scholarly journals Thyroid Hormone Abnormalities in Hemodialyzed Patients: Low Triiodothyronine As Well As High Reverse Triiodothyronine Are Associated With Increased Mortality

2012 ◽  
pp. 495-501 ◽  
Author(s):  
J. HORÁČEK ◽  
S. DUSILOVÁ SULKOVÁ ◽  
M. KUBIŠOVÁ ◽  
R. ŠAFRÁNEK ◽  
E. MALÍŘOVÁ ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Reference Range ◽  
Rank Test ◽  
Nonthyroidal Illness ◽  
Log Rank Test ◽  
Low T3 ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact ◽  
Esrd Patients

Numerous abnormalities of thyroid hormones in end-stage renal disease (ESRD) have been described. Our aim was to analyze the impact of these abnormalities on survival. In 167 hemodialyzed ESRD patients, TSH and thyroid hormone levels (T4, fT4, T3, fT3, rT3) were determined. The patients were then prospectively followed up for up to 5 years and the possible impact of any observed abnormalities on their mortality was studied. Only 16.8 % patients had all six tests within the reference range. The pattern of nonthyroidal illness syndrome was found in 56.3 %. Low T3 was particularly common (44.3 %), and clearly associated with increased 6- and 12-month mortality and decreased overall survival (log rank test, P=0.007). Independent of T3 levels (Spearman correlation, NS), increased rT3 was more frequently observed (9.9 %) than expected from the literature, and was also related to increased mortality and decreased survival (log rank test, P=0.021). Increased rT3 may be more common in ESRD patients than previously described, and together with decreased T3 it may serve as an indicator of poor prognosis in subsequent months.

Abstract 347: End-Stage Renal Disease (ESRD) Patients Undergoing Hemodialysis Have Higher Possibility of Return of Spontaneous Circulation (ROSC) During Out-Hospital Cardiac Arrest (OHCA) and Non-Inferior Short-Term Survival: A Nationwide Population Cohort Study in Taiwan

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Ming-Shun Hsieh ◽  
Chorng-Kuang How ◽  
Pau-Chung Chen
Keyword(s):  
Incidence Rate ◽  
End Stage Renal Disease ◽  
Spontaneous Circulation ◽  
Rank Test ◽  
Short Term ◽  
Log Rank Test ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Hospital Cardiac Arrest

Objective: To compare the incidence rate of return of spontaneous circulation (ROSC) between end-stage renal disease (ESRD) patients undergoing hemodialysis and non-ESRD patients after out-hospital cardiac arrest (OHCA) and subsequent hospital outcomes. Participants and Methods: We enrolled a cohort of 101,876 ESRD patients undergoing hemodialysis between 2000 and 2010 years. After matching for age and gender, an equal number of non-ESRD patients were enrolled to serve as the comparison cohort. We compared the incidence rate of OHCA and subsequent ROSC between the two cohorts. Hazard ratios (HRs) with 95% confidence interval (CI) of OHCA incidence rate were calculated using the Cox proportional hazards regression model. Chi-square test was conducted to compare the incidence rate of ROSC between the two cohorts. Multi-variate analysis with logistic regression was conducted to calculate the odds ratio (OR) of ROSC for different variables. Kaplan-Meier analysis with log-rank test was conducted to determine the difference of survival rate after ROSC between the two cohorts. Results: During the median follow-up of 3.71 and 5.65 years for ESRD and non-ESRD patients, there were 2563 (2.51%) and 1125 (1.10%) OHCA events, respectively. The condition of ESRD undergoing hemodialysis presented as an risk factor to develop OHCA compared with non-ESRD patients (adjusted HR = 2.11, 95% CI 1.89-2.36, P <0.0001 ). Within these OHCA patients with ESRD and non-ESRD, 1085 of 2563 (42.33%) and 202 of 1125 (17.96%) patients got ROSC. In the multivariate analysis with logistic regression, ESRD under hemodialysis presented to be a protective factor for ROSC (adjusted OR = 2.47, 95% CI 1.90-3.21, P <0.0001). In the further Kaplain-Meier analysis with log-rank test, the ESRD patients with OHCA and subsequent ROSC had a better 30-day hospital survival rate compared with the non-ESRD patients. Conclusion: Although, ESRD patients undergoing hemodialysis had a higher incidence rate of OHCA compared with non-ESRD patients. They had a higher possibility to get ROSC and had a better short-term hospital outcome. This observation may be explained by the training of vascular compliance during regular hemodialysis.

P0273THE EFFECT OF END STAGE RENAL DISEASE AND RENAL REPLACEMENT THERAPY ON B LYMPHOCYTE SUBPOPULATIONS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Dimitra Vasileia Daikidou ◽  
MARIA STANGOU ◽  
Erasmia Sampani ◽  
Vasiliki Nikolaidou ◽  
Despoina Asouchidou ◽  
...  
Keyword(s):  
B Cells ◽  
Renal Replacement Therapy ◽  
Renal Disease ◽  
B Cell ◽  
Replacement Therapy ◽  
End Stage Renal Disease ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact ◽  
Esrd Patients

Abstract Background and Aims End-stage renal disease (ESRD) is linked to immunodeficiency, which makes a significant contribution to morbidity and mortality. Disturbances in innate and adaptive immunity have been described in patients on dialysis, although their association with the therapy itself is yet to be defined. The present study aimed to assess the impact of dialysis on B cell subpopulations Method B cells (CD19+) and their subsets B1a (CD19+CD5+), naive (CD19+CD27−), memory (CD19+CD27+), (CD19+BAFFR+) and (CD19+IgM+), were quantified using flow-cytometry of in the peripheral blood of ESRD patients, the first day on dialysis (T0), and repeated 6 months later (T6). The results were compared to age-matched healthy control group. Exclusion criteria were age &lt;18 or&gt;75 years, active autoimmune or chronic inflammatory disease, medical history of malignancy, corticosteroids or immunosuppresive treatment for the last 12 months Results Pre dialysis ESRD patients had reduced lymphocyte count (1527±646μ/L vs. 2459±520μ/L, p&lt;0.001) and B cell (CD19+) count (82.7±59.5μ/L vs. 177.6±73.8μ/L, p&lt;0.001) compared to controls, whereas the percentages of B cell subsets were not particularly affected, except for B1a subset which presented a significant increase (4.1±3.6% vs. 0.7±0.7% p&lt;0.001). In 17 patients who had a follow-up sample 6 months later, the percentage of most subsets was reduced (CD19+CD5+: 1.02±0.8% from 3.6±4.6%, p=0.015, Naive: 40±22.3% from 61±17.4%, p=0.001, CD19+BAFF+:75.8±12.6% from 82.1±9.1%, p=0.04,), apart from memory B cells percentage, which was increased (49.4±52.1% from 32,9±35,5%, p=0.01) and CD19+ IgM+ percentage, which was unaffected . Conclusion A significant reduction of almost all subsets of B cells was noticed in patients with ESRD on pre-dialysis stage. Furthermore, the initiation of renal replacement therapy may be linked to further alterations in B cells subpopulations, especially at their early stages.

P1488RECOVERY OF LOW TRIIODOTHYRONINE CAN IMPROVE MORTALITY IN HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Hong Joo Lee
Keyword(s):  
Thyroid Stimulating Hormone ◽  
Normal Group ◽  
Free T4 ◽  
Low T3 ◽  
All Cause Mortality ◽  
Tertiary Hospitals ◽  
Recovery Group ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background and Aims Low circulating triiodothyronine (T3) levels are the most frequently encountered thyroid functional test derangement in end-stage renal disease (ESRD) patients on hemodialysis. Low T3 is known as independent predictive value for all-cause mortality and, particularly, for cardiovascular-related death in patients with ESRD on hemodialysis. This study investigated that recovery of low T3 level to normal can lower mortality in ESRD patients on hemodialysis. Method We have constructed the 500 K-cohort of ESRD patients attending the hemodialysis center of 6 tertiary hospitals of South Korea to evaluate the mortality of the ESRD patients since 2016. From this prospective cohort, we invited patients with ESRD from June 2016 to May 2019 The participants were divided into four groups based on the change of the T3 level: normal group showed the normal T3 continuously, low group showed the low T3 continuously, recovery group showed the low T3 change to normal and decrease group showed the normal T3 change to low. We evaluate relationships between change of the T3 level and mortality. Statistical analysis was carried out by using SPSS.  Results Of the total 500 patients in K-cohort, 333 patients were enrolled with detailed thyroid hormone profile including T3 level. 167 (50.2 %) patients out of the 333 patients showed low T3 level initially. Normal group include 126 patients(37.8%), low group include 135 patients(40.5%), recovery group include 32 patients(9.6%) and decrease group include 40 patients(12.0%). Patients with the low T3 level were older and more diabetic compare to those with normal T3 level. They had lower K-MMSE score than the others, Low T3 group had lower free T4 level but thyroid stimulating hormone(TSH) showed no significant different comparing normal T3 group. The mortality of normal group was lowest and that of decrease group was highest. The mortality of recovery group recovered to similar with that of the normal group and mortality of decrease group was highest. Lowering of T3 level would affect to mortality than low T3 level continuously. Conclusion Therefore, the change of T3 level is significantly associated with the mortality. Recover lower T3 to normal level can lower the mortality.

scholarly journals KENASABAN FOSFAT SERUM, C-REAKTIF PROTEIN DAN FETUIN A DI PASIEN GINJAL TAHAP AKHIR DENGAN HEMODIALISIS

2018 ◽  
Vol 22 (2) ◽  
pp. 187
Author(s):  
Indranila KS ◽  
Heri Winarto ◽  
Purwanto AP
Keyword(s):  
Reference Range ◽  
Serum Phosphate ◽  
Serum Phosphate Level ◽  
Cross Sectional ◽  
Fetuin A ◽  
Hemodialysis Unit ◽  
Spearman Correlation Test ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Patients with end-stage renal disease (ESRD) who undergo hemodialysis have chronic inflammation caused by several factors,including biocompatibility of dialyzer membran. Inflammation will decrease the fetuin A level in serum. The elevation of the markerinflammation (CRP), hyperphosphatemia and decrease of fetuin A level are the risk faktors for vascular calcification. The aim of thisstudy was to know the relationship between serum phosphate, CRP and fetuin A levels in ESRD patients who underwent hemodialysis. Theresearch was carried out by observational cross sectional analytical approach with consecutive sampling on 31 ESRD patients undergoingchronic hemodialysis in the Hemodialysis Unit of the Dr.Kariadi Hospital, by examining levels of CRP by ELISA, serum phosphate byPhosphomolibdate methods and fetuin A by ELISA. The relationships between phosphate serum and CRP, CRP and fetuin A, phosphateserum and fetuin A were analyzed using Spearman correlation test. In this study it was found that 100% of subjects had CRP levels >0.3mg/dL (reference range 0.1-0.3 mg/dL); 61.3% of subjects had serum phosphate >5.1 mg/dL (reference range 2.5-5.1 mg/dL) and allsubjects (100%) had fetuin A levels <0.5 ng/mL (reference range 0.5-1 ng/mL). There was a moderate positive significant correlationbetween serum phosphate and CRP (p=0.024 and r=0.404), there was a strong negative significant correlation between CRP and fetuinA (p=0.000 and r=-0.628). No significant correlation between the phosphate serum and fetuin A (p=0.365 and r=-0.168) was found.Based on this study, it was found that the higher serum phosphate level resulted in a higher CRP and lower fetuin A.

scholarly journals Hemodialysis and Plasma Oxylipin Biotransformation in Peripheral Tissue

Metabolites ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 34
Author(s):  
Tong Liu ◽  
Inci Dogan ◽  
Michael Rothe ◽  
Julius V. Kunz ◽  
Felix Knauf ◽  
...  
Keyword(s):  
Epoxide Hydrolase ◽  
Venous Blood ◽  
Blood Stream ◽  
Arterial Blood ◽  
Cardiovascular Morbidity And Mortality ◽  
Before And After ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact ◽  
Esrd Patients

(1) Background: Factors causing the increased cardiovascular morbidity and mortality in hemodialysis (HD) patients are largely unknown. Oxylipins are a superclass of lipid mediators with potent bioactivities produced from oxygenation of polyunsaturated fatty acids. We previously assessed the impact of HD on oxylipins in arterial blood plasma and found that HD increases several oxylipins. To study the phenomenon further, we now evaluated the differences in arterial and venous blood oxylipins from patients undergoing HD. (2) Methods: We collected arterial and venous blood samples in upper extremities from 12 end-stage renal disease (ESRD) patients before and after HD and measured oxylipins in plasma by LC-MS/MS tandem mass spectrometry. (3) Results: Comparison between cytochrome P450 (CYP), lipoxygenase (LOX), and LOX/CYP ω/(ω-1)-hydroxylase metabolites levels from arterial and venous blood showed no arteriovenous differences before HD but revealed arteriovenous differences in several CYP metabolites immediately after HD. These changes were explained by metabolites in the venous blood stream of the upper limb. Decreased soluble epoxide hydrolase (sEH) activity contributed to the release and accumulation of the CYP metabolites. However, HD did not affect arteriovenous differences of the majority of LOX and LOX/CYP ω/(ω-1)-hydroxylase metabolites. (4) Conclusions: The HD treatment itself causes changes in CYP epoxy metabolites that could have deleterious effects in the circulation.

Exploring the Association between Changes in Dialysis Reimbursement Policies and Care Outcomes of Peritoneal Dialysis

2020 ◽  
Author(s):  
Ray-E Chang ◽  
Shih-Pi Lin ◽  
Feng-Jung Yang ◽  
Robert C. Myrtle
Keyword(s):  
Peritoneal Dialysis ◽  
Cost Effective ◽  
Control Group ◽  
Technical Failure ◽  
Care Providers ◽  
Before And After ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact ◽  
Esrd Patients

Abstract Background: Except for renal transplantation, peritoneal dialysis (PD) is considered to be relatively cost-effective option for end-stage renal disease (ESRD) patients. Less than 7% of ESRD patients receiving PD in Taiwan, and the promising benefits of PD treatment influenced health policy makers to seek ways to encourage PD utilization. The purpose of this study is to evaluate the effect of their policy initiatives.Methods: An observational longitudinal study using a before-and-after analysis was conducted. The propensity score matching technique was employed to match PD patients before and after the introduction of Taiwan’s efforts to encourage PD utilization in ESRD patients, and the change in PD technical failure was analyzed. HD patients were also matched as the control group to assess the impact of Taiwan’s PD utilization encouraging policies on mortality in PD patients. The competing risk regression approach for survival analysis was adopted in our study.Results: The results showed that while the PD encouraging policies had increased the PD utilization, the increase in PD utilization was accompanied by an increase in technique failure and an increase in mortality.Conclusions: The adoption of new treatments which may benefit patients and incentives to change physician practice behaviors require more disciplined and carefully managed implementation efforts. Care providers need to be equipped by adequate training and sufficient manpower as part of the policy package.

The impact of therapeutical intervention on lipid metabolism of end stage renal disease (ESRD) patients

Nutrition ◽  
2008 ◽  
Vol 24 (6) ◽  
pp. 612
Author(s):  
V. Bláha ◽  
E. Mistrík ◽  
S. Dusilová-Sulková ◽  
D. Solichová ◽  
C. Andrýs ◽  
...  
Keyword(s):  
Lipid Metabolism ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact ◽  
Esrd Patients

Neurovascular coupling dysfunction in end-stage renal disease patients related to cognitive impairment

2021 ◽  
pp. 0271678X2110079
Author(s):  
Peng Li ◽  
Junya Mu ◽  
Xueying Ma ◽  
Dun Ding ◽  
Shaohui Ma ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Neurovascular Coupling ◽  
Healthy Controls ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact ◽  
The Relationship ◽  
Esrd Patients

We aimed to investigate the neurovascular coupling (NVC) dysfunction in end-stage renal disease (ESRD) patients related with cognitive impairment. Twenty-five ESRD patients and 22 healthy controls were enrolled. To assess the NVC dysfunctional pattern, resting-state functional MRI and arterial spin labeling were explored to estimate the coupling of spontaneous neuronal activity and cerebral blood perfusion based on amplitude of low-frequency fluctuation (ALFF)-cerebral blood flow (CBF), fractional ALFF (fALFF)-CBF, regional homogeneity (ReHo)-CBF, and degree centrality (DC)-CBF correlation coefficients. Multivariate partial least-squares correlation and mediation analyses were used to evaluate the relationship among NVC dysfunctional pattern, cognitive impairment and clinical characteristics. The NVC dysfunctional patterns in ESRD patients were significantly decreased in 34 brain regions compared with healthy controls. The decreased fALFF-CBF coefficients in the cingulate gyrus (CG) were associated positively with lower kinetic transfer/volume urea (Kt/V) and lower short-term memory scores, and were negatively associated with higher serum urea. The relationship between Kt/V and memory deficits of ESRD patients was partially mediated by the fALFF-CBF alteration of the CG. These findings reveal the NVC dysfunction may be a potential neural mechanism for cognitive impairment in ESRD. The regional NVC dysfunction may mediate the impact of dialysis adequacy on memory function.

scholarly journals Association of thyroid status prior to transition to end-stage renal disease with early dialysis mortality

2018 ◽  
Vol 34 (12) ◽  
pp. 2095-2104 ◽  
Author(s):  
Amy S You ◽  
John J Sim ◽  
Csaba P Kovesdy ◽  
Elani Streja ◽  
Danh V Nguyen ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Dialysis Initiation ◽  
Case Mix ◽  
Thyroid Status ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact ◽  
Esrd Patients ◽  
Tsh Levels

AbstractBackgroundAdvanced chronic kidney disease (CKD) patients, including those receiving dialysis, have a high prevalence of thyroid dysfunction. Although hypothyroidism is associated with higher death risk in end-stage renal disease (ESRD) patients, no studies have examined whether thyroid status in the pre-ESRD period impacts mortality after dialysis initiation.MethodsAmong US veterans with CKD identified from the national Veterans Affairs database that transitioned to dialysis over the period from October 2007 to September 2011, we examined the association of pre-ESRD serum thyrotropin (TSH) levels averaged over the 1-year pre-dialysis (‘prelude’) period with all-cause mortality in the first year following dialysis initiation.ResultsAmong 15 335 patients in the 1-year prelude cohort, TSH levels &gt;5.0 mIU/L were associated with higher mortality in expanded case-mix Cox models (reference: TSH 0.5–5.0 mIU/L): adjusted hazard ratio (aHR) [95% confidence interval (CI) 1.20 (1.07–1.33). Similar findings were observed for TSH &gt;5.0 mIU/L and mortality in the 2- and 5-year cohorts: aHRs (95% CI) 1.11 (1.02–1.21) and 1.15 (1.07–1.24), respectively. Analyses of finer gradations of TSH in the 1-year prelude cohort demonstrated that incrementally higher levels &gt;5.0 mIU/L were associated with increasingly higher mortality in expanded case-mix models (reference: TSH 0.5–3.0 mIU/L): aHRs (95% CI) 1.18 (1.04–1.33) and 1.28 (1.03–1.59) for TSH levels &gt;5.0–10.0 mIU/L and &gt;10.0 mIU/L, respectively. In the 2- and 5-year cohorts, mortality associations persisted most strongly for those with TSH &gt;10.0 mIU/L, particularly after laboratory covariate adjustment.ConclusionsAmong new ESRD patients, there is a dose-dependent relationship between higher pre-ESRD TSH levels &gt;5.0 mIU/L and post-ESRD mortality. Further studies are needed to determine the impact of TSH reduction with thyroid hormone supplementation in this population.

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