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Ookawara S, Ito K, Sasabuchi Y, Hayasaka H, Kofuji M, Uchida T, Horigome K, Imai S, Akikawa T, Wada N, Kiryu S, Imada S, Shindo M, Miyazawa H, Hirai K, Onishi Y, Shimoyama H, Watanabe A, Tabei K, Morishita Y. Associations of cerebral oxygenation with hemoglobin levels evaluated by near-infrared spectroscopy in hemodialysis patients. PLoS One 2020; 15:e0236720. [PMID: 32776946 PMCID: PMC7416957 DOI: 10.1371/journal.pone.0236720] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/13/2020] [Indexed: 12/29/2022] Open
Abstract
Hemoglobin (Hb) is associated with cerebral oxygenation status owing to its important role of carrying oxygen to systemic tissues. However, data concerning the associations between Hb levels and cerebral regional oxygen saturation (rSO2) of hemodialysis (HD) patients is limited. We aimed to identify these associations to consider a target Hb level for renal anemia management. This study included 375 HD patients. Cerebral rSO2 before HD was monitored using the INVOS 5100c oxygen saturation monitor. Multivariable linear regression analysis showed that cerebral rSO2 was independently associated with natural logarithm (Ln)-HD duration (standardized coefficient: -0.36), mean blood pressure (standardized coefficient: 0.13), pH (standardized coefficient: -0.10), serum albumin (standardized coefficient: 0.14), presence of diabetes mellitus (standardized coefficient: -0.20), and Hb level (standardized coefficient: 0.29). Furthermore, a generalized linear model with restricted cubic spline function was used to investigate the non-linear association between cerebral rSO2 and Hb levels. In the multivariable analysis for the adjustment with Ln-HD duration, mean blood pressure, pH, serum albumin, and presence of diabetes mellitus, a linear relationship was demonstrated between the two variables (p for linearity = 0.79). Hb levels revealed the positive and significant association with cerebral rSO2 in this study. Moreover, the relationship between cerebral rSO2 and Hb level was proven to be linear. Therefore, the target Hb level in renal anemia management would be considered to be the upper limits for the appropriate management of renal anemia by previous guidelines and position statement from the viewpoint of maintaining cerebral oxygenation in HD patients.
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Affiliation(s)
- Susumu Ookawara
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
- * E-mail:
| | - Kiyonori Ito
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | | | - Hideyuki Hayasaka
- Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masaya Kofuji
- Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takayuki Uchida
- Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Keita Horigome
- Division of Hemodialysis, Yuai Nakagawa Clinic, Hakuyukai Medical Corporation, Saitama, Japan
| | - Sojiro Imai
- Department of Dialysis, Minami-uonuma City Hospital, Niigata, Japan
| | - Toshiko Akikawa
- Division of Hemodialysis, Yuai Nakagawa Clinic, Hakuyukai Medical Corporation, Saitama, Japan
| | - Noriko Wada
- Department of Dialysis, Minami-uonuma City Hospital, Niigata, Japan
| | - Satoshi Kiryu
- Department of Dialysis, Minami-uonuma City Hospital, Niigata, Japan
| | - Satoru Imada
- Division of Hemodialysis, Yuai Nakagawa Clinic, Hakuyukai Medical Corporation, Saitama, Japan
| | - Mitsutoshi Shindo
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Haruhisa Miyazawa
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Keiji Hirai
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yasushi Onishi
- Department of Internal Medicine, Minami-uonuma City Hospital, Niigata, Japan
| | - Hirofumi Shimoyama
- Division of Nephrology, Yuai Nisshin Clinic, Hakuyukai Medical Corporation, Saitama, Japan
| | - Akihisa Watanabe
- Division of Nephrology, Yuai Nakagawa Clinic, Hakuyukai Medical Corporation, Saitama, Japan
| | - Kaoru Tabei
- Department of Internal Medicine, Minami-uonuma City Hospital, Niigata, Japan
| | - Yoshiyuki Morishita
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Lever-van Milligen BA, Vogelzangs N, Smit JH, Penninx BWJH. Hemoglobin levels in persons with depressive and/or anxiety disorders. J Psychosom Res 2014; 76:317-21. [PMID: 24630183 DOI: 10.1016/j.jpsychores.2014.01.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 01/13/2014] [Accepted: 01/20/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Both low and high hemoglobin levels lead to more physical diseases, and both are linked to mortality. Low hemoglobin, often classified as anemia, has also been linked to more depressive symptoms, but whether both hemoglobin extremes are associated with depressive disorder and potentially also with anxiety disorder has not been examined before. This study examines to which extent hemoglobin levels are associated with depression and anxiety disorders in a large cohort. METHODS The study sample consisted of 2920 persons from the Netherlands Study of Depression and Anxiety. Hemoglobin levels were determined after venipuncture. Depressive and anxiety disorders were determined according to a DSM-IV-based psychiatric interview. Clinical psychiatric characteristics included the severity of depression and anxiety, the duration of symptoms, the age of onset and the antidepressant use. RESULTS Higher hemoglobin levels were found in those with current depressive and/or anxiety disorders after sociodemographic adjustment and both higher, and lower hemoglobin levels were found in persons with higher depression and anxiety severity. However, after full adjustment for sociodemographics, disease indicators and lifestyle, associations were no longer significant. CONCLUSIONS This cohort study showed that there is no independent association between depressive and/or anxiety disorders and hemoglobin levels or anemia status.
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Affiliation(s)
- Bianca A Lever-van Milligen
- Department of Psychiatry, EMGO(+) Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Nicole Vogelzangs
- Department of Psychiatry, EMGO(+) Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes H Smit
- Department of Psychiatry, EMGO(+) Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, EMGO(+) Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
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Mugisha JO, Baisley K, Asiki G, Seeley J, Kuper H. Prevalence, types, risk factors and clinical correlates of anaemia in older people in a rural Ugandan population. PLoS One 2013; 8:e78394. [PMID: 24194926 PMCID: PMC3806814 DOI: 10.1371/journal.pone.0078394] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 09/11/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Studies conducted in high income countries have shown that anaemia is a common medical condition among older people, but such data are scarce in Africa. The objectives of this study were to estimate the prevalence, types, risk factors and clinical correlates of anaemia in older people. METHODS Participants were aged (≥ 50) years recruited from a general population cohort from January 2012 to January 2013. Blood samples were collected for assessing hemoglobin, serum ferritin, serum vitamin B12, serum folate, C-reactive protein, malaria infection and stool samples for assessment of hookworm infection. HIV status was assessed using an algorithm for HIV rapid testing. Questionnaires were used to collect data on sociodemographic characteristics and other risk factors for anaemia. RESULTS In total, 1449 people participated (response rate 72.3%). The overall prevalence of anaemia was 20.3 % (95% CI 18.2-22.3%), and this was higher for males (24.1%, 95% CI=20.7-27.7%) than females (17.5%, 95% CI=15.0-20.1%). In males, the prevalence of anaemia increased rapidly with age almost doubling between 50 and 65 years (p-trend<0.001). Unexplained anaemia was responsible for more than half of all cases (59.7%). Anaemia was independently associated with infections including malaria (OR 3.49, 95% CI 1.78-6.82), HIV (OR 2.17, 1.32-3.57) heavy hookworm infection (OR 3.45, 1.73-6.91), low fruit consumption (OR 1.55, 1.05-2.29) and being unmarried (OR 1.37 , 95% CI 1.01-1.89). However, the odds of anaemia were lower among older people with elevated blood pressure (OR 0.47, 95% CI 0.29-0.77). CONCLUSION Anaemia control programmes in Uganda should target older people and should include interventions to treat and control hookworms and educational programs on diets that enhance iron absorption. Clinicians should consider screening older people with HIV or malaria for anaemia. Further studies should be done on unexplained anaemia and serum ferritin levels that predict iron deficiency anaemia in older people.
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Affiliation(s)
- Joseph O. Mugisha
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kathy Baisley
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gershim Asiki
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Janet Seeley
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of International Development, University of East Anglia, Norwich, United Kingdom
| | - Hannah Kuper
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Pendse S, Singh AK. Complications of chronic kidney disease: anemia, mineral metabolism, and cardiovascular disease. Med Clin North Am 2005; 89:549-61. [PMID: 15755467 DOI: 10.1016/j.mcna.2004.12.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This article focuses on the importance of three major complications of chronic kidney disease: (1) anemia, (2) calcium-phosphorus regulation and bone disease, and (3) cardiovascular risk profiling and treatment. The arguments for early and effective intervention have been amply made with respect to these three complications. Substantive trial data are sorely need to provide the definitive evidence that effective treatment of these complications results in better outcomes.
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Affiliation(s)
- Shona Pendse
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Dumler F, McCullough PA. Optimal dialysis for the end-stage renal disease patient with cardiovascular disease. Adv Chronic Kidney Dis 2004; 11:261-73. [PMID: 15241741 DOI: 10.1053/j.arrt.2004.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The increasing incidence and prevalence of end-stage renal disease (ESRD) that requires renal replacement therapy has placed a focus on the dialysis procedure itself with respect to its hemodynamic and cardiovascular complications. More than 50% of patients with ESRD will die of cardiovascular disease (CVD). A considerable contribution to cardiovascular events occurs with the dialysis procedure itself. This paper explores the intradialytic complications of hemodialysis as they relate to the cardiovascular system and highlights opportunities for research and improved quality of care.
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Affiliation(s)
- Francis Dumler
- Department of Medicine, Division of Nephrology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
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