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Virtanen J, Heiro M, Koivuviita N, Löyttyniemi E, Järvisalo MJ, Tertti R, Metsärinne K, Hellman T. Survival, cumulative hospital days and infectious complications in urgent-start PD compared with urgent-start HD. Perit Dial Int 2024:8968608241244939. [PMID: 38661183 DOI: 10.1177/08968608241244939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Urgent-start peritoneal dialysis (PD) carries a similar efficacy and safety profile compared to urgent-start haemodialysis (HD) but is only sparsely applied due to resource issues and concerns of complication risks. Furthermore, few data exist on adverse outcomes associated with central venous catheter (CVC) insertions in urgent-start HD patients. Thus, we sought to compare patient and dialysis-related outcomes in patients undergoing urgent-start PD or HD. METHODS All patients initiating urgent-start PD in a tertiary research hospital in 2005-2018 were included in this retrospective, single-centre, comparative study and matched with urgent-start HD patients of similar age and chronic kidney disease aetiology. All urgent-start PDs were initiated within 72 h after catheter insertion, and urgent-start HDs were performed via a CVC. All analyses were performed at 3 months and at 1 year of follow-up, respectively. RESULTS Thirty-three patients who commenced urgent-start PD and 58 matched urgent-start HD control patients were included. Altogether, 26 patients (29%; PD: 36%, HD 24%) died within the 1-year follow-up, and patient survival was similar at 3 months (hazard ratio (HR): 1.15, 95% confidence interval (CI): 0.35-3.81, p = 0.82) and at 1 year of follow-up (HR: 0.64, 95% CI: 0.30-1.39, p = 0.26) between the study groups. There were no differences in the total kidney replacement therapy (KRT)-related infection rate (p = 0.66) or cumulative first-year hospital care days (p = 0.43) between the treatment groups. Altogether, 139 CVCs were inserted during the 1-year follow-up. The number of CVCs per patient was associated with the emergence of blood culture-positive bacteraemia and increased cumulative first-year hospital care days. CONCLUSIONS Patient survival, cumulative first-year hospital care days and total KRT-related infection rate at 3 months and 1-year follow-up are similar between urgent-start PD and urgent-start HD patients. Furthermore, CVC insertion rate is associated with incident blood culture-positive bacteraemia and increased cumulative first-year hospital care days.
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Affiliation(s)
- Jonna Virtanen
- Kidney Center, Department of Internal Medicine, Turku University Hospital and University of Turku, Finland
| | - Maija Heiro
- Department of Internal Medicine, Vaasa Central Hospital and University of Turku, Vaasa, Finland
| | - Niina Koivuviita
- Kidney Center, Department of Internal Medicine, Turku University Hospital and University of Turku, Finland
| | - Eliisa Löyttyniemi
- Department of Biostatistics, University of Turku and Turku University Hospital, Finland
| | - Mikko J Järvisalo
- Kidney Center, Department of Internal Medicine, Turku University Hospital and University of Turku, Finland
- Department of Internal Medicine, Satakunta Central Hospital, Pori, Finland
| | - Risto Tertti
- Department of Internal Medicine, Vaasa Central Hospital and University of Turku, Vaasa, Finland
| | - Kaj Metsärinne
- Kidney Center, Department of Internal Medicine, Turku University Hospital and University of Turku, Finland
| | - Tapio Hellman
- Kidney Center, Department of Internal Medicine, Turku University Hospital and University of Turku, Finland
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Shen Y, Su X, Yu Z, Yan H, Ma D, Xu Y, Yuan J, Ni Z, Gu L, Fang W. Association between sarcopenic obesity and mortality in patients on peritoneal dialysis: a prospective cohort study. Front Med (Lausanne) 2024; 11:1342344. [PMID: 38449887 PMCID: PMC10915053 DOI: 10.3389/fmed.2024.1342344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/06/2024] [Indexed: 03/08/2024] Open
Abstract
Background Whether sarcopenic obesity had unfavorable effect on survival of peritoneal dialysis (PD) patients is unknown. We aimed to investigate the association between sarcopenic obesity and survival in PD patients. Methods This was a prospective observational study. Eligible PD patients from November 2016 to December 2017 were enrolled and followed until August 31, 2023. Sarcopenia was defined following the recommendations of the Asian Working Group for Sarcopenia (AWGS) as low appendicular skeletal muscle mass index (ASMI) and handgrip strength (HGS). Obesity was defined using the percentage of body fat (PBF). Survival analysis was conducted using the Kaplan-Meier and log-rank test. The Cox regression and the cumulative incidence competing risk (CICR) analyzes were used to investigate the association between sarcopenic obesity and all-cause mortality. Results A total of 223 patients were enrolled with 133 (59.6%) males, a median age of 57.5 (44.6, 65.7) years, a median dialysis vintage of 20.3 (6.4, 57.7) months and 48 (21.5%) who had comorbid diabetes mellitus. Among them, 46 (20.6%) patients were sarcopenic, and 25 (11.2%) patients were diagnosed with sarcopenic obesity. After followed up for 51.6 (25.6, 73.9) months, the Kaplan-Meier curve showed the sarcopenic obesity (log-rank = 13.527, p < 0.001) group had significant lower survival rate compared to the nonsarcopenic non-obesity group. For multivariate analysis, the CICR method showed patients with sarcopenic obesity had significantly higher mortality rate (HR: 2.190, 95% CI: 1.011-4.743, p = 0.047) compared to those with nonsarcopenic non-obesity. Conclusion Sarcopenia is not uncommon in PD patients, with a considerable proportion having sarcopenic obesity. There is a significant association between sarcopenic obesity and an increased risk of mortality in PD patients.
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Affiliation(s)
- Yiwei Shen
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Xinyu Su
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Zanzhe Yu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Hao Yan
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Dahua Ma
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Yimei Xu
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Jiangzi Yuan
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Zhaohui Ni
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Leyi Gu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Wei Fang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
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Mussnig S, Krenn S, Hecking M, Wabel P. Assessment of bioimpedance spectroscopy devices: a comparative study and error analysis of gold-plated copper electrodes. Physiol Meas 2024; 45:025001. [PMID: 38237199 DOI: 10.1088/1361-6579/ad205b] [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] [Received: 10/11/2023] [Accepted: 01/18/2024] [Indexed: 02/06/2024]
Abstract
Objective. Bioimpedance spectroscopy (BIS) is a non-invasive diagnostic tool to derive fluid volume compartments from frequency dependent voltage drops in alternating currents by extrapolating to the extracellular resistance (R0) and intracellular resistance (Ri). Here we tested whether a novel BIS device with reusable and adhesive single-use electrodes produces results which are (in various body positions) equivalent to an established system employing only single-use adhesive electrodes.Approach. Two BIS devices ('Cella' and the 'Body Composition Monitor' [BCM]) were compared using four dedicated resistance testboxes and by measuring 40 healthy volunteers.Invivocomparisons included supine wrist-to-ankle (WA) reference measurements and wrist-to-wrist (WW) measurements with pre-gelled silver/silver-chloride (Ag/AgCl) electrodes and WW measurements with reusable gold-plated copper electrodes.Main results. Coefficient of variation were <1% for all testbox measurements with both BIS devices. Accuracy was within ±1% of true resistance variability, a threshold which was only exceeded by the Cella device for all resistances in a testbox designed with a lowR0/Riratio.Invivo, WA-BIS differed significantly between BIS devices (p< 0.001). Reusable WW electrodes exhibited larger resistances than WW-BIS with Ag/AgCl electrodes (R0: 738.36 and 628.69 Ω;Ri: 1508.18 and 1390 Ω) and the relative error varied from 7.6% to 31.1% (R0) and -15.6% to 37.3% (Ri).Significance. Both BIS devices produced equivalent resistances measurements but different estimates of body composition bothinsilicoand in WA setupsinvivo, suggesting that the devices should not be used interchangeably. Employing WW reusable electrodes as opposed to WA and WW measurement setups with pre-gelled Ag/AgCl electrodes seems to be associated with measurement variations that are too large for safe clinical use. We recommend further investigations of measurement errors originating from electrode material and current path.
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Affiliation(s)
- Sebastian Mussnig
- Medical University of Vienna, Department of Medicine III, Division for Nephrology and Dialysis, Vienna, Austria
- Medical University of Vienna, Center for Public Health, Department of Epidemiology, Vienna, Austria
| | - Simon Krenn
- AIT Austrian Institute of Technology GmbH, Center for Health & Bioresources, Medical Signal Analysis, Vienna, Austria
| | - Manfred Hecking
- Medical University of Vienna, Department of Medicine III, Division for Nephrology and Dialysis, Vienna, Austria
- Medical University of Vienna, Center for Public Health, Department of Epidemiology, Vienna, Austria
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Ștefan G, Zugravu A, Stancu S. Glasgow prognostic score as an outcome predictor for patients initiating hemodialysis. Ther Apher Dial 2024; 28:34-41. [PMID: 37596836 DOI: 10.1111/1744-9987.14057] [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] [Received: 05/24/2023] [Revised: 07/13/2023] [Accepted: 08/10/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION This retrospective study examined the relationship between the Glasgow Prognostic Score (GPS) at hemodialysis (HD) initiation and overall/cardiovascular mortality. METHODS A total of 264 patients starting HD between 2014 and 2015 at a single center were studied. Follow-up persisted until therapy change, death, or study end (December 31, 2021), with a median of 6.8 years. RESULTS Patients with a higher GPS more frequently had emergent HD initiation and showed increased eGFR at initiation. During follow-up, 60% of patients died, with cardiovascular disease being the leading cause. Univariate analysis revealed a significant difference in median survival time across GPS classes. Cox proportional hazard models confirmed a significant association between GPS and mortality. CONCLUSIONS We report a significant association between GPS at HD initiation and mortality. GPS may prove useful as a prognostic tool for identifying high-risk patients, underscoring the need for future research to validate these findings and explore the potential of GPS-based interventions.
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Affiliation(s)
- Gabriel Ștefan
- Nephrology Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
- Nephrology Department, "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Adrian Zugravu
- Nephrology Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
- Nephrology Department, "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Simona Stancu
- Nephrology Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
- Nephrology Department, "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
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Zheng D, Liu Y, Li Y, Jin J, He Q, Shen X. Lung Ultrasound and Bioelectrical Impedance Analysis for Fluid Status Assessing Patients Undergoing Maintenance Hemodialysis. Int J Clin Pract 2024; 2024:1232211. [PMID: 38229934 PMCID: PMC10791474 DOI: 10.1155/2024/1232211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/12/2023] [Accepted: 12/30/2023] [Indexed: 01/18/2024] Open
Abstract
Background Volume overload is a fatal complication for people undergoing hemodialysis. Therefore, regulating a patient's "dry weight" based on their fluid status is imperative. Clinical experiences are too subjective to accurately judge a patient's fluid status, but techniques have emerged for improved fluid control in the two decades. Specifically, lung ultrasonography (LUS) uses a unique aspect of ultrasound images, the B-lines, to evaluate extravascular lung water, which has increasingly attracted attention. However, the role of B-line quantification in predicting short-mid-term death and/or cardiovascular complications is unclear. Methods Patients undergoing MHD at the hemodialysis center of Zhejiang Provincial People's Hospital from October 1, 2020, to February 28, 2021, were examined using LUS and a bioelectrical impedance analysis before and after dialysis, and related clinical data were collected. All patients were followed up for one year after the examination, and deaths and first cardiovascular events (e.g., stroke, myocardial infarction, and heart failure) during this period were recorded. Results 98 patients were enrolled and divided into three groups in relation to their mild (<16 B-lines), moderate (16-30 B-lines), or severe (>30 B-lines) hypervolemia, defined by the number of B-lines. The long-term survival rate was significantly lower in the severe group than in the mild and moderate groups. LUS and bioelectrical impedance-related parameters (e.g., extracellular water-to-water ratio) were closely related to cardiac ultrasound parameters (left ventricular ejection fraction) (P < 0.001). The optimal B-line cutoff value on LUS for predicting fluid overload (defined clinically) in patients on hemodialysis was 11.5 lines (AUC = 0.840, 95% confidence interval 0.735-0.945, P < 0.001), and the diagnostic sensitivity and specificity were both 76.5%. During the one-year follow-up period, ten deaths and six cardiovascular events occurred. The survival rate was significantly lower in the severe group than in the mild group (log-rank test χ2 = 10.050, P=0.002) but did not differ between the severe and moderate groups (χ2 = 2.629, P=0.105). Conclusion LUS is a cheap, noninvasive, simple, and repeatable volume-monitoring method that can assist with individualized fluid volume management in patients undergoing MHD. LUS results may also help to predict the short-mid-term survival rate of patients to a certain extent.
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Affiliation(s)
- Danna Zheng
- Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yueming Liu
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yuting Li
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Juan Jin
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Qiang He
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xiaogang Shen
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
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Vinje V, Bomholt T, Lundby C, Oturai P, Rix M, Lindhard K, Hornum M. Intravascular volumes and the influence on anemia assessed by a carbon monoxide rebreathing method in patients undergoing maintenance hemodialysis. Hemodial Int 2024; 28:40-50. [PMID: 37827985 DOI: 10.1111/hdi.13118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Fluid overload is a major challenge in hemodialysis patients and might cause hypervolemia. We speculated that hemodialysis patients reaching dry weight could have undetected hypervolemia and low hemoglobin (Hb) concentration (g/dL) due to hemodilution. METHODS The study included hemodialysis patients (n = 22) and matched healthy controls (n = 22). Blood volume, plasma volume, red blood cell volume, and total Hb mass were determined using a carbon monoxide (CO)-rebreathing method in hemodialysis patients reaching dry weight and controls. Blood volume measurements were also obtained by a dual-isotope labeling technique in a subgroup for validation purposes. FINDINGS In the hemodialysis group, the median specific blood volume was 89.3 mL/kg (interquartile range [IQR]: 76.7-95.4 mL/kg) and was higher than in the control group (79.9 mL/kg [IQR: 70.4-88.0 mL/kg]; p < 0.037). The median specific plasma volume was 54.7 mL/kg (IQR: 47.1-61.0 mL/kg) and 44.0 mL/kg (IQR: 38.7-49.5 mL/kg) in the hemodialysis and control groups, respectively (p < 0.001). Hb concentration was lower in hemodialysis patients (p < 0.001), whereas no difference in total Hb mass was observed between groups (p = 0.11). A correlation was found between blood volume measured by the CO-rebreathing test and the dual-isotope labeling technique in the control group (r = 0.83, p = 0.015), but not the hemodialysis group (r = 0.25, p = 0.60). DISCUSSION The hemodialysis group had increased specific blood volume at dry weight due to high plasma volume, suggesting a hypervolemic state. However, correlation was not established against the dual-isotope labeling technique underlining that the precision of the CO-rebreathing test should be further validated. The total Hb mass was similar between hemodialysis patients and controls, unlike Hb concentration, which emphasizes that Hb concentration is an inaccurate marker of anemia among hemodialysis patients.
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Affiliation(s)
- Vårin Vinje
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Tobias Bomholt
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Lundby
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
- Section for Health and Exercise Physiology, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Lillehammer, Norway
| | - Peter Oturai
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Rix
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kristine Lindhard
- Department of Nephrology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mads Hornum
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Ulrich C, Canim Z, Herberger E, Girndt M, Fiedler R. Inflammation in Hypervolemic Hemodialysis Patients: The Roles of RelB and Caspase-4. Int J Mol Sci 2023; 24:17550. [PMID: 38139378 PMCID: PMC10743509 DOI: 10.3390/ijms242417550] [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] [Received: 11/09/2023] [Revised: 12/05/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Hypervolemia is associated with inflammation in hemodialysis (HD) patients. How hypervolemia triggers inflammation is not entirely known. We initiated a cross-sectional study enrolling 40 hemodialysis patients who were categorized into normovolemic (N; 23) and hypervolemic (H; 17) groups by bioimpedance measurement. A caspase activity assay in combination with a specific caspase-4 inhibitor was used to detect caspase-4 activity in isolated peripheral blood mononuclear cells (PBMCs). Transcription factors RelA (pS529) and RelB (pS552) were analyzed by phospho-flow cytometry. Serum endotoxins were detected by an amebocyte lysate-based assay, and IL-6 (interleukin-6) and TNF-α (Tumor necrosis factor-α) gene expression were detected using the ELISA technique. Hypervolemic patients were older, more frequently had diabetes and showed increased CRP and IL-6 levels. Caspase-4 activity, which is linked to intracellular endotoxin detection, was significantly elevated in H patients. While the frequency of RelA-expressing immune cells and the expression density in these cells did not differ, the monocytic frequency of cells positively stained for RelB (pS552) was significantly decreased in H patients. Increased caspase-4 activity in H patients may indicate a cause of inflammation in H patients. The post-translational modification of RelB (pS552) is linked to downregulation of NF-kB activity and may indicate the resolution of inflammation, which is more distinct in N patients compared to H patients. Therefore, both higher inflammatory loads and lower inflammatory resolution capacities are characteristics of H patients.
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Affiliation(s)
- Christof Ulrich
- Department of Internal Medicine II, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany; (Z.C.); (E.H.); (M.G.); (R.F.)
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Yang K, Pan S, Yang N, Wu J, Liu Y, He Q. Effect of bioelectrical impedance technology on the prognosis of dialysis patients: a meta-analysis of randomized controlled trials. Ren Fail 2023; 45:2203247. [PMID: 37133857 PMCID: PMC10158555 DOI: 10.1080/0886022x.2023.2203247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Managing patient 'dry weight' according to clinical standards has deficiencies. Research has focused on the effectiveness of using bioelectrical impedance technology for fluid management in dialysis patients. Whether bioelectrical impedance monitoring can improve dialysis patients prognoses remain controversial. We performed a meta-analysis of randomized controlled trials to determine whether bioelectrical impedance was effective in improving dialysis patients prognoses. The primary outcome was all-cause mortality (13.6 ± 9.1 months). Secondary outcomes were left ventricular mass index (LVMI), arterial stiffness assessed using Pulse Wave Velocity (PWV), and N-terminal brain natriuretic peptide precursor (NT-proBNP). Of 4,641 citations retrieved, we identified 15 eligible trials involving 2763 patients divided into experimental (n = 1386) and control (n = 1377) groups. In 14 studies with mortality data, the meta-analysis showed that bioelectrical impedance intervention reduced the risk of all-cause mortality (rate ratios [RR]: 0.71; 95% confidence interval [CI]: 0.51, 0.99; p = .05; I2 = 1%). Subgroup analysis of patients on hemodialysis (RR: 0.72; 95% CI: 0.42, 1.22; p = .22) and peritoneal dialysis (RR: 0.62; 95% CI: 0.35, 1.07; p = .08) showed no significant mortality difference between intervention and control groups. It reduced the risk of all-cause mortality in the Asian population (RR: 0.52; p = .02), and reduced NT-proBNP (mean difference [MD]: -1495.73; p = 0.002; I2=0%) and PWV (MD: -1.55; p = .01; I2=89%). Bioelectrical impedance intervention reduced the LVMI in hemodialysis patients (MD: -12.69; p < .0001; I2=0%). Our analysis shows that in dialysis patients, bioelectrical impedance technology intervention could reduce, but not eliminate, the risk of all-cause mortality. Overall, this technology can improve the prognosis of dialysis patients.
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Affiliation(s)
- Kaibi Yang
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Shujun Pan
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Nan Yang
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Juan Wu
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Yueming Liu
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Qiang He
- Department of Nephrology, the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
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Schoutteten MK, Lindeboom L, Brys A, Lanssens D, Smeets CJP, De Cannière H, De Moor B, Peeters J, Heylen L, Van Hoof C, Groenendaal W, Kooman JP, Vandervoort PM. Comparison of whole body versus thoracic bioimpedance in relation to ultrafiltration volume and systolic blood pressure during hemodialysis. J Appl Physiol (1985) 2023; 135:1330-1338. [PMID: 37767559 DOI: 10.1152/japplphysiol.00600.2022] [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] [Received: 10/10/2022] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 09/29/2023] Open
Abstract
In contrast to whole body bioimpedance, which estimates fluid status at a single point in time, thoracic bioimpedance applied by a wearable device could enable continuous measurements. However, clinical experience with thoracic bioimpedance in patients on dialysis is limited. To test the reproducibility of whole body and thoracic bioimpedance measurements and to compare their relationship with hemodynamic changes during hemodialysis, these parameters were measured pre- and end-dialysis in 54 patients during two sessions. The resistance from both bioimpedance techniques was moderately reproducible between two dialysis sessions (intraclass correlations of pre- to end-dialysis whole body and thoracic resistance between session 1 and 2 were 0.711 [0.58-0.8] and 0.723 [0.6-0.81], respectively). There was a very high to high correlation between changes in ultrafiltration volume and changes in whole body thoracic resistance. Changes in systolic blood pressure negatively correlated to both bioimpedance techniques. Although the relationship between changes in ultrafiltration volume and changes in resistance was stronger for whole body bioimpedance, the relationship with changes in blood pressure was at least comparable for thoracic measurements. These results suggest that thoracic bioimpedance, measured by a wearable device, may serve as an interesting alternative to whole body measurements for continuous hemodynamic monitoring during hemodialysis.NEW & NOTEWORTHY We examined the role of whole body and thoracic bioimpedance in hemodynamic changes during hemodialysis. Whole body and thoracic bioimpedance signals were strongly related to ultrafiltration volume and moderately, negatively, to changes in blood pressure. This work supports the further development of a wearable device measuring thoracic bioimpedance longitudinally in patients on hemodialysis. As such, it may serve as an innovative tool for continuous hemodynamic monitoring during hemodialysis in hospital or in a home-based setting.
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Affiliation(s)
- Melanie K Schoutteten
- Faculty of Biomedical and Life Sciences, Limburg Clinical Research Center/Mobile Health Unit, Hasselt University, Diepenbeek, Belgium
- Department of Future Health, Ziekenhuis Oost Limburg, Genk, Belgium
- Department of Health Research, imec the Netherlands, Eindhoven, The Netherlands
| | - Lucas Lindeboom
- Department of Health Research, imec the Netherlands, Eindhoven, The Netherlands
| | - Astrid Brys
- Division of Geriatrics, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Dorien Lanssens
- Faculty of Biomedical and Life Sciences, Limburg Clinical Research Center/Mobile Health Unit, Hasselt University, Diepenbeek, Belgium
- Department of Future Health, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Christophe J P Smeets
- Department of Future Health, Ziekenhuis Oost Limburg, Genk, Belgium
- Department of Health Research, imec the Netherlands, Eindhoven, The Netherlands
| | - Hélène De Cannière
- Faculty of Biomedical and Life Sciences, Limburg Clinical Research Center/Mobile Health Unit, Hasselt University, Diepenbeek, Belgium
- Department of Future Health, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Bart De Moor
- Faculty of Biomedical and Life Sciences, Limburg Clinical Research Center/Mobile Health Unit, Hasselt University, Diepenbeek, Belgium
- Department of Nephrology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Jacques Peeters
- Department of Nephrology, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Line Heylen
- Faculty of Biomedical and Life Sciences, Limburg Clinical Research Center/Mobile Health Unit, Hasselt University, Diepenbeek, Belgium
- Department of Nephrology, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Chris Van Hoof
- Imec Belgium, Leuven, Belgium
- Department of Electrical Engineering, Elektronische Circuits en Systemen, Katholieke Universiteit Leuven-ESAT, Leuven, Belgium
| | | | - Jeroen P Kooman
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Pieter M Vandervoort
- Faculty of Biomedical and Life Sciences, Limburg Clinical Research Center/Mobile Health Unit, Hasselt University, Diepenbeek, Belgium
- Department of Future Health, Ziekenhuis Oost Limburg, Genk, Belgium
- Department of Health Research, imec the Netherlands, Eindhoven, The Netherlands
- Department of Cardiology, Ziekenhuis Oost Limburg, Genk, Belgium
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10
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Mussnig S, Schmiedecker M, Waller M, Niknam J, Paschen C, Schneditz D, Hecking M, Krenn S. Differences in bioimpedance-derived fluid status between two versions of the Body Composition Monitor. Nutrition 2023; 114:112131. [PMID: 37467529 DOI: 10.1016/j.nut.2023.112131] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVES The Body Composition Monitor (BCM) (Fresenius Medical Care) measures body impedances in alternating currents to subsequently calculate fat and lean tissue mass, fluid compartments, and overhydration (OH). The aim of this study was to investigate differences between two versions of the BCM (an older version, 3.2.5, and a newer version, 3.3.3). METHODS Between September 2021 and December 2021, 28 hemodialysis patients were included to undergo BCM measurements before each of 14 consecutive dialysis sessions with versions 3.2.5 and 3.3.3 devices. Measurements were performed according to instructions provided by the manufacturer. Differences between BCM devices were tested for statistical significance using paired Wilcoxon tests, neglecting clustering. RESULTS A total of 288 measurement pairs of 27 patients were left after exclusion of 43 flawed data points. The mean difference in OH between both BCM devices was 0.548 L (higher for version 3.2.5). Analysis of impedance data revealed differences in the high-frequency spectrum, quantifiable by the intracellular resistance, Ri (median Ri version 3.2.5 = 1750.3 Ω; Ri version 3.3.3 = 1612.45 Ω; P < 0.001), and the time delay, Td (median Td version 3.2.5 = 1.85 ns; Td version 3.3.3 = 8.88 nanoseconds; P < 0.001). CONCLUSIONS This study finds that results between the two versions of the BCM differed in a clinically meaningful fashion and that the newer version 3.3.3 device had a bias toward less OH. Circulating BCM devices should be checked for versions and only devices of the same version should be used for each patient to ensure better within-patient consistency.
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Affiliation(s)
- Sebastian Mussnig
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Michael Schmiedecker
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Maximilian Waller
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Janosch Niknam
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Christopher Paschen
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Daniel Schneditz
- Division of Physiology and Pathophysiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Graz, Austria
| | - Manfred Hecking
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria.
| | - Simon Krenn
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria; Medical Signal Analysis, Center for Health & Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
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11
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Pinter J, Genser B, Moissl U, Stuard S, Kooman J, Canaud B, Wanner C. Hyponatraemia and fluid overload are associated with higher risk of mortality in dialysis patients. Nephrol Dial Transplant 2023; 38:2248-2256. [PMID: 36861328 DOI: 10.1093/ndt/gfad041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND The 5-year mortality rate for haemodialysis patients is over 50%. Acute and chronic disturbances in salt and fluid homeostasis contribute to poor survival and are established as individual mortality risk factors. However, their interaction in relation to mortality is unclear. METHODS We used the European Clinical Database 5 to investigate in a retrospective cohort analysis the relationship between transient hypo- and hypernatremia, fluid status and mortality risk of 72 163 haemodialysis patients from 25 countries. Incident haemodialysis patients with at least one valid measurement of bioimpedance spectroscopy were followed until death or administrative censoring from 1 January 2010 to 4 December 2019. Fluid overload and depletion were defined as >2.5 L above, and -1.1 L below normal fluid status, respectively. N = 2 272 041 recorded plasma sodium and fluid status measurements were available over a monthly time grid and analysed in a Cox regression model for time-to-death. RESULTS Mortality risk of hyponatremia (plasma sodium <135 mmol/L) was slightly increased when fluid status was normal [hazard ratio (HR) 1.26, 95% confidence interval (CI) 1.18-1.35], increased by half when patients were fluid depleted (HR 1.56, 95% CI 1.27-1.93) and accelerated during fluid overload (HR 1.97, 95% CI 1.82-2.12). CONCLUSIONS Plasma sodium and fluid status act independently as risk factors on mortality. Patient surveillance of fluid status is especially important in the high-risk subpopulation of patients with hyponatremia. Prospective patient-level studies should examine the effects of chronic hypo- and hypernatremia, risk determinants, and their outcome risk.
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Affiliation(s)
- Jule Pinter
- University Hospital Würzburg, Würzburg, Germany
| | - Bernd Genser
- Centre for Preventive Medicine & Digital Health Baden Württemberg, Ruprecht Karls University Heidelberg, Mannheim, Germany
- High5Data GmbH, Heidelberg, Germany
| | - Ulrich Moissl
- Global Research and Development, FMC Deutschland GmbH, Bad Homburg, Germany
| | - Stefano Stuard
- Global Medical Office, FMC Germany, Bad Homburg, Germany
| | - Jeroen Kooman
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bernard Canaud
- Global Research and Development, FMC Deutschland GmbH, Bad Homburg, Germany
- Global Medical Office, FMC Germany, Bad Homburg, Germany
- School of Medicine, University of Montpellier, Montpellier, France
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12
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Lambie M, Davies S. An update on absolute and relative indications for dialysis treatment modalities. Clin Kidney J 2023; 16:i39-i47. [PMID: 37711635 PMCID: PMC10497377 DOI: 10.1093/ckj/sfad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Indexed: 09/16/2023] Open
Abstract
Background Choosing a dialysis modality is an important decision for people to make as their kidney failure progresses. In doing so, their options should be informed by any absolute or relative indications that may favour one modality over another. Methods In creating this update, we reviewed literature using a framework that considered first, high-level outcomes (survival and modality transition) from large registry data and cohort studies when considering optimal patient pathways; second, factors at a dialysis provider level that might affect relative indications; and third, specific patient-level factors. Both main types of dialysis modality, peritoneal (PD) and haemodialysis (HD), and their subtypes were considered. Results For most people starting dialysis, survival is independent of modality, including those with diabetes. Better survival is seen in those with less comorbidity starting with PD or home HD, reflecting continued improvements over recent decades that have been greater than improvements seen for centre HD. There are provider-level differences in the perceived relative indications for home dialysis that appear to reflect variability in experience, prejudice, enthusiasm, and support for patients and carers. Absolute contraindications are uncommon and, in most cases, where modality prejudice exists, e.g. obesity, Adult Polycystic Kidney Disease, and social factors, this is not supported by reported outcomes. Conclusion Absolute contraindications to a particular dialysis modality are rare. Relative indications for or against particular modalities should be considered but are rarely more important than patient preferences.
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Affiliation(s)
- Mark Lambie
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, UK
| | - Simon Davies
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, UK
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13
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El Shamy O, Ikizler TA. Fluid management protocols in hemodialysis patients using bioimpedance validation: time to look elsewhere? Kidney Int 2023; 104:425-427. [PMID: 37599016 DOI: 10.1016/j.kint.2023.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 08/22/2023]
Abstract
The management of volume status in dialysis patients is an important determinant of the rate of decline of residual kidney function. The implementation of clinical protocols to guide volume management in the in-center hemodialysis unit resulted in comparable rates of development of anuria and decline in residual kidney function when compared with bioimpedance spectroscopy-guided volume management. Clinical judgment and experience are important drivers of patient outcomes. The importance and applicability of bioimpedance spectroscopy in other clinical settings, such as units without clear volume management protocols or in home dialysis units, remain to be seen.
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Affiliation(s)
- Osama El Shamy
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - T Alp Ikizler
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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14
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Wijaya A, Marbun MBH, Nugroho P, Rinaldi I. The Association Between Fluid Overload and Endothelial Dysfunction in Chronic Kidney Failure Patients Undergoing Hemodialysis Twice a Week. Cureus 2023; 15:e44381. [PMID: 37779742 PMCID: PMC10540707 DOI: 10.7759/cureus.44381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Fluid overload causes excessive systemic vasoconstriction and decreased perfusion of peripheral tissues, leading to abnormalities in cardiopulmonary physiological functions. Prolonged fluid overload caused by inadequate hemodialysis may cause heart dilatation, left ventricular hypertrophy, hypertension, and a decrease in coronary reserves, which later will develop into coronary ischemia, leading to increased morbidity and mortality of cardiovascular disease (CVD). Endothelial dysfunction plays a role in excessive vasoconstriction on fluid overload. Brain natriuretic peptide (BNP) and asymmetric dimethylarginine (ADMA) are used as parameters of fluid overload and endothelial dysfunction, respectively. This study is conducted to describe the relationship between fluid overload with endothelial dysfunction. METHOD This study is a cross-sectional study of kidney failure patients who underwent hemodialysis twice weekly for at least three months. BNP and ADMA were used as parameters for fluid overload and taken prior to hemodialysis. RESULT From 126 subjects, the proportion with fluid overload (BNP>356 pg/ml) was found to be 64.3% with the median age of subjects being 52 years (47-62). There was 47.6% population with endothelial dysfunction (ADMA>100 ng/ml). Presumptive causes of primary chronic kidney disease (CKD) were hypertension (38.9%), diabetes mellitus (DM) (28.6%), and glomerulonephritis (21.4%). There was no significant association between fluid overload and endothelial dysfunction (PR=1,042, p=0.832 CI 95%=0.714-1.521). CONCLUSION There was no relationship between fluid overload and endothelial dysfunction.
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Affiliation(s)
- Adi Wijaya
- Internal Medicine, Cipto Mangunkusumo Hospital - Faculty of Medicine Universitas Indonesia, Jakarta, IDN
| | | | - Pringgodigdo Nugroho
- Internal Medicine, Cipto Mangunkusumo Hospital - Faculty of Medicine Universitas Indonesia, Jakarta, IDN
| | - Ikhwan Rinaldi
- Internal Medicine, Cipto Mangunkusumo Hospital - Faculty of Medicine Universitas Indonesia, Jakarta, IDN
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15
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Inoue H, Oya M, Aizawa M, Wagatsuma K, Kamimae M, Kashiwagi Y, Ishii M, Wakabayashi H, Fujii T, Suzuki S, Hattori N, Tatsumoto N, Kawakami E, Asanuma K. Predicting dry weight change in Hemodialysis patients using machine learning. BMC Nephrol 2023; 24:196. [PMID: 37386392 PMCID: PMC10308746 DOI: 10.1186/s12882-023-03248-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Machine Learning has been increasingly used in the medical field, including managing patients undergoing hemodialysis. The random forest classifier is a Machine Learning method that can generate high accuracy and interpretability in the data analysis of various diseases. We attempted to apply Machine Learning to adjust dry weight, the appropriate volume status of patients undergoing hemodialysis, which requires a complex decision-making process considering multiple indicators and the patient's physical conditions. METHODS All medical data and 69,375 dialysis records of 314 Asian patients undergoing hemodialysis at a single dialysis center in Japan between July 2018 and April 2020 were collected from the electronic medical record system. Using the random forest classifier, we developed models to predict the probabilities of adjusting the dry weight at each dialysis session. RESULTS The areas under the receiver-operating-characteristic curves of the models for adjusting the dry weight upward and downward were 0.70 and 0.74, respectively. The average probability of upward adjustment of the dry weight had sharp a peak around the actual change over time, while the average probability of downward adjustment of the dry weight formed a gradual peak. Feature importance analysis revealed that median blood pressure decline was a strong predictor for adjusting the dry weight upward. In contrast, elevated serum levels of C-reactive protein and hypoalbuminemia were important indicators for adjusting the dry weight downward. CONCLUSIONS The random forest classifier should provide a helpful guide to predict the optimal changes to the dry weight with relative accuracy and may be useful in clinical practice.
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Affiliation(s)
- Hiroko Inoue
- Department of Nephrology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Megumi Oya
- Department of Artificial Intelligence Medicine, Graduate School of Medicine, Chiba University, Chuo- ku, Chiba, Japan
- Advanced Data Science Project (ADSP), RIKEN Information R&D and Strategy Headquarters, RIKEN, Yokohama, Kanagawa, Japan
| | - Masashi Aizawa
- Department of Nephrology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Kyogo Wagatsuma
- Department of Artificial Intelligence Medicine, Graduate School of Medicine, Chiba University, Chuo- ku, Chiba, Japan
- Advanced Data Science Project (ADSP), RIKEN Information R&D and Strategy Headquarters, RIKEN, Yokohama, Kanagawa, Japan
| | - Masatomo Kamimae
- Department of Artificial Intelligence Medicine, Graduate School of Medicine, Chiba University, Chuo- ku, Chiba, Japan
- Advanced Data Science Project (ADSP), RIKEN Information R&D and Strategy Headquarters, RIKEN, Yokohama, Kanagawa, Japan
| | - Yusuke Kashiwagi
- Department of Nephrology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Masayoshi Ishii
- Department of Nephrology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
- Department of Artificial Kidney, Chiba University Hospital, Chuo-ku, Chiba, Japan
| | - Hanae Wakabayashi
- Department of Nephrology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
- Department of Artificial Kidney, Chiba University Hospital, Chuo-ku, Chiba, Japan
| | - Takayuki Fujii
- Department of Nephrology, Seirei Sakura Citizen hospital, Sakura, Chiba, Japan
| | - Satoshi Suzuki
- Department of Nephrology, Seirei Sakura Citizen hospital, Sakura, Chiba, Japan
| | - Noriyuki Hattori
- Department of Artificial Kidney, Chiba University Hospital, Chuo-ku, Chiba, Japan
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Narihito Tatsumoto
- Department of Nephrology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Eiryo Kawakami
- Department of Artificial Intelligence Medicine, Graduate School of Medicine, Chiba University, Chuo- ku, Chiba, Japan.
- Advanced Data Science Project (ADSP), RIKEN Information R&D and Strategy Headquarters, RIKEN, Yokohama, Kanagawa, Japan.
| | - Katsuhiko Asanuma
- Department of Nephrology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan.
- Department of Artificial Kidney, Chiba University Hospital, Chuo-ku, Chiba, Japan.
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16
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Canaud B, Kooman J, Davenport A, Campo D, Carreel E, Morena-Carrere M, Cristol JP. Digital health technology to support care and improve outcomes of chronic kidney disease patients: as a case illustration, the Withings toolkit health sensing tools. FRONTIERS IN NEPHROLOGY 2023; 3:1148565. [PMID: 37675376 PMCID: PMC10479582 DOI: 10.3389/fneph.2023.1148565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/07/2023] [Indexed: 09/08/2023]
Abstract
Cardiovascular disease (CVD) is a major burden in dialysis-dependent chronic kidney disease (CKD5D) patients. Several factors contribute to this vulnerability including traditional risk factors such as age, gender, life style and comorbidities, and non-traditional ones as part of dialysis-induced systemic stress. In this context, it appears of utmost importance to bring a closer attention to CVD monitoring in caring for CKD5D patients to ensure early and appropriate intervention for improving their outcomes. Interestingly, new home-used, self-operated, connected medical devices offer convenient and new tools for monitoring in a fully automated and ambulatory mode CKD5D patients during the interdialytic period. Sensoring devices are installed with WiFi or Bluetooth. Some devices are also available in a cellular version such as the Withings Remote Patient Monitoring (RPM) solution. These devices analyze the data and upload the results to Withings HDS (Hybrid data security) platform servers. Data visualization can be viewed by the patient using the Withings Health Mate application on a smartphone, or with a web interface. Health Care Professionals (HCP) can also visualize patient data via the Withings web-based RPM interface. In this narrative essay, we analyze the clinical potential of pervasive wearable sensors for monitoring ambulatory dialysis patients and provide an assessment of such toolkit digital medical health devices currently available on the market. These devices offer a fully automated, unobtrusive and remote monitoring of main vital functions in ambulatory subjects. These unique features provide a multidimensional assessment of ambulatory CKD5D patients covering most physiologic functionalities, detecting unexpected disorders (i.e., volume overload, arrhythmias, sleep disorders) and allowing physicians to judge patient's response to treatment and recommendations. In the future, the wider availability of such pervasive health sensing and digital technology to monitor patients at an affordable cost price will improve the personalized management of CKD5D patients, so potentially resulting in improvements in patient quality of life and survival.
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Affiliation(s)
- Bernard Canaud
- Montpellier University, School of Medicine, Montpellier, France
- Global Medical Office, Fresenius Medical Care (FMC), Fresnes, France
| | - Jeroen Kooman
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Andrew Davenport
- UCL Department of Renal Medicine, Royal Free Hospital, University College, London, United Kingdom
| | | | | | - Marion Morena-Carrere
- PhyMedExp, University of Montpellier, INSERM, CNRS, Department of Biochemistry and Hormonology, University Hospital Center of Montpellier, Montpellier, France
| | - Jean-Paul Cristol
- PhyMedExp, University of Montpellier, INSERM, CNRS, Department of Biochemistry and Hormonology, University Hospital Center of Montpellier, Montpellier, France
- AIDER-Santé, Ch. Mion Foundation, Montpellier, France
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17
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Chan GCK, Fung WWS, Szeto CC, Ng JKC. From MIA to FIFA: The vicious matrix of frailty, inflammation, fluid overload and atherosclerosis in peritoneal dialysis. Nephrology (Carlton) 2023; 28:215-226. [PMID: 36807408 DOI: 10.1111/nep.14150] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/25/2023] [Accepted: 02/14/2023] [Indexed: 02/20/2023]
Abstract
Cardiovascular disease (CVD) is a major cause of mortality and morbidity in peritoneal dialysis (PD) patients. Two decades ago, the common co-existence of malnutrition and systemic inflammation PD patients with atherosclerosis and CVD led to the proposed terminology of 'malnutrition-inflammation-atherosclerosis (MIA) syndrome'. Although the importance of malnutrition is well accepted, frailty represents a more comprehensive assessment of the physical and functional capability of the patient and encompasses the contributions of sarcopenia (a key component of malnutrition), obesity, cardiopulmonary as well as neuropsychiatric impairment. In recent years, it is also increasingly recognized that fluid overload is not only the consequence but also play an important role in the pathogenesis of CVD. Moreover, fluid overload is closely linked with the systemic inflammatory status, presumably by gut oedema, gastrointestinal epithelial barrier dysfunction and leakage of bacterial fragments to the systemic circulation. There are now a wealth of published evidence to show intricate relations between frailty, inflammation, fluid overload and atherosclerotic disease in patients with chronic kidney disease (CKD) and those on PD, a phenomenon that we propose the term 'FIFA complex'. In this system, frailty and atherosclerotic disease may be regarded as two patient-oriented outcomes, while inflammation and fluid overload are two inter-connected pathogenic processes. However, there remain limited data on how the treatment of one component affect the others. It is also important to define how treatment of fluid overload affect the systemic inflammatory status and to develop effective anti-inflammatory strategies that could alleviate atherosclerotic disease and frailty.
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Affiliation(s)
- Gordon Chun-Kau Chan
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Winston Wing-Shing Fung
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Cheuk-Chun Szeto
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
- Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jack Kit-Chung Ng
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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18
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Suzuki Y, Otsuka T, Yoshioka Y, Iida T, Maruyama S, Watanabe H, Kaseda R, Yamamoto S, Kaneko Y, Goto S, Aoyagi R, Narita I. Assessing fluid volume and determining outcomes of acute heart failure using plasma human atrial natriuretic peptide. Clin Exp Nephrol 2023; 27:565-573. [PMID: 36941501 DOI: 10.1007/s10157-023-02333-1] [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: 12/08/2022] [Accepted: 02/25/2023] [Indexed: 03/22/2023]
Abstract
BACKGROUND The post-dialysis plasma level of human atrial natriuretic peptide (hANP) reflects the fluid volume in patients on hemodialysis. The threshold hANP level is reportedly 100 pg/mL; however, the clinical usefulness of the threshold hANP level for volume control has not been sufficiently studied. METHODS We conducted a single-center, retrospective, observational study that included 156 hemodialysis patients without atrial fibrillation. First, we examined the usefulness of the threshold hANP level (100 pg/mL) for predicting hypoxemia due to congestion in a short-term observational study from December 30, 2015 to January 5, 2016. Subsequently, we conducted a 5-year follow-up study wherein the outcomes were hospitalization due to acute heart failure (AHF), development of cardiovascular diseases (CVD), and all-cause death. Finally, we collected echocardiography data to investigate the relationship between cardiac function and hANP. RESULTS Our short-term observational study showed that patients with an hANP level ≥ 100 pg/mL developed hypoxemia due to congestion (odds ratio, 3.52; 95% confidence interval, 1.06-11.71; P = 0.040). At the 5-year follow-up, patients with an hANP level ≥ 100 pg/mL had significantly higher rates of hospitalization due to AHF, CVD, and all-cause death based on the log-rank test (P = 0.003, P = 0.019, P < 0.001, respectively). Cardiac disfunctions were significantly associated with the high hANP level. CONCLUSIONS The hANP level is indicative of both fluid volume and cardiac dysfunction. A threshold hANP level of 100 pg/mL can serve as a predictive marker for AHF and a practical indicator for volume control.
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Affiliation(s)
- Yuya Suzuki
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8510, Japan
| | - Tadashi Otsuka
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8510, Japan.
| | - Yuki Yoshioka
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Tomomichi Iida
- Department of Nephrology, Tachikawa General Hospital, Niigata, Japan
| | - Shingo Maruyama
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8510, Japan
| | - Hirofumi Watanabe
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8510, Japan
| | - Ryohei Kaseda
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8510, Japan
| | - Suguru Yamamoto
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8510, Japan
| | - Yoshikatsu Kaneko
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8510, Japan
| | - Shin Goto
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8510, Japan
| | - Ryuji Aoyagi
- Department of Nephrology, Tachikawa General Hospital, Niigata, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8510, Japan
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19
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Association between Intra- and Extra-Cellular Water Ratio Imbalance and Natriuretic Peptides in Patients Undergoing Hemodialysis. Nutrients 2023; 15:nu15051274. [PMID: 36904273 PMCID: PMC10005491 DOI: 10.3390/nu15051274] [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: 02/02/2023] [Revised: 02/24/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
Natriuretic peptides are associated with malnutrition and volume overload. Over-hydration cannot simply be explained by excess extracellular water in patients undergoing hemodialysis. We assessed the relationship between the extracellular and intracellular water (ECW/ICW) ratio, N-terminal pro-B-type natriuretic peptide (NT-proBNP), human atrial natriuretic peptide (hANP), and echocardiographic findings. Body composition was examined by segmental multi-frequency bioelectrical impedance analysis in 368 patients undergoing maintenance dialysis (261 men and 107 women; mean age, 65 ± 12 years). Patients with higher ECW/ICW ratio quartiles tended to be older, were on dialysis longer, and had higher post-dialysis blood pressure and lower body mass index, ultrafiltration volume, serum albumin, blood urea nitrogen, and creatinine levels (p < 0.05). The ECW/ICW ratio significantly increased with decreasing ICW, but not with ECW. Patients with a higher ECW/ICW ratio and lower percent fat had significantly higher natriuretic peptide levels. After adjusting for covariates, the ECW/ICW ratio remained an independent associated factor for natriuretic peptides (β = 0.34, p < 0.001 for NT-proBNP and β = 0.40, p < 0.001 for hANP) and the left ventricular mass index (β = 0.20, p = 0.002). The ICW-ECW volume imbalance regulated by decreased cell mass may explain the reserve capacity for fluid accumulation in patients undergoing hemodialysis.
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20
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Detection of Hyponatremia Development in Hemodialysis Patients by Routine Automated Conductivity-Based Monitoring. ASAIO J 2023; 69:239-246. [PMID: 35438654 DOI: 10.1097/mat.0000000000001737] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Predialytic hyponatremia is associated with poor outcome in hemodialysis patients. Hypotonic hyponatremia is the most frequently encountered disorder reflecting mixed disorders combining extracellular fluid overload and free water excess, resulting from the interplay of intermittency of dialysis and diet observance, and likely precipitated by an acute or subacute illness. In this context, hyponatremia requires to be detected and worked up to identify and cure the cause. In this clinical case report, we describe preliminary results of using an online biosensor on a dialysis machine that provides automated predialysis plasma sodium concentration derived from dialysate conductivity measurements. Based on this biosensor, within a 5 year time frame, 11 patients out of more than 130 maintenance hemodialysis patients and over 40,000 dialysis sessions were identified with episodes of predialysis hyponatremia (≤135 mmol/l). In all patients, hyponatremic episodes were indicative of a severe underlying illness associated with fluid overload leading to plasma hypotonicity. Automated online predialysis plasma sodium concentration measurement offers an innovative, reliable, and cost-free tool that permits to detect hyponatremia as marker of an underlying illness development in dialysis patients. The value of this tool in supporting clinical decision-making deserves further studies in a large dialysis population.
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21
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Schmiedecker M, Krenn S, Waller M, Paschen C, Mussnig S, Niknam J, Wabel P, Mayer CC, Hecking M, Schneditz D. Ultrafiltration-induced decrease in relative blood volume is larger in hemodialysis patients with low specific blood volume: Results from a dialysate bolus administration study. Hemodial Int 2023; 27:174-183. [PMID: 36703281 DOI: 10.1111/hdi.13066] [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: 05/16/2022] [Revised: 11/04/2022] [Accepted: 01/10/2023] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Prescribing the ultrafiltration in hemodialysis patients remains challenging and might benefit from the information on absolute blood volume, estimated by intradialytic dialysate bolus administration. Here, we aimed at determining the relationship between absolute blood volume, normalized for body mass (specific blood volume, Vs), and ultrafiltration-induced decrease in relative blood volume (∆RBV) as well as clinical parameters including body mass index (BMI). METHODS This retrospective analysis comprised 77 patients who had their dialysate bolus-based absolute blood volume extracted routinely with an automated method. Patient-specific characteristics and ∆RBV were analyzed as a function of Vs, dichotomizing the data above or below a previously proposed threshold of 65 ml/kg for Vs. Statistical methodology comprised descriptive analyses, two-group comparisons, and correlation analyses. FINDINGS Median Vs was 68.6 ml/kg (54.9 ml/kg [Quartile 1], 83.4 ml/kg [Quartile 3]). Relative blood volume decreased by 6.3% (2.6%, 12.2%) over the entire hemodialysis session. Vs correlated inversely with BMI (rs = -0.688, p < 0.001). ∆RBV was 9.8% in the group of patients with Vs <65 ml/kg versus 6.0% in the group of patients with Vs ≥65 ml/kg (p = 0.024). The two groups did not differ significantly regarding their specific ultrafiltration volume, normalized for body mass, which amounted to 34.1 ml/kg and 36.0 ml/kg in both groups, respectively (p = 0.630). ∆RBV correlated inversely with Vs (rs = -0.299, p = 0.008). DISCUSSION The present study suggests that patients with higher BMI and lower Vs experience larger blood volume changes, despite similar ultrafiltration requirements. These results underline the clinical plausibility and importance of dialysate bolus-based absolute blood volume determination in the assessment of target weight, especially in view of a previous study where intradialytic morbid events could be decreased when the target weight was adjusted, based on Vs.
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Affiliation(s)
- Michael Schmiedecker
- Department of Medicine III, Division of Nephrology & Dialysis, Medical University of Vienna, Vienna, Austria
| | - Simon Krenn
- Department of Medicine III, Division of Nephrology & Dialysis, Medical University of Vienna, Vienna, Austria.,Center for Public Health, Department of Epidemiology, Medical University of Vienna, Vienna, Austria.,AIT Austrian Institute of Technology, Center for Health & Bioresources, Medical Signal Analysis, Vienna, Austria
| | - Maximilian Waller
- Department of Medicine III, Division of Nephrology & Dialysis, Medical University of Vienna, Vienna, Austria.,Department of Nephrology, Klinik Favoriten Vienna, Vienna, Austria
| | - Christopher Paschen
- Department of Medicine III, Division of Nephrology & Dialysis, Medical University of Vienna, Vienna, Austria
| | - Sebastian Mussnig
- Department of Medicine III, Division of Nephrology & Dialysis, Medical University of Vienna, Vienna, Austria
| | - Janosch Niknam
- Department of Medicine III, Division of Nephrology & Dialysis, Medical University of Vienna, Vienna, Austria
| | | | - Christopher C Mayer
- AIT Austrian Institute of Technology, Center for Health & Bioresources, Medical Signal Analysis, Vienna, Austria
| | - Manfred Hecking
- Department of Medicine III, Division of Nephrology & Dialysis, Medical University of Vienna, Vienna, Austria
| | - Daniel Schneditz
- Otto Loewi Research Center, Division of Physiology, Medical University of Graz, Graz, Austria
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22
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Chaudhuri S, Larkin J, Guedes M, Jiao Y, Kotanko P, Wang Y, Usvyat L, Kooman JP. Predicting mortality risk in dialysis: Assessment of risk factors using traditional and advanced modeling techniques within the Monitoring Dialysis Outcomes initiative. Hemodial Int 2023; 27:62-73. [PMID: 36403633 PMCID: PMC10100028 DOI: 10.1111/hdi.13053] [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: 03/04/2022] [Revised: 10/08/2022] [Accepted: 10/26/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Several factors affect the survival of End Stage Kidney Disease (ESKD) patients on dialysis. Machine learning (ML) models may help tackle multivariable and complex, often non-linear predictors of adverse clinical events in ESKD patients. In this study, we used advanced ML method as well as a traditional statistical method to develop and compare the risk factors for mortality prediction model in hemodialysis (HD) patients. MATERIALS AND METHODS We included data HD patients who had data across a baseline period of at least 1 year and 1 day in the internationally representative Monitoring Dialysis Outcomes (MONDO) Initiative dataset. Twenty-three input parameters considered in the model were chosen in an a priori manner. The prediction model used 1 year baseline data to predict death in the following 3 years. The dataset was randomly split into 80% training data and 20% testing data for model development. Two different modeling techniques were used to build the mortality prediction model. FINDINGS A total of 95,142 patients were included in the analysis sample. The area under the receiver operating curve (AUROC) of the model on the test data with XGBoost ML model was 0.84 on the training data and 0.80 on the test data. AUROC of the logistic regression model was 0.73 on training data and 0.75 on test data. Four out of the top five predictors were common to both modeling strategies. DISCUSSION In the internationally representative MONDO data for HD patients, we describe the development of a ML model and a traditional statistical model that was suitable for classification of a prevalent HD patient's 3-year risk of death. While both models had a reasonably high AUROC, the ML model was able to identify levels of hematocrit (HCT) as an important risk factor in mortality. If implemented in clinical practice, such proof-of-concept models could be used to provide pre-emptive care for HD patients.
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Affiliation(s)
- Sheetal Chaudhuri
- Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, USA.,Maastricht University Medical Center, Maastricht, The Netherlands
| | - John Larkin
- Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, USA
| | - Murilo Guedes
- Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Yue Jiao
- Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, USA
| | - Peter Kotanko
- Renal Research Institute, New York, New York, USA.,Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yuedong Wang
- University of California, Santa Barbara, California, USA
| | - Len Usvyat
- Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, USA
| | - Jeroen P Kooman
- Maastricht University Medical Center, Maastricht, The Netherlands
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23
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Zhou C, Zhan L, He P, Yuan J, Zha Y. A Higher Whole-Body Extracellular to Intracellular Water Ratio Is Associated with Increased Odds of Cognitive Impairment in Hemodialysis Patients. J Alzheimers Dis 2023; 95:171-179. [PMID: 37522207 DOI: 10.3233/jad-230196] [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: 08/01/2023]
Abstract
BACKGROUND Cognitive impairment (CI) is highly prevalent in patients undergoing hemodialysis. Whether fluid overload with malnutrition as assessed by the ratio of extracellular water to intracellular water (ECW/ICW) is associated with CI in patients on maintenance hemodialysis (MHD) has yet to be studied. OBJECTIVE This study aimed to investigate the association between ECW/ICW and CI in patients with MHD. METHODS We conducted a multicenter, cross-sectional study that enrolled 3,025 adult patients with MHD. Cognitive function was assessed through the Mini-Mental State Examination. The ECW/ICW was derived from a portable body composition monitor and analyzed by quartiles. RESULTS 23.04% of participants had CI in our study. The prevalence of CI tended to increase as the quartiles of the ECW/ICW ratio increased. Unadjusted analysis showed that participants in quartile 4 were 3.02 times more likely to have a CI compared to those in quartile 1. After adjusting for age, sex, education, smoking status, body mass index, dialysis vintage, history of hypertension, and history of stroke, the adjusted OR (95% CI) for the highest quartile of ECW/ICW ratio was 1.36 (1.01, 1.83) for CI compared with the lowest quartile. Interestingly, the association between ECW/ICW ratio and CI persisted across all subgroups stratified by age, gender, history of diabetes, and stroke. (p for interaction > 0.05 for all). CONCLUSION An increased ECW/ICW ratio is associated with higher odds of cognitive impairment in patients undergoing hemodialysis.
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Affiliation(s)
- Chaomin Zhou
- Department of Nephrology, NHC Key Laboratory of Pulmonary Immune-related Diseases, Renal Division, Guizhou Provincial People's Hospital, Guiyang, China
- Medical College, Gui Zhou University, Guiyang, China
| | - Lin Zhan
- Research Laboratory Center, Guizhou Provincial People's Hospital, Guiyang, China
| | - Pinghong He
- Department of Nephrology, NHC Key Laboratory of Pulmonary Immune-related Diseases, Renal Division, Guizhou Provincial People's Hospital, Guiyang, China
| | - Jing Yuan
- Department of Nephrology, NHC Key Laboratory of Pulmonary Immune-related Diseases, Renal Division, Guizhou Provincial People's Hospital, Guiyang, China
| | - Yan Zha
- Department of Nephrology, NHC Key Laboratory of Pulmonary Immune-related Diseases, Renal Division, Guizhou Provincial People's Hospital, Guiyang, China
- Medical College, Gui Zhou University, Guiyang, China
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24
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Liu T, Zhuang XX, Qin XJ, Wei LB, Gao JR. Identifying effective diagnostic biomarkers and immune infiltration features in chronic kidney disease by bioinformatics and validation. Front Pharmacol 2022; 13:1069810. [PMID: 36642989 PMCID: PMC9838551 DOI: 10.3389/fphar.2022.1069810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022] Open
Abstract
Background: Chronic kidney disease (CKD), characterized by sustained inflammation and immune dysfunction, is highly prevalent and can eventually progress to end-stage kidney disease. However, there is still a lack of effective and reliable diagnostic markers and therapeutic targets for CKD. Methods: First, we merged data from GEO microarrays (GSE104948 and GSE116626) to identify differentially expressed genes (DEGs) in CKD and healthy patient samples. Then, we conducted GO, KEGG, HPO, and WGCNA analyses to explore potential functions of DEGs and select clinically significant modules. Moreover, STRING was used to analyse protein-protein interactions. CytoHubba and MCODE algorithms in the cytoscape plug-in were performed to screen hub genes in the network. We then determined the diagnostic significance of the obtained hub genes by ROC and two validation datasets. Meanwhile, the expression level of the biomarkers was verified by IHC. Furthermore, we examined immunological cells' relationships with hub genes. Finally, GSEA was conducted to determine the biological functions that biomarkers are significantly enriched. STITCH and AutoDock Vina were used to predict and validate drug-gene interactions. Results: A total of 657 DEGs were screened and functional analysis emphasizes their important role in inflammatory responses and immunomodulation in CKD. Through WGCNA, the interaction network, ROC curves, and validation set, four hub genes (IL10RA, CD45, CTSS, and C1QA) were identified. Furthermore, IHC of CKD patients confirmed the results above. Immune infiltration analysis indicated that CKD had a significant increase in monocytes, M0 macrophages, and M1 macrophages but a decrease in regulatory T cells, activated dendritic cells, and so on. Moreover, four hub genes were statistically correlated with them. Further analysis exhibited that IL10RA, which obtained the highest expression level in hub genes, was involved in abnormalities in various immune cells and regulated a large number of immune system responses and inflammation-related pathways. In addition, the drug-gene interaction network contained four potential therapeutic drugs targeting IL10RA, and molecular docking might make this relationship viable. Conclusion: IL10RA and its related hub molecules might play a key role in the development of CKD and could be potential biomarkers in CKD.
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Affiliation(s)
- Tao Liu
- Department of Pharmacy, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China,College of Pharmacy, Anhui University of Chinese Medicine, Hefei, China
| | - Xing Xing Zhuang
- Department of Pharmacy, Chaohu Hospital of Anhui Medical University, Chaohu, China
| | - Xiu Juan Qin
- Department of Pharmacy, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Liang Bing Wei
- Department of Pharmacy, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Jia Rong Gao
- Department of Pharmacy, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China,Anhui Province Key Laboratory of Chinese Medicinal Formula, Hefei, China,*Correspondence: Jia Rong Gao,
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25
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Nekooeian M, Ezzatzadegan Jahromi S, Masjedi F, Sohooli M, Shekouhi R, Moaref A. The significance of volume overload in the development of pulmonary arterial hypertension in continuous ambulatory peritoneal dialysis patients. Ther Apher Dial 2022. [PMID: 36579477 DOI: 10.1111/1744-9987.13965] [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: 06/18/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The underlying pathophysiology of pulmonary arterial hypertension (PAH) is multifactorial; however, the significance of chronic volume overload and its subsequent effects on cardiac function must be studied thoroughly. The main objective of this study was to determine the predictive parameters of PAH in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) using transthoracic echocardiography (TTE) and bioimpedance analysis (BIA). METHODS In this cross-sectional study, 43 eligible CAPD patients were chosen. The patients were examined by TTE and BIA before the morning dialysis session, and baseline patient characteristics, echocardiography, and BIA parameters were recorded. RESULTS Sixteen (37.2%) patients were diagnosed with PAH. Patients with PAH had significantly greater left atrial diameter (LAD), left ventricular mass index (LVMI), and higher grades of diastolic dysfunction (DDF). Systolic pulmonary artery pressure (sPAP) correlated with LAD (p < 0.001, r = 0.566), interventricular septal diameter (IVSD) (p = 0.004, r = 0.425), LVMI (p = 0.030, r = 0.323), and extracellular water/total body water (ECW/TBW) ratio (p = 0.002, r = 0.458). CONCLUSION Two volume status-related parameters including ECW/TBW ratio and inferior vena cava (IVC) expiratory diameter, and cardiac-related TTE findings such as LAD and DDF were predictors of sPAP in CAPD patients.
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Affiliation(s)
- Mohammad Nekooeian
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahrokh Ezzatzadegan Jahromi
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Internal Medicine, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | - Fatemeh Masjedi
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Sohooli
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Shekouhi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.,Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Moaref
- Department of Cardiology, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran.,Cardiovascular Research Center, Shiraz University of Medical Science, Shiraz, Iran
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26
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Trirattanapikul A, Kongpetch S, Lukkanalikitkul E, Ahooja A, Seesuk P, Sharma A, Anutrakulchai S. Lung Ultrasound Estimates the Overhydration and Benefits Blood Pressure Control in Normal or Mild Symptomatic Hemodialysis Patients. Int J Nephrol Renovasc Dis 2022; 15:383-395. [PMID: 36570492 PMCID: PMC9784469 DOI: 10.2147/ijnrd.s374569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 11/12/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Lung ultrasound (LUS) is used for dry weight guidance by assessment of pulmonary congestion in hemodialysis (HD) patients. The aim of this study was to estimate amounts of accumulated fluid by total LUS scores (TLUSS), which were scarcely reported in HD patients who were normal or had a mild functional abnormality. In addition, the correlations between the LUS score of each area and TLUSS were determined to suggest fewer specific areas valuable to shorten the examination time of LUS. Methods This cohort study was conducted in adult HD patients who have New York Heart Association Classes I-II. LUS and multifrequency bioimpedance (BIA) were performed at baseline and the individual prescribed dry weight was set. Then each LUS was conducted at 28 areas of bilateral intercostal spaces and calculated as TLUSS weekly for eight weeks in which dry weight was adjusted. The second BIA was also measured at week eight. The difference of pre-HD weight and target weight (weight gain; WG) represented the amount of fluid accumulation. Results Twenty patients with a mean age of 62.2±14.0 years were enrolled. One hundred and sixty-six LUS were performed in which forty episodes of them were simultaneously measured with BIA. Optimum dry weight adjusted by TLUSS which benefited in mean reductions of blood pressure, and cardiothoracic ratios. WG amounts were significantly correlated with TLUSS (r=0.38), and with extracellular fluid (r=0.35) and overhydration fluid (r=0.39) assessed by BIA. Estimations of mean fluid overload were 2.18 (TLUSS ≤15), 2.72 (TLUSS 16-24), 3.17 (TLUSS 25-33), 3.65 (TLUSS 34-38) and 5.03 (TLUSS ≥39) in liters. The cut-off points of sum scores of 12 specific lung areas represented the none-mild were <8, moderate at 8-16, and severe pulmonary congestions were >16. Conclusion TLUSS estimated accumulated fluid useful for volume and blood pressure controls. Performance of LUS in 12 specific lung areas may reduce spending time and support routine uses of LUS in clinical practice.
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Affiliation(s)
| | - Sawinee Kongpetch
- Deparment of Medicine, Khon Kaen University, Khon Kaen, Thailand,Center of Excellence in Kidney Diseases, Khon Kaen University, Khon Kaen, Thailand
| | - Eakalak Lukkanalikitkul
- Deparment of Medicine, Khon Kaen University, Khon Kaen, Thailand,Center of Excellence in Kidney Diseases, Khon Kaen University, Khon Kaen, Thailand
| | - Anucha Ahooja
- Department of Radiology, Khon Kaen University, Khon Kaen, Thailand
| | - Patamapon Seesuk
- Center of Excellence in Kidney Diseases, Khon Kaen University, Khon Kaen, Thailand
| | - Amod Sharma
- Chronic Kidney Disease Prevention in the Northeast of Thailand (CKDNET) Project, Khon Kaen University, Khon Kaen, Thailand
| | - Sirirat Anutrakulchai
- Deparment of Medicine, Khon Kaen University, Khon Kaen, Thailand,Chronic Kidney Disease Prevention in the Northeast of Thailand (CKDNET) Project, Khon Kaen University, Khon Kaen, Thailand,Correspondence: Sirirat Anutrakulchai, Division of Nephrology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand, Email ;
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27
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Cheng L, Chang L, Tian R, Zhou J, Luo F, Zhang H. The predictive value of bioimpedance-derived fluid parameters for cardiovascular events in patients undergoing hemodialysis. Ren Fail 2022; 44:1192-1200. [PMID: 35856161 PMCID: PMC9318232 DOI: 10.1080/0886022x.2022.2095287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background It is becoming increasingly evident that the accurate assessment of fluid
status is critical to ensure optimal care in patients undergoing
hemodialysis (HD). Various fluid parameters, including
overhydration (OH) and overhydration/extracellular water
(OH/ECW%), which can be obtained using a
bioimpedance spectroscopy device have been used to indicate the hydration
status in such patients. This study aimed to explore the effect of these
fluid parameters on cardiovascular events and determine which parameter was
a better predictor of cardiovascular events (CVEs). Methods A total of 227 patients who underwent HD at the Hangzhou Hospital of
Traditional Chinese Medicine were enrolled in this prospective study between
December 2017 and August 2018. Clinical data were collected, and the fluid
status of patients was assessed using a body composition monitor. The
patients were followed up until December 2020. The primary outcomes were
CVEs. The association between fluid parameters and CVEs was analyzed using
Cox proportional hazards models. The areas under the curve
(AUCs) of receiver operating characteristic analysis and
improvement in the global chi-squared value were used to compare the
predictive values of fluid parameters for CVEs. Results During a median follow-up of 31 months, 66 CVEs were recorded. The
patients with a higher absolute hydration index (OH) and a
relative hydration index (OH/ECW%) exhibited an
increased risk of developing CVEs. After adjusting for confounding factors,
both OH [hazard ratio (HR) 1.279 per L, 95%
confidence interval (CI) 1.047–1.562;
p = 0.016] and OH/ECW%
(HR 1.061 per %, 95% CI 1.017–1.108;
p = 0.006) were
independently associated with CVEs. The predictive ability of the absolute
hydration index was superior to the relative hydration index based on AUC
calculations for CVEs. Furthermore, a greater change in
χ2 in predicting CVEs was noted
for the absolute hydration index. Conclusions Both absolute hydration index and relative hydration index were found to be
independent predictors of CVEs in univariate and multivariate analyses.
Furthermore, the absolute hydration index had a better additive predictive
value than the relative hydration index in predicting CVEs.
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Affiliation(s)
- Linghong Cheng
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Liyang Chang
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Rongrong Tian
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jianfang Zhou
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Fenxia Luo
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Hongmei Zhang
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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28
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Biphasic Dynamics of Inflammatory Markers Following Hemodialysis Initiation: Results From the International MONitoring Dialysis Outcome Initiative. Kidney Int Rep 2022; 8:75-80. [PMID: 36644346 PMCID: PMC9831940 DOI: 10.1016/j.ekir.2022.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 09/28/2022] [Accepted: 10/17/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Inflammation is highly prevalent among patients with end-stage kidney disease and is associated with adverse outcomes. We aimed to investigate longitudinal changes in inflammatory markers in a diverse international incident hemodialysis patient population. Methods The MONitoring Dialysis Outcomes (MONDO) Consortium encompasses hemodialysis databases from 31 countries in Europe, North America, South America, and Asia. The MONDO database was queried for inflammatory markers (total white blood cell count [WBC], neutrophil count, lymphocyte count, serum albumin, and C-reactive protein [CRP]) and hemoglobin levels in incident hemodialysis patients. Laboratory parameters were measured every month. Patients were stratified by survival time (≤6 months, >6 to 12 months, >12 to 18 months, >18 to 24 months, >24 to 30 months, >30 to 36 months, and >36 months) following dialysis initiation. We used cubic B-spline basis function to evaluate temporal changes in inflammatory parameters in relationship with patient survival. Results We studied 18,726 incident hemodialysis patients. Their age at dialysis initiation was 71.3 ± 11.9 years; 10,802 (58%) were males. Within the first 6 months, 2068 (11%) patients died, and 12,295 patients (67%) survived >36 months (survivor cohort). Hemodialysis patients who died showed a distinct biphasic pattern of change in inflammatory markers where an initial decline of inflammation was followed by a rapid rise that was consistently evident approximately 6 months before death. This pattern was similar in all patients who died and was consistent across the survival time intervals. In contrast, in the survivor cohort, we observed initial decline of inflammation followed by sustained low levels of inflammatory biomarkers. Conclusion Our international study of incident hemodialysis patients highlights a temporal relationship between serial measurements of inflammatory markers and patient survival. This finding may inform the development of prognostic models, such as the integration of dynamic changes in inflammatory markers for individual risk profiling and guiding preventive and therapeutic interventions.
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29
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Canaud B, Morena-Carrere M, Leray-Moragues H, Cristol JP. Fluid Overload and Tissue Sodium Accumulation as Main Drivers of Protein Energy Malnutrition in Dialysis Patients. Nutrients 2022; 14:4489. [PMID: 36364751 PMCID: PMC9658859 DOI: 10.3390/nu14214489] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 01/15/2024] Open
Abstract
Protein energy malnutrition is recognized as a leading cause of morbidity and mortality in dialysis patients. Protein-energy-wasting process is observed in about 45% of the dialysis population using common biomarkers worldwide. Although several factors are implicated in protein energy wasting, inflammation and oxidative stress mechanisms play a central role in this pathogenic process. In this in-depth review, we analyzed the implication of sodium and water accumulation, as well as the role of fluid overload and fluid management, as major contributors to protein-energy-wasting process. Fluid overload and fluid depletion mimic a tide up and down phenomenon that contributes to inducing hypercatabolism and stimulates oxidation phosphorylation mechanisms at the cellular level in particular muscles. This endogenous metabolic water production may contribute to hyponatremia. In addition, salt tissue accumulation likely contributes to hypercatabolic state through locally inflammatory and immune-mediated mechanisms but also contributes to the perturbation of hormone receptors (i.e., insulin or growth hormone resistance). It is time to act more precisely on sodium and fluid imbalance to mitigate both nutritional and cardiovascular risks. Personalized management of sodium and fluid, using available tools including sodium management tool, has the potential to more adequately restore sodium and water homeostasis and to improve nutritional status and outcomes of dialysis patients.
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Affiliation(s)
- Bernard Canaud
- School of Medicine, Montpellier University, 34000 Montpellier, France
- Global Medical Office, FMC-France, 94260 Fresnes, France
| | - Marion Morena-Carrere
- PhyMedExp, Department of Biochemistry and Hormonology, INSERM, CNRS, University Hospital Center of Montpellier, University of Montpellier, 34000 Montpellier, France
| | | | - Jean-Paul Cristol
- PhyMedExp, Department of Biochemistry and Hormonology, INSERM, CNRS, University Hospital Center of Montpellier, University of Montpellier, 34000 Montpellier, France
- Charles Mion Foundation, AIDER-Santé, 34000 Montpellier, France
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Mayne KJ, Lees JS, Herrington WG. Bioimpedance in CKD: an untapped resource? Nephrol Dial Transplant 2022; 38:583-585. [PMID: 36260361 PMCID: PMC9976732 DOI: 10.1093/ndt/gfac275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Jennifer S Lees
- School of Cardiovascular and Metabolic Health, College of Medical and Veterinary Life Sciences, University of Glasgow, Glasgow, UK
| | - William G Herrington
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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31
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Costa FL, Reis NSDC, Reis FM, de Oliveira RC, Zanati Bazan SG, Canedo da Silva MZ, Martin LC, Barretti P. Multifrequency bioimpedance by spectroscopy vs. routine methods in the management of hydration status in peritoneal dialysis patients: A randomized control trial. Front Med (Lausanne) 2022; 9:911047. [PMID: 36160161 PMCID: PMC9492968 DOI: 10.3389/fmed.2022.911047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Overhydration (OH) is common in peritoneal dialysis (PD) and increases the cardiovascular risk. Multifrequency bioimpedance spectroscopy (BIS) has been proposed to estimate the hydration in dialysis. Our objective was to evaluate if BIS is superior than control based on clinical assessment plus single-frequency bioimpedance (SF-BIA) on the fluid control and intermediate cardiovascular outcomes. Methods Randomized controlled study in adult PD patients, with a 9-month follow-up, allocated into two groups: control and BIS. Data were collected from medical records. SF-BIA and BIS, laboratory exams, ambulatory blood pressure monitoring, echocardiography (ECHO), and pulse wave velocity (PWV) were evaluated. The BIS data were available to the medical team only in BIS group. Results 34 patients completed the study, 17 in each group. At the endpoint the BIS group had a significant (p < 0.05) greater proportion of patients with OH/extracellular water (OH/ECW%) ≤ 15% than the control (94.1% vs. 52.9%), and a lower OH mean (2.1 ± 1.6 vs. 0.9 ± 1.1 L). The control group has a significant increase in the tumor necrosis factor alpha median concentration from baseline to six [11.9 (6.0–24.1) vs. 44.7 (9.4–70.6) pg/ml] and 9 months [11.9 (6.0–24.1) vs. 39.4 (27.9–62.6) pg/ml], and in the N-terminal fragment of pro-B-type natriuretic peptide median [239 (171.5–360.5) vs. 356 (219–1,555) pg/ml]. For cardiovascular parameters, BIS group presented a significant reduction in radial PWV [7.7 (6.9–9.2) vs. 6.5 (5.5–8.4) m/s] at 9 month, while in the control presented a significant increase in mean central systolic blood pressure (BP) (106.8 ± 11.2 vs. 117.6 ± 16.5 mmHg) and in central diastolic BP (90.4 ± 9.8 vs. 103.3 ± 12.5 mmHg) at 9 months. The left ventricular mass (LVM)/body surface presented a significant reduction in the control (109.6 ± 30.8 vs. 101.2 ± 28.9 g/m2) and BIS group (107.7 ± 24.9 vs. 96.1 ± 27.0 g/m2) at 9 months. Conclusion The results suggest BIS is superior than the clinical evaluation plus SF-BIA for the fluid control of PD patients. Clinical trial registration [https://www.ClinicalTrials.gov], identifier [RBR-10k8j3bx].
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Mayne KJ, Shemilt R, Keane DF, Lees JS, Mark PB, Herrington WG. Bioimpedance indices of fluid overload and cardiorenal outcomes in heart failure and chronic kidney disease: a systematic review. J Card Fail 2022; 28:1628-1641. [PMID: 36038013 DOI: 10.1016/j.cardfail.2022.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/23/2022] [Accepted: 08/04/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Bioimpedance-based estimates of fluid overload have been widely studied and systematically reviewed in dialysis populations, but data from heart failure or non-dialysis chronic kidney disease (CKD) populations have not. METHODS AND RESULTS We conducted a systematic review of studies using whole-body bioimpedance from heart failure and non-dialysis CKD populations which reported associations with mortality, cardiovascular outcomes and/or CKD progression. We searched MEDLINE, Embase databases and the Cochrane CENTRAL registry from inception to 14th March 2022. Thirty one eligible studies were identified: 20 heart failure and 11 CKD cohorts, with 2 studies including over 1000 participants. A wide range of different bioimpedance methods were used across the studies (heart failure: 8 parameters; CKD: 6). Studies generally reported positive associations, but between-study differences in bioimpedance methods, fluid overload exposure definitions, and modelling approaches precluded meta-analysis. The largest identified study was in non-dialysis CKD (Chronic Renal Insufficiency Cohort, 3751 participants) which reported adjusted hazard ratios (95% confidence intervals) for phase angle <5.59 versus ≥6.4 of 2.02 (1.67-2.43) for all-cause mortality; 1.80 (1.46-2.23) for heart failure events; and 1.78 (1.56-2.04) for CKD progression. CONCLUSIONS Bioimpedance indices of fluid overload are associated with risk of important cardiorenal outcomes in heart failure and CKD. Facilitation of more widespread use of bioimpedance needs consensus on the optimum device, standardized analytical methods, and larger studies including more detailed characterization of cardiac and renal phenotypes.
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Affiliation(s)
- Kaitlin J Mayne
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre (GCRC), University of Glasgow, Glasgow, UK.
| | - Richard Shemilt
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre (GCRC), University of Glasgow, Glasgow, UK
| | - David F Keane
- CÚRAM SFI Research Centre for Medical Devices, HRB-Clinical Research Facility Galway, National University of Ireland Galway, Ireland
| | - Jennifer S Lees
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre (GCRC), University of Glasgow, Glasgow, UK
| | - Patrick B Mark
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre (GCRC), University of Glasgow, Glasgow, UK
| | - William G Herrington
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.
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Kooman JP, Carioni P, Kovarova V, Arkossy O, Winter A, Zhang Y, Bellocchio F, Kotanko P, Zhang H, Usvyat L, Larkin J, Stuard S, Neri L. Modifiable Risk Factors Are Important Predictors of COVID-19-Related Mortality in Patients on Hemodialysis. FRONTIERS IN NEPHROLOGY 2022; 2:907959. [PMID: 37674993 PMCID: PMC10479683 DOI: 10.3389/fneph.2022.907959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/01/2022] [Indexed: 09/08/2023]
Abstract
Introduction Patients with end-stage kidney disease face a higher risk of severe outcomes from SARS-CoV-2 infection. Moreover, it is not well known to what extent potentially modifiable risk factors contribute to mortality risk. In this historical cohort study, we investigated the incidence and risk factors for 30-day mortality among hemodialysis patients with SARS-CoV-2 infection treated in the European Fresenius Medical Care NephroCare network using conventional and machine learning techniques. Methods We included adult hemodialysis patients with the first documented SARS-CoV-2 infection between February 1, 2020, and March 31, 2021, registered in the clinical database. The index date for the analysis was the first SARS-CoV-2 suspicion date. Patients were followed for up to 30 days until April 30, 2021. Demographics, comorbidities, and various modifiable risk factors, expressed as continuous parameters and as key performance indicators (KPIs), were considered to tap multiple dimensions including hemodynamic control, nutritional state, and mineral metabolism in the 6 months before the index date. We used logistic regression (LR) and XGBoost models to assess risk factors for 30-day mortality. Results We included 9,211 patients (age 65.4 ± 13.7 years, dialysis vintage 4.2 ± 3.7 years) eligible for the study. The 30-day mortality rate was 20.8%. In LR models, several potentially modifiable factors were associated with higher mortality: body mass index (BMI) 30-40 kg/m2 (OR: 1.28, CI: 1.10-1.50), single-pool Kt/V (OR off-target vs on-target: 1.19, CI: 1.02-1.38), overhydration (OR: 1.15, CI: 1.01-1.32), and both low (<2.5 mg/dl) and high (≥5.5 mg/dl) serum phosphate levels (OR: 1.52, CI: 1.07-2.16 and OR: 1.17, CI: 1.01-1.35). On-line hemodiafiltration was protective in the model using KPIs (OR: 0.86, CI: 0.76-0.97). SHapley Additive exPlanations analysis in XGBoost models shows a high influence on prediction for several modifiable factors as well, including inflammatory parameters, high BMI, and fluid overload. In both LR and XGBoost models, age, gender, and comorbidities were strongly associated with mortality. Conclusion Both conventional and machine learning techniques showed that KPIs and modifiable risk factors in different dimensions ascertained 6 months before the COVID-19 suspicion date were associated with 30-day COVID-19-related mortality. Our results suggest that adequate dialysis and achieving KPI targets remain of major importance during the COVID-19 pandemic as well.
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Affiliation(s)
- Jeroen Peter Kooman
- Department of Internal Medicine, University Hospital Maastricht, Maastricht, Netherlands
| | - Paola Carioni
- Fresenius Medical Care Italia SpA, Palazzo Pignano, Italy
| | | | - Otto Arkossy
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Anke Winter
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Yan Zhang
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | | | - Peter Kotanko
- Renal Research Institute, New York, NY, United States
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Hanjie Zhang
- Renal Research Institute, New York, NY, United States
| | - Len Usvyat
- Fresenius Medical Care, Waltham, MA, United States
| | - John Larkin
- Fresenius Medical Care, Waltham, MA, United States
| | - Stefano Stuard
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Luca Neri
- Fresenius Medical Care Italia SpA, Palazzo Pignano, Italy
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Hussein U, Cimini M, Handelman GJ, Raimann JG, Liu L, Abbas SR, Kotanko P, Levin NW, Finkelstein FO, Zhu F. Identification of fluid overload in elderly CKD Patients using bioimpedance techniques. J Appl Physiol (1985) 2022; 133:205-213. [PMID: 35652832 DOI: 10.1152/japplphysiol.00645.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Diagnosis of fluid overload (FO) in early stage is essential to manage chronic kidney disease (CKD) patients' fluid balance and to prevent cardiovascular disease (CVD). However, identification of fluid status in CKD patient is largely dependent on physician's clinical acumen. The ratio of fluid overload to extracellular volume (FO/ECV) has been used as a reference to assess fluid status. The primary aim of this study was to compare FO/ECV with other bioimpedance methods and clinical assessment in CKD patients. Whole body ECV, intracellular volume (ICV), total body water (TBW) and calf normalized resistivity (CNR) were measured (Hydra 4200). Thresholds of FO utilizing CNR and ECV/TBW were derived by receiver operator characteristic (ROC) analysis based on data from pooled CKD patients and healthy subjects (HS). Clinical assessments of FO in CKD patients were performed by nephrologists . CKD (stage 3 and stage 4) patients (n=50) and HS (n=189) were studied. The thresholds of FO were ≤ 14.3 (10-2 Ωm3/kg) for females and ≤ 13.1 (10-2 Ωm3/kg) for males using CNR and ≥ 0.445 in females and ≥ 0.434 in males using ECV/TBW. FO was diagnosed in 78%, 62% and 52% of CKD patients by CNR, FO/ECV and ECV/TBW, respectively while only 24% of CKD patients were diagnosed to be FO by clinical assessment . The proportion of FO in non-dialysis CKD patients was largely underestimated by clinical assessment compared to FO/ECV, CNR and ECV/TBW. CNR, and FO/ECV methods were more sensitive than ECV/TBW in identifying fluid overload in these CKD patients.
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Affiliation(s)
- Usama Hussein
- Renal Research Institute, New Haven, New Haven, CT, United States
| | - Monica Cimini
- Renal Research Institute, New Haven, New Haven, CT, United States
| | - Garry J Handelman
- Renal Research Institute, New York, NY, United States.,University of Massachusetts, Lowell, MA, United States
| | | | - Li Liu
- Renal Research Institute, New York, NY, United States.,Renal Division, Peking University First Hospital, Beijing, China
| | - Samer R Abbas
- Renal Research Institute, New York, NY, United States
| | - Peter Kotanko
- Renal Research Institute, New York, NY, United States.,Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nathan W Levin
- Renal Research Institute, New York, NY, United States.,Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Fredric O Finkelstein
- Renal Research Institute, New Haven, New Haven, CT, United States.,Yale University, New Haven, CT, United States
| | - Fansan Zhu
- Renal Research Institute, New York, NY, United States
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Salerno FR, Akbari A, Lemoine S, Filler G, Scholl TJ, McIntyre CW. Outcomes and predictors of skin sodium concentration in dialysis patients. Clin Kidney J 2022; 15:1129-1136. [PMID: 35664280 PMCID: PMC9155229 DOI: 10.1093/ckj/sfac021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Indexed: 11/19/2022] Open
Abstract
Background Sodium-23 magnetic resonance imaging (23Na MRI) allows the measurement of skin sodium concentration ([Na+]). In patients requiring dialysis, no data are available relating to the clinical outcomes associated with skin sodium accumulation or the determinants of increasing deposition. Methods This was an exploratory, observational study of adult hemodialysis (HD) and peritoneal dialysis (PD) patients. Participants underwent skin [Na+] quantification with leg 23Na MRI at the study's beginning. Outcomes of interest were all-cause mortality and composite all-cause mortality plus major adverse cardiovascular events. Cumulative total and event-free survival were assessed using the Kaplan-Meier survival function after stratification into skin [Na+] quartiles. Cox proportional hazards regression was used to model the association between skin [Na+] and outcomes of interest. Multiple linear regression was used to model the predictors of skin [Na+]. Results A total of 52 participants (42 HD and 10 PD) underwent the study procedures. The median follow-up was 529 days (interquartile range: 353-602). Increasing skin [Na+] quartiles were associated with significantly shorter overall and event-free survival (log-rank χ2(1) = 3.926, log-rank χ2(1) = 5.685; P for trend <0.05 in both instances). Skin [Na+] was associated with all-cause mortality {hazard ratio (HR) 4.013, [95% confidence interval (95% CI) 1.988-8.101]; P < 0.001} and composite events [HR 2.332 (95% CI 1.378-3.945); P < 0.01], independently of age, sex, serum [Na+] and albumin. In multiple regression models, dialysate [Na+], serum albumin and congestive heart failure were significantly associated with skin [Na+] in HD patients (R2 adj = 0.62). Conclusions Higher skin [Na+] was associated with worse clinical outcomes in dialysis patients and may represent a direct therapeutic target.
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Affiliation(s)
- Fabio R Salerno
- Department of Medical Biophysics, Western University, London, ON, Canada
- The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada
| | - Alireza Akbari
- The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada
- Robarts Research Institute, Western University, London, ON, Canada
| | - Sandrine Lemoine
- The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada
- Claude Bernard Lyon 1 University, Lyon, France
| | - Guido Filler
- The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada
- Departments of Pediatrics, London Health Sciences Centre, London, ON, Canada
| | - Timothy J Scholl
- Department of Medical Biophysics, Western University, London, ON, Canada
- Robarts Research Institute, Western University, London, ON, Canada
| | - Christopher W McIntyre
- Department of Medical Biophysics, Western University, London, ON, Canada
- The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada
- Division of Nephrology, London Health Sciences Centre, London, ON, Canada
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Moromizato T, Sakaniwa R, Miyauchi T, So R, Iso H, Iseki K. Long-term weight loss as a predictor of mortality in haemodialysis patients. J Epidemiol 2022; 33:390-397. [PMID: 35283398 PMCID: PMC10319526 DOI: 10.2188/jea.je20210389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/17/2022] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Serial weight decrease can be a prognostic predictor in chronic haemodialysis (HD) patients. We investigated the impact of long-term post-HD body weight (BW) changes on all-cause mortality among HD patients. METHODS This longitudinal cohort study and post-hoc analysis evaluated participants of a previous randomised controlled trial conducted between 2006 and 2011 who were followed up until 2018. Weight change slopes were generated with repeated measurements every 6 months during the trial for patients having ≥5 BW measurements. Participants were categorised into four groups based on quartiles of weight change slopes; the median weight changes per 6 months were -1.02 kg, -0.25 kg, +0.26 kg, and +0.86 kg. Cox proportional hazard regression was used to evaluate differences in subsequent survival among the four groups. BW trajectories were plotted with a backward time-scale and multilevel regression analysis to visualise the difference in BW trajectories between survivors and non-survivors. RESULTS Among the 461 patients, 404 were evaluated, and 168 (41.6%) died within a median follow-up period of 10.2 years. The Cox proportional hazard regression adjusted for covariates and baseline BW showed that a higher rate of weight loss was associated with higher mortality. The hazard ratios were 2.02 (1.28-3.20), 1.77 (1.10-2.85), 1.00 (reference), and 1.11 (0.67-1.83) for the first, second, third (reference), and fourth quartiles, respectively. BW trajectories revealed a significant decrease in BW in non-survivors. CONCLUSIONS Weight loss elucidated by serial BW measurements every 6 months is significantly associated with higher mortality among HD patients.
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Affiliation(s)
- Takuhiro Moromizato
- Renal and Rheumatology Division, Internal Medicine Department, Okinawa Prefectural Nanbu Medical Center and Children’s Medical Center, Shimajiri, Okinawa, Japan
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryoto Sakaniwa
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takamasa Miyauchi
- Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna School of Medicine, Kawasaki, Japan
| | - Ryuhei So
- Okayama Psychiatric Medical Center, Okayama, Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kunitoshi Iseki
- Clinical Research Support Center, Nakamura Clinic, Urasoe, Okinawa, Japan
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Kim JC, Do JY, Kang SH. Clinical Significance of Volume Status in Body Composition and Physical Performance Measurements in Hemodialysis Patients. Front Nutr 2022; 9:754329. [PMID: 35299757 PMCID: PMC8922218 DOI: 10.3389/fnut.2022.754329] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction This study aimed to evaluate the association between volume status and body composition or physical performance measurements in hemodialysis patients. Methods A total of 84 patients were enrolled in this study. The participants were divided into tertiles based on the edema index (extracellular water/total body water): low, middle, and high tertiles. Serum albumin and serum high-sensitivity C-reactive protein levels were measured. The appendicular lean mass index (ALM/Ht2, kg/m2) was measured using dual-energy X-ray absorptiometry. The thigh muscle area index (TMA/Ht2, cm2/m2) was measured using CT. Extracellular and total body water and phase angles were obtained using bioimpedance analysis. The results of the subjective global assessment (SGA), hand-grip strength (HGS), gait speed (GS), short physical performance battery (SPPB), sit-to-stand for 30-second (STS30) test, timed up and go (TUG), sit-to-stand test performed five times (STS5), and 6-minute walk (6-MW) tests were also evaluated. Results On the univariate analysis, the SGA score and phase angle in the high tertile group were the lowest among the three groups. On multivariate analysis, TMA/Ht2 and phase angle in the high tertile were the lowest among the three groups. Inverse correlations were observed between edema index and TMA/Ht2, SGA score, phase angle, HGS, GS, SPPB, STS30, or 6-MW. Positive correlations were observed between the edema index and the STS5 or TUG test. The sensitivity and specificity for predicting low GS were 34.5 and 89.7%, respectively. The values for predicting low SPPB were 68.0 and 79.7%, respectively. Conclusion This study demonstrates that high volume status may be associated with decreased muscle mass and physical performance regardless of inflammatory or nutritional status.
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Affiliation(s)
- Jun Chul Kim
- Division of Nephrology, Department of Internal Medicine, CHA Gumi Medical Center, CHA University, Gumi, South Korea
| | - Jun Young Do
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, South Korea
| | - Seok Hui Kang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, South Korea
- *Correspondence: Seok Hui Kang
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Zsom L, Zsom M, Salim SA, Fülöp T. Estimated Glomerular Filtration Rate in Chronic Kidney Disease: A Critical Review of Estimate-Based Predictions of Individual Outcomes in Kidney Disease. Toxins (Basel) 2022; 14:toxins14020127. [PMID: 35202154 PMCID: PMC8875627 DOI: 10.3390/toxins14020127] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 12/13/2022] Open
Abstract
Chronic kidney disease (CKD) is generally regarded as a final common pathway of several renal diseases, often leading to end-stage kidney disease (ESKD) and a need for renal replacement therapy. Estimated GFR (eGFR) has been used to predict this outcome recognizing its robust association with renal disease progression and the eventual need for dialysis in large, mainly cross-sectional epidemiological studies. However, GFR is implicitly limited as follows: (1) GFR reflects only one of the many physiological functions of the kidney; (2) it is dependent on several non-renal factors; (3) it has intrinsic variability that is a function of dietary intake, fluid and cardiovascular status, and blood pressure especially with impaired autoregulation or medication use; (4) it has been shown to change with age with a unique non-linear pattern; and (5) eGFR may not correlate with GFR in certain conditions and disease states. Yet, many clinicians, especially our non-nephrologist colleagues, tend to regard eGFR obtained from a simple laboratory test as both a valid reflection of renal function and a reliable diagnostic tool in establishing the diagnosis of CKD. What is the validity of these beliefs? This review will critically reassess the limitations of such single-focused attention, with a particular focus on inter-individual variability. What does science actually tell us about the usefulness of eGFR in diagnosing CKD?
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Affiliation(s)
- Lajos Zsom
- Fresenius Medical Care, Cegléd Dialysis Center, Törteli u 1-3, 2700 Cegléd, Hungary
- Correspondence: (L.Z.); (T.F.)
| | - Marianna Zsom
- Department of Medicine, St. Rókus Hospital, Rókus u 10, 6500 Baja, Hungary;
| | - Sohail Abdul Salim
- Department of Medicine, Division of Nephrology, University of Mississippi, 2500 N State St., Jackson, MS 39216, USA;
| | - Tibor Fülöp
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 629, CSB 822, Charleston, SC 29425, USA
- Medicine Services, Ralph H. Johnson VA Medical Center, 109 Bee St., Charleston, SC 29401, USA
- Correspondence: (L.Z.); (T.F.)
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Casper S, Fuertinger DH, Tapia Silva LM, Rivera Fuentes L, Thijssen S, Kotanko P. Proportional integral feedback control of ultrafiltration rate in hemodialysis. Int J Artif Organs 2022; 45:271-277. [PMID: 35075944 DOI: 10.1177/03913988211069395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Most hemodialysis patients without residual kidney function accumulate fluid between dialysis session that needs to be removed by ultrafiltration. Ultrafiltration usually results in a decline in relative blood volume (RBV). Recent epidemiological research has identified RBV ranges that were associated with significantly better survival. The objective of this work was to develop an ultrafiltration controller to steer a patient's RBV trajectory into these favorable RBV ranges. METHODS We designed a proportional-integral feedback ultrafiltration controller that utilizes signals from a device that reports RBV. The control goal is to attain the RBV trajectory associated with improved patient survival. Additional constraints such as upper and lower bounds of ultrafiltration volume and rate were realized. The controller was evaluated in in silico and ex vivo bench experiments, and in a clinical proof-of-concept study in two maintenance dialysis patients. RESULTS In all tests, the ultrafiltration controller performed as expected. In the in silico and ex vivo bench experiments, the controller showed robust reaction toward deliberate disruptive interventions (e.g. signal noise; extreme plasma refill rates). No adverse events were observed in the clinical study. CONCLUSIONS The ultrafiltration controller can steer RBV trajectories toward desired RBV ranges while obeying to a set of constraints. Prospective studies in hemodialysis patients with diverse clinical characteristics are warranted to further explore the controllers impact on intradialytic hemodynamic stability, quality of life, and long-term outcomes.
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Affiliation(s)
- Sabrina Casper
- Global Research and Development, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Doris H Fuertinger
- Global Research and Development, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
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Role of the new bioimpedance monitoring device (Seca ®) in assessing dry weight in hemodialysis patients. Clin Exp Nephrol 2022; 26:460-465. [PMID: 34982308 DOI: 10.1007/s10157-021-02177-7] [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: 08/29/2021] [Accepted: 12/23/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND In recent years, bioimpedance analysis has come to be widely used in clinical practice for dialysis patients, but there is not sufficient consensus on its significance. We aimed to examine the merits of performing bioimpedance analysis in addition to conventional evaluation methods for dry weight such as measuring human atrial natriuretic peptide (hANP), blood pressure, and cardiothoracic ratio in patients on chronic hemodialysis. METHODS Body composition of 78 hemodialysis patients was performed by using a new and more accurate segmental multifrequency bioimpedance analysis device (Seca® medical body composition analyzer 525, Seca GmbH & Co. KG, Hamburg, Germany). Laboratory data including hANP at post-dialysis and demographic profile were collected. Statistical analysis was performed with SPSS software. RESULTS Mean age of the patients was 66.9 ± 12.6 years and 80.8% were males. Mean value of hANP and the ratio of extracellular water to total body water (ECW/TBW) were 61.4 ± 36.4 pg/mL and 46.1 ± 3.9%, respectively. The calculated ECW/TBW cutoff point for hANP > 50 pg/mL was 45.0%, with sensitivity of 74.4% and specificity of 64.7%. Patients with an ECW/TBW of more than 45% and hANP value of > 50 pg/mL had a higher blood pressure and cardiothoracic ratio on chest X-ray examination. CONCLUSIONS Our results suggest that the ratio of extracellular water to total body water of more than 45% and hANP value of ≥ 50 pg/mL were overhydrated in chronic hemodialysis patients. Whether monitoring levels of these parameters has a role in the outcome including patients' survival and cardiovascular events requires further study.
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Moissl U, Fuentes LR, Hakim MI, Hassler M, Kothari DA, Rosales L, Zhu F, Raimann JG, Thijssen S, Kotanko P. Prevalence of fluid overload in an urban US hemodialysis population: A cross-sectional study. Hemodial Int 2021; 26:264-273. [PMID: 34897937 DOI: 10.1111/hdi.12986] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/25/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Inadequate fluid status remains a key driver of cardiovascular morbidity and mortality in chronic hemodialysis (HD) patients. Quantification of fluid overload (FO) using bioimpedance spectroscopy (BIS) has become standard in many countries. To date, no BIS device has been approved in the United States for fluid status assessment in kidney patients. Therefore, no previous quantification of fluid status in US kidney patients using BIS has been reported. Our aim was to conduct a cross-sectional BIS-based assessment of fluid status in an urban US HD population. METHODS We determined fluid status in chronic HD patients using whole body BIS (Body Composition Monitor, BCM). The BCM reports FO in liters; negative FO denotes fluid depletion. Measurements were performed before dialysis. Post-HD FO was estimated by subtracting the intradialytic weight loss from the pre-HD FO. FINDINGS We studied 170 urban HD patients (age 61 ± 14 years, 60% male). Pre- and post-HD FO (mean ± SD), were 2.2 ± 2.4 and -0.2 ± 2.7 L, respectively. Pre-HD, 43% of patients were fluid overloaded, 53% normally hydrated, and 4% fluid depleted. Post-HD, 12% were fluid overloaded, 55% normohydrated and 32% fluid depleted. Only 48% of fluid overloaded patients were hypertensive, while 38% were normotensive and 14% hypotensive. Fluid status did not differ significantly between African Americans (N = 90) and Caucasians (N = 61). DISCUSSION While about half of the patients had normal fluid status pre-HD, a considerable proportion of patients was either fluid overloaded or depleted, indicating the need for tools to objectively quantify fluid status.
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Affiliation(s)
- Ulrich Moissl
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Hessen, Germany
| | | | | | - Manuel Hassler
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Hessen, Germany
| | | | | | - Fansan Zhu
- Renal Research Institute, New York, New York, USA
| | | | | | - Peter Kotanko
- Renal Research Institute, New York, New York, USA.,Icahn School of Medicine at Mount Sinai, New Nork, New York, USA
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Canaud B, Stephens MP, Nikam M, Etter M, Collins A. Multitargeted interventions to reduce dialysis-induced systemic stress. Clin Kidney J 2021; 14:i72-i84. [PMID: 34987787 PMCID: PMC8711765 DOI: 10.1093/ckj/sfab192] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Indexed: 11/13/2022] Open
Abstract
Hemodialysis (HD) is a life-sustaining therapy as well as an intermittent and repetitive stress condition for the patient. In ridding the blood of unwanted substances and excess fluid from the blood, the extracorporeal procedure simultaneously induces persistent physiological changes that adversely affect several organs. Dialysis patients experience this systemic stress condition usually thrice weekly and sometimes more frequently depending on the treatment schedule. Dialysis-induced systemic stress results from multifactorial components that include treatment schedule (i.e. modality, treatment time), hemodynamic management (i.e. ultrafiltration, weight loss), intensity of solute fluxes, osmotic and electrolytic shifts and interaction of blood with components of the extracorporeal circuit. Intradialytic morbidity (i.e. hypovolemia, intradialytic hypotension, hypoxia) is the clinical expression of this systemic stress that may act as a disease modifier, resulting in multiorgan injury and long-term morbidity. Thus, while lifesaving, HD exposes the patient to several systemic stressors, both hemodynamic and non-hemodynamic in origin. In addition, a combination of cardiocirculatory stress, greatly conditioned by the switch from hypervolemia to hypovolemia, hypoxemia and electrolyte changes may create pro-arrhythmogenic conditions. Moreover, contact of blood with components of the extracorporeal circuit directly activate circulating cells (i.e. macrophages-monocytes or platelets) and protein systems (i.e. coagulation, complement, contact phase kallikrein-kinin system), leading to induction of pro-inflammatory cytokines and resulting in chronic low-grade inflammation, further contributing to poor outcomes. The multifactorial, repetitive HD-induced stress that globally reduces tissue perfusion and oxygenation could have deleterious long-term consequences on the functionality of vital organs such as heart, brain, liver and kidney. In this article, we summarize the multisystemic pathophysiological consequences of the main circulatory stress factors. Strategies to mitigate their effects to provide more cardioprotective and personalized dialytic therapies are proposed to reduce the systemic burden of HD.
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Affiliation(s)
- Bernard Canaud
- Montpellier University, Montpellier, France
- Global Medical Office, FMC Deutschland, Bad Homburg, Germany
| | - Melanie P Stephens
- MSL & Medical Strategies for Innovative Therapies, Fresenius Medical Care, Waltham, MA, USA
| | - Milind Nikam
- Global Medical Office, Fresenius Medical Care, Hong Kong
| | - Michael Etter
- Global Medical Office, Fresenius Medical Care, Hong Kong
| | - Allan Collins
- Global Medical Office, Fresenius Medical Care, Waltham, MA, USA
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Koch J, Hijmans RS, Ossa Builes M, Dam WA, Pol RA, Bakker SJL, Pas HH, Franssen CFM, van den Born J. Direct Evidence of Endothelial Dysfunction and Glycocalyx Loss in Dermal Biopsies of Patients With Chronic Kidney Disease and Their Association With Markers of Volume Overload. Front Cell Dev Biol 2021; 9:733015. [PMID: 34621749 PMCID: PMC8491614 DOI: 10.3389/fcell.2021.733015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/30/2021] [Indexed: 02/04/2023] Open
Abstract
Cardiovascular morbidity is a major problem in patients with chronic kidney disease (CKD) and endothelial dysfunction (ED) is involved in its development. The luminal side of the vascular endothelium is covered by a protective endothelial glycocalyx (eGC) and indirect evidence indicates eGC loss in CKD patients. We aimed to investigate potential eGC loss and ED in skin biopsies of CKD patients and their association with inflammation and volume overload. During living kidney transplantation procedure, abdominal skin biopsies were taken from 11 patients with chronic kidney disease stage 5 of whom 4 were treated with hemodialysis and 7 did not receive dialysis treatment. Nine healthy kidney donors served as controls. Biopsies were stained and quantified for the eGC marker Ulex europaeus agglutinin-1 (UEA1) and the endothelial markers vascular endothelial growth factor-2 (VEGFR2) and von Willebrand factor (vWF) after double staining and normalization for the pan-endothelial marker cluster of differentiation 31. We also studied associations between quantified log-transformed dermal endothelial markers and plasma markers of inflammation and hydration status. Compared to healthy subjects, there was severe loss of the eGC marker UEA1 (P < 0.01) while VEGFR2 was increased in CKD patients, especially in those on dialysis (P = 0.01). For vWF, results were comparable between CKD patients and controls. Skin water content was identical in the three groups, which excluded dermal edema as an underlying cause in patients with CKD. The dermal eGC/ED markers UEA1, VEGFR2, and vWF all associated with plasma levels of NT-proBNP and sodium (all R2 > 0.29 and P < 0.01), except for vWF that only associated with plasma NT-proBNP. This study is the first to show direct histopathological evidence of dermal glycocalyx loss and ED in patients with CKD. In line with previous research, our results show that ED associates with markers of volume overload arguing for strict volume control in CKD patients.
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Affiliation(s)
- Josephine Koch
- Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ryanne S Hijmans
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Manuela Ossa Builes
- Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Wendy A Dam
- Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Robert A Pol
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Stephan J L Bakker
- Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Hendri H Pas
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Casper F M Franssen
- Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jacob van den Born
- Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Yu J, Chen X, Li Y, Wang Y, Cao X, Liu Z, Shen B, Zou J, Ding X. Pro-inflammatory cytokines as potential predictors for intradialytic hypotension. Ren Fail 2021; 43:198-205. [PMID: 33459124 PMCID: PMC7833080 DOI: 10.1080/0886022x.2021.1871921] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Intradialytic hypotension (IDH) is a common complication in maintaining hemodialysis (MHD) patients. Immune activation might be part of the mechanisms. However, the association between pro-inflammatory cytokines and blood pressure (BP) has not been deeply explored. So we aim to evaluate the potential role of pro-inflammatory cytokines in IDH. Methods MHD patients starting hemodialysis before January 2016 were enrolled in our retrospective study. Patients' characteristics, laboratory results, and intradialytic BP were collected. IDH was defined as nadir systolic BP ≤ 90 mmHg during hemodialysis. The definition of IDH group was that those who suffered from more than one hypotensive event during one month after the enrollment (10% of dialysis treatments). Spearman correlation analysis and logistic regression were employed to explore the relationship between pro-inflammatory cytokines and IDH. Results Among 390 patients, 72 were identified with IDH (18.5%). High levels of serum tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were observed in the IDH group (p < 0.001). Both TNF-α and IL-1β positively correlated with predialysis BP (p < 0.01). Receiver operating characteristic curve (ROC) analysis was used to evaluate the diagnostic accuracy of serum IL-1β and TNF-α for IDH. The area under the curve of IL-1β was 0.772 (95% CI: 0.708-0.836, p < 0.01), and that of TNF-α was 0.701 (95% CI: 0.620-0.781, p < 0.01). After adjusting for patients' characteristics, biochemical parameters, comorbid conditions, predialysis BP, and medications, elevated TNF-α and IL-1β were still risk factors for IDH. Conclusion Pro-inflammatory cytokines (TNF-α and IL-1β) could be potential predictors for IDH.
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Affiliation(s)
- Jinbo Yu
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
| | - Xiaohong Chen
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
| | - Yang Li
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
| | - Yaqiong Wang
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
| | - Xuesen Cao
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
| | - Zhonghua Liu
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
| | - Bo Shen
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
| | - Jianzhou Zou
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
| | - Xiaoqiang Ding
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
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Wang Y, Gu Z. Effect of bioimpedance-defined overhydration parameters on mortality and cardiovascular events in patients undergoing dialysis: a systematic review and meta-analysis. J Int Med Res 2021; 49:3000605211031063. [PMID: 34496645 PMCID: PMC8438275 DOI: 10.1177/03000605211031063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 06/18/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the role of bioimpedance-defined overhydration (BI-OH) parameters in predicting the risk of mortality and cardiovascular (CV) events in patients undergoing dialysis. METHODS We searched multiple electronic databases for studies investigating BI-OH indicators in the prediction of mortality and CV events through 23 May 2020. We assessed the effect of BI-OH indexes using unadjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Sensitivity analysis was used for each outcome. RESULTS We included 55 studies with 104,758 patients in the meta-analysis. Extracellular water/total body water (ECW/TBW) >0.4 (HR 5.912, 95% CI: 2.016-17.342), ECW/intracellular water (ICW) for every 0.01 increase (HR 1.041, 95% CI: 1.031-1.051), and OH/ECW >15% (HR 2.722, 95% CI: 2.005-3.439) increased the risk of mortality in patients receiving dialysis. ECW/TBW >0.4 (HR 2.679, 95% CI: 1.345-5.339) and ECW/ICW per increment of 10% (HR 1.032, 95% CI: 1.017-1.047) were associated with an increased risk of CV events in patients undergoing dialysis. A 1-degree increase in phase angle was a protective factor for both mortality (HR 0.676, 95% CI: 0.474-0.879) and CV events (HR 0.736, 95% CI: 0.589-0.920). CONCLUSIONS BI-OH parameters might be independent predictors for mortality and CV events in patients undergoing dialysis.
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Affiliation(s)
- Yajie Wang
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zejuan Gu
- Department of Nursing, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China
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Reducing the burden of cardiovascular disease in children with chronic kidney disease: prevention vs. damage limitation. Pediatr Nephrol 2021; 36:2537-2544. [PMID: 34143301 DOI: 10.1007/s00467-021-05102-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
Cardiovascular disease (CVD) is a life-limiting condition in patients with chronic kidney disease (CKD) and is rapidly progressive, especially in those with stage 5 CKD and on dialysis. Cardiovascular mortality, although reducing, remains at least 30 times higher than in the general pediatric population. The American Heart Association guidelines for cardiovascular risk reduction in high-risk pediatric patients has stratified pediatric CKD patients in the "high risk" category for the development of CVD, with associated pathological and/or clinical evidence for manifest coronary disease before 30 years of age. While improving patient survival is a key priority, other patient-related outcomes, such as psychosocial development, quality of life and growth are of major importance to children and their caregivers. Once vascular damage or calcification has developed, there are no data to suggest that they can be reversed. Treatments such as intensified dialysis and transplantation may attenuate the progression of subclinical cardiovascular disease, but no treatment to date has shown that the inexorable progression of CVD in CKD can be reversed. Thus, our management must focus on early diagnosis and robust preventative strategies to give our patients the best chance of optimal cardiovascular health and survival. In this review, the pathophysiology and importance of preventing the development of CVD in CKD is discussed.
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Covic A, Siriopol D. Assessment and Management of Volume Overload Among Patients on Chronic Dialysis. Curr Vasc Pharmacol 2021; 19:34-40. [PMID: 32096744 DOI: 10.2174/1570161118666200225093827] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 12/11/2022]
Abstract
Volume overload is the most common complication in end-stage renal disease (ESRD) patients, being directly related to numerous complications including resistant hypertension, cardiac hypertrophy, congestive heart failure or arterial stiffness, among others. Therefore, volume overload is now considered an important risk factor for hard outcomes, like all-cause or cardiovascular mortality. Relying solely on clinical examination for assessing volume overload in ESRD patients lacks sensitivity and specificity. Numerous efforts have been made to identify new methods that could objectively assess volume status; however, each of them has important limitations. This review aims to discuss the most frequently used methods (biomarkers, inferior vena cava assessment, lung ultrasonography, bioimpedance analysis and blood volume monitoring) and to compare the advantage of each method vs. the overall/ clinical strategy.
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Affiliation(s)
- Adrian Covic
- Nephrology Department, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Iasi 700115, Romania
| | - Dimitrie Siriopol
- Nephrology Department, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Iasi 700115, Romania
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Cianciolo G, Cappuccilli M, Tondolo F, Gasperoni L, Zappulo F, Barbuto S, Iacovella F, Conte D, Capelli I, La Manna G. Vitamin D Effects on Bone Homeostasis and Cardiovascular System in Patients with Chronic Kidney Disease and Renal Transplant Recipients. Nutrients 2021; 13:1453. [PMID: 33922902 PMCID: PMC8145016 DOI: 10.3390/nu13051453] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/14/2021] [Accepted: 04/22/2021] [Indexed: 12/25/2022] Open
Abstract
Poor vitamin D status is common in patients with impaired renal function and represents one main component of the complex scenario of chronic kidney disease-mineral and bone disorder (CKD-MBD). Therapeutic and dietary efforts to limit the consequences of uremia-associated vitamin D deficiency are a current hot topic for researchers and clinicians in the nephrology area. Evidence indicates that the low levels of vitamin D in patients with CKD stage above 4 (GFR < 15 mL/min) have a multifactorial origin, mainly related to uremic malnutrition, namely impaired gastrointestinal absorption, dietary restrictions (low-protein and low-phosphate diets), and proteinuria. This condition is further worsened by the compromised response of CKD patients to high-dose cholecalciferol supplementation due to the defective activation of renal hydroxylation of vitamin D. Currently, the literature lacks large and interventional studies on the so-called non-calcemic activities of vitamin D and, above all, the modulation of renal and cardiovascular functions and immune response. Here, we review the current state of the art of the benefits of supplementation with native vitamin D in various clinical settings of nephrological interest: CKD, dialysis, and renal transplant, with a special focus on the effects on bone homeostasis and cardiovascular outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Gaetano La Manna
- Nephrology, Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.C.); (M.C.); (F.T.); (L.G.); (F.Z.); (S.B.); (F.I.); (D.C.); (I.C.)
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Sommerer C, Felten P, Toernig J, Zeier M, Dikow R. Bioimpedance analysis is not superior to clinical assessment in determining hydration status: A prospective randomized-controlled trial in a Western dialysis population. Hemodial Int 2021; 25:380-390. [PMID: 33709483 DOI: 10.1111/hdi.12919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Fluid management is an important goal of dialysis treatment. The accurate assessment of fluid status is still a challenge for clinical nephrologists. Bioimpedance analysis (BIA) has been proposed as an objective tool to assess hydration. METHODS This was a prospective randomized controlled study to compare hydration status measured by clinical assessment compared to BIA using a body composition monitor (BCM). The primary outcome was defined as the decline of cardiac biomarker N-terminal pro brain natriuretic peptide (NT-proBNP) from baseline to the end of the study. FINDINGS About 281 chronic hemodialysis patients were assessed for eligibility, and 132 patients provided written informed consent to participate (65 BIA group, 67 clinical group). Predialytic NT-proBNP, and decline of NT-proBNP were similar in both groups. The amount of overhydration (2.18 ± 2.11 L vs. 1.29 ± 1.97 L; p 0.016) and the number of patients with severe overhydration (46.0% vs. 30.6%, p = 0.04) were significantly higher in the BIA group at the end of the study. Fluid accumulation in the interdialytic period was significantly lower in the clinical group (p = 0.013). Adverse events occurred more often in the BIA group (p = 0.032). The cumulative number of hypovolemic events was significantly higher in the BIA group (p = 0.002). DISCUSSION Fluid management by BIA does not lead to a better cardiac outcome (appraised by surrogate markers) than fluid management by careful clinical assessment. Adapting the dry weight according to BIA results increases the risk of adverse events, especially hypovolemic episodes. Careful clinical fluid assessment is important for optimal care of chronic hemodialysis patients.
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Affiliation(s)
- Claudia Sommerer
- Department of Nephrology, University Hospital Heidelberg, Heidelberg, Germany
| | - Paul Felten
- Department of Nephrology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Martin Zeier
- Department of Nephrology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ralf Dikow
- Department of Nephrology, University Hospital Heidelberg, Heidelberg, Germany
- Dialysis Center Bruchsal, Bruchsal, Germany
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Hilderman M, Bruchfeld A. The cholinergic anti-inflammatory pathway in chronic kidney disease-review and vagus nerve stimulation clinical pilot study. Nephrol Dial Transplant 2021; 35:1840-1852. [PMID: 33151338 PMCID: PMC7643692 DOI: 10.1093/ndt/gfaa200] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/17/2020] [Accepted: 06/09/2020] [Indexed: 12/15/2022] Open
Abstract
Inflammation and autonomic dysfunction are common findings in chronic and end-stage kidney disease and contribute to a markedly increased risk of mortality in this patient population. The cholinergic anti-inflammatory pathway (CAP) is a vagal neuro-immune circuit that upholds the homoeostatic balance of inflammatory activity in response to cell injury and pathogens. CAP models have been examined in preclinical studies to investigate its significance in a range of clinical inflammatory conditions and diseases. More recently, cervical vagus nerve stimulation (VNS) implants have been shown to be of potential benefit for patients with chronic autoimmune diseases such as rheumatoid arthritis and inflammatory bowel disease. We have previously shown that dialysis patients have a functional CAP ex vivo. Here we review the field and the potential role of the CAP in acute kidney injury and chronic kidney disease (CKD) as well as in hypertension. We also present a VNS pilot study in haemodialysis patients. Controlling inflammation by neuroimmune modulation may lead to new therapeutic modalities for improved treatment, outcome, prognosis and quality of life for patients with CKD.
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Affiliation(s)
- Marie Hilderman
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Annette Bruchfeld
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine, Linköping University, Linköping, Sweden
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