scholarly journals Clinical Outcomes After Coronary Artery Bypass Grafting in Patients with Dialysis-Dependent End-Stage Renal Disease and an Analysis of the Related Influencing Factors

2020 ◽  
Author(s):  
Xihui Li ◽  
Siyu Zhang ◽  
Feng Xiao
Keyword(s):  
End Stage Renal Disease ◽  
Artery Bypass ◽  
Survival Rates ◽  
Postoperative Survival ◽  
Perioperative Mortality ◽  
Term Survival ◽  
Factors Influencing ◽  
Stage Renal Disease ◽  
End Stage

Abstract Backgroud Perioperative and short/mid-term survival rates of dialysis-dependent patients with end-stage renal disease (ESRD), who undergo coronary artery bypass grafting (CABG), and the factors influencing mortality are not well evaluated In China. Method We retrospectively analyzed the perioperative and postoperative 1-, 3-, and 5-year survival rates of 53 dialysis-dependent ESRD patients who underwent CABG, and compared the factors related to perioperative mortality and all-cause mortality during the postoperative follow-up. Survival rates were expressed as Kaplan–Meier survival curves, and factors influencing the follow-up survival rates were analyzed using the log rank (Mantel–Cox) test. Result There were eight perioperative deaths, resulting in 15.1% mortality. Intraoperative intra-aortic balloon pump use (P=0.01), advanced age (P=0.0027), and high EuroSCORE II score (P=0.047) were associated with increased perioperative mortality. Forty-five discharged patients were followed from 2 months to 10 years (median, 4.2 years) postoperatively. There were 19 all-cause deaths, including 10 cardiac deaths (10/19, 52.6%). Comparisons between groups indicated that the presence of peripheral artery disease (PAD) increased mortality during follow-up (P=0.025); 1-, 3-, and 5-year survival rates were 93.3%, 79.5%, and 66.8%, respectively. The results of the long-rank analysis indicated that the presence of PAD was a risk factor for postoperative survival (log rank χ 2 =4.543; P=0.033). Conclusion Dialysis-dependent patients with ESRD had high perioperative mortality and unsatisfactory short- and medium-term survival after CABG. PAD was a risk factor affecting patients’ postoperative survival. Multidisciplinary teamwork is needed to enhance postoperative management and reduce complications, to improve postoperative survival in these patients.

scholarly journals SAT-028 Factors Influencing Treatment Decisions for End-Stage Renal Disease

2019 ◽  
Vol 4 (7) ◽  
pp. S14-S15
Author(s):  
Z.E.B. KHOO ◽  
S.C. Yeo ◽  
P. Shen ◽  
L.K.E. Pang ◽  
A. Liew
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Treatment Decisions ◽  
Factors Influencing ◽  
Stage Renal Disease ◽  
End Stage

MO282EARLY RENAL RECOVERY AFTER A FIRST FLARE OF PAUCI IMMUNE GLOMERULONEPHRITIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Jeremy Zaworski ◽  
Cyrille Vandenbussche ◽  
Pierre Bataille ◽  
Eric Hachulla ◽  
Francois Glowacki ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Interstitial Fibrosis ◽  
Univariate Analysis ◽  
Renal Recovery ◽  
Neurological Involvement ◽  
Factors Associated ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Renal involvement is a severe manifestation of ANCA-associated vasculitis. Patients often progress to end-stage renal disease. The potential for renal recovery after a first flare has seldom been studied. Our objectives were to describe the evolution of the estimated glomerular filtration rate (eGFR) and identify factors associated with the change in eGFR between diagnosis and follow-up at 3 months (ΔeGFRM0–M3) in a cohort of patients with a first flare of pauci-immune glomerulonephritis. Methods This was a retrospective study over the period 2003–2018 of incident patients in the Nord-Pas-de-Calais (France). Patients were recruited if they had a first histologically-proven flare of pauci immune glomerulonephritis with at least 1 year of follow up. Kidney function was estimated with MDRD-equation and analysed at diagnosis, 3rd, 6th and 12th months. The primary outcome was ΔeGFRM0–M3. Factors evaluated were histological (Berden classification, interstitial fibrosis, percentage of crescents), clinical (extra-renal manifestations, sex, age) or biological (severity of acute kidney injury, dialysis, ANCA subtype). Results One hundred and seventy-seven patients were included. The eGFR at 3 months was significantly higher than at diagnosis (mean ± standard deviation, 40 ± 24 vs 28 ± 26 ml/min/1.73 m2, p < 0.001), with a ΔeGFRM0–M3 of 12 ± 19 ml/min/1.73 m2. The eGFR at 12 months was higher than at 3 months (44 ± 13 vs 40 ± 24 ml/min/1.73m2, p = 0.003). The factors significantly associated with ΔeGFRM0–M3 in univariate analysis were: sclerotic class according to Berden classification, percentage of interstitial fibrosis, percentage of cellular crescents, acute tubular necrosis, neurological involvement. The factors associated with ΔeGFRM0–M3 in multivariate analysis were the percentage of cellular crescents and neurological involvement. The mean increase in eGFR was 2.90 ± 0.06 ml/min/1.73m2 for every 10-point gain in the percentage of cellular crescents. ΔeGFRM0–M3 was not associated with the risks of end-stage renal disease or death in long-term follow-up. Conclusions Early renal recovery after a first flare of pauci-immune glomerulonephritis occurred mainly in the first three months of treatment. The percentage of cellular crescents was the main independent predictor of early renal recovery.

Abstract 20155: The Adverse Effect of End Stage Renal Disease on Intimal Hyperplasia of Internal Thoracic Artery

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Hirofumi Sato ◽  
Yuko Ohashi ◽  
Chikara Ueki ◽  
Takehide Akimoto ◽  
Genichi Sakaguchi
Keyword(s):  
Renal Disease ◽  
Intimal Hyperplasia ◽  
End Stage Renal Disease ◽  
Artery Bypass ◽  
Rank Correlation ◽  
Arterial Disease ◽  
Off Pump ◽  
Luminal Narrowing ◽  
Stage Renal Disease ◽  
End Stage

Introduction: Internal thoracic arteries (ITA) are widely used as a reliable conduit in coronary artery bypass grafting surgery (CABG) because they are said to be less affected by arterioscrelosis. Little is known about the relationships between patient’s characteristics and intimal hyperplasia of ITAs. Hypothesis: The condition of intima of ITA of patients with end stage renal disease (ESRD) is worse than those of patients without ESRD. Methods: The specimens of LITAs and RITAs, obtained from 48 patients who underwent CABG or OPCAB (off-pump CABG) , were evaluated with histopathology; 56 arteries were suitable for morphometric analysis. The severity of disease was evaluated on the basis of percentage of luminal narrowing (%LN) , intimal thickness index (ITI), and intima-to-media ratio (IMR). Results: The patients included 36 males, 15 ESRD, 11 HD patients, 8 peripheral arterial disease (PAD) patients, and their average age was 69.3, average estimated glomerular filtration rate (eGFR) was 49.0 ml/min/1.73m 2 . The %LN was 6.26, ITI was 0.24, and IMR was 0.96 in average. In Spearman's rank correlation test, eGFR was associated with %LN (correlation coefficient -0.242, p=0.07). The %LN of patients with ESRD was significantly higher than that of patients without ESRD ( 7.99 vs 5.48, p=0.001). Conclusions: The lumen of ITAs of patients with ESRD was significantly narrower than that of patients without ESRD.

Abstract MP30: Chronic Kidney Disease Progression and Risk of End-Stage Renal Disease: The Use of Change in Novel Kidney Filtration Markers

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Casey M Rebholz ◽  
Kunihiro Matsushita ◽  
Elizabeth Selvin ◽  
Morgan E Grams ◽  
Josef Coresh
Keyword(s):  
Chronic Kidney Disease ◽  
Clinical Trials ◽  
Kidney Disease ◽  
Cystatin C ◽  
End Stage Renal Disease ◽  
Ckd Progression ◽  
Percent Change ◽  
Stage Renal Disease ◽  
End Stage

Introduction: Chronic kidney disease (CKD) progression assessed by estimated GFR from creatinine (eGFR-Cr) is a risk factor for cardiovascular disease and end-stage renal disease (ESRD) and has been proposed as a surrogate endpoint for clinical trials. It is unclear if CKD progression assessed by change in different filtration markers has similar risk associations with ESRD. Hypothesis: We hypothesized that percent change in novel kidney filtration markers (β 2 -microglobulin and cystatin C) over a 6-year period would be independently associated with increased risk of ESRD during 15 years of follow-up, similar to the risk seen with change in eGFR-Cr. Methods: We conducted prospective analyses of the ARIC study (N=9,703). β 2 -microglobulin, cystatin C, and creatinine were measured at study visits 1 (1990-92) and 2 (1996-98). Incident ESRD (kidney dialysis or transplant) was defined as entry into the U.S. Renal Data System registry between study visit 2 and September 30, 2011. Cox proportional hazards regression was used to estimate the association between percent change in filtration marker and incident ESRD, adjusting for demographics, kidney disease risk factors, and 1 st measurement of the filtration marker. Results: During a median follow-up of 13.1 years, there were 142 incident ESRD cases. Median eGFR-Cr was 97.3 mL/min/1.73 m 2 at 1 st measurement and 89.0 mL/min/1.73 m 2 at 2 nd measurement. Percent change in eGFR-Cr was moderately correlated with percent change in the inverse of β 2 -microglobulin (r = 0.34) and the inverse of cystatin C (r = 0.36). Progression of CKD (10-25% and >25% decline in filtration function) was associated with increased ESRD risk, with novel markers (β 2 -microglobulin, cystatin C) showing an association at least as strong as the creatinine and eGFR-Cr estimates (Table). Conclusions: CKD progression assessed using novel filtration markers is independently associated with ESRD risk, suggesting the potential utility of measuring change in β 2 -microglobulin and cystatin C in clinical trials.

Impact of statin on long-term outcome among patients with end-stage renal disease with acute myocardial infarction (AMI): a nationwide case–control study

2021 ◽  
pp. postgradmedj-2019-137292
Author(s):  
Feng-You Kuo ◽  
Wei-Chun Huang ◽  
Pei-Ling Tang ◽  
Chin-Chang Cheng ◽  
Cheng-Hung Chiang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Survival Rate ◽  
Statin Therapy ◽  
End Stage Renal Disease ◽  
Term Survival ◽  
Receptor Blockers ◽  
Stage Renal Disease ◽  
End Stage ◽  
Statin Use

BackgroundUse of statin has been associated with reduced risk of cardiovascular diseases events and mortality. However, in patients with end-stage renal disease (ESRD), the protective effects of statin are controversial. To evaluate the impact of chronic statin use on clinical outcomes of patients with acute myocardial infarction (AMI) with ESRD.MethodsWe enrolled 8056 patients with ESRD who were initially diagnosed and admitted for first AMI from Taiwan’s National Health Insurance Research Database. Of which, 2134 patients underwent statin therapy. We randomly selected and use age, sex, hypertension, diabetes mellitus (DM), peripheral vascular diseases (PVD), heart failure (HF), cerebrovascular accidents (CVA), chronic obstructive pulmonary disease, matched with the study group as controls (non-stain user). We compared the effects of statin use in term of all-cause death among patients with AMI with ESRD.ResultsStatin use resulted in a significantly higher survival rate in patients ith AMI with ESRD compared with non-statin users. After adjusted the comorbidities the male patients and patients with DM, PVD, HF and CVA had lower long-term survival rate (all p<0.001). Patients who underwent percutaneous coronary intervention (p<0.001), ACE inhibitors/angiotensin II receptor blockers (p<0.001), β receptor blockers (p<0.001) and statin therapy (p=0.007) had better long-term survival rate. Patients with AMI with ESRD on statin therapy exhibited a significantly lower risk of mortality compared with non-statin users (p<0.0001).ConclusionAmong patients with ESRD with AMI, statin therapy was associated with reduced all-cause mortality.

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