Serum Phosphorus and Albumin in Patients Undergoing Peritoneal Dialysis: Interaction and Association With Mortality

Hyperphosphatemia and hypoalbuminemia confer worse clinical outcomes, whether these risk factors interact to predispose to mortality is unclear. In this prospective cohort study, 2,118 patients undergoing incident continuous ambulatory peritoneal dialysis (CAPD) were enrolled and categorized into four groups based on the changing point regarding mortality at 1.5 mmol/L for serum phosphorus and 35 g/L for serum albumin. Risks of all-cause and cardiovascular mortality were examined independently and interactively in overall and subgroups. There was no association between serum phosphorus with all-cause and cardiovascular mortality, but significant interactions (p = 0.02) between phosphorus and albumin existed in overall population. Patients in subgroup with high phosphorus and low albumin were at greater risk of all-cause (HR 1.95, 95%CI 1.27–2.98, p = 0.002) but not cardiovascular mortality (HR 0.37, 95%CI 0.10–1.33, p = 0.13), as compared to those with low phosphorus and high albumin. In contrast, patients with both low parameters had a higher risk of all-cause (HR 1.75, 95%CI 1.22–2.50, p = 0.002) and cardiovascular mortality (HR 1.92, 95%CI 1.07–3.45, p = 0.03). Notably, an elevated risk of both all-cause and cardiovascular mortality was observed in those with low serum albumin, irrespective of phosphorus levels, suggesting low albumin may be useful to identify a higher-risk subgroup of patients undergoing CAPD with different serum phosphorus levels.

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The association of parameters of body composition and laboratory markers with the severity of hypertriglyceridemia-induced pancreatitis

Lipids in Health and Disease ◽

10.1186/s12944-021-01443-7 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Lifang Chen ◽

Yingbao Huang ◽

Huajun Yu ◽

Kehua Pan ◽

Zhao Zhang ◽

...

Keyword(s):

Risk Factors ◽

Body Composition ◽

Adipose Tissue ◽

Serum Albumin ◽

C Reactive Protein ◽

Reactive Protein ◽

Apolipoprotein A ◽

Laboratory Markers ◽

Subcutaneous Adipose ◽

Low Serum

AbstractBackgroundHypertriglyceridemia has arisen as the third leading cause of acute pancreatitis. This study aimed at exploring the association between the severity of hypertriglyceridemia-induced pancreatitis (HTGP) and computed tomography (CT)-based body composition parameters and laboratory markers.MethodsLaboratory and clinical parameters were collected from 242 patients with HTGP between 2017 and 2020. Severity of HTGP was evaluated by original or modified CT severity index. Body composition parameters such as area and radiodensity of muscle, subcutaneous adipose tissue and visceral adipose tissue were calculated by CT at the level of third lumbar vertebra. Parameters were compared between mild and moderately severe to severe HTGP. Uni-variate and multi-variate Logistic regression analyses were employed to assess the risk factors of the severity of HTGP.ResultsSeventy patients (28.9%) presented with mild HTGP. Body mass index, waist circumference and all CT-based body composition parameters differed between male and female patients. None was associated with the severity of HTGP, neither in males nor in females. Receiver operating characteristic curves showed that areas under the curves of apolipoprotein A-I and albumin to predict the severity of HTGP were 0.786 and 0.759, respectively (allP < 0.001). Uni-variate and further multi-variate Logistic regression analysis confirmed that low serum albumin (< 35 g/L,P = 0.004, OR = 3.362, 95%CI = 1.492–8.823) and apolipoprotein A-I (< 1.1 g/L,P < 0.001, OR = 5.126, 95%CI = 2.348–11.195), as well as high C-reactive protein (> 90 mg/L,P = 0.005, OR = 3.061, 95%CI = 1.407–6.659) and lipase (P = 0.033, OR = 2.283, 95%CI = 1.070–4.873) were risk factors of moderately severe to severe HTGP. Levels of albumin, apolipoprotein A-I, C-reactive protein and lipase were also associated with the length of hospital stay (allP < 0.05). Besides, low serum albumin, low-density lipoprotein cholesterol and high radiodensity of subcutaneous adipose tissue were significant risk factors of pancreatic necrosis in patients with HTGP (allP < 0.05).ConclusionsLow serum albumin and apolipoprotein A-I, and high C-reactive protein and lipase upon admission were associated with a more severe type of HTGP and longer hospital stay for these patients. Albumin and apolipoprotein A-I may serve as novel biomarkers for the severity of HTGP. However, none of the body composition parameters was associated with the severity of HTGP.

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FC 100ASSOCIATION OF SINGLE AND SERIAL MEASURES OF SERUM PHOSPHORUS WITH ADVERSE OUTCOMES IN PATIENTS ON PERITONEAL DIALYSIS: RESULTS FROM THE INTERNATIONAL PDOPPS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab141.003 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Marcelo Lopes ◽

Angelo Karaboyas ◽

David W Johnson ◽

Talerngsak Kanjanabuch ◽

Martin Wilkie ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Adverse Outcomes ◽

Serum Phosphorus ◽

Target Range ◽

Recent Measurement ◽

Baseline Serum ◽

All Cause Mortality ◽

Serial Measurements ◽

Phosphorus Levels

Abstract Background and Aims While it has been established that high serum phosphorus is associated with mortality in hemodialysis (HD) patients, there is limited evidence in the peritoneal dialysis (PD) setting. We evaluated the association of serum phosphorus with mortality and major adverse cardiovascular events (MACE) in patients on PD, and investigated various parameterizations using single and serial measurements of serum phosphorus. Method We utilized data from 7 countries in phase 1 (2014-2017) of the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS): Australia, Canada, Japan, New Zealand, Thailand, the UK, and the US. We investigated the association of serum phosphorus and 3 outcomes: all-cause mortality, cardiovascular (CV) mortality, and MACE (CV mortality + non-fatal angina, myocardial infarction, stroke, and heart failure). We parameterized serum phosphorus using 4 different methods: (1) single measurement of baseline serum phosphorus [most recent measurement during 6-month run-in period]; (2) mean serum phosphorus over a 6-month run-in period; (3) number of months (over the past 6 months) with serum phosphorus above the target range (>4.5 mg/dL); (4) mean area-under-the-curve (AUC), calculated as the average amount of time spent with serum phosphorus >4.5 mg/dL multiplied by the extent to which this threshold was exceeded over 6 months. Cox regression was used to estimate the association between each of these 4 exposures with the time-to-event outcomes, in models thoroughly adjusted for possible confounders. Follow-up began after the 6-month run-in period and continued until the outcome occurred, 7 days after leaving the facility due to transfer or change in kidney replacement therapy modality, loss to follow-up, or end of study phase (whichever event occurred first). Results Our sample consisted of 5904 patients who were on PD. Those with higher serum phosphorus levels were younger and had lower hemoglobin levels. Compared to patients with serum phosphorus ≥3.5 to <4.5 mg/dL, we found an all-cause mortality hazard ratio (HR) of 1.62 (95% CI: 1.19, 2.20) for patients with serum phosphorus ≥ 7 mg/dL. Strong associations were also observed using serial phosphorus measures [Table]. For example, compared to the reference group of AUC=0, the HR (95% CI) of death was 1.49 (1.10, 2.00) for AUC >1 to 2; and 1.67 (1.15, 2.41) for AUC >2. Akaike Information Criteria (AIC) results showed that, among the 4 exposures, AUC was the strongest predictor of all-cause mortality, and the single phosphorus measure was the weakest predictor. Associations between serum phosphorus and adverse outcomes were generally stronger for CV death and MACE than for all-cause mortality [Table]. Conclusion As seen in HD patients, this analysis demonstrates that serum phosphorus is a strong predictor of adverse outcomes in patients on PD. When considering serial measurements of serum phosphorus, rates of adverse events began to rise at phosphorus levels >4.5 mg/dL. As recommended by KDIGO guidelines, serial measurements that consider a history of serum phosphorus excursions >4.5 mg/dL should be considered when assessing risks of adverse outcomes.

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Serum albumin and von Willebrand factor: possible markers for early detection of vascular damage in children undergoing peritoneal dialysis

Clinical & Investigative Medicine ◽

10.25011/cim.v39i4.27090 ◽

2016 ◽

Vol 39 (4) ◽

pp. 111 ◽

Cited By ~ 4

Author(s):

Nuran Cetın ◽

Nadide M Sav ◽

Duran Karabel ◽

Ali Yildirim ◽

Bilal Yıldız

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Early Detection ◽

Serum Albumin ◽

Von Willebrand Factor ◽

Independent Predictor ◽

Left Ventricular ◽

Dialysis Patients ◽

Von Willebrand ◽

Willebrand Factor

Purpose: Cardiovascular diseases are the main causes of morbidity and mortality in children with end-stage renal disease and the relationships among several relevant potential biomarkers were investigated in pediatric peritoneal dialysis patients. Methods: Serum homocysteine, von Willebrand factor (vWF), apolipoproteins A and B, lipoprotein-a, high sensitive-CRP, hemoglobin, phosphorus and parathyroid hormone (PTH) levels, systolic (SBP) and diastolic (DBP) blood pressure, carotid intima-media thickness (cIMT) and left ventricular mass index (LVMI) were measured in 21 pediatric peritoneal dialysis patients and control subjects. Results: All risk factors were higher in patients than controls. LVMI values were negatively correlated with hemoglobin and positively correlated with PTH and phosphorus levels (p=0.007, r= - 0.573; p=0.013, r= 0.532 and p=0.035, r= 0.461, respectively). cIMT was negatively associated with serum albumin and positively correlated with vWF levels and with SBP and DBP (p=0.006, r= - 0.578; p=0.039, r= 0.453; p=0.02, r= 0.503; p=0.024, r= 0.491, respectively). Robust regression analyses showed that hemoglobin was an independent predictor of LVMI and serum albumin was an independent predictor of cIMT. Conclusion: Only uremia-related factors were independent risk factors for predicting LVMI and cIMT. Hemoglobin level may be a critical factor in the development of left ventricular hypertrophy; therefore, effective treatment of anemia is crucial. Low serum albumin and high hsCRP and vWF levels, and their correlations with cIMT, indicate these patients could be at risk of developing malnutrition–inflammation–atherosclerosis syndrome and suggest that serum albumin and vWF levels may be useful markers for early detection of vascular damage.

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Subclinical Peripheral Artery Disease in Patients Undergoing Peritoneal Dialysis: Risk Factors and Outcome

Peritoneal Dialysis International ◽

10.1177/089686080902900110 ◽

2009 ◽

Vol 29 (1) ◽

pp. 64-71 ◽

Cited By ~ 21

Author(s):

Jiung-Hsiun Liu ◽

Hsin-Hung Lin ◽

Ya-Fei Yang ◽

Yao-Lung Liu ◽

Huey-Liang Kuo ◽

...

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Serum Albumin ◽

Peripheral Artery Disease ◽

Serum Triglyceride ◽

Advanced Age ◽

Peripheral Artery ◽

Technique Survival ◽

Artery Disease ◽

Highly Correlated

Background Peripheral artery disease (PAD) is highly prevalent among patients in end-stage renal disease. The ankle–brachial index (ABI) is believed to be highly correlated with the subclinical PAD of lower extremities but little is known about the associated risk factors and outcome for PAD and ABI in patients on peritoneal dialysis (PD). Methods We performed a cohort study of 153 patients from a single center receiving stable PD for more than 3 months. These patients were screened for subclinical PAD using the ABI measurement. The ABI was measured and a ratio of <0.9 was considered abnormal. Clinical outcomes included actuarial patient and technique survival in this study. Results 30 patients were classified into a subclinical PAD group. The prevalence of PAD (subclinical and overt) in our PD center was 19.61% (30/153). Advanced age, preexisting diabetes, preexisting cardiovascular and/or cerebrovascular disease (CVD), lower renal Kt/V urea, lower renal creatinine clearance (WCrCl), lower serum albumin level, and higher serum triglyceride level were risk factors for PAD in our PD center. Bivariate analysis showed that ABI was positively correlated with residual renal Kt/V urea and WCrCl, but was not correlated with peritoneal Kt/V urea and WCrCl. Patient and technique survival rates were significantly lower in the low ABI group than in the normal ABI group. Conclusions ABI is highly correlated with advanced age, preexisting diabetes, preexisting CVD, serum albumin, serum triglyceride, and residual renal clearance in PD patients. Also, lower ABI is independently associated with a high risk of patient mortality and PD technique failure.

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Assessing Dietary Phosphorus Intake and Serum Phosphorus in Adults with Liver Conditions: NHANES 2015–2016

Current Developments in Nutrition ◽

10.1093/cdn/nzaa044_040 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 341-341

Author(s):

Sowmiya Muthuraju ◽

Derek Miketinas

Keyword(s):

Liver Cancer ◽

Cross Sectional Study ◽

Serum Phosphorus ◽

Cross Sectional ◽

Funding Sources ◽

Dietary Phosphorus ◽

Usual Intake ◽

Low Phosphorus ◽

Phosphorus Intake ◽

Phosphorus Levels

Abstract Objectives Patients with liver conditions may have increased phosphorus turnover which can increase the risk of severe hypophosphatemia and other complications. The objective of this cross-sectional study was to quantify the usual intake of phosphorus, assess serum phosphorus (SP) levels across levels of liver conditions, and to estimate and assess the odds for having critically low phosphorus levels across adults with and without liver conditions. Methods Data were obtained from the NHANES 2015–2016 cycle. Adults were divided into four groups based on self-reported responses from the NHANES medical history questionnaire: liver cancer (LC), unspecified current liver condition (CLC), unspecified resolved liver condition (RLC), and no liver condition. Usual intake was estimated using the NCI method and all analyses were adjusted to account for the complex, multistage, probability sampling design. Results Usual phosphorus intake was highest in participants with RLC (1399 ± 26.5 mg) and lowest in participants with LC (1267 ± 140.7 mg). Although the percentage of those meeting the EAR for phosphorus was high (>95%), SP levels are lowest in participants with LC. SP levels differed slightly across liver conditions: participants with LC had a SP level of 1.0 ± 0.07 mmol/L, while participants with CLC, RLC, or no liver conditions had SP levels of 1.2 ± 0.01 mmol/L, 1.2 ± 0.01 mmol/L, and 1.2 ± 0.02 mmol/L, respectively. Participants with CLC had a usual phosphorus intake of 1350 ± 49.6 mg, and those who had no liver conditions had a usual phosphorus intake of 1387 ± 18.5 mg. The odds for normal phosphorus levels in participants with LC was low (Odds = 0.06; 95% CI: 0.01–0.45); the odds for CLC participants having normal SP levels was 1.6 (95% CI: 1.2–2.15); the odds for normal SP levels in participants with RLC were 2.2 (95% CI: 1.3–3.75), and the odds for normal SP in participants with no liver conditions odds for low were 1.9, (95% CI: 1.71–2.14). Conclusions These results indicate that patients with liver cancer are at higher risk of hypophosphatemia, and that phosphorus recommendations for patients with liver cancer may need to be adjusted. However, the variability in this subpopulation with liver cancer is high and warrants further investigation. Funding Sources None.

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End-Stage Renal Disease Patients with Low Serum Albumin: Is Peritoneal Dialysis an Option?

Peritoneal Dialysis International ◽

10.3747/pdi.2018.00204 ◽

2019 ◽

Vol 39 (6) ◽

pp. 562-567 ◽

Cited By ~ 1

Author(s):

Tripti Singh ◽

Brad C. Astor ◽

Sana Waheed

Keyword(s):

Peritoneal Dialysis ◽

Renal Disease ◽

Serum Albumin ◽

End Stage Renal Disease ◽

Chronic Dialysis ◽

Lower Mortality ◽

Dialysis Modality ◽

Stage Renal Disease ◽

End Stage ◽

Low Serum

Introduction Low serum albumin is associated with high mortality in patients with end-stage renal disease (ESRD) on chronic dialysis. Clinicians are reluctant to offer peritoneal dialysis (PD) as an option for dialysis for patients with low serum albumin due to concerns of loss of albumin with PD, but evidence supporting differences in outcomes is limited. We evaluated mortality based on dialysis modality in patients with very low serum albumin (< 2.5 g/dL). Methods We analyzed United States Renal Data System (USRDS) data from 2010 to 2015 to assess mortality by modality adjusted for age, sex, race, employment, number of comorbidities, and year of dialysis initiation. Results Low serum albumin (< 2.5 g/dL) was present in 78,625 (19.9%) of 395,656 patients with ESRD on chronic dialysis. Patients with low serum albumin were less likely to use PD as their first modality than those with higher albumin (3.1% vs 10.9%; p < 0.001). Use of PD was associated with lower mortality compared with hemodialysis (HD) (hazard ratio [HR] = 0.88, 95% confidence interval [CI] 0.81 – 0.95, p < 0.05) in patients with low serum albumin. This difference was more pronounced in patients who had glomerulonephritis (HR = 0.72) or hypertension (HR = 0.81) than in those with end-stage renal disease (ESRD) due to diabetes mellitus or other causes. Conclusion Peritoneal dialysis is less likely to be the first dialysis modality in patients with low serum albumin requiring dialysis. However, PD is associated with lower mortality than HD in patients with low serum albumin on dialysis. We recommend advocating the use of PD in patients with low serum albumin.

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P0766ACUTE KIDNEY INJURY INCREASES THE RISK OF PROGRESSION OF RENAL DISEASE AFTER CARDIAC SURGERY : A SINGLE CENTER EXPERIENCE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0766 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Mahesh Kota

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Cardiac Surgery ◽

Renal Disease ◽

Serum Albumin ◽

Renal Dysfunction ◽

Study Group ◽

Protein Loss ◽

Progression Of Renal Disease ◽

Low Serum

Abstract Background and Aims With increasing global burden of cardiovascular diseases and advances in managing them, the number of cardiac surgeries performed in India has been increasing in the last couple of decades.A lot of western data from the last 5 to 10 years say that AKI episodes can cause significant renal damage and progress to chronic kidney disease (CKD) ,however the association between acute kidney injury (AKI) and chronic kidney disease (CKD) remains elusive in cardiac surgery. We investigated the association between postoperative AKI and CKD development, emphasizing the role of AKI in post cardiac surgery patients. Method We observed the incidence of cardiac surgery associated AKI (CSA-AKI), determinants of progressive kidney disease after CSA-AKI and followed the patients with CSA-AKI for three months to find out the incidence of CKD or progressive renal dysfunction. Results 150 consecutive post cardiac surgery patients were included in the study. CSA-AKI incidence was 35.4%[Figure 1].Incidence of AKI was significant with prior AKI episodes(P<0.01) and with pre-existing CKD (P<0.01)[Figure 2].Among intraoperative risk factors for CSA-AKI, need for CPB(P-0.01), prolonged pump time(P-0.01), blood transfusion(P-0.04) and ultrafiltration(P-0.01) during surgery were found to be significant[Figure 3,4].Duration of ICU stay (P<0.01), hospital stay (P<0.01) and death rate (P-0.04) was higher in patients with AKI[Table 1]. Out of 53 patients who developed CSA-AKI, follow up for the progression of renal disease was done for 50 patients, as 3 patients with AKI died during hospital stay. Progressive renal dysfunction (new development of CKD or progressive CKD ) after 90 days was seen in 48% of patients with CSA-AKI. All the risk factors for the progression of renal disease after AKI like increased age, low serum albumin, presence of hypertension, diabetes mellitus, protein loss in urine, severe AKI(KDIGO stage>2) and multi factorial AKI was higher in patients who had progressive renal disease after AKI in the study group, however the relation was not statistically significant[Table 2]. Conclusion AKI is not uncommon after cardiac surgery, progressive renal dysfunction was seen in 48% of patients after CSA-AKI and progressive renal dysfunction was common in those with increased age, low serum albumin, presence of hypertension, diabetes mellitus, protein loss in urine, severe AKI(KDIGO stage>2) and multi factorial AKI. Mean age of patients with AKI in the study group was found to be 61±10 years and for NO AKI group mean age was found to be 58±12 years. This variation was not found to be statistically significant. Among other pre-operative risk factors, though there was some difference in percentage for many risk factors, but the percentage variation was quite significant for subjects with prior AKI episodes and those with existing CKD. The increased incidence of AKI in patients with prior AKI episodes (P<0.01) and in those with pre-existing CKD (P<0.01) was found to be statistically significant. Low socioeconomic status was found to be high in NO AKI group, however this was not found to be statistically significant (P-0.11). When compared to both the groups, duration of stay in ICU (P<0.01), overall duration of hospital stay (P<0.01) and death rate (P-0.04) was higher in AKI group and this variation was found to be statistically significant. All the risk factors for the progression of renal disease after AKI like increased age, low serum albumin, presence of hypertension, diabetes mellitus, protein loss in urine, severe AKI(KDIGO stage>2) and multifactorial AKI was higher in patients who had progressive renal disease after AKI in the study group, however the relation was not statistically significant.

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Risk Factors for Early Mortality in U.S. Peritoneal Dialysis Patients: Impact of Residual Renal Function

Peritoneal Dialysis International ◽

10.1177/089686080202200312 ◽

2002 ◽

Vol 22 (3) ◽

pp. 371-379 ◽

Cited By ~ 45

Author(s):

◽

Michael V. Rocco ◽

Diane L. Frankenfield ◽

Barbara Prowant ◽

Pamela Frederick ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Renal Function ◽

Peritoneal Dialysis ◽

Serum Albumin ◽

Creatinine Clearance ◽

Residual Renal Function ◽

Chronic Peritoneal Dialysis ◽

Dialysis Patients ◽

The Mean

Background Potential risk factors for 1-year mortality, including the peritoneal component of dialysis dose, residual renal function, demographic data, hematocrit, serum albumin, dialysate-to-plasma creatinine ratio, and blood pressure, were examined in a national cohort of peritoneal dialysis patients randomly selected for the Centers for Medicare and Medicaid Services End-Stage Renal Disease (ESRD) Core Indicators Project. Methods The study involved retrospective analysis of a cohort of 1219 patients receiving chronic peritoneal dialysis who were alive on December 31, 1996. Results During the 1-year follow-up period, 275 patients were censored and 200 non censored patients died. Among the 763 patients who had at least one calculable adequacy measure, the mean [± standard deviation (SD)] weekly Kt/V urea was 2.16 ± 0.61 and the mean weekly creatinine clearance was 66.1 ± 24.4 L/1.73 m2. Excluding the 365 patients who were anuric, the mean (±SD) urinary weekly Kt/V urea was 0.64 ± 0.52 (median: 0.51) and the mean (±SD) urinary weekly creatinine clearance was 31.0 ± 23.3 L/1.73 m2 (median: 26.3 L/1.73 m2). By Cox proportional hazard modeling, lower quartiles of renal Kt/V urea were predictive of 1-year mortality; lower quartiles of renal creatinine clearance were of borderline significance for predicting 1-year mortality. The dialysate component of neither the weekly creatinine clearance nor the weekly Kt/V urea were predictive of 1-year mortality. Other predictors of 1-year mortality ( p < 0.01) included lower serum albumin level, older age, and the presence of diabetes mellitus as the cause of ESRD, and, for the creatinine clearance model only, lower diastolic blood pressure. Conclusion Residual renal function is an important predictor of 1-year mortality in chronic peritoneal dialysis patients.

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Changes in serum albumin and other nutritional markers when using sucroferric oxyhydroxide as phosphate binder among hemodialysis patients: a historical cohort study

BMC Nephrology ◽

10.1186/s12882-019-1582-9 ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Kamyar Kalantar-Zadeh ◽

Linda H. Ficociello ◽

Vidhya Parameswaran ◽

Nicolaos V. Athienites ◽

Claudy Mullon ◽

...

Keyword(s):

Serum Albumin ◽

Dietary Intake ◽

Phosphate Binder ◽

Clinical Care ◽

Elevated Serum ◽

Hemodialysis Patients ◽

Serum Phosphorus ◽

Pill Burden ◽

Historical Cohort ◽

Phosphorus Levels

Abstract Background Elevated serum phosphorus concentrations are common among maintenance hemodialysis patients. Protein is a major source of dietary phosphate, but restriction of protein intake can result in hypoalbuminemia and protein-energy wasting. We hypothesized that sucroferric oxyhydroxide (SO), a potent phosphate binder with a low pill burden, may reduce serum phosphorus levels in hemodialysis patients with hypoalbuminemia without adversely impacting albumin levels or dietary intake of protein. Methods We retrospectively examined de-identified data from 79 adult, in-center hemodialysis patients with baseline hypoalbuminemia (≤ 3.5 g/dL) switched to SO as part of routine clinical care for at least 1 year. Temporal changes (3-month intervals from baseline through Q4) in phosphate binder pill burden, serum phosphorous levels, nutritional markers, and equilibrated Kt/V were analyzed. Data from a matched reference group of non-hypoalbuminemic patients (N = 79) switched to SO were also examined. Results SO therapy was associated with a mean reduction of 45.7 and 45.1% in daily phosphate binder pill burden, and a mean reduction of 0.4 mg/dL and 0.51 mg/dL in serum phosphorus levels for the hypoalbuminemic and non-hypoalbuminemic patients, respectively. Hypoalbuminemic patients demonstrated significant increases in mean serum albumin levels from 3.50 mg/dL at baseline to 3.69, 3.74, 3.70, and 3.69 mg/dL during Q1 through Q4, respectively (P < 0.0001), whereas serum albumin levels remained unchanged in the non-hypoalbuminemic group. Conclusions Both hypoalbuminemic and non-hypoalbuminemic patients switching to SO exhibited significant reductions in serum phosphorus concentrations and daily phosphate binder pill burden. Among hypoalbuminemic patients, the initiation of SO therapy was also associated with increases in serum albumin, suggesting therapy may have allowed patients to increase their dietary intake of protein.

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Outcome Predictors of Biopsy-Proven Myeloperoxidase-Anti-Neutrophil Cytoplasmic Antibody-Associated Glomerulonephritis

Frontiers in Immunology ◽

10.3389/fimmu.2020.607261 ◽

2021 ◽

Vol 11 ◽

Author(s):

Yifei Ge ◽

Guang Yang ◽

Xiangbao Yu ◽

Bin Sun ◽

Bo Zhang ◽

...

Keyword(s):

Risk Factors ◽

Serum Albumin ◽

Patient Survival ◽

Significant Risk ◽

Significant Risk Factor ◽

Albumin Level ◽

High Serum ◽

Poor Renal Function ◽

Low Serum

ObjectiveTo determine the prognostic values of histopathologic classification of myeloperoxidase-anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis and other clinical and laboratory features at the time of presentation on renal and patient survival associated with myeloperoxidase-ANCA-associated glomerulonephritis (MPO-ANCA-GN).MethodsA total of 112 patients diagnosed with MPO-ANCA-GN from October 2005 to December 2018 were enrolled. The baseline clinical characteristics, renal histopathological data, and risk factors predictive of renal and patient survival were retrospectively analyzed.ResultsAll 112 patients underwent renal biopsy. Disease in 32 patients was classified as focal, 26 as mixed, 29 as crescentic, and 25 as sclerotic. Over a median follow-up period of 41.5 months, there were 44 patients dialysis-dependent. The renal survival rate was significantly higher in the focal group than the other groups (p < 0.001) and significantly lower in the sclerotic group (p < 0.05). In addition, disease histopathologically classified as sclerotic (p = 0.044), high serum creatinine level (≥320 μmol/L, p < 0.001), low albumin (<30 g/L, p = 0.024) and hemoglobin level (<90 g/L, p = 0.044) were associated with a greater risk of ESRD. After follow-up, 70 (62.5%) of 112 patients survived. Old age (≥60 years, p = 0.018) and low serum albumin (<30 g/L, p = 0.006) was significant risk factor for patient survival.ConclusionAmong patients with MPO-ANCA-GN, those with poor renal function, disease histopathologically classified as sclerotic, and lower albumin and hemoglobin levels were risk factors for ESRD, while older age and low serum albumin level were associated with a greater risk for all-cause mortality.

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