The effect of erythropoietin treatment on glycohemoglobin values in diabetic hemodialysis patients-an examination based on the relationship between glycohemoglobin and glycated albumin-

Introduction: The effect of high serum ferritin levels on long-term mortality in hemodialysis patients is unknown. The relationship between serum ferritin levels and 5-year all-cause mortality in hemodialysis patients was investigated in this study. Methods: A total of 173 prevalent hemodialysis patients were included in this study. The patients were followed for up to 5 years and divided into 3 groups according to time-averaged serum ferritin levels (group 1: serum ferritin <800 ng/mL, group 2: serum ferritin 800–1,500 ng/mL, and group 3: serum ferritin >1,500 ng/mL). Along with the serum ferritin levels, other clinical and laboratory variables that may affect mortality were also included in the Cox proportional-hazards regression analysis. Results: Eighty-one (47%) patients died during the 5-year follow-up period. The median follow-up time was 38 (17.5–60) months. The 5-year survival rates of groups 1, 2, and 3 were 44, 64, and 27%, respectively. In group 3, the survival was lower than in groups 1 and 2 (log-rank test, p = 0.002). In group 1, the mortality was significantly lower than in group 3 (HR [95% CI]: 0.16 [0.05–0.49]; p = 0.001). In group 2, the mortality was also lower than in group 3 (HR [95% CI]: 0.32 [0.12–0.88]; p = 0.026). No significant difference in mortality between groups 1 and 2 was found (HR [95% CI]: 0.49 [0.23–1.04]; p = 0.063). Conclusion: Time-averaged serum ferritin levels >1,500 ng/mL in hemodialysis patients are associated with an increased 5-year all-cause mortality risk.

Download Full-text

The relationship of indoxyl sulfate and p-cresyl sulfate with target cardiovascular proteins in hemodialysis patients

Scientific Reports ◽

10.1038/s41598-021-83383-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ping-Hsun Wu ◽

Yi-Ting Lin ◽

Yi-Wen Chiu ◽

Gabriel Baldanzi ◽

Jiun-Chi Huang ◽

...

Keyword(s):

Hemodialysis Patients ◽

Complement Component ◽

Uremic Toxins ◽

Indoxyl Sulfate ◽

Free Form ◽

Negatively Associated ◽

Coronary Syndrome ◽

Increased Risk ◽

Related Proteins ◽

The Relationship

AbstractProtein-bound uremic toxins (Indoxyl sulfate [IS] and p-cresyl sulfate [PCS]) are both associated with cardiovascular (CV) and all-cause mortality in subjects with chronic kidney disease (CKD). Possible mechanisms have not been elucidated. In hemodialysis patients, we investigated the relationship between the free form of IS and PCS and 181 CV-related proteins. First, IS or PCS concentrations were checked, and high levels were associated with an increased risk of acute coronary syndrome (ACS) in 333 stable HD patients. CV proteins were further quantified by a proximity extension assay. We examined associations between the free form protein-bound uremic toxins and the quantified proteins with correction for multiple testing in the discovery process. In the second step, the independent association was evaluated by multivariable-adjusted models. We rank the CV proteins related to protein-bound uremic toxins by bootstrapped confidence intervals and ascending p-value. Six proteins (signaling lymphocytic activation molecule family member 5, complement component C1q receptor, C–C motif chemokine 15 [CCL15], bleomycin hydrolase, perlecan, and cluster of differentiation 166 antigen) were negatively associated with IS. Fibroblast growth factor 23 [FGF23] was the only CV protein positively associated with IS. Three proteins (complement component C1q receptor, CCL15, and interleukin-1 receptor-like 2) were negatively associated with PCS. Similar findings were obtained after adjusting for classical CV risk factors. However, only higher levels of FGF23 was related to increased risk of ACS. In conclusion, IS and PCS were associated with several CV-related proteins involved in endothelial barrier function, complement system, cell adhesion, phosphate homeostasis, and inflammation. Multiplex proteomics seems to be a promising way to discover novel pathophysiology of the uremic toxin.

Download Full-text

The effect of electroacupuncture on hemodialysis patients with restless legs syndrome (RLS): study protocol for a randomized crossover trial

10.21203/rs.3.rs-32357/v1 ◽

2020 ◽

Author(s):

Jia-Ming Chen ◽

Ping-Fang Chiu ◽

Yu-Jun Chang ◽

Po-Chi Hsu ◽

Chia-Chu Chang ◽

...

Keyword(s):

Restless Legs Syndrome ◽

Rating Scale ◽

Severity Index ◽

Hemodialysis Patients ◽

Restless Legs ◽

The Subject ◽

Group 2 ◽

And Control ◽

The Relationship ◽

Registration Date

Abstract Background The aim of the present study was to evaluate the effects of electroacupuncture (EA) in hemodialysis patients with restless leg syndrome (RLS) by heart rate variability (HRV) monitor. Methods112 subjects who were hemodialysis patients with RLS will be divided into 2 groups: experimental and control. Each subject will receive the treatment relevant to their group 2 times a week for 4 weeks. After 4 weeks of treatment the subject will enter a 2-week washout period, after which the subjects will switch groups. Measurements will include HRV recordings, International Restless Legs Syndrome Rating Scale (IRLSRS) and Insomnia Severity Index (ISI). DiscussionThis study is the first investigation to analyze the relationship between EA and the change of HRV by an objective monitor. If the findings of the current trial are positive, this study will also help support an effective, safe and cheap approach to clinical treatment of this challenging disorder, help foster improved understanding the relationship between RLS and HRV, and ultimately contribute to elucidate the mechanisms of EA. Trial registrationClinicalTrials.gov Identifier: NCT04356794; registration date: April 22, 2020.

Download Full-text

The Relationship of a Novel Marker of Inflammation (Neutrophil-to-Lymphocyte Ratio) to Nutritional Status, Diet and Clinical Outcomes in Hemodialysis Patients

10.25148/etd.fidc007708 ◽

2019 ◽

Author(s):

Janet Diaz Martinez

Keyword(s):

Nutritional Status ◽

Clinical Outcomes ◽

Hemodialysis Patients ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Relationship Of ◽

The Relationship

Download Full-text

Assessment of Hyperglycemia, Hypoglycemia and Inter-Day Glucose Variability Using Continuous Glucose Monitoring among Diabetic Patients on Chronic Hemodialysis

Journal of Clinical Medicine ◽

10.3390/jcm10184116 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4116

Author(s):

Maria Divani ◽

Panagiotis I. Georgianos ◽

Triantafyllos Didangelos ◽

Vassilios Liakopoulos ◽

Kali Makedou ◽

...

Keyword(s):

Continuous Glucose Monitoring ◽

Glycated Albumin ◽

Glucose Monitoring ◽

Area Under The Curve ◽

Glucose Variability ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Diabetic Patients ◽

Lower Efficiency ◽

Target Glucose

Continuous glucose monitoring (CGM) facilitates the assessment of short-term glucose variability and identification of acute excursions of hyper- and hypo-glycemia. Among 37 diabetic hemodialysis patients who underwent 7-day CGM with the iPRO2 device (Medtronic Diabetes, Northridge, CA, USA), we explored the accuracy of glycated albumin (GA) and hemoglobin A1c (HbA1c) in assessing glycemic control, using CGM-derived metrics as the reference standard. In receiver operating characteristic (ROC) analysis, the area under the curve (AUC) in diagnosing a time in the target glucose range of 70–180 mg/dL (TIR70–180) in <50% of readings was higher for GA (AUC: 0.878; 95% confidence interval (CI): 0.728–0.962) as compared to HbA1c (AUC: 0.682; 95% CI: 0.508–0.825) (p < 0.01). The accuracy of GA (AUC: 0.939; 95% CI: 0.808–0.991) in detecting a time above the target glucose range > 250 mg/dL (TAR>250) in >10% of readings did not differ from that of HbA1c (AUC: 0.854; 95% CI: 0.699–0.948) (p = 0.16). GA (AUC: 0.712; 95% CI: 0.539–0.848) and HbA1c (AUC: 0.740; 95% CI: 0.570–0.870) had a similarly lower efficiency in detecting a time below target glucose range < 70 mg/dL (TBR<70) in >1% of readings (p = 0.71). Although the mean glucose levels were similar, the coefficient of variation of glucose recordings (39.2 ± 17.3% vs. 32.0 ± 7.8%, p < 0.001) and TBR<70 (median (range): 5.6% (0, 25.8) vs. 2.8% (0, 17.9)) were higher during the dialysis-on than during the dialysis-off day. In conclusion, the present study shows that among diabetic hemodialysis patients, GA had higher accuracy than HbA1c in detecting a 7-day CGM-derived TIR70–180 < 50%. However, both biomarkers provided an imprecise reflection of acute excursions of hypoglycemia and inter-day glucose variability.

Download Full-text

RELATIONSHIP BETWEEN INTERDIALYTIC WEIGHT GAIN AND PRE HEMODIALYSIS BLOOD PRESSURE IN HEMODIALYSIS PATIENTS

10.36106/gjra/4611884 ◽

2020 ◽

pp. 169-171

Author(s):

M Manasa ◽

Aravind Reddy. Gangula

Keyword(s):

Blood Pressure ◽

Weight Gain ◽

Water Retention ◽

Salt Intake ◽

Hemodialysis Patients ◽

Interdialytic Weight Gain ◽

Stage Renal Disease ◽

End Stage ◽

The Relationship ◽

Esrd Patients

Interdialytic weight gain in patients with hemodialysis depends on fluid, salt intake in interdialytic period and compliance of dialysis patients. In end stage renal disease(ESRD) patients due to decreased and absent residual urine output there is salt and water retention in body which leads to interdialytic weight gain. Overhydration and IDWG is assumed to be the main cause of pre hemodialysis raised blood pressure(BP) in ESRD patients. Here the relationship between IDWG and pre HD blood pressure is studied in 40 hemodialysis patients. We recorded pre HD BP and IDWG in four subsequent hemodialysis sessions for each patient during the period of 2 weeks in patients who are on twice weekly hemodialysis. so, in total we studied 160 hemodialysis sessions. Mean of four pre HD BP is compared with mean of four IDWG for each patient. Then correlation between 40 mean IDWG and 40 mean pre HD BP is studied and also correlation between IDWG and pre HD blood pressure during 160 hemodidlysis sessions studied individually.

Download Full-text