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Khatri P, Davenport A. Comparison of hemodialysis urea clearance using spent dialysate and Kt/Vurea equations. Artif Organs 2024. [PMID: 39177022 DOI: 10.1111/aor.14848] [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: 05/13/2024] [Revised: 07/15/2024] [Accepted: 08/07/2024] [Indexed: 08/24/2024]
Abstract
INTRODUCTION Dialysis adequacy is traditionally calculated from pre- and post-hemodialysis session serum urea concentrations and expressed as the urea reduction ratio, or Kt/Vurea. However, with increasing hemodiafiltration usage, we wished to determine whether there were any differences between standard Kt/Vurea equations and directly measured spent dialysate urea clearance. METHODS Urea clearance was measured from collected effluent dialysate and compared with various other methods of Kt/Vurea calculation, including change in total body urea from measuring pre- and post-total body water with bioimpedance and the Watson equation, by standard Kt/V equations, and online clearance measurements using effective ionic dialysance (OLC). RESULTS We compared urea clearance in 41 patients, 56.1% male, mean age 69.3 ± 12.6 years with 87.8% treated by hemodiafiltration. Reduction in total body urea was greater when estimating changes in total body urea, compared to measured dialysate losses of 58.4% (48.5-67.6) vs 71.6% (62.1-78), p < 0.01. Sessional urea clearance (Kt/Vurea) was greater using the online Solute-Solver program compared to OLC, median 1.45(1.13-1.75) vs 1.2 (0.93-1.4), and 2nd generation Kt/V equations 1.3 (1.02-1.66), p < 0.01, but not different from estimated total body urea clearance 1.36 (1.15-1.73) and dialysate clearance 1.36 (1.07-1.76). The mean bias compared to the Solute-Solver program was greatest with OLC (-0.25), compared to second-generation equations (-0.02), estimated total body clearance (-0.02) and measured dialysate clearance (-0.01). CONCLUSION This study demonstrated that the result from equations estimating urea clearance indirectly from pre- and postblood samples from hemo- and hemodiafiltration treatments was highly correlated with direct measurements of dialysate urea clearance.
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Affiliation(s)
- Priyanka Khatri
- Fast and Chronic Programmes, Alexandra Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andrew Davenport
- UCL Department of Renal Medicine, Royal Free Hospital, London, UK
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Is the measurement of tissue advanced glycosylation products by skin autofluorescence associated with mortality in patients treated by peritoneal dialysis? J Nephrol 2023; 36:217-224. [PMID: 35980536 PMCID: PMC9895012 DOI: 10.1007/s40620-022-01415-9] [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: 06/18/2022] [Accepted: 07/19/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Advanced glycosylated end-products (AGEs) have been shown to cause cardiovascular disease, and tissue AGE accumulation can be measured by skin autofluorescence (SAF). AGEs are cleared by the kidney, and thus accumulate in dialysis patients. However, as the results of SAF measurements in peritoneal dialysis patients (PD) have been ambiguous, we examined the association between mortality and SAF. METHODS We reviewed SAF measurements in PD patients attending a university associated PD program, along with standard measurements of dialysis adequacy and peritoneal membrane function. RESULTS We studied 341 prevalent PD patients, 61.9% male, mean age 61.2 ± 16 years, and 31.4% of all patients died during a median follow-up of 27.2 (23.3-36.3) months. Patients who died were older, mean age 72 ± 10.5 years, were more often diabetic (60.7%), and had higher median SAF 3.8 (3.2-4.5) AU. On logistic regression, mortality was independently associated with age (odds ratio (OR) 1.1 (95% confidence limits 1.06-1.16), diabetes OR 10.1 (3.1-33.4), SAF OR 3.3 (1.8-6.2), all p < 0.001, and male gender OR 5.2 (1.6-17.4), p = 0.007; and negatively associated with weight OR 0.91 (0.86-0.95), p < 0..001, normalised nitrogen appearance rate (nPNA) OR 0.05 (0.01-0.4), p = 0.005 and mean arterial blood pressure (MAP) OR 0.96 (0.93-0.96), p = 0.03. CONCLUSIONS In this observational study, SAF was independently associated with mortality. However, other factors were also associated with mortality, including age, diabetes and malnutrition which have all been reported to affect SAF measurements. Thus, the additional predictive value of measuring SAF compared to standard risk factors for mortality remains to be determined.
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Feret W, Safranow K, Ciechanowski K, Kwiatkowska E. How Is Body Composition and Nutrition Status Associated with Erythropoietin Response in Hemodialyzed Patients? A Single-Center Prospective Cohort Study. J Clin Med 2022; 11:jcm11092426. [PMID: 35566552 PMCID: PMC9105329 DOI: 10.3390/jcm11092426] [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: 03/15/2022] [Revised: 04/07/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Anemia is the most common finding in patients with end-stage kidney disease undergoing renal replacement therapy. A certain percentage of patients does not respond adequately to erythropoietin (EPO) treatment, not being able to reach desirable hemoglobin levels even when treated with large-dose EPO and intravenous/oral iron. In our study, we wanted to further investigate how nutritional status is associated with erythropoietin responsiveness. To quantify EPO response, we used the Erythropoietin Resistance Index (ERI), which is defined as the weekly weight-adjusted dose of EPO divided by the hemoglobin level. Patients and methods: Seventy-eight patients undergoing hemodialysis were included. All of them were measured by a SECA mBCA body composition analyzer and evaluated by Kalantar-Zadeh’s MIS score. Routine biochemical tests were also taken into account. The Shapiro-Wilk test was used to study the distributions of quantitative variables, which were significantly different from normal (p < 0.05). We used nonparametric Mann-Whitney U-test to compare groups. Correlations were studied by means of Spearman’s rank correlation coefficient. Bonferroni correction for multiple testing was performed. To find independent determinants of ERI, we additionally performed multivariate analysis using the General Linear Model (GLM). Results: In terms of body composition, factors that are associated with high ERI are low BMI, low fat mass, low visceral fat volume, high total body water percentage, low phase angle and low fat-free mass. In addition to body composition parameters, total MIS score and IL-6 serum levels correlated positively with ERI value. IL-6 was an independent determinant of ERI value, based on multivariate analysis. After correction for multiple analysis, BMI and eGFR both remained significant factors associated with EPO response. Conclusions: It seems crucial to prevent inflammatory malnutrition as a part of a holistic approach to anemia treatment in dialysis patients.
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Affiliation(s)
- Wiktoria Feret
- Clinical Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-001 Szczecin, Poland; (K.C.); (E.K.)
- Correspondence:
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-001 Szczecin, Poland;
| | - Kazimierz Ciechanowski
- Clinical Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-001 Szczecin, Poland; (K.C.); (E.K.)
| | - Ewa Kwiatkowska
- Clinical Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-001 Szczecin, Poland; (K.C.); (E.K.)
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Davenport A. Application of the Clinical Frailty Score and body composition and upper arm strength in haemodialysis patients. Clin Kidney J 2021; 15:553-559. [PMID: 35211309 PMCID: PMC8862041 DOI: 10.1093/ckj/sfab228] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Indexed: 11/21/2022] Open
Abstract
Background To improve outcomes, simple screening tests are required to detect patients at increased risk of mortality. As patients with muscle weakness and wasting are at increased risk of death, we wished to review the use of the Clinical Frailty Score (CFS). Patients and methods Dialysis staff graded haemodialysis (HD) patients attending for routine outpatient sessions using the CFS, a functional scoring scale, for patients who require help with their instrumental activities of daily living, classified as clinically frail with scores >4, which were compared with contemporaneous Stoke–Davies comorbidity scores, post-HD body composition measured by bioimpedance, hand grip strength (HGS) and standard laboratory investigations. Results The results from 2089 patients (60.2% male) were reviewed, with 890 (42.6%) classified as frail. Frail patients were older [mean ± standard deviation (SD) 71.5 ± 15.6 versus 59.1 ± 15.6 years) and female (50.7% versus 37.3%) and had greater comorbidity {median 2 [interquartile range (IQR) 1–3] versus 1 [0–2]}, body mass index (BMI) (26.0 ± 6.7 versus 25.5 ± 5.4 kg/m2), C-reactive protein (CRP) [8 (IQR 3–20) versus 5 (2–11) mg/L], lower serum albumin (37.6 ± 4.7 versus 40.1 ± 4.7 g/L), lean BMI (8.9 ± 1.7 versus 9.7 ± 1.6 kg/m2) and HGS [13.4 (IQR 9.6–18.8) versus 20.9 (14.5–29) kg] (all P < 0.001). Frailty was independently associated in a multivariable logistic model with age {odds ratio [OR] 2.33 [95% confidence limit (CL) 2.01–2.7]}, body fat mass [OR 1.02 (CL 1.01–1.03)], log CRP [OR 1.63 (CL 1.28–2.07)] (all P < 0.001) and comorbidity [OR 1.45 (CL 1.17–1.8); P = 0.001] and negatively associated with albumin [OR 0.95 (CL 0.92–0.98) and HGS [OR 0.91 (CL 0.9–0.93)] (both P < 0.001). Conclusion Frail patients are at increased risk of mortality and, as such, simple reliable screening tools are required to rapidly detect patients at risk. The CFS is a useful screening tool that can be readily performed by dialysis staff to identify frail patients. Frailty in HD patients was associated with increasing age, comorbidity, fat weight and inflammation and reduced muscle strength and muscle mass. There is an overlap between frailty and both sarcopenia and protein energy wasting, which requires additional assessments, potentially including body composition, strength, dietary assessments and laboratory investigations. In addition, as the CFS offers a scale, patient trajectories can potentially be serially monitored over time, thus allowing patient-specific interventions or holistic care plans.
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Affiliation(s)
- Andrew Davenport
- Department of Renal Medicine, Royal Free Hospital, University College London, London, UK
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Choudhury D, Yalamanchili HB, Hasan A. Dialysis of the Obese Patient: Meeting Needs for a Growing Epidemic. Semin Nephrol 2021; 41:371-379. [PMID: 34715966 DOI: 10.1016/j.semnephrol.2021.06.008] [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: 10/20/2022]
Abstract
Increasing population obesity and associated metabolic consequences has led to increased number of obese patients with chronic kidney disease and end-stage renal disease. While obesity is associated with increased cardiovascular morbidity and mortality, obese dialysis patients present a seeming paradox for survival benefit, given other acute intervening illnesses for those on dialysis with loss of lean body mass overtime. Challenges remain in providing adequate renal replacement options and therapy for this growing segment of obese patients on dialysis which are discussed in this article.
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Affiliation(s)
- Devasmita Choudhury
- Department of Medicine, Division of Nephrology, Salem Veterans Affairs Health System, Salem, VA; Department of Medicine, Division of Nephrology, Virginia Tech Carilion School of Medicine, Roanoke, VA; Department of Medicine, Division of Nephrology, University of Virginia School of Medicine, Charlottesville, VA.
| | - Hima Bindu Yalamanchili
- Department of Medicine, Division of Nephrology, Salem Veterans Affairs Health System, Salem, VA; Department of Medicine, Division of Nephrology, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Alia Hasan
- Department of Medicine, Division of Nephrology, Salem Veterans Affairs Health System, Salem, VA
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Gotta V, Marsenic O, Atkinson A, Pfister M. Hemodialysis (HD) dose and ultrafiltration rate are associated with survival in pediatric and adolescent patients on chronic HD-a large observational study with follow-up to young adult age. Pediatr Nephrol 2021; 36:2421-2432. [PMID: 33651178 PMCID: PMC8260402 DOI: 10.1007/s00467-021-04972-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/19/2021] [Accepted: 01/27/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hemodialysis (HD) dose targets and ultrafiltration rate (UFR) limits for pediatric patients on chronic HD are not known and are derived from adults (spKt/V>1.4 and <13 ml/kg/h). We aimed to characterize how delivered HD dose and UFR are associated with survival in a large cohort of patients who started HD in childhood. METHODS Retrospective analysis on a cohort of patients <30 years, on chronic HD since childhood (<19 years), having received thrice-weekly HD 2004-2016 in outpatient DaVita centers. OUTCOME Survival while remaining on HD. PREDICTORS (I) primary analysis: mean delivered dialysis dose stratified as spKt/V ≤1.4/1.4-1.6/>1.6 (Kaplan-Meier analysis), (II) secondary analyses: UFR and alternative dialysis adequacy measures [eKt/V, body-surface normalized Kt/BSA] on continuous scale (Weibull regression model). RESULTS A total of 1780 patients were included (age at the start of HD: 0-12y: n=321, >12-18y: n=1459; median spKt/V=1.55, eKt/V=1.31, Kt/BSA=31.2 L/m2, UFR=10.6 mL/kg/h). (I) spKt/V<1.4 was associated with lower survival compared to spKt/V>1.4-1.6 (P<0.001, log-rank test), and spKt/V>1.6 (P<0.001), with 10-year survival of 69.3% (59.4-80.9%) versus 83.0% (76.8-89.8%) and 84.0% (79.6-88.5%), respectively. (II) Kt/BSA was a better predictor of survival than spKt/V or eKt/V. UFR was additionally associated with survival (P<0.001), with increased mortality <10/>18 mL/kg/h. Associations did not alter significantly following adjustment for demographic characteristics (age, etiology of kidney disease, and ethnicity). CONCLUSIONS Our results suggest usefulness of targeting Kt/BSA>30 L/m2 for best long-term outcomes, corresponding to spKt/V>1.4 (>12 years) and >1.6 (<12 years). In contrast to adults, higher UFR of 10-18 ml/kg/h was not associated with greater mortality in this population.
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Affiliation(s)
- Verena Gotta
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Spitalstrasse 33, 4031, Basel, Switzerland.
| | - Olivera Marsenic
- Pediatric Nephrology, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA, USA
| | - Andrew Atkinson
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Spitalstrasse 33, 4031, Basel, Switzerland
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Spitalstrasse 33, 4031, Basel, Switzerland
- Certara, Princeton, NJ, USA
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Yoowannakul S, Vongsanim S, Tangvoraphonkchai K, Mohamed A, Davenport A. Patient-reported symptoms during dialysis: the effect of pre-dialysis extracellular water and change in extracellular water post-dialysis. RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00321-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Abstract
Background
Quality of life for haemodialysis (HD) patients may be affected by symptoms during dialysis treatments, and patient groups have highlighted the need to improve post-dialysis fatigue and dialysis-related symptoms. As changes in extracellular water (ECW) may lead to cramps and other symptoms, we wished to determine whether there was an association between ECW and intra-dialytic symptoms.
Methods
We reviewed the hospital records of HD patients who completed a self-reported intra-dialytic symptom questionnaire, using a visual analogue scale, who had contemporaneous pre- and postdialysis bioimpedance ECW measurements adjusted to height (aECW).
Results
We studied dialysis sessions of 506 patients, 314 (62.1%) male, 226 (44.7%) diabetic, mean age 64.6 ± 15.7 years, weight 69.9 ± 17.4 kg, and duration of dialysis treatment 26 (9.6–60.1) months. We divided patients into three groups according to pre-dialysis aECW, and total dialysis symptom scores were greater for those in the lower tertile (25 (10–41) vs middle 18 (8.5–34) vs upper 20 (7–31), p < 0.05). Only feeling cold, dizziness, and low blood pressure were statistically different between the three pre-dialysis aECW groups, and there was no difference in post-dialysis recovery times.
We analysed the effect of the fall in aECW pre-to post-dialysis. Patients in the group with the greatest fall in aECW did not report more intra-dialytic symptoms or longer recovery times.
Conclusion
We found that patients starting dialysis with lower relative ECW were more likely to report intra-dialytic symptoms than those with greater amounts of fluid to remove, and most commonly reported symptoms were associated with intra-vascular volume depletion.
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Pattharanitima P, Chauhan K, Shamy OE, Chaudhary K, Sharma SR, Coca SG, Nadkarni GN, Uribarri J, Chan L. The association of standard Kt/V and surface area-normalized standard Kt/V with clinical outcomes in hemodialysis patients. Hemodial Int 2020; 24:495-505. [PMID: 32809268 PMCID: PMC8006157 DOI: 10.1111/hdi.12865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/19/2020] [Accepted: 07/18/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION A previous study demonstrated that the surface area-normalized standard Kt/V (SAstdKt/V) was better associated with mortality than standard Kt/V (stdKt/V). This study investigates the association of SAstdKt/V and stdKt/V with mortality, anemia, and hypoalbuminemia in a larger patient cohort with a longer follow-up period. METHODS We included adult patients on thrice-weekly hemodialysis in the USRDS database and excluded amputated patients. StdKt/V and SAstdKt/V were calculated from the available single-pool Kt/V. Patients were categorized into five groups according to their stdKt/V and SAstdKt/V: <2.00, 2.00-2.19, 2.20-2.39, 2.40-2.59, and ≥2.60. Hazard ratios (HR) and odds ratios (OR) were calculated using Cox and logistic regression analysis respectively. FINDINGS There were 507,656 patients included in the analysis. The patients had a median age of 65.5 years with a median follow-up period of 2 years. Thirty-four percent died during follow-up. HRs for mortality progressively decreased as SAstdKt/V increased in both unadjusted and adjusted models. Unlike SAstdKt/V, HRs were the lowest in the categories with stdKt/V of 2.40-2.59 and they increased in the higher stdKt/V category. The adjusted HR for SAstdKt/V vs. stdKt/V were 0.68 vs. 0.62 in the category of 2.40-2.59, and 0.63 vs. 0.73 in the category of ≥2.60. The adjusted ORs for anemia progressively decreased as SAstdKt/V increased, whereas ORs decreased to the lowest in stdKt/V category 2.40-2.59 and increased in the ≥2.60 category. The adjusted ORs for hypoalbuminemia progressively decreased as SAstdKt/V and stdKt/V increased which were both 0.45 in 2.40-2.59 category and decreased to 0.29 and 0.42 in the ≥2.60 category. DISCUSSION SAstdKt/V is better associated with mortality, anemia, and hypoalbuminemia than stdKt/V. SAstdKt/V is a better parameter in defining hemodialysis dosing which can be calculated by an available online tool. Further studies to determine the optimal SAstdKt/V dose required to achieve improved clinical outcomes with better cost-effectiveness are needed.
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Affiliation(s)
- Pattharawin Pattharanitima
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, NY
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Kinsuk Chauhan
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, NY
| | - Osama El Shamy
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, NY
| | - Kumardeep Chaudhary
- Institute for Personalized Medicine, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, NY
| | - Shuchita R. Sharma
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, NY
| | - Steven G. Coca
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, NY
| | - Girish N. Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, NY
- Institute for Personalized Medicine, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, NY
| | - Jaime Uribarri
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, NY
| | - Lili Chan
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, NY
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Diwan TS, Cuffy MC, Linares-Cervantes I, Govil A. Impact of obesity on dialysis and transplant and its management. Semin Dial 2020; 33:279-285. [PMID: 32277512 DOI: 10.1111/sdi.12876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Obesity is increasing to unprecedented levels, including in the end-stage kidney disease population, where upwards of 60% of kidney transplant patients are overweight or obese. Obesity poses additional challenges to the care of the dialysis patient, including difficulties in creating vascular access and inserting Tenckhoff catheters, higher rates of catheter malfunction and peritonitis, the need for longer and/or more frequent dialysis (or peritoneal dialysis [PD] exchanges) to achieve adequate clearance, increased metabolic complications particularly with PD, and obesity is a barrier to kidney transplantation. In this article, we review special considerations in performing PD, hemodialysis and transplant in the obese patient, as well as the evidence behind medical and surgical management of obesity in dialysis patients.
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Affiliation(s)
- Tayyab S Diwan
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Madison C Cuffy
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Ivan Linares-Cervantes
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Amit Govil
- Division of Nephrology, Department of Medicine, University of Cincinnati, Cincinnati, OH, USA
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Michel LM, Baroux N, Frimat L, Quirin N. Telenephrology and on-site nephrology: Comparable adequate dialysis care to patients living in remote Pacific Islands. J Telemed Telecare 2020; 27:562-571. [DOI: 10.1177/1357633x19896680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction End-stage renal disease is a major public health concern in New Caledonia and in Wallis and Futuna (prevalence value: 2542 per million population in 2017). Spread over the territory, 594 dialysis patients are followed up by nephrologists and partially by telemedicine due to the distance. The aim of our this study was to evaluate the quality of care provided by telemedicine for chronic dialysis patients on Wallis Island, a dialysis unit remote from Noumea (2100 km). Methods We compared two populations of haemodialysis patients, one based in Poindimie in New Caledonia and followed by monthly physical consultation, the other based on Wallis Island and followed by monthly teleconsultation and quarterly on-site consultation. Results From January 2012–December 2017, dialysis adequacy and survival data were recorded for 84 patients: 44 in Poindimie, 40 on Wallis Island. Dialysis adequacy (i.e. clinical, biological parameters) as well as occurrence of vascular access complications were no different regardless of the means of follow-up. During the study, 23 deaths occurred (11 in Poindimie, 12 on Wallis Island; p = 0.464). We did not find any difference in survival at one and six years ( p = 0.46) between the two dialysis units. Evaluation for transplantation was lower for Wallisian patients ( p = 0.042), without impact on the number of patients being transplanted ( p = 0.678). Conclusion Telemedicine is a valuable opportunity for the follow-up of remote chronic haemodialysis patients, allowing them to be treated close to home while ensuring optimal quality of care
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Affiliation(s)
- Laurie-Mathilde Michel
- Service de Néphrologie, Centre Hospitalier Universitaire de Nancy, Vandoeuvre Cedex, New Caledonia
| | - Noémie Baroux
- Reseau de l’Insuffisance Renale en Nouvelle-Caledonie, Noumea Cedex, New Caledonia
| | - Luc Frimat
- Service de Néphrologie, Centre Hospitalier Universitaire de Nancy, Vandoeuvre Cedex, New Caledonia
| | - Nicolas Quirin
- Nephrology Department, Centre Hospitalier Territorial Gaston Bourret, Noumea Cedex, New Caledonia
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Vongsanim S, Davenport A. The effect of gender on survival for hemodialysis patients: Why don't women live longer than men? Semin Dial 2019; 32:438-443. [PMID: 31044468 DOI: 10.1111/sdi.12817] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Women in the general population have a survival advantage over men, but this advantage is not sustained in end-stage kidney disease (ESKD) patients treated by hemodialysis. To understand why gender may affect survival we need to understand confounders which may affect dialysis practices. The current paradigm is to prescribe hemodialysis to achieve a target dialyzer urea clearance adjusted to total body water volume (Kt/Vurea ). Estimated glomerular filtration calculated from serum creatinine is often used to determine when patients start dialysis; as creatinine generation rates are lower in women, this may potentially result in a lead time bias with male patients starting dialysis earlier than females. When hemodialysis dose is scaled to total body water (Kt/Vurea ) women receive shorter dialysis session times. Scaling dialysis for body surface area may be more appropriate since urea generation (a surrogate for uremic toxin production) depends upon resting energy expenditure (ie, cellular metabolism) which reflects internal organ sizes. Resting energy expenditure is proportionally greater for smaller people. Women are generally smaller than men and as such have smaller sized internal organs. However, when comparing individuals, then internal organ size is best adjusted for using body surface area, not body water. The shorter, resultant dialysis session also results in lower middle molecule clearances, increases fluid removal rates and the risk of intra-dialytic hypotension; the latter potentially results in earlier loss of residual renal function. Observational studies report that the association between survival and dialyzer Kt/Vurea is improved after adjustment for body surface area, or energy expenditure. These studies also demonstrated that the conventional prescription of hemodialysis based on current Kt/Vurea targets leads to less treatment delivered to women. These multiple consequences of the generally smaller size of women compared with men may account for the unexpectedly higher relative mortality for women. As such, prospective studies investigating alternative scaling parameters are required to confirm that increasing dialysis treatments for women improves survival.
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Affiliation(s)
- Surachet Vongsanim
- Renal Division, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Andrew Davenport
- Department of Nephrology, Royal Free Hospital, University College London, London, UK
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Abstract
Dialyzer clearance of urea multiplied by dialysis time and normalized for urea distribution volume (Kt/Vurea or simply Kt/V) has been used as an index of dialysis adequacy since more than 30 years. This article reviews the flaws of Kt/V, starting with a lack of proof of concept in three randomized controlled hard outcome trials (RCTs), and continuing with a long list of conditions where the concept of Kt/V was shown to be flawed. This information leaves little room for any conclusion other than that Kt/V, as an indicator of dialysis adequacy, is obsolete. The dialysis patient might benefit more if, instead, the nephrology community concentrates in the future on pursuing the optimal dialysis dose that conforms with adequate quality of life and on factors that are likely to affect outcomes more than Kt/V. These include residual renal function, volume status, dialysis length, ultrafiltration rate, the number of intra-dialytic hypotensive episodes, interdialytic blood pressure, serum potassium and phosphate, serum albumin, and C reactive protein.
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Affiliation(s)
- Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium
| | - Wim Van Biesen
- Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium
| | - Norbert Lameire
- Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium
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13
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Davenport A, Guirguis A, Almond M, Day C, Chilcot J, Wellsted D, Farrington K. Comparison of characteristics of centers practicing incremental vs. conventional approaches to hemodialysis delivery - postdialysis recovery time and patient survival. Hemodial Int 2019; 23:288-296. [DOI: 10.1111/hdi.12743] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/08/2019] [Accepted: 02/10/2019] [Indexed: 12/27/2022]
Affiliation(s)
| | - Ayman Guirguis
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences; University of Hertfordshire, College Lane Campus; Hatfield UK
- Renal Unit, Lister Hospital, East & North Herts NHS Trust; Coreys Mill Lane; Stevenage UK
- Oxford Health NHS Foundation Trust; Oxford UK
| | - Michael Almond
- Southend University Hospital NHS Foundation Trust; Essex UK
| | - Clara Day
- Department of Renal Medicine; Queen Elizabeth Hospital; Birmingham UK
| | - Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience; King's College London; London UK
| | - David Wellsted
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences; University of Hertfordshire, College Lane Campus; Hatfield UK
| | - Ken Farrington
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences; University of Hertfordshire, College Lane Campus; Hatfield UK
- Renal Unit, Lister Hospital, East & North Herts NHS Trust; Coreys Mill Lane; Stevenage UK
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14
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Piccoli GB, Nielsen L, Gendrot L, Fois A, Cataldo E, Cabiddu G. Prescribing Hemodialysis or Hemodiafiltration: When One Size Does Not Fit All the Proposal of a Personalized Approach Based on Comorbidity and Nutritional Status. J Clin Med 2018; 7:E331. [PMID: 30297628 PMCID: PMC6210736 DOI: 10.3390/jcm7100331] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/26/2018] [Accepted: 09/26/2018] [Indexed: 12/14/2022] Open
Abstract
There is no simple way to prescribe hemodialysis. Changes in the dialysis population, improvements in dialysis techniques, and different attitudes towards the initiation of dialysis have influenced treatment goals and, consequently, dialysis prescription. However, in clinical practice prescription of dialysis still often follows a "one size fits all" rule, and there is no agreed distinction between treatment goals for the younger, lower-risk population, and for older, high comorbidity patients. In the younger dialysis population, efficiency is our main goal, as assessed by the demonstrated close relationship between depuration (tested by kinetic adequacy) and survival. In the ageing dialysis population, tolerance is probably a better objective: "good dialysis" should allow the patient to attain a stable metabolic balance with minimal dialysis-related morbidity. We would like therefore to open the discussion on a personalized approach to dialysis prescription, focused on efficiency in younger patients and on tolerance in older ones, based on life expectancy, comorbidity, residual kidney function, and nutritional status, with particular attention placed on elderly, high-comorbidity populations, such as the ones presently treated in most European centers. Prescription of dialysis includes reaching decisions on the following elements: dialysis modality (hemodialysis (HD) or hemodiafiltration (HDF)); type of membrane (permeability, surface); and the frequency and duration of sessions. Blood and dialysate flow, anticoagulation, and reinfusion (in HDF) are also briefly discussed. The approach described in this concept paper was developed considering the following items: nutritional markers and integrated scores (albumin, pre-albumin, cholesterol; body size, Body Mass Index (BMI), Malnutrition Inflammation Score (MIS), and Subjective Global Assessment (SGA)); life expectancy (age, comorbidity (Charlson Index), and dialysis vintage); kinetic goals (Kt/V, normalized protein catabolic rate (n-PCR), calcium phosphate, parathyroid hormone (PTH), beta-2 microglobulin); technical aspects including vascular access (fistula versus catheter, degree of functionality); residual kidney function and weight gain; and dialysis tolerance (intradialytic hypotension, post-dialysis fatigue, and subjective evaluation of the effect of dialysis on quality of life). In the era of personalized medicine, we hope the approach described in this concept paper, which requires validation but has the merit of providing innovation, may be a first step towards raising attention on this issue and will be of help in guiding dialysis choices that exploit the extraordinary potential of the present dialysis "menu".
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Affiliation(s)
- Giorgina Barbara Piccoli
- Néphrologie Centre Hospitalier Le Mans, Avenue Roubillard 196, 72000 Le Mans, France.
- Dipartimento di Scienze Cliniche e Biologiche, University of Torino, Ospedale san Luigi, Regione Gonzole, 10100 Torino, Italy.
| | - Louise Nielsen
- Néphrologie Centre Hospitalier Le Mans, Avenue Roubillard 196, 72000 Le Mans, France.
| | - Lurilyn Gendrot
- Néphrologie Centre Hospitalier Le Mans, Avenue Roubillard 196, 72000 Le Mans, France.
| | - Antioco Fois
- Néphrologie Centre Hospitalier Le Mans, Avenue Roubillard 196, 72000 Le Mans, France.
| | - Emanuela Cataldo
- Néphrologie Centre Hospitalier Le Mans, Avenue Roubillard 196, 72000 Le Mans, France.
- Nefrologia, Università Aldo Moro, Piazza Umberto I, 70121 Bari, Italy.
| | - Gianfranca Cabiddu
- Nefrologia Ospedale Brotzu, Piazzale Alessandro Ricchi, 1, 09134 Cagliari, Italy.
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Sridharan S, Vilar E, Davenport A, Ashman N, Almond M, Banerjee A, Roberts J, Farrington K. Indexing dialysis dose for gender, body size and physical activity: Impact on survival. PLoS One 2018; 13:e0203075. [PMID: 30192771 PMCID: PMC6128479 DOI: 10.1371/journal.pone.0203075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/14/2018] [Indexed: 12/27/2022] Open
Abstract
Current practice basing dialysis dose on urea distribution volume (V) has been questioned. We explored the impact on survival of scaling dialysis dose (Kt) to parameters reflective of metabolic activity. In a multicentre prospective cohort study of 1500 patients on thrice-weekly haemodialysis, body surface area (BSA) and resting energy expenditure (REE) were estimated using validated equations and physical activity by the Recent Physical Activity Questionnaire. Total energy expenditure (TEE) was estimated from REE and physical activity data. Kt was calculated from delivered (single-pool Kt/V)*Watson V. Kt/BSA, Kt/REE and Kt/TEE were then calculated at baseline and 6 monthly during follow-up for 2 years. In adjusted Cox models Kt/TEE, Kt/BSA, Kt/REE, in that order, had lower hazard ratios for death than single-pool Kt/V. On the basis of adjusted survival differences, putative minimum target doses were estimated for Kt/BSA as 27119 ml/m2 and Kt/TEE as 25.79 ml/kcal. We identified spKt/V values equivalent to these estimated targets, ranging from 1.4 to 1.8 in patient groups based on gender, body size and physical activity. For sedentary patients, the minimum target dose was 1.4 for large males, 1.5 for small males and 1.7 for women. For active patients the target was 1.8 irrespective of gender and body-weight. Patients achieving these individualised minimum targets had greater adjusted two-year survival compared to those achieving conventional minimum targets. Metabolic activity related parameters, such as Kt/TEE and Kt/BSA, may have a clinically important role in scaling haemodialysis dose. Using such parameters or their spKt/V equivalents to adjust minimum target doses based on gender, body size and habitual physical activity may have a positive impact on survival.
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Affiliation(s)
- Sivakumar Sridharan
- Renal Unit, Lister Hospital, Stevenage, United Kingdom
- University of Hertfordshire, Hatfield, United Kingdom
- * E-mail:
| | - Enric Vilar
- Renal Unit, Lister Hospital, Stevenage, United Kingdom
- University of Hertfordshire, Hatfield, United Kingdom
| | - Andrew Davenport
- Department of Nephrology, University College London, Royal Free Hospital, London, United Kingdom
| | - Neil Ashman
- Royal London Hospital, London, United Kingdom
| | - Michael Almond
- Southend University Hospital, Westcliff-on-Sea, United Kingdom
| | | | | | - Ken Farrington
- Renal Unit, Lister Hospital, Stevenage, United Kingdom
- University of Hertfordshire, Hatfield, United Kingdom
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Gotta V, Marsenic O, Pfister M. Age- and weight-based differences in haemodialysis prescription and delivery in children, adolescents and young adults. Nephrol Dial Transplant 2018; 33:1649-1660. [PMID: 29684176 DOI: 10.1093/ndt/gfy067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 02/27/2018] [Indexed: 12/29/2022] Open
Abstract
Background Limited systematic data are available on prescription and dosing of haemodialysis (HD) in children and adolescents compared with adults. We aimed to characterize age- and weight-based differences in HD delivery in children, adolescents and young adults. Methods This is a retrospective observational study including 1852 patients <30 years on chronic HD from childhood (53 903 HD sessions), receiving thrice weekly outpatient HD between 2004 and 2016 in the USA (6075 patient-years, of which 2535 were in patients aged 1-18 years; weight range 8.3-168 kg). Median individual prescriptions per year were calculated and overall 50% (IQR) and 90% distribution ranges over age and weight were derived. Repeated measurements analysis of variance assessed differences between age and weight groups. Results Prescriptions significantly differed among age and weight groups (P < 0.001). Lower weight patients (<75 kg) had higher (inter-quartile range, IQR) weight-normalized blood flow rate (highest in <25 kg: QB/kg = 6.5-9.1 mL/min/kg), urea dialytic clearance (KD/kg) and single pool Kt/V (spKt/V) (<25 kg: 1.43-1.78; 25-50 kg: 1.52-1.92; 50-75 kg: 1.43-1.74) than heavier patients (lowest in >100 kg: QB/kg = 3.1-4.0 mL/min/kg, spKt/V = 1.22-1.47, respectively). Adolescents had significantly lower QB/kg, KD/kg and spKt/V (1.34-1.71) compared with adults (1.45-1.79) and children <12 years (range of 25th percentiles: 1.37-1.44). Dialytic clearance derived from a mechanistic equation underpredicted KD in children but not in young adults. Significant growth retardation was observed, with the proportion of patients <3rd percentile (height for age) decreasing from 71% (1-2 years) to 15% (>18 years). Conclusion Delivered HD treatment varies with age and weight and is more intensified in children aged <12 years, compared with adolescents and overweight young adults, who appear to be at highest risk of receiving suboptimal treatment. Still, delivery of target or higher spKt/V values did not result in appropriate growth in these children, questioning the value of spKt/V as a measure of HD adequacy in children. Provided ranges of outpatient HD prescription can help clinicians and researchers in personalizing and optimizing delivery of dialysis treatment.
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Affiliation(s)
- Verena Gotta
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - Olivera Marsenic
- Pediatric Nephrology, Yale University School of Medicine, New Haven, CT, USA
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
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17
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Oliveira B, Sridharan S, Farrington K, Davenport A. Comparison of resting energy equations and total energy expenditure in haemodialysis patients and body composition measured by multi-frequency bioimpedance. Nephrology (Carlton) 2018; 23:748-754. [DOI: 10.1111/nep.13112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Ben Oliveira
- UCL Centre for Nephrology, Royal Free Hospital; University College London Medical School; London UK
| | | | - Ken Farrington
- Renal Unit; Lister Hospital; Stevenage UK
- University of Hertfordshire; Hatfield UK
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital; University College London Medical School; London UK
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18
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Abstract
INTRODUCTION Dialysis adequacy is traditionally measured by monthly blood urea sampling and calculating sessional Kt/Vurea. Modern dialysis machines can estimate clearances each session, so we wished to compare online measurements with standard Kt/Vurea. METHODS Urea clearance was estimated by intermittent changes in effective ionic dialysance and by continuous ultraviolet light absorption spent during the mid-week dialysis session. Total body water was calculated by the Watson equation and measured by multifrequency bioimpedance. RESULTS We compared Kt/Vurea measurements in 162 patients with online assessments: 38 by ultraviolet absorption and 124 by effective ionic dialysance (50 Fresenius 4008 and 74 Fresenius 5008). All online measurements overestimated single-pool Kt/Vurea (ultraviolet absorption mean bias 0.25 ± 0.24, effective ionic dialysance 4008H 0.25 ± 0.21 and 5008H 0.20 ± 0.25; p < 0.001). However, there was no difference between dual-pool Kt/V and ultraviolet absorbance (1.28 ± 0.26 vs 1.29 ± 0.27) or by effective ionic dialysance with the 4008 (1.40 ± 0.26 vs 1.46 ± 0.33), although the effective ionic dialysance 5008 overestimated clearance (1.39 ± 0.27 vs 1.31 ± 0.22; p < 0.01). Similarly, with dual-pool Kt/Vurea, the mean bias for ultraviolet absorption was 0.08 ± 0.35, for effective ionic dialysance (EID) 4008 was 0.13 ± 0.55 and for EID 5008 was -0.2 ± 0.36. Hence, the mean bias was greater with the EID 5008 compared to ultraviolet absorption (0.08 ± 0.35 vs -0.2 ± 0.36 vs p < 0.01). CONCLUSIONS Online measurements allow dialysis adequacy to be measured every session. We found that although online clearances overestimated single-pool Kt/Vurea measurements, there were no significant differences between the continuous ultraviolet light absorbance method and intermittent effective ionic dialysance.
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Affiliation(s)
- Ahmed Mohamed
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
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19
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Jones CB, Bargman JM. Should we look beyond Kt/V urea in assessing dialysis adequacy? Semin Dial 2018; 31:420-429. [PMID: 29573025 DOI: 10.1111/sdi.12684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Since the advent of maintenance dialysis therapy, our interpretation of what adequate dialysis really is has broadened and become more controversial. This is not only due to our changing and aging dialysis population but also to our evolving knowledge base. As nephrologists, we strive to achieve both quality and (often) quantity of life for our patients and we feel reassured when we have a quantifiable marker to show for our efforts. However, we suggest that adequate dialysis reaches far beyond the realms of attaining a particular biochemical result. Dialysis adequacy should encompass a more comprehensive assessment of patient well-being. This metric could comprise quality of life and patient-specified goals, sufficient small solute and middle molecule clearance, optimal blood pressure control, and effective bone-mineral balance, all in the context of minimizing mortality and morbidity, and a livable dialysis regimen for the patient.
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Affiliation(s)
- Clare B Jones
- Division of Nephrology, University Health Network, Toronto, Canada
| | - Joanne M Bargman
- Division of Nephrology, University Health Network, Toronto, Canada
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20
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Davenport A, Guirguis A, Almond M, Day C, Chilcot J, Da Silva Gane M, Fineberg N, Friedl K, Spencer B, Wellsted D, Farrington K. Postdialysis recovery time is extended in patients with greater self-reported depression screening questionnaire scores. Hemodial Int 2018; 22:369-376. [PMID: 29461016 DOI: 10.1111/hdi.12642] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/26/2017] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Most patients take time to recover after a hemodialysis (HD) session. It has been suggested that recovery time is associated with intradialytic hypotension and rapid solute clearances. Other studies have reported a linkage to depression. We investigated the association between recovery time and intradialytic hypotension and depression. METHODS In five UK HD units, we screened for depressive symptoms using the Beck depression inventory-II, Patient Health Questionnaire, and recorded sessional blood pressures and Kt/Vurea. FINDINGS Seven hundred and one HD patients were studied; 63.6% male, mean age 64.1 ± 16.6 years, 33.5% diabetic. About 24.1% recovered in <1 hour, 27% 1-4 hours, 15.4% 4-8 hours, 10.7% 8-12 hours, and 22.8% after 12 hours. Systolic blood pressure fell by ≥20 mmHg in 30.9% postdialysis, and to <100 mmHg in 7.6%. In multivariate analysis, patients with recovery times >1 hour were more likely to be female, have high self-reported Beck depression inventory-II scores, a past medical history of depression, and be living without a partner. Longer recovery times were also associated with very low postdialysis systolic blood pressures (<100 mmHg), and higher body weight. However, the model predicted only 18% of the variation in recovery times. We found no association between recovery times and short-term mortality risk. DISCUSSION Prolonged postdialysis recovery times are associated with higher self-reported depression scores, and very low postdialysis blood pressure. Future studies investigating changes in dialysis practice and recovery times will need to target strategies to prevent intradialytic hypotension and adjust for patient psychological status.
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Affiliation(s)
| | - Ayman Guirguis
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Renal Unit, Lister Hospital, East & North Herts NHS Trust, Stevenage, UK.,Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Welwyn Garden City, UK
| | - Michael Almond
- Southend University Hospital NHS Foundation Trust, Essex, UK
| | - Clara Day
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - Joseph Chilcot
- Health Psychology Section, Psychology Department, King's College London, London, UK
| | - Maria Da Silva Gane
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Renal Unit, Lister Hospital, East & North Herts NHS Trust, Stevenage, UK
| | - Naomi Fineberg
- Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Welwyn Garden City, UK
| | - Karin Friedl
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Benjamin Spencer
- Department of Psychological Medicine, Weston Education Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - David Wellsted
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Ken Farrington
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Renal Unit, Lister Hospital, East & North Herts NHS Trust, Stevenage, UK
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Noori N, Wald R, Sharma Parpia A, Goldstein MB. Volume Estimates in Chronic Hemodialysis Patients by the Watson Equation and Bioimpedance Spectroscopy and the Impact on the Kt/V urea calculation. Can J Kidney Health Dis 2018; 5:2054358117750156. [PMID: 29348925 PMCID: PMC5768265 DOI: 10.1177/2054358117750156] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/03/2017] [Indexed: 11/15/2022] Open
Abstract
Background Accurate assessment of total body water (TBW) is essential for the evaluation of dialysis adequacy (Kt/Vurea). The Watson formula, which is recommended for the calculation of TBW, was derived in healthy volunteers thereby leading to potentially inaccurate TBW estimates in maintenance hemodialysis recipients. Bioimpedance spectroscopy (BIS) may be a robust alternative for the measurement of TBW in hemodialysis recipients. Objectives The primary objective of this study was to evaluate the accuracy of Watson formula-derived TBW estimates as compared with TBW measured with BIS. Second, we aimed to identify the anthropometric characteristics that are most likely to generate inaccuracy when using the Watson formula to calculate TBW. Finally, we derived novel anthropometric equations for the more accurate estimation of TBW. Design and Setting This was a cross-sectional study of prevalent in-center HD patients at St Michael's Hospital. Patients One hundred eighty-four hemodialysis patients (109 men and 75 women) were evaluated in this study. Measurements Anthropometric measurements including weight, height, waist circumference, midarm circumference, and 4-site skinfold (biceps, triceps, subscapular, and suprailiac) thickness were measured; fat mass was measured using the formula by Durnin and Womersley. We measured TBW by BIS using the Body Composition Monitor (Fresenius Medical Care, Bad Homburg, Germany). Methods We used the Bland-Altman method to calculate the difference between the TBW derived from the Watson method and the BIS. To derive new equations for TBW estimation, Pearson's correlation coefficients between BIS-TBW (the reference test) and other variables were examined. We used the least squares regression analysis to develop parsimonious equations to predict TBW. Results TBW values based on the Watson method had a high correlation with BIS-TBW (correlation coefficients = 0.87 and P < .001). Despite the high correlation, the Watson formula overestimated TBW by 5.1 (4.5-5.8) liters and 3.8 (3.0-4.5) liters, in men and women, respectively. Higher fat mass and waist circumference (general and abdominal obesity) were correlated with the greater TBW overestimation by the Watson formula. We created separate equations for men and women based on weight and waist circumference. Limitations The main limitation of our study was the lack of an external validation for our novel estimating equation. Furthermore, though BIS has been validated against traditional reference standards, our assumption that it represents the "gold standard" for body compartment assessment may be flawed. Conclusions The Watson formula generally overestimates TBW in chronic dialysis recipients, particularly in patients with the highest waist circumference. Widespread reliance on the Watson formula for derivation of TBW may lead to the underestimation of Kt/Vurea..
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Affiliation(s)
- Nazanin Noori
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ron Wald
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Arti Sharma Parpia
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Marc B Goldstein
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada
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Davenport A. More frequent hemodialysis does not effectively clear protein-bound azotemic solutes derived from gut microbiome metabolism. Kidney Int 2017; 91:1008-1010. [DOI: 10.1016/j.kint.2016.12.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 12/30/2016] [Accepted: 12/30/2016] [Indexed: 01/26/2023]
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Sridharan S, Vilar E, Davenport A, Ashman N, Almond M, Banerjee A, Roberts J, Farrington K. Scaling Hemodialysis Target Dose to Reflect Body Surface Area, Metabolic Activity, and Protein Catabolic Rate: A Prospective, Cross-sectional Study. Am J Kidney Dis 2017; 69:358-366. [DOI: 10.1053/j.ajkd.2016.07.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 07/18/2016] [Indexed: 11/11/2022]
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Davenport A. Is Hemodialysis Patient Survival Dependent upon Small Solute Clearance (Kt/V)?: If So How Can Kt/V be Adjusted to Prevent Under Dialysis in Vulnerable Groups? Semin Dial 2017; 30:86-92. [PMID: 28074616 DOI: 10.1111/sdi.12566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Small solute clearance achieved during a single hemodialysis session has been traditionally evaluated by urea clearance, normalized for total body water (Kt/Vurea) for more than 30 years. By consensus, the target sessional KtVurea for thrice weekly treatments has been increased from 0.9 to 1.2 over the years. Although this is supported by observational studies, there is a fundamental lack of prospective studies to support this threshold target. In clinical practice achieving sessional Kt/Vurea targets are most closely followed in the US. Yet there appears to be a paradox in that by following Kt/Vurea targets in the US hemodialysis patient survival is better for men and the obese, the opposite of what is seen in the general population. Delivery of a lower dose of hemodialysis to women and smaller men can be explained by underestimation of total body water. The advent of bioimpedance techniques which can measure both body water and body composition will potentially allow a rescaling and re-evaluation of the importance of small solute clearances (Kt/Vurea) in the hemodialysis patient population.
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Affiliation(s)
- Andrew Davenport
- University College London Centre for Nephrology, Royal Free Hospital, London, United Kingdom
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25
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El-Kateb S, Sridharan S, Farrington K, Fan S, Davenport A. A single weekly Kt/Vurea target for peritoneal dialysis patients does not provide an equal dialysis dose for all. Kidney Int 2016; 90:1342-1347. [DOI: 10.1016/j.kint.2016.07.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/11/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
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Davenport A. Measuring residual renal function in dialysis patients: can we dispense with 24-hour urine collections? Kidney Int 2016; 89:978-980. [PMID: 27083273 DOI: 10.1016/j.kint.2016.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 01/31/2016] [Accepted: 02/03/2016] [Indexed: 10/21/2022]
Abstract
Residual renal function is associated with improved survival and quality of life for dialysis patients. Whereas residual renal function is monitored in peritoneal dialysis patients, many hemodialysis centers simply concentrate on achieving dialyzer urea clearance targets. Accurately quantifying residual renal function from urine collections is arduous. Thus, there is a clinical need to develop alternative methods of assessing residual renal function based on serum testing, especially for patients receiving less than thrice weekly dialysis.
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Affiliation(s)
- Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London, London, UK; University College London Medical School, London, UK.
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Zaloszyc A, Fischbach M, Schaefer B, Uhlmann L, Salomon R, Krid S, Schmitt CP. Body composition monitoring-derived urea distribution volume in children on chronic hemodialysis. Pediatr Nephrol 2016; 31:991-9. [PMID: 26754039 DOI: 10.1007/s00467-015-3283-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/17/2015] [Accepted: 11/19/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Modern hemodialysis (HD) machines are able to measure ionic dialysance online and thereby continuously monitor Kt/V. The accuracy of measurement depends on the input of the correct urea distribution volume (V), available from anthropometric equations and body composition monitoring (BCM). The latter method, however, has not been validated in children. METHODS We compared V determined by BCM to that calculated using four different anthropometric formulas (Morgenstern, Mellits and Cheek, Hume-Weyers and Watson equations) in 23 pediatric HD patients. We also compared online Kt/V using BCM-derived V with the Kt/V calculated from pre- and post-dialytic urea concentrations using the single-pool second-generation Daugirdas equation. RESULTS The V calculated by the Morgenstern equation was similar to that derived by BCM, with a mean difference of -0.7% (95% limits of agreement -11.7 to 10.3%). In contrast, the V calculated by the other equations was 5.4, 6.2 and 18%, respectively higher than the BCM-derived V. The mean difference between Kt/V calculated using the Daugirdas equation and online Kt/V determination based on BCM-derived V data was 0.10 (95% limits of agreement -0.50 to 0.70%). CONCLUSIONS In our pediatric HD patients the V measured by BCM was in agreement with that calculated using the Morgenstern equation, which is the only equation which has been validated to date in children on dialysis. Online determination of Kt/V using a BCM-derived V largely agreed with that calculated by the Daugirdas equation. We therefore conclude that the former approach is suitable for frequent online assessment of dialytic small solute clearance.
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Affiliation(s)
- Ariane Zaloszyc
- Nephrology Dialysis Transplantation Children's Unit, University Hospital Hautepierre, 67098, Strasbourg, France
| | - Michel Fischbach
- Nephrology Dialysis Transplantation Children's Unit, University Hospital Hautepierre, 67098, Strasbourg, France
| | - Betti Schaefer
- Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Lorenz Uhlmann
- Institute of Medical Biometry and Informatics, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - Rémi Salomon
- Pediatric Nephrology, Hôpital Necker-Enfants Malades, 75015, Paris, France
| | - Saoussen Krid
- Pediatric Nephrology, Hôpital Necker-Enfants Malades, 75015, Paris, France
| | - Claus Peter Schmitt
- Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.
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Davenport A. Dialysis and Patient Factors Which Determine Convective Volume Exchange in Patients Treated by Postdilution Online Hemodiafiltration. Artif Organs 2016; 40:1121-1127. [DOI: 10.1111/aor.12709] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 01/07/2016] [Indexed: 01/09/2023]
Affiliation(s)
- Andrew Davenport
- UCL, Centre for Nephrology, Royal Free Hospital; University College London Medical School; London United Kingdom
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Davenport A, Peters SA, Bots ML, Canaud B, Grooteman MP, Asci G, Locatelli F, Maduell F, Morena M, Nubé MJ, Ok E, Torres F, Woodward M, Blankestijn PJ. Higher convection volume exchange with online hemodiafiltration is associated with survival advantage for dialysis patients: the effect of adjustment for body size. Kidney Int 2016; 89:193-9. [DOI: 10.1038/ki.2015.264] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 06/26/2015] [Accepted: 07/02/2015] [Indexed: 12/15/2022]
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Vega A, Ruiz C, Abad S, Quiroga B, Velázquez K, Ampuero J, López-Gómez JM. Body Composition Affects Urea Distribution Volume Estimated by Watson's Formula. J Ren Nutr 2015; 25:420-5. [PMID: 25906704 DOI: 10.1053/j.jrn.2015.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 02/24/2015] [Accepted: 02/26/2015] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Dialysis machines use the Watson formula (Vwatson) to estimate the urea distribution volume (UDV) to calculate the online Kt/V for each dialysis session. However, the equation could give rise to inaccuracies. The present study analyzes whether body composition affects UDV estimated by Vwatson in comparison to bioimpedance spectroscopy (Vbis) as the reference method. DESIGN This is a transversal study performed in the setting of a hemodialysis unit. SUBJECTS Prevalent hemodialysis patients. INTERVENTION The same day, UDV was measured using Vwatson and Vbis. We compared their results. MAIN OUTCOME MEASURE Differences between UDV using Watson equation and Vbis. RESULTS We included 144 prevalent patients. Vwatson overestimated the volume with regard to Vbis (Vwatson - Vbis) by 2.5 L (1.8 L; P = .001). We found an excellent correlation between the 2 methods. A higher mean Vwatson - Vbis value was correlated to older age (P = .03), body mass index (P = .01), fat tissue index (P = .001), lower lean tissue index (P = .001), lower extracellular water (P = .01), and intracellular water (P = .001). CONCLUSION Body composition affects UDV estimated by Vwatson, thus modifying the result of Kt/V. In young patients who present more lean tissue and less fat tissue, Kt/V is underestimated with Vwatson.
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Affiliation(s)
- Almudena Vega
- Department of Nephrology, Hospital Gregorio Marañón, Madrid, Spain.
| | - Caridad Ruiz
- Department of Nephrology, Hospital Gregorio Marañón, Madrid, Spain
| | - Soraya Abad
- Department of Nephrology, Hospital Gregorio Marañón, Madrid, Spain
| | - Borja Quiroga
- Department of Nephrology, Hospital Gregorio Marañón, Madrid, Spain
| | - Kyra Velázquez
- Department of Nephrology, Hospital Gregorio Marañón, Madrid, Spain
| | - Jara Ampuero
- Department of Nephrology, Hospital Gregorio Marañón, Madrid, Spain
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Davenport A. Will incremental hemodialysis preserve residual function and improve patient survival? Semin Dial 2014; 28:16-9. [PMID: 25385441 PMCID: PMC4320773 DOI: 10.1111/sdi.12320] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The progressive loss of residual renal function in peritoneal dialysis patients is associated with increased mortality. It has been suggested that incremental dialysis may help preserve residual renal function and improve patient survival. Residual renal function depends upon both patient related and dialysis associated factors. Maintaining patients in an over-hydrated state may be associated with better preservation of residual renal function but any benefit comes with a significant risk of cardiovascular consequences. Notably, it is only observational studies that have reported an association between dialysis patient survival and residual renal function; causality has not been established for dialysis patient survival. The tenuous connections between residual renal function and outcomes and between incremental hemodialysis and residual renal function should temper our enthusiasm for interventions in this area.
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Affiliation(s)
- Andrew Davenport
- University College London Center for Nephrology, Royal Free Hospital, University College London Medical School, London, United Kingdom
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Nongnuch A, Panorchan K, Davenport A. Predialysis NTproBNP predicts magnitude of extracellular volume overload in haemodialysis patients. Am J Nephrol 2014; 40:251-7. [PMID: 25322897 DOI: 10.1159/000368376] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 09/07/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Increased natriuretic peptides are associated with increased cardiovascular and all-cause mortality for haemodialysis (HD) patients. However, debate continues whether these biomarkers are increased by extracellular water (ECW) excess and can be used to aid clinical assessment of volume status and help determine target weight. METHODS We measured N terminal probrain natriuretic peptide (NT-proBNP) predialysis in 375 stable haemodialysis outpatients with corresponding pre and postdialysis multifrequency bioelectrical impedance assessments (MFBIA) of (ECW)/total body water (TBW). RESULTS Median age 64 (51-75), 63.9% male, 42.9% diabetic, 43.2% Caucasoid, 14.4% with a history of myocardial infarction, 8.4% coronary artery bypass surgery, dialysis vintage 28.2 (12.3-55.5) months. Median predialysis NT-proBNP 283 (123-989) pmol/l, and predialysis ECW/TBW ratio 0.397 ± 0.029. On multivariate analysis, predialysis log NT-proBNP was associated with predialysis systolic blood pressure (β 0.007, p = 0.000), weight (β -0.008, p = 0.001), valvular heart disease (β 0.342, p = 0.015, ECW/TBW (β 1.3, p = 0.019) and log CRP (β 0.145, p = 0.037). Dividing patients into NTproBNP quartiles, %ECW/TBW and relative ECW overhydration were significantly greater for the highest quartile vs. lowest (40.5 ± 4.1 vs. 39.0 ± 1.1, and 1.51 ± 1.24 vs. 0.61 ± 0.69 l, respectively, p < 0.001). CONCLUSION In this study, predialysis NTproBNP values were associated with direct assessments of the extracellular volume excess measured by MFBIA and systolic arterial blood pressure. This suggests that predialysis NTproBNP values can potentially be used to aid clinical assessment of volume status in dialysis patients to determine target weight.
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Affiliation(s)
- Arkom Nongnuch
- Renal Unit, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Davies SJ, Davenport A. The role of bioimpedance and biomarkers in helping to aid clinical decision-making of volume assessments in dialysis patients. Kidney Int 2014; 86:489-96. [DOI: 10.1038/ki.2014.207] [Citation(s) in RCA: 198] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 03/21/2014] [Accepted: 04/17/2014] [Indexed: 11/09/2022]
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Nongnuch A, Campbell N, Stern E, El-Kateb S, Fuentes L, Davenport A. Increased postdialysis systolic blood pressure is associated with extracellular overhydration in hemodialysis outpatients. Kidney Int 2014; 87:452-7. [PMID: 25075771 DOI: 10.1038/ki.2014.276] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 06/16/2014] [Accepted: 06/19/2014] [Indexed: 02/01/2023]
Abstract
Recently, intradialytic hypertension was reported to be associated with increased mortality for hemodialysis patients. To determine whether volume status plays a role in dialysis-associated hypertension, we prospectively audited 531 patients that had volume assessments measured by multiple-frequency bioelectrical impedance during their midweek dialysis session. Mean pre- and postdialysis weights were 73.2 vs 71.7 kg, and systolic blood pressures (SBPs) 140.5 vs. 130.3 mm Hg, respectively. Patients were divided into groups based on a fall in SBP of 20 mm Hg or more (32%), an increased SBP of 10 mm Hg or more (18%), and a stable group (50%). There were no differences in patient demographics, dialysis prescriptions, predialysis weight, total body (TBW), and extracellular (ECW) and intracellular water (ICW). However, the change in weight was significantly less in the increased blood pressure group (1.01 kg vs. stable 1.65, and 1.7 hypotensive). The ratio of ECW to TBW was significantly higher in the increased blood pressure group, particularly post dialysis (39.1 vs. stable 38.7% and fall in blood pressure group 38.7%). ECW overhydration was significantly greater in the increased blood pressure group post dialysis (0.7 (0.17 to 1.1) vs. stable 0.39 (-0.2 to 0.95) and fall in blood pressure group 0.38 (-0.19 to 0.86) liter). We found that patients who had increased blood pressure post dialysis had greater hydration status, particularly ECW. Thus, patients who increase their blood pressure post dialysis should have review of target weight, consideration of lowering the post-dialysis weight, and may benefit from increasing dialysis session time or frequency.
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Affiliation(s)
- Arkom Nongnuch
- UCL Center for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
| | - Neil Campbell
- UCL Center for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
| | - Edward Stern
- UCL Center for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
| | - Sally El-Kateb
- UCL Center for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
| | - Laura Fuentes
- UCL Center for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
| | - Andrew Davenport
- UCL Center for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
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Charitaki E, Davenport A. Aortic pulse wave velocity in haemodialysis patients is associated with the prescription of active vitamin D analogues. J Nephrol 2014; 27:431-7. [PMID: 24473732 DOI: 10.1007/s40620-014-0040-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 11/03/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cardiovascular disease remains the most common cause of death for haemodialysis patients. In addition to traditional cardiovascular risk factors, haemodialysis patients have additional risk factors, including vascular calcification. Pulse wave velocity (PWV) is a measurement of arterial stiffness, and we wished to determine whether PWV is affected by different factors in haemodialysis patients compared to the general population. METHODS Aortic PWV was measured in 303 adult patients attending for routine outpatient dialysis. RESULTS 303 patients, 63.4% male, mean age 68.5 ± 15.8 years, 47.5% diabetic with a body mass index of 25.8 ± 5.3 kg/m(2), were studied. Systolic blood pressure (SBP) was 148.7 ± 28.6 mmHg and diastolic 80.4 ± 15.3 mmHg. Aortic PWV was 9.73 ± 2.08 m/s, and was correlated with SBP (β 0.015, F 5.29, p = 0.023), log serum parathyroid hormone (PTH) (β 1.58, F 13.85, p < 0.001) and prescription of alfacalcidol (β -1.11, F 6.81, p = 0.010). 197 patients had corresponding ECHO cardiograms, and in this cohort PWV was associated with SBP (β 0.017, F 7.49, p = 0.006), log serum parathyroid hormone (β 0.85, F 5.99, p < 0.015) and prescription of alfacalcidol (β -0.8, F 4.18, p = 0.042), left ventricular mass index (LVMI) (β 0.01, F 11.4, p = 0.001), and log serum triglycerides (β 1.43, F 4.79, p = 0.03). CONCLUSIONS We found that PWV, a measurement of arterial stiffness, was associated with both traditional cardiovascular risk factors, including SBP and LVMI, but also non-traditional risk factors such as prescription of active vitamin D analogues, suggesting a potential link between vascular calcification and arterial stiffness in haemodialysis patients.
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Affiliation(s)
- Evangelina Charitaki
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, Rowland Hill Street, London, NW3 2PF, UK,
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