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Böhme T, Noory E, Beschorner U, Jacques B, Bürgelin K, Hofmann V, Nührenberg T, Neumann FJ, Zeller T. Mortality Following Treatment With and Without Paclitaxel-Coated Devices in Dialysis Patients. J Endovasc Ther 2024; 31:248-256. [PMID: 36052426 DOI: 10.1177/15266028221120524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the mortality after treatment with a paclitaxel (PTX)-coated device and with uncoated devices of iliac, femoropopliteal, and below-the-knee lesions in dialysis patients. METHODS Retrospective mortality analysis of dialysis patients with peripheral artery disease who underwent treatment of iliac, femoropopliteal, and/or infrapopliteal lesions with PTX-coated or uncoated devices. RESULTS Between 2010 and 2018, 1125 dialysis patients were treated with iliac and/or femoropopliteal and/or infrapopliteal lesions. In all, 359 patients were selected for this retrospective analysis. Of those, 122 patients were treated with uncoated devices without crossover to a PTX-coated device during follow-up and 237 patients were treated with a PTX-coated device. Mean follow-up time was 27.38±24.76 months (range=0-103). For the entire cohort, the overall mortality was 95.1% after uncoated treatment and 75.9% after PTX treatment (p<0.001). After propensity score matching (n=119), overall mortality was 95.0% after uncoated treatment and 78.2% after PTX treatment (p<0.001). For the entire cohort, multivariate logistic regression analysis revealed age (p=0.002) and critical limb ischemia (p<0.001) as independent predictors for mortality. PTX treatment was a protective factor for mortality (p<0.001). CONCLUSION Mortality in dialysis patients is in general high and higher after use of uncoated devices compared with PTX-coated devices. Mortality predictors were risk factors and disease severity but not PTX treatment. CLINICAL IMPACT After the publication of Katsanos's metaanalyses, the uncertainty regarding PTX device safety in peripheral interventions in patients mainly without end-stage renal insufficiency was initially considerable. The present study for the first time investigates the potential long-term mortality risk of dialysis patients following PTX device treatment of PAD. In contrast to a recent meta-analysis, this real-world study could show a better survival after PTX treatment in comparison to uncoated devices.
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Affiliation(s)
- Tanja Böhme
- Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Elias Noory
- Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Ulrich Beschorner
- Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Börries Jacques
- Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Karlheinz Bürgelin
- Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Vincent Hofmann
- Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Thomas Nührenberg
- Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Thomas Zeller
- Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
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Morooka H, Tanaka A, Inaguma D, Maruyama S. Peripheral artery disease at the time of dialysis initiation and mortality: a prospective observational multicenter study. BMJ Open 2020; 10:e042315. [PMID: 33384396 PMCID: PMC7780557 DOI: 10.1136/bmjopen-2020-042315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Patients with peripheral artery disease (PAD) are reported to have a poorer prognosis than those without PAD. PAD is sometimes found at dialysis initiation, but its influence on the prognosis in these patients has not been investigated. We aimed to compare the mortality rate between patients with PAD at the time of dialysis initiation and those without PAD. DESIGN We undertook an observational prospective multicenter study of patients starting dialysis treatment. Data were collected on patients' sex, age, presence of PAD, medication, medical history and clinical and laboratory data. SETTING Seventeen centers participated in the Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis. PARTICIPANTS A total of 1524 patients with chronic kidney disease started dialysis from October 2011 to September 2013. The patients were followed-up until March 2015. During this time, there were two patients who lost the follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was defined as all-cause mortality. The secondary outcomes were defined as each cause of mortality. RESULTS This study included 1030 men and 492 women with a mean age of 67.50±13.10 years. Of these, 71 had PAD and 1451 did not have PAD. After a median follow-up of 814.5 days, 33.80% of the former group and 17.00% of the latter group had died in March 2015 (p=0.001). After adjusting for confounding factors, PAD at dialysis initiation remained an independent risk factor for mortality (p<0.01). CONCLUSIONS Patients with PAD at the time of dialysis initiation had a poorer prognosis than patients without PAD. Therefore, the presence of PAD in patients starting dialysis should be considered for their monitoring and follow-up.
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Affiliation(s)
- Hikaru Morooka
- Departmnt of Nephrology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Akihito Tanaka
- Departmnt of Nephrology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Daijo Inaguma
- Department of Nephrology, Fujita Health University, Toyoake, Aichi, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Impact of Aortoiliac Stenosis on Graft and Patient Survival in Kidney Transplant Recipients Using the TASC II Classification. Transplantation 2020; 103:2164-2172. [PMID: 30801546 DOI: 10.1097/tp.0000000000002635] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients with end-stage renal disease and aortoiliac stenosis are often considered ineligible for kidney transplantation, although kidney transplantation has been acknowledged as the best therapy for end-stage renal disease. The clinical outcomes of kidney transplantation in patients with aortoiliac stenosis are not well-studied. This study aimed to assess the impact of aortoiliac stenosis on graft and patient survival. METHODS This retrospective, single-center study included kidney transplant recipients transplanted between January 1, 2000, and December 31, 2016, who received contrast-enhanced imaging. Patients with aortoiliac stenosis were classified using the Trans-Atlantic Inter-Society Consensus (TASC) II classification and categorized as having TASC II A/B lesions or having TASC II C/D lesions. Patients without aortoiliac stenosis were functioning as controls. RESULTS A total number of 374 patients was included in this study (n = 88 with TASC II lesions, n = 286 as controls). Death-censored graft survival was similar to the controls. Patient and uncensored graft survival was decreased in patients with TASC II C/D lesions (log-rank test P < 0.001). Patients with TASC II C/D lesions had a higher risk of 90-day mortality (hazard ratio, 3.96; 95% confidence interval, 1.12-14.04). In multivariable analysis, having a TASC II C/D lesion was an independent risk factor for mortality (hazard ratio, 3.25; 95% confidence interval, 1.87-5.67; P < 0.001). Having any TASC II lesion was not a risk factor for graft loss (overall P = 0.282). CONCLUSIONS Kidney transplantation in patients with TASC II A/B is feasible and safe without increased risk of perioperative mortality. TASC II C/D decreases patient survival. Death-censored graft survival is unaffected.
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Lai YH, Lin YL, Wang CH, Kuo CH, Hsu BG. Negative correlation of serum adiponectin level with peripheral artery occlusive disease in hemodialysis patients. Tzu Chi Med J 2020; 32:70-74. [PMID: 32110524 PMCID: PMC7015003 DOI: 10.4103/tcmj.tcmj_19_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 12/24/2018] [Accepted: 01/14/2018] [Indexed: 01/23/2023] Open
Abstract
Objective: Adiponectin is a fat-derived hormone that secretes exclusively by adipocytes and has antiatherosclerotic effects. Peripheral arterial occlusive disease (PAOD) is associated with an increased risk of death in hemodialysis (HD) patients. The aim of this study was to evaluate the relationship between serum adiponectin levels and PAOD by ankle–brachial index (ABI) in HD patients. Materials and Methods: Blood samples were obtained from 100 HD patients. Serum adiponectin levels were measured using a commercial enzyme-linked immunosorbent assay kit. ABI values were measured using the automated oscillometric method (VaSera VS-1000). ABI values that <0.9 were included in the low ABI group. Results: Among the 100 HD patients, 18 of them (18.0%) were in the low ABI group. Compared with patients in the normal ABI group, the patients in the low ABI group had a higher prevalence of diabetes (P = 0.043), older age (P = 0.027), and lower serum adiponectin level (P = 0.003). In addition, the multivariable logistic regression analysis showed that adiponectin (Odds ratio [OR]: 0.927, 95% confidence interval [CI]: 0.867–0.990, P = 0.025) and age (OR: 1.054, 95% CI: 1.002–1.109, P = 0.043) were the independently associated with PAOD in HD patients. Conclusion: In this study, serum adiponectin level was found to be associated with PAOD in HD patients.
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Affiliation(s)
- Yu-Hsien Lai
- Division of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,PhD Program in Pharmacology and Toxicology, Tzu Chi University, Hualien, Taiwan
| | - Yu-Li Lin
- Division of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Chih-Hsien Wang
- Division of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Chiu-Huang Kuo
- Division of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Bang-Gee Hsu
- Division of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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Tian SL, Zhang K, Xu PC. Increased prevalence of peripheral arterial disease in patients with obese sarcopenia undergoing hemodialysis. Exp Ther Med 2018; 15:5148-5152. [PMID: 29805542 DOI: 10.3892/etm.2018.6002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 03/24/2017] [Indexed: 11/05/2022] Open
Abstract
Background peripheral arterial disease (PAD) is a common complication in patients undergoing dialysis, which reduces the quality of life and increases the risk of mortality. Recent literature has documented an association between increased visceral fat (VF) content and a proatherogenic factors in end-stage renal disease. The present study investigated the prevalence of PAD in patients undergoing hemodialysis. PAD was determined as an ankle-brachial index <0.9. Additionally, VF content was determined using multiple frequency bioelectrical impendence analysis. The nutritional status of the patients was evaluated by subjective global assessment and endothelial function was measured by ultrasonographic brachial artery flow-mediated dilatation. Patients divided into two groups (malnourished and non-malnourished) with two further subgroups in each (high VF and low VF content). The prevalence of PAD was identified to be significantly higher in patients with a high VF mass compared with a low VF mass in non-malnourished patients. PAD was significantly more common in malnourished patients compared with non-malnourished patients (P<0.01). The presence of PAD in patients undergoing hemodialysis was identified to be significantly correlated with age, diabetes mellitus (DM) status VF content, malnutrition, serum albumin level, diastolic blood pressure and log C-reactive protein levels. Furthermore, logistic regression analysis determined that age, DM, VF content and malnutrition were significant independent risk factors for PAD in patients undergoing hemodialysis. In conclusion, the results of the present study indicated that obesity and malnutrition act synergistically to increase the risk of PAD in patients undergoing dialysis.
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Affiliation(s)
- Shun-Li Tian
- Department of Geratology, Tianjin Geriatric Institute, Tianjin 300052, P.R. China
| | - Kai Zhang
- Department of Geratology, Tianjin Geriatric Institute, Tianjin 300052, P.R. China
| | - Peng-Cheng Xu
- Division of Nephrology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
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Miguel JB, Matos JPSD, Lugon JR. Ankle-Brachial Index as a Predictor of Mortality in Hemodialysis: A 5-Year Cohort Study. Arq Bras Cardiol 2017; 108:204-211. [PMID: 28443959 PMCID: PMC5389869 DOI: 10.5935/abc.20170026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/02/2016] [Indexed: 12/12/2022] Open
Abstract
Background Abnormal ankle-brachial index (ABI) has been found to be a strong predictor
of mortality in some hemodialysis populations in studies with relatively
short periods of follow-up, lower than 2 years. Objective This study aimed to assess the predictive value of abnormal ABI as a risk
factor for death among patients on maintenance hemodialysis after a 5-year
follow-up. Methods A total of 478 patients on hemodialysis for at least 12 months were included
in the study. ABI measurement was performed using a mercury column
sphygmomanometer and portable Doppler. Patients were divided into 3 groups
according to ABI (low: <0.9; normal: 0.9 to 1.3; and high: >1.3) and
followed for a 60-month period. Results The prevalence rates of low, normal and high ABI were 26.8%, 64.6% and 8.6%,
respectively. The 5-year survival rate was lower in the groups with low ABI
(44.1%, P<0.0001) and high ABI (60.8%, P= 0.025) than in the group with
normal ABI (71.7%). Cox regression was used to evaluate the association
between ABI and mortality, adjusting for potential confounders. Using normal
ABI as reference, a low, but not a high ABI was found to be an independent
risk factor for all-cause mortality (HR2.57; 95% CI, 1.84-3.57 and HR 1.62;
95% CI, 0.93-2.83, respectively). Conclusions long-term survival rates of patients with either low or high ABI were lower
than the one from those with normal ABI. However, after adjustment for
potential confounders, only low ABI persisted as an independent risk factor
for all-cause mortality among hemodialysis patients.
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Skin perfusion pressure predicts mortality in hemodialysis patients: long term follow-up. RENAL REPLACEMENT THERAPY 2016. [DOI: 10.1186/s41100-016-0078-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abe T, Otsubo S, Kimata N, Okajima T, Otani Y, Murakami J, Kaneko I, Miwa N, Mineshima M, Tsuchiya K, Nitta K, Akiba T. Changes in the ankle-brachial blood pressure index among hemodialysis patients. RENAL REPLACEMENT THERAPY 2016. [DOI: 10.1186/s41100-016-0053-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Yang Y, Ning Y, Shang W, Luo R, Li L, Guo S, Xu G, He X, Ge S. Association of peripheral arterial disease with all-cause and cardiovascular mortality in hemodialysis patients: a meta-analysis. BMC Nephrol 2016; 17:195. [PMID: 27887592 PMCID: PMC5124247 DOI: 10.1186/s12882-016-0397-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 11/11/2016] [Indexed: 12/18/2022] Open
Abstract
Background Recent studies have shown an association between peripheral arterial disease (PAD) and increased risk of mortality in hemodialysis (HD) patients; however, the estimates vary widely and are inconsistent. It is necessary to elucidate the degree of mortality risk for PAD patients in HD population. Methods PubMed, EMBASE, Web of Science and Cochrane Library (from inception to September 4th, 2016) were systematically searched for cohort studies assessing the association between PAD and mortality in HD patients. We calculated the pooled risk ratios (RRs) with 95% confidence intervals (CI) of all-cause and cardiovascular (CV) mortality using random effects models. Subgroup analyses were conducted to explore the source of heterogeneity. Results The search identified 2,973 potentially eligible records and 10 studies (n = 32,864) were included. Our meta-analysis revealed that PAD significantly increased the risk of all-cause mortality (RR 2.15, 95 % CI 1.67–2.77, n = 32,864) and CV mortality (RR 2.99, 95 % CI 1.66-5.38, n = 31,794) in HD patients after multivariate adjustment. Subgroup analyses showed the study design and follow-up time might be two sources of heterogeneity. Conclusion PAD may be a prognostic marker of all-cause and CV mortality in HD patients. More attention should be paid to diagnosis and management of PAD in HD patients. Electronic supplementary material The online version of this article (doi:10.1186/s12882-016-0397-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yi Yang
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People's Republic of China
| | - Yong Ning
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People's Republic of China
| | - Weifeng Shang
- Department of Nephrology, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430000, People's Republic of China
| | - Ran Luo
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People's Republic of China
| | - Lixi Li
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People's Republic of China
| | - Shuiming Guo
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People's Republic of China
| | - Gang Xu
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People's Republic of China
| | - Xiaofeng He
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People's Republic of China.
| | - Shuwang Ge
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People's Republic of China
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Zhou Y, Zhang J, Zhang W, Ni Z. Association of adiponectin with peripheral arterial disease and mortality in nondiabetic hemodialysis patients: Long-term follow-up data of 7 years. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 21:50. [PMID: 27904596 PMCID: PMC5121992 DOI: 10.4103/1735-1995.184000] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 01/20/2016] [Accepted: 04/14/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND The relationships between adiponectin and clinical outcomes in hemodialysis (HD) patients remain highly controversial. Meanwhile, the association between adiponectin and the peripheral artery disease (PAD) has not been well studied in HD patients without diabetic mellitus. MATERIALS AND METHODS The ankle-brachial index was measured in HD patients. Adiponectin levels in 105 HD patients were measured by Enzyme-Linked Immunosorbant Assay. RESULTS 105 HD patients were enrolled; 14 (13%) patients had PAD. Using receiver-operating-characteristic (ROC) curve analysis for PAD, adiponectin (area under the curve [AUC] 0.935, 95% confidence interval [CI]: 0.848-0.981, P < 0.001) showed significantly positive predictive value. During follow-up (mean 63 ± 30 months), 34 deaths (32%) occurred. Kaplan-Meier analysis found those patients lower median adiponectin had a significantly poor outcome (P < 0.05), and Cox analysis further confirmed that adiponectin was an independent predictor of overall mortality (hazard ratio [HR], 0.832, 95% CI: 0.696-0.995, P < 0.05). The ROC curve of overall mortality showed that the AUC of adiponectin was 0.719 (95% CI: 0.586-0.813, P < 0.05). In HD patients with PAD, the univariate analysis showed that adiponectin (HR, 0.649, 95% CI: 0.527-0.800, P < 0.001) was also associated with overall mortality. CONCLUSION Decreasing levels of adiponectin were associated with a significant increase in the risk of PAD in HD patients without diabetic mellitus. Furthermore, as the results of our observation period (maximum of 7 years) showed, adiponectin was a predictor of all-cause mortality in HD patients.
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Affiliation(s)
- Yijun Zhou
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiwei Zhang
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weiming Zhang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhaohui Ni
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Hsu YH, Yu HY, Chen HJ, Li TC, Hsu CC, Kao CH. The Risk of Peripheral Arterial Disease after Parathyroidectomy in Patients with End-Stage Renal Disease. PLoS One 2016; 11:e0156863. [PMID: 27284924 PMCID: PMC4902219 DOI: 10.1371/journal.pone.0156863] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/17/2016] [Indexed: 11/21/2022] Open
Abstract
Purpose The changes of the risk of peripheral arterial disease (PAD) in patients with end-stage renal disease after parathyroidectomy are scant. Methods We used a nationwide health insurance claims database to select all dialysis-dependent patients with end-stage renal disease aged 18 years and older for the study population in 2000 to 2006. Of the patients with end-stage renal disease, we selected 947 patients who had undergone parathyroidectomy as the parathyroidectomy group and frequency matched 3746 patients with end-stage renal disease by sex, age, years since the disease diagnosis, and the year of index date as the non-parathyroidectomy group. We used a multivariate Cox proportional hazards regression analysis with the use of a robust sandwich covariance matrix estimate, accounting for the intra-cluster dependence of hospitals or clinics, to measure the risk of peripheral arterial disease for the parathyroidectomy group compared with the non-parathyroidectomy group after adjusting for sex, age, premium-based income, urbanization, and comorbidity. Results The mean post-op follow-up periods were 5.08 and 4.52 years for the parathyroidectomy and non-parathyroidectomy groups, respectively; the incidence density rate of PAD in the PTX group was 12.26 per 1000 person-years, significantly lower than the data in the non-PTX group (24.09 per 1000 person-years, adjusted HR = 0.66, 95% CI = 0.46–0.94). Conclusion Parathyroidectomy is associated with reduced risk of peripheral arterial disease in patients with end-stage renal disease complicated with severe secondary hyperparathyroidism.
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Affiliation(s)
- Yueh-Han Hsu
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
- Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Hui-Yi Yu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yiy, Taiwan
- Department of Sports Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
| | - Chih-Cheng Hsu
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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Ethnic Differences in Prevalence of Peripheral Artery Disease in Patients Undergoing Hemodialysis. J Racial Ethn Health Disparities 2016; 2:275-9. [PMID: 26863457 DOI: 10.1007/s40615-014-0066-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/14/2014] [Accepted: 10/24/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hemodialysis patients experience poor outcomes associated with the presence of atherosclerosis, particularly lower-extremity peripheral artery disease (PAD). Prevalence of PAD is known to vary between ethnic groups; however, no information on ethnic-specific PAD prevalence in a hemodialysis cohort is available. METHODS Data from the Canadian Kidney Dialysis Cohort Study was used in a secondary analysis of 1293 adults starting hemodialysis in three major Canadian centres. PAD diagnosis was determined through structured interview and supplemented by clinical record. Ethnicity was self-reported. RESULTS Overall PAD prevalence was 19.1 % with no significant difference between ethnic groups. Ethnic differences observed in diabetes prevalence in the full hemodialysis group were not present in the subset of PAD patients. CONCLUSIONS The prevalence of PAD in patients undergoing hemodialysis is high, however we found no apparent ethnic differences in prevalence between ethnic groups.
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Zhou Y, Zhang J, Zhu M, Lu R, Wang Y, Ni Z. Plasma Pentraxin 3 Is Closely Associated with Peripheral Arterial Disease in Hemodialysis Patients and Predicts Clinical Outcome: A 6-Year Follow-Up. Blood Purif 2015; 39:266-73. [PMID: 25924996 DOI: 10.1159/000381254] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 02/24/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study is to investigate the value of plasma PTX3 level for assessing peripheral artery disease (PAD) and clinical outcome in hemodialysis (HD) patients. METHODS The ankle-brachial index (ABI) was measured in HD patients. PTX3 levels in 116 HD patients were measured by ELISA. RESULTS Overall, 116 HD patients were enrolled; 21 (18%) patients had PAD. Using the ROC curve analysis for PAD, PTX3 (cut-off value 4.06 ng/ml, AUC 0.901, p < 0.0001) showed a significantly better positive predictive value than hsCRP (cut-off value 3.33 ng/ml, AUC 0.640, p < 0.05). During follow-up (mean 57 ± 26 months), 40 deaths (34%) occurred. Kaplan-Meier analysis found that those patients with elevated PTX3 had a significantly poor outcome (p < 0.0001), and Cox analysis further confirmed that PTX3 was an independent predictor of overall mortality (HR, 1.105, p = 0.03). For prediction of overall mortality, the AUC for PTX3 (cut-off value 3.22 ng/ml, AUC 0.690, p < 0.0001) was close to hsCRP (cut-off value 5.84 ng/ml, AUC 0.620, p < 0.001). CONCLUSIONS For the prediction of PAD in HD patients, the diagnostic sensitivity and specificity of PTX3 were higher than those of hsCRP. Furthermore, PTX3 was also a predictor of all-cause mortality in HD patients. PTX3 may be considered a novel biomarker of inflammation in HD patients.
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Affiliation(s)
- Yijun Zhou
- Department of Nephrology, Shanghai Jiao Tong University, Shanghai, China
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Otani Y, Otsubo S, Kimata N, Takano M, Abe T, Okajima T, Miwa N, Tsuchiya K, Nitta K, Akiba T. Effects of the ankle-brachial blood pressure index and skin perfusion pressure on mortality in hemodialysis patients. Intern Med 2013; 52:2417-21. [PMID: 24190145 DOI: 10.2169/internalmedicine.52.0410] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Clinically, the ankle-brachial blood pressure index (ABI) and skin perfusion pressure (SPP) are used to screen for subclinical peripheral artery disease. However, the association between the SPP and mortality in hemodialysis patients has not been previously reported. We investigated these factors and compared the ABI and SPP in patients receiving hemodialysis. METHODS A total of 102 patients receiving maintenance hemodialysis were enrolled in this study. The ABI was determined using an ABI-form (Colin, Japan). The SPP was measured using a SensiLase(TM) PAD3000 (Kaneka, Osaka, Japan). RESULTS The mean follow-up period was 3.2 ± 1.4 years. A multivariate Cox analysis identified a low ABI (p=0.019) and a low SPP (p=0.047) as being independent predictors of mortality. A receiver operating characteristic (ROC) analysis of the ABI revealed a cutoff point of 1.1 and an area under the curve (AUC) of 0.79, with a sensitivity of 90% and a specificity of 62%. A ROC analysis of the SPP revealed a cutoff point of 54.0 mmHg and an AUC of 0.71, with a sensitivity of 55% and a specificity of 84%. CONCLUSION Both low ABI and SPP values were found to be independent risk factors for mortality among hemodialysis patients. The cutoff point for ABI as a predictor of mortality was 1.1, while that for SPP was 54.0 mmHg.
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Affiliation(s)
- Yumi Otani
- Department of Clinical Engineering, Tokyo Women's Medical University, Japan
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15
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Screening for peripheral artery disease in dialysis patients: an opportunity for early disease detection and timely initiation of appropriate therapeutic measures. Int Urol Nephrol 2011; 43:143-5. [PMID: 21210222 DOI: 10.1007/s11255-010-9892-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Accepted: 12/21/2010] [Indexed: 10/18/2022]
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