ajprenal.00252.2018 ◽

2019 ◽

Vol 316 (1) ◽

pp. F121-F127 ◽

Cited By ~ 1

Author(s):

Josephine Koch ◽

Nienke M. A. Idzerda ◽

Wendy Dam ◽

Solmaz Assa ◽

Casper F. M. Franssen ◽

...

Keyword(s):

Cardiovascular Events ◽

Cox Regression ◽

Hemodialysis Patients ◽

Volume Status ◽

Cox Regression Analysis ◽

Endothelial Markers ◽

Kaplan Meier ◽

Dialysis Vintage ◽

All Cause Mortality ◽

Renal Tubular

Syndecan-1, a transmembrane heparan sulfate proteoglycan, associates with renal and cardiovascular functioning. We earlier reported syndecan-1 to be involved in renal tubular regeneration. We now examined plasma values of syndecan-1 in a hemodialysis cohort and its association with volume and inflammatory and endothelial markers in addition to outcome. Eighty-four prevalent hemodialysis patients were evaluated for their plasma syndecan-1 levels by ELISA before the start of hemodialysis, as well as 60, 180, and 240 min after start of dialysis. Patients were divided into sex-stratified tertiles based on predialysis plasma syndecan-1 levels. We studied the association between plasma levels of syndecan-1 and volume, inflammation, and endothelial markers and its association with cardiovascular events and all-cause mortality using Kaplan-Meier curves and Cox regression analyses with adjustments for gender, age, diabetes, and dialysis vintage. Predialysis syndecan-1 levels were twofold higher in men compared with women ( P = 0.0003). Patients in the highest predialysis plasma syndecan-1 tertile had a significantly higher ultrafiltration rate ( P = 0.034) and lower plasma values of BNP ( P = 0.019), pro-ANP ( P = 0.024), and endothelin ( P < 0.0001) compared with the two lower predialysis syndecan-1 tertiles. No significant associations with inflammatory markers were found. Cox regression analysis showed that patients in the highest syndecan-1 tertile had significantly less cardiovascular events and better survival compared with the lowest syndecan-1 tertile ( P = 0.02 and P = 0.005, respectively). In hemodialysis patients, higher plasma syndecan-1 levels were associated with lower concentrations of BNP, pro-ANP, and endothelin and with better patient survival. This may suggest that control of volume status in hemodialysis patients allows an adaptive tissue regenerative response as reflected by higher plasma syndecan-1 levels.

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