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Chen YJ, Chou CY, Er TK. Correlations of sST2 and Gal-3 with Cardiothoracic Ratio in Patients with Chronic Kidney Disease. Biomedicines 2024; 12:791. [PMID: 38672149 PMCID: PMC11048335 DOI: 10.3390/biomedicines12040791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
Chronic kidney disease (CKD) frequently correlates with cardiovascular complications. Soluble suppression of tumorigenicity 2 (sST2) and Galectin-3 (Gal-3) are emerging as cardiac markers with potential relevance in cardiovascular risk prediction. The cardiothoracic ratio (CTR), a metric easily obtainable from chest radiographs, has traditionally been used to assess cardiac size and the potential for cardiomegaly. Understanding the correlation between these cardiac markers and the cardiothoracic ratio (CTR) could provide valuable insights into the cardiovascular prognosis of CKD patients. This study aimed to explore the relationship between sST2, Gal-3, and the CTR in individuals with CKD. Plasma concentrations of sST2 and Gal-3 were assessed in a cohort of 123 CKD patients by enzyme-linked immunosorbent assay (ELISA). On a posterior-to-anterior chest X-ray view, the CTR was determined by comparing the widths of the heart to that of the thorax. The mean concentration of sST2 in the study participants ranged from 775.4 to 4475.6 pg/mL, and the mean concentration of Gal-3 ranged from 4.7 to 9796.0 ng/mL. Significant positive correlations were observed between sST2 and the CTR (r = 0.291, p < 0.001) and between Gal-3 and the CTR (r = 0.230, p < 0.01). Our findings indicate that elevated levels of sST2 and Gal-3 are associated with an increased CTR in CKD patients. This relationship may enable better cardiovascular risk evaluation for CKD patients. Further studies are warranted to explore the clinical implications of these associations.
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Affiliation(s)
- Ying-Ju Chen
- Division of Laboratory Medicine, Asia University Hospital, Asia University, Taichung 41354, Taiwan
| | - Che-Yi Chou
- Division of Nephrology, Asia University, Taichung 41354, Taiwan
| | - Tze-Kiong Er
- Division of Laboratory Medicine, Asia University Hospital, Asia University, Taichung 41354, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung 41354, Taiwan
- Department of Nursing, Asia University, Taichung 41354, Taiwan
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2
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Chou CY, Wang CCN, Chiang HY, Huang CF, Hsiao YL, Sun CH, Hu CS, Wu MY, Chen SH, Chang CM, Lin YT, Wang JS, Hong YC, Ting IW, Yeh HC, Kuo CC. Cardiothoracic ratio values and trajectories are associated with risk of requiring dialysis and mortality in chronic kidney disease. COMMUNICATIONS MEDICINE 2023; 3:19. [PMID: 36750687 PMCID: PMC9905092 DOI: 10.1038/s43856-023-00241-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 01/10/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND The prognostic role of the cardiothoracic ratio (CTR) in chronic kidney disease (CKD) remains undetermined. METHODS We conducted a retrospective cohort study of 3117 patients with CKD aged 18-89 years who participated in an Advanced CKD Care Program in Taiwan between 2003 and 2017 with a median follow up of 1.3(0.7-2.5) and 3.3(1.8-5.3) (IQR) years for outcome of end-stage renal disease (ESRD) and overall death, respectively. We developed a machine learning (ML)-based algorithm to calculate the baseline and serial CTRs, which were then used to classify patients into trajectory groups based on latent class mixed modelling. Association and discrimination were evaluated using multivariable Cox proportional hazards regression analyses and C-statistics, respectively. RESULTS The median (interquartile range) age of 3117 patients is 69.5 (59.2-77.4) years. We create 3 CTR trajectory groups (low [30.1%], medium [48.1%], and high [21.8%]) for the 2474 patients with at least 2 CTR measurements. The adjusted hazard ratios for ESRD, cardiovascular mortality, and all-cause mortality in patients with baseline CTRs ≥0.57 (vs CTRs <0.47) are 1.35 (95% confidence interval, 1.06-1.72), 2.89 (1.78-4.71), and 1.50 (1.22-1.83), respectively. Similarly, greater effect sizes, particularly for cardiovascular mortality, are observed for high (vs low) CTR trajectories. Compared with a reference model, one with CTR as a continuous variable yields significantly higher C-statistics of 0.719 (vs 0.698, P = 0.04) for cardiovascular mortality and 0.697 (vs 0.693, P < 0.001) for all-cause mortality. CONCLUSIONS Our findings support the real-world prognostic value of the CTR, as calculated by a ML annotation tool, in CKD. Our research presents a methodological foundation for using machine learning to improve cardioprotection among patients with CKD.
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Affiliation(s)
- Che-Yi Chou
- grid.252470.60000 0000 9263 9645Division of Nephrology, Department of Internal Medicine, Asia University Hospital, Wufeng, Taichung, Taiwan ,grid.252470.60000 0000 9263 9645Department of Post-baccalaureate Veterinary Medicine, Asia University, Wufeng, Taichung, Taiwan ,grid.254145.30000 0001 0083 6092Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Charles C. N. Wang
- grid.252470.60000 0000 9263 9645Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.
| | - Chien-Fong Huang
- grid.254145.30000 0001 0083 6092Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Ya-Luan Hsiao
- grid.21107.350000 0001 2171 9311Department of Health Administration, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Chuan-Hu Sun
- grid.254145.30000 0001 0083 6092Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Chun-Sheng Hu
- grid.254145.30000 0001 0083 6092Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Min-Yen Wu
- grid.254145.30000 0001 0083 6092Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Sheng-Hsuan Chen
- grid.254145.30000 0001 0083 6092Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Chun-Min Chang
- grid.14003.360000 0001 2167 3675Department of Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, WI USA
| | - Yu-Ting Lin
- grid.254145.30000 0001 0083 6092Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Jie-Sian Wang
- grid.254145.30000 0001 0083 6092Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Yu-Cuyan Hong
- grid.254145.30000 0001 0083 6092Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - I-Wen Ting
- grid.254145.30000 0001 0083 6092Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan ,grid.254145.30000 0001 0083 6092AKI-CARE (Clinical Advancement, Research and Education) Center, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Hung-Chieh Yeh
- grid.254145.30000 0001 0083 6092Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan ,grid.254145.30000 0001 0083 6092AKI-CARE (Clinical Advancement, Research and Education) Center, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Chin-Chi Kuo
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan. .,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan. .,Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan. .,AKI-CARE (Clinical Advancement, Research and Education) Center, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.
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3
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Neutralization Assessments Reveal High Cardiothoracic Ratio and Old Age as Independent Predictors of Low Neutralizing Antibody Titers in Hemodialysis Patients Receiving a Single Dose of COVID-19 Vaccine. J Pers Med 2022; 12:jpm12010068. [PMID: 35055386 PMCID: PMC8781271 DOI: 10.3390/jpm12010068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Data are lacking regarding predictors of quantification of neutralizing antibodies (nAbs) based on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 50% neutralization titer (NT50) after a single dose of COVID-19 vaccine in hemodialysis (HD) patients. Methods: This prospective single-center study enrolled 200 HD patients and 82 healthy subjects to estimate antibodies against the SARS-CoV-2 viral spike protein 1 and receptor-binding domain after a first dose of a COVID-19 vaccine (ChAdOx1 or mRNA-1273), measured by enzyme-linked immunosorbent assay and applied spline-based generalized additive model regression analysis to predict NT50 converted to international units. Results: After the first dose of ChAdOx1, multiple linear regression showed that age (p = 0.011) and cardiothoracic ratio (p = 0.002) were negatively associated with NT50. Older age (OR = 0.958, p = 0.052) and higher cardiothoracic ratio (OR < 0.001, p = 0.037) could predict negative humoral response (NT50 < 35.13 IU/mL). NT50 was lower in HD patients compared with healthy controls receiving ChAdOx1 (10.68 vs. 43.01 IU/m, p < 0.001) or mRNA-1273 (36.39 vs. 262.2 IU/mL, p < 0.001). ChAdOx1 elicited lower GMTs than mRNA-1273 in the HD cohort (10.68 vs. 36.39 IU/mL, p < 0.001) and in healthy controls (43.01 vs. 262.22 IU/mL, p < 0.001). Conclusion: High cardiothoracic ratio and old age could independently predict a decline in nAb titers in an HD cohort vaccinated with a single dose of ChAdOx1.
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Prognostic Implication of Longitudinal Changes in Cardiothoracic Ratio and Aortic Arch Calcification in Hemodialysis Patients. J Pers Med 2021; 11:jpm11080788. [PMID: 34442433 PMCID: PMC8397966 DOI: 10.3390/jpm11080788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/11/2021] [Indexed: 01/04/2023] Open
Abstract
Patients with end-stage renal disease have a high prevalence of cardiovascular disease. Chest radiography can be used to assess cardiothoracic ratio (CTR) and aortic arch calcification (AoAC). The aims of this longitudinal follow-up study were to investigate factors associated with changes in CTR and AoAC and understand whether these changes are associated with overall and cardiovascular mortality in hemodialysis (HD) patients. We enrolled 260 patients undergoing HD who had at least two available chest X-rays from 2008 to 2015. CTR and AoAC were assessed in each patient using measurements from baseline and annual chest X-rays. The CTR increased from 49.05% to 51.86% and the AoAC score increased from 3.84 to 9.73 over 7 years. The estimated slopes were 0.24 (p < 0.0001) for CTR and 0.08 (p = 0.0441) for AoAC. Increased AoAC, older age, female sex, coronary artery disease, and decreased albumin were associated with an increase in CTR, and older age, cerebrovascular disease, decreased albumin, increased Kt/V, and the use of antiplatelet agents were associated with an increase in AoAC. During follow-up, 136 of the 260 (52.3%) patients died, of whom 72 died due to cardiovascular causes. The change in CTR was greater in those who died (p = 0.0125) than in those who survived. The AoAC score was also higher in those who died than in those who survived, although there was no significant difference in the change in AoAC between the two groups (p = 0.8035). CTR and AoAC increased significantly over time in the HD patients in this longitudinal follow-up study, and the change in CTR was greater in those who died than in those who survived. Chest radiography is a simple and useful tool to assess the progression of CTR and AoAC as a prognostic marker.
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5
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Morinaga J, Kakuma T, Fukami H, Hayata M, Uchimura K, Mizumoto T, Kakizoe Y, Miyoshi T, Shiraishi N, Adachi M, Izumi Y, Kuwabara T, Okadome Y, Sato M, Horiguchi H, Sugizaki T, Kadomatsu T, Miyata K, Tajiri S, Tajiri T, Tomita K, Kitamura K, Oike Y, Mukoyama M. Circulating angiopoietin-like protein 2 levels and mortality risk in patients receiving maintenance hemodialysis: a prospective cohort study. Nephrol Dial Transplant 2020; 35:854-860. [PMID: 31840173 DOI: 10.1093/ndt/gfz236] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/10/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Patients undergoing hemodialysis treatment have a poor prognosis, as many develop premature aging. Systemic inflammatory conditions often underlie premature aging phenotypes in uremic patients. We investigated whether angiopoietin-like protein 2 (ANGPTL 2), a factor that accelerates the progression of aging-related and noninfectious inflammatory diseases, was associated with increased mortality risk in hemodialysis patients. METHODS We conducted a multicenter prospective cohort study of 412 patients receiving maintenance hemodialysis and evaluated the relationship between circulating ANGPTL2 levels and the risk for all-cause mortality. Circulating ANGPTL2 levels were log-transformed to correct for skewed distribution and analyzed as a continuous variable. RESULTS Of 412 patients, 395 were included for statistical analysis. Time-to-event data analysis showed high circulating ANGPTL2 levels were associated with an increased risk for all-cause mortality after adjustment for age, sex, hemodialysis vintage, nutritional status, metabolic parameters and circulating high-sensitivity C-reactive protein levels {hazard ratio [HR] 2.04 [95% confidence interval (CI) 1.10-3.77]}. High circulating ANGPTL2 levels were also strongly associated with an increased mortality risk, particularly in patients with a relatively benign prognostic profile [HR 3.06 (95% CI 1.86-5.03)]. Furthermore, the relationship between circulating ANGPTL2 levels and mortality risk was particularly strong in patients showing few aging-related phenotypes, such as younger patients [HR 7.99 (95% CI 3.55-18.01)], patients with a short hemodialysis vintage [HR 3.99 (95% CI 2.85-5.58)] and nondiabetic patients [HR 5.15 (95% CI 3.19-8.32)]. CONCLUSION We conclude that circulating ANGPTL2 levels are positively associated with mortality risk in patients receiving maintenance hemodialysis and that ANGPTL2 could be a unique marker for the progression of premature aging and subsequent mortality risk in uremic patients, except those with significant aging-related phenotypes.
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Affiliation(s)
- Jun Morinaga
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.,Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.,Department of Clinical Investigation, Kumamoto University Hospital, Kumamoto, Japan.,Biostatistics Center, Kurume University, Fukuoka, Japan
| | | | - Hirotaka Fukami
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.,Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Manabu Hayata
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kohei Uchimura
- Third Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Teruhiko Mizumoto
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yutaka Kakizoe
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Taku Miyoshi
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Naoki Shiraishi
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masataka Adachi
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuichiro Izumi
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Takashige Kuwabara
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yusuke Okadome
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Michio Sato
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Haruki Horiguchi
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Taichi Sugizaki
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tsuyoshi Kadomatsu
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Keishi Miyata
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | | | | | - Kimio Tomita
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichiro Kitamura
- Third Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Yuichi Oike
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masashi Mukoyama
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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6
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Jin M, Wang L, Wang H, Han X, Diao Z, Guo W, Yang Z, Ding H, Wang Z, Zhang P, Zhao P, Lv H, Liu W, Wang Z. Disturbed neurovascular coupling in hemodialysis patients. PeerJ 2020; 8:e8989. [PMID: 32328355 PMCID: PMC7166048 DOI: 10.7717/peerj.8989] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/26/2020] [Indexed: 01/14/2023] Open
Abstract
Background Altered cerebral blood flow (CBF) and amplitude of low-frequency fluctuation (ALFF) have been reported in hemodialysis patients. However, neurovascular coupling impairments, which provide a novel insight into the human brain, have not been reported in hemodialysis patients. Methods We combined arterial spin labeling (ASL) and blood oxygen level dependent (BOLD) techniques to investigate neurovascular coupling alterations and its relationships with demographic and clinical data in 46 hemodialysis patients and 47 healthy controls. To explore regional neuronal activity, ALFF was obtained from resting-state functional MRI. To measure cerebral vascular response, CBF was calculated from ASL. The across-voxel CBF-ALFF correlations for global neurovascular coupling and CBF/ALFF ratio for regional neurovascular coupling were compared between hemodialysis patients and healthy controls. Two-sample t-tests were used to compare the intergroup differences in CBF and ALFF. Multiple comparisons were corrected using a voxel-wise false discovery rate (FDR) method (P < 0.05). Results All hemodialysis patients and healthy controls showed significant across-voxel correlations between CBF and ALFF. Hemodialysis patients showed a significantly reduced global CBF-ALFF coupling (P = 0.0011) compared to healthy controls at the voxel-level. Of note, decreased CBF/ALFF ratio was exclusively located in the bilateral amygdala involved in emotional regulation and cognitive processing in hemodialysis patients. In hemodialysis patients, the decreased CBF (right olfactory cortex, anterior cingulate gyrus and bilateral insula) and ALFF (bilateral precuneus and superior frontal gyrus) were mainly located in the default mode network and salience network-related regions as well as increased CBF in the bilateral thalamus. Conclusions These novel findings reveal that disrupted neurovascular coupling may be a potential neural mechanism in hemodialysis patients.
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Affiliation(s)
- Mei Jin
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Liyan Wang
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hao Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xue Han
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zongli Diao
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wang Guo
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Heyu Ding
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zheng Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Peng Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Pengfei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wenhu Liu
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Effects of magnesium supplementation on carotid intima-media thickness and metabolic profiles in diabetic haemodialysis patients: a randomised, double-blind, placebo-controlled trial. Br J Nutr 2019; 121:809-817. [PMID: 30739626 DOI: 10.1017/s0007114519000163] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study evaluated the effects of Mg administration on carotid intima-media thickness (CIMT), glycaemic control and markers of cardio-metabolic risk in diabetic haemodialysis (HD) patients. This randomised, double-blind, placebo-controlled clinical trial was conducted in fifty-four diabetic HD patients. Participants were randomly divided into two groups to take either 250 mg/d Mg as magnesium oxide (n 27) or placebo (n 27) for 24 weeks. Mg supplementation resulted in a significant reduction in mean (P<0·001) and maximum levels of left CIMT (P=0·02) and mean levels of right CIMT (P=0·004) compared with the placebo. In addition, taking Mg supplements significantly reduced serum insulin levels (β=-9·42 pmol/l; 95% CI -14·94, -3·90; P=0·001), homoeostasis model of assessment-insulin resistance (β=-0·56; 95 % CI -0·89, -0·24; P=0·001) and HbA1c (β=-0·74 %; 95 % CI -1·10, -0·39; P<0·001) and significantly increased the quantitative insulin sensitivity check index (β=0·008; 95 % CI 0·002, 0·01; P=0·002) compared with the placebo. In addition, Mg administration led to a significant reduction in serum total cholesterol (β=-0·30 mmol/l; 95% CI -0·56, -0·04; P=0·02), LDL-cholesterol (β=-0·29 mmol/l; 95% CI -0·52, -0·05; P=0·01), high-sensitivity C-reactive protein (hs-CRP) (P<0·001) and plasma malondialdehyde (MDA) (P=0·04) and a significant rise in plasma total antioxidant capacity (TAC) levels (P<0·001) compared with the placebo. Overall, we found that taking Mg for 24 weeks by diabetic HD patients significantly improved mean and maximum levels of left and mean levels of right CIMT, insulin metabolism, HbA1c, total cholesterol and LDL-cholesterol, hs-CRP, TAC and MDA levels.
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8
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Fallah M, Askari G, Soleimani A, Feizi A, Asemi Z. Clinical Trial of the Effects of Coenzyme Q10 Supplementation on Biomarkers of Inflammation and Oxidative Stress in Diabetic Hemodialysis Patients. Int J Prev Med 2019; 10:12. [PMID: 30774846 PMCID: PMC6360842 DOI: 10.4103/ijpvm.ijpvm_418_18] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/01/2018] [Indexed: 11/04/2022] Open
Abstract
Background The aim of the study was to determine the effects of coenzyme Q10 (CoQ10) supplementation on biomarkers of inflammation and oxidative stress among diabetic hemodialysis (HD) patients. Methods Sixty diabetic HD patients participated in the randomized, double blind, placebo-controlled clinical trial. They were randomly assigned into two groups to intake either 60 mg CoQ10 supplements (n = 30) or placebo (n = 30) twice a day for 12 weeks. Results After 12 weeks of intervention, CoQ10 supplementation significantly increased total antioxidant (TAC) (54.921 ± 26.437 vs. -126.781 ± 26.437, P < 0.001) and nitric oxide (NO) levels (4.121 ± 1.314 vs. -1.427 ± 1.314, P = 0.006) and decreased C-reactive protein (CRP) (-1.302 ± 0.583 vs. 0.345 ± 0.583, 0.042) levels compared with the placebo. We did not observe any significant effect of CoQ10 supplementation on malondialdehyde (MDA) and glutathione (GSH) levels compared with the placebo. Conclusions Overall, our study showed that CoQ10 supplementation to diabetic HD patients for 12 weeks was associated with increased levels of TAC and NO levels and decreased level of high-sensitivity CRP (hs-CRP) levels, but did not have any beneficial effects on MDA and GSH.
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Affiliation(s)
- Melika Fallah
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Askari
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Soleimani
- Department of Internal Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Awat Feizi
- Isfahan Endocrine and Metabolism Research Center, Isfahan, Iran.,Department of Biostatistics and Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
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9
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Tsai MH, Fang YW, Liou HH, Leu JG, Lin BS. Association of Serum Aluminum Levels with Mortality in Patients on Chronic Hemodialysis. Sci Rep 2018; 8:16729. [PMID: 30425257 PMCID: PMC6233210 DOI: 10.1038/s41598-018-34799-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 08/28/2018] [Indexed: 12/29/2022] Open
Abstract
Despite reported evidence on the relationship between higher serum aluminum levels and poor outcomes in patients on chronic hemodialysis (CHD), the acceptable cutoff value of serum aluminum for mortality remains unclear. A retrospective observational cohort study with 636 Taiwanese patients on CHD was conducted to investigate the impact of serum aluminum levels on mortality. The predictors were bivariate serum aluminum level (<6 and ≥6 ng/mL) and the Outcomes were all-cause and cardiovascular (CV) mortality. During the mean follow-up of 5.3 ± 2.9 years, 253 all-cause and 173 CV deaths occurred. Crude analysis showed that a serum aluminum level of ≥6 ng/mL was a significant predictor of all-cause [hazard ratio (HR), 1.80; 95% confidence interval (CI), 1.40–2.23] and CV (HR, 1.84; 95% CI, 1.36–2.50) mortality. After multivariable adjustment, the serum aluminum level of ≥6 ng/mL remained a significant predictor of all-cause mortality (HR, 1.37, 95% CI, 1.05–1.81) but became insignificant for CV mortality (HR, 1.29; 95% CI, 0.92–1.81). Therefore, our study revealed that a serum aluminum level of ≥6 ng/mL was independently associated with all-cause death in patients on CHD, suggesting that early intervention for aluminum level in patients on CHD might be beneficial even in the absence of overt aluminum toxicity.
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Affiliation(s)
- Ming-Hsien Tsai
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, ROC, Taiwan.,Fu-Jen Catholic University School of Medicine, Taipei, ROC, Taiwan.,Division of Biostatistics, Institutes of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, ROC, Taiwan
| | - Yu-Wei Fang
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, ROC, Taiwan.,Fu-Jen Catholic University School of Medicine, Taipei, ROC, Taiwan
| | - Hung-Hsiang Liou
- Division of Nephrology, Department of Internal Medicine, Hsin-Jen Hospital, New Taipei City, ROC, Taiwan
| | - Jyh-Gang Leu
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, ROC, Taiwan.,Fu-Jen Catholic University School of Medicine, Taipei, ROC, Taiwan
| | - Bing-Shi Lin
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, ROC, Taiwan.
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10
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Clinical trial of the effects of coenzyme Q10 supplementation on
glycemic control and markers of lipid profiles in diabetic hemodialysis
patients. Int Urol Nephrol 2018; 50:2073-2079. [DOI: 10.1007/s11255-018-1973-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/23/2018] [Indexed: 12/19/2022]
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11
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Wang TL, Fang YW, Leu JG, Tsai MH. Association between serum aluminum levels and cardiothoracic ratio in patients on chronic hemodialysis. PLoS One 2017; 12:e0190008. [PMID: 29261793 PMCID: PMC5738104 DOI: 10.1371/journal.pone.0190008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/06/2017] [Indexed: 11/18/2022] Open
Abstract
The cardiothoracic ratio (CTR) and serum aluminum levels are both associated with mortality in hemodialysis patients. However, limited data regarding the association between serum aluminum levels and the CTR have been published to date. Therefore, we aimed to elucidate this association in patients on chronic hemodialysis (CHD). We investigated the association between the serum aluminum level and the CTR in CHD in a retrospective cross-sectional study of 547 Taiwanese patients on CHD. The mean age of patients was 62.5±13.2 years, with a mean hemodialysis time of 7.1±5.2 years. Among the patients, 36.9% were diabetic and 47.9% were male. After natural logarithmic transformation (ln(aluminum)), the serum aluminum level exhibited an independent and linear relationship with the CTR (β: 1.40, 95% confidence interval (CI), 0.6–2.2). A high serum aluminum level (≥6 ng/dL) was significantly associated with a CTR >0.5 in the crude analysis (odds ratio (OR): 2.15, 95% CI, 1.52–3.04) and remained significant after multivariable adjustment (OR: 2.45, 95% CI, 1.63–3.67). Moreover, the ln(aluminum) value was significantly associated with a CTR >0.5 (OR: 1.71, 95%CI, 1.28–2.29) in multivariable analysis, indicating a dose effect of aluminum on cardiomegaly. In conclusion, the serum aluminum level was independently associated with cardiac remodeling (elevated CTR) in patients on CHD.
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Affiliation(s)
- Tzu-Lin Wang
- Division of Cardiology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, R.O.C
| | - Yu-Wei Fang
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, R.O.C.,Fu-Jen Catholic University School of Medicine, Taipei, Taiwan, R.O.C
| | - Jyh-Gang Leu
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, R.O.C.,Fu-Jen Catholic University School of Medicine, Taipei, Taiwan, R.O.C
| | - Ming-Hsien Tsai
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, R.O.C.,Fu-Jen Catholic University School of Medicine, Taipei, Taiwan, R.O.C.,Division of Biostatistics, Institutes of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, R.O.C
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12
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Ogata H, Kumasawa J, Fukuma S, Mizobuchi M, Kinugasa E, Fukagawa M, Fukuhara S, Akizawa T. The cardiothoracic ratio and all-cause and cardiovascular disease mortality in patients undergoing maintenance hemodialysis: results of the MBD-5D study. Clin Exp Nephrol 2017; 21:797-806. [PMID: 28508128 PMCID: PMC5648748 DOI: 10.1007/s10157-017-1380-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 01/04/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The cardiothoracic ratio (CTR) is a non-invasive left ventricular hypertrophy index. However, whether CTR associates with cardiovascular disease (CVD) and mortality in hemodialysis (HD) populations is unclear. METHODS Using a Mineral and Bone disorder Outcomes Study for Japanese CKD Stage 5D Patients (MBD-5D Study) subcohort, 2266 prevalent HD patients (age 62.8 years, female 38.0%, HD duration 9.4 years) with secondary hyperparathyroidism (SHPT) whose baseline CTR had been recorded were selected. We evaluated associations between CTR and all-cause death, CVD death, or composite events in HD patients. RESULTS CTR was associated significantly with various background and laboratory characteristics. All-cause death, CVD-related death, and composite events increased across the CTR quartiles (Q). Adjusted hazard risk (HR) for all-cause death was 1.4 (95% confidential interval, 0.9-2.1) in Q2, 1.9 (1.3-2.9) in Q3, and 2.6 (1.7-4.0) in Q4, respectively (Q1 as a reference). The corresponding adjusted HR for CVD-related death was 1.8 (0.8-4.2), 3.1 (1.4-6.8), and 3.5 (1.6-7.9), and that for composite outcome was 1.2 (1.0-1.6), 1.7 (1.3-2.2), and 1.8 (1.5-2.3), respectively. Exploratory analysis revealed that there were relationships between CTR and age, sex, body mass index, comorbidity of CVD, dialysis duration and intact parathyroid hormone, phosphorus, hemoglobin, and usage of phosphate binder [corrected]. CONCLUSION CTR correlated with all-cause death, CVD death, and composite events in HD patients with SHPT.
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Affiliation(s)
- Hiroaki Ogata
- Department of Internal Medicine, Showa University Northern Yokohama Hospital, Chigsaki-chuo 35-1, Tsuzuki, Yokohama, Kanagawa, 224-8503, Japan.
| | - Junji Kumasawa
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,Department of Critical Care Medicine, Sakai City Medical Center, Osaka, Japan.,Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Shingo Fukuma
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan.,Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan
| | - Masahide Mizobuchi
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Eriko Kinugasa
- Department of Internal Medicine, Showa University Northern Yokohama Hospital, Chigsaki-chuo 35-1, Tsuzuki, Yokohama, Kanagawa, 224-8503, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Kanagawa, Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan
| | - Tadao Akizawa
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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13
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Liou KY, Liou HH, Fang YW, Leu JG, Tsai MH. Association between peripheral arterial occlusive disease and cardiothoracic ratio in patients on chronic hemodialysis. Sci Rep 2016; 6:38458. [PMID: 27918569 PMCID: PMC5137470 DOI: 10.1038/srep38458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 11/09/2016] [Indexed: 11/09/2022] Open
Abstract
The cardiothoracic ratio (CTR) and peripheral arterial occlusive disease (PAOD) are related to mortality in hemodialysis patients. However, data on the association between PAOD and CTR are limited. In this study, we aim to elucidate this relationship in patients on chronic hemodialysis. Using a retrospective cross-sectional study of 622 Taiwanese patients, we investigated the association of PAOD and CTR. PAOD was significantly associated with CTR in the crude analysis. The odds ratio (OR) for CTR >0.5 was 1.77 [95% confidence interval (CI), 1.32-2.37], and the odds ratio for CTR >0.6 was 2.18 [95% CI, 1.44-3.30]. After adjusting for confounding variables, this difference continued to exhibit significant predictive power for CTR >0.6 (OR, 1.88; 95% CI, 1.14-3.11), but the predictive power for CTR >0.5 was attenuated (OR, 1.41; 95% CI, 0.98-2.03). In the subgroup analysis, PAOD was an independent factor for CTR >0.6, particularly in elderly and female patients or patients with hemoglobin >10 mg/dl and with no history of cardiovascular disease. In this research, we showed that the detection of PAOD was independently associated with CTR >0.6 in patients on chronic hemodialysis.
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Affiliation(s)
- Kang-Yi Liou
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (R.O.C)
| | - Hung-Hsiang Liou
- Division of Nephrology, Department of Internal Medicine, Hsin-Jen Hospital, New Taipei City, Taiwan (R.O.C)
| | - Yu-Wei Fang
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (R.O.C).,Fu-Jen Catholic University School of Medicine, Taipei, Taiwan (R.O.C)
| | - Jyh-Gang Leu
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (R.O.C).,Fu-Jen Catholic University School of Medicine, Taipei, Taiwan (R.O.C)
| | - Ming-Hsien Tsai
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (R.O.C).,Fu-Jen Catholic University School of Medicine, Taipei, Taiwan (R.O.C).,Division of Biostatistics, Institutes of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (R.O.C)
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14
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Okute Y, Shoji T, Hayashi T, Kuwamura Y, Sonoda M, Mori K, Shioi A, Tsujimoto Y, Tabata T, Emoto M, Inaba M. Cardiothoracic Ratio as a Predictor of Cardiovascular Events in a Cohort of Hemodialysis Patients. J Atheroscler Thromb 2016; 24:412-421. [PMID: 27629255 PMCID: PMC5392479 DOI: 10.5551/jat.36426] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM The cardiothoracic ratio (CTR) on a chest X-ray is an indicator of cardiac enlargement, although its predictive power for cardiovascular disease (CVD) events in chronic kidney disease is unknown. We examined it in a cohort of hemodialysis patients, as compared with an N-terminal fragment of probrain natriuretic peptide (NT-proBNP). METHOD This was an observational study with cross-sectional and longitudinal analyses including 517 maintenance hemodialysis patients and 122 healthy control subjects. The main predictors were CTR and serum NT-proBNP, and the main outcome was CVD events in 5 years. RESULTS At baseline, the hemodialysis patients had higher median (interquartile range) levels of CTR [0.487 (0.457-0.520)] than the control group [0.458 (0.432-0.497)]. In the hemodialysis group, CTR was positively correlated with NT-proBNP (Spearman's r=0.44, P<0.001). During follow-up, 190 CVD events occurred. CTR was significantly associated with the risk of CVD [HR 2.12 (95% CI, 1.38-3.25) for the fourth quartile as compared with the second quartile of CTR] in a multivariate Cox model. In the same model, NT-proBNP (fourth versus first quartile) showed a HR of 3.27 (2.02-5.31). When CTR and NT-proBNP were simultaneously included as predictors, only NT-proBNP remained a significant predictor of CVD events, all-cause mortality and composite of CVD plus all-cause mortality. CONCLUSIONS We showed that CTR was a significant and independent predictor of CVD in hemodialysis patients. CTR can be used for CVD risk stratification in hemodialysis patients when NT-proBNP is not available.
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Affiliation(s)
- Yujiro Okute
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine
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15
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Ito K, Ookawara S, Ueda Y, Miyazawa H, Yamada H, Goto S, Ishii H, Shindo M, Kitano T, Hirai K, Yoshida M, Kaku Y, Hoshino T, Nabata A, Mori H, Yoshida I, Kakei M, Morishita Y, Tabei K. A Higher Cardiothoracic Ratio Is Associated with 2-Year Mortality after Hemodialysis Initiation. NEPHRON EXTRA 2015; 5:100-10. [PMID: 26951636 PMCID: PMC4777940 DOI: 10.1159/000442591] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED A high cardiothoracic ratio (CTR) is indicative of a cardiac disorder. However, few reports have revealed an association between the CTR and mortality in patients starting hemodialysis (HD). METHODS Patients with HD initiation (n = 387; mean age, 66.7 ± 12.7 years) were divided into the following three groups according to their CTR at HD initiation: CTR <50%, 50% ≤ CTR < 55%, and CTR ≥55%. Kaplan-Meier analysis was performed to compare 2-year all-cause mortality among these groups. Furthermore, we investigated the factors affecting their 2-year mortality using a Cox proportional hazard regression analysis. RESULTS Sixty-five patients (17%) died within 2 years after HD initiation. Kaplan-Meier analysis showed that patients with CTR ≥55% had a higher mortality rate than those in the other groups. Cox proportional hazard regression analysis was performed using parameters with p values <0.1 among these three groups [sex, age, presence or absence of ischemic heart disease, hemoglobin levels, serum albumin levels, CTR, body mass index (BMI)] and confounding factors [presence or absence of diabetes mellitus, and estimated glomerular filtration rate (eGFR)]. Age, eGFR, BMI, and CTR ≥55% at HD initiation were identified as factors influencing 2-year mortality. CONCLUSION CTR >55% is one of the most important independent factors to affect 2-year all-cause mortality. Thus, confirming the cardiac condition of patients at HD initiation with a CTR >55% may improve their survival.
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Affiliation(s)
- Kiyonori Ito
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Susumu Ookawara
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yuichiro Ueda
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Haruhisa Miyazawa
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hodaka Yamada
- Endocrinology and Metabolism, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Sawako Goto
- Division of Clinical Nephrology and Rheumatology, Niigata University Medical and Dental Hospital, Japan
| | - Hiroki Ishii
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Mitsutoshi Shindo
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Taisuke Kitano
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Keiji Hirai
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masashi Yoshida
- Endocrinology and Metabolism, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yoshio Kaku
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Taro Hoshino
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Aoi Nabata
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Honami Mori
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | | | - Masafumi Kakei
- Endocrinology and Metabolism, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yoshiyuki Morishita
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kaoru Tabei
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan; Minami-Uonuma City Hospital, Niigata, Japan
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16
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Liu SL, Qi L, Han WQ, Zhu BS, Zhou X, Jiang SS, Chen MF, Li Y, He W, Liu LF, Hu XH, Xie Y, Zeng FH, Zu XB. Shorter hemodialysis duration is a risk factor for the recurrence of urothelial carcinoma of the bladder in patients on maintenance hemodialysis. Clin Transl Oncol 2015. [PMID: 26220096 DOI: 10.1007/s12094-015-1368-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the association of hemodialysis duration with the recurrence of urothelial carcinoma (UC) of the bladder and overall survival in patients undergoing maintenance hemodialysis (MHD). PATIENTS AND METHODS 52 bladder cancer patients who underwent MHD at the Xiangya Hospital of The Central South University between 2001 and 2011 were enrolled in the study. The patients were divided into three groups according to hemodialysis duration, and patient mortality and tumor recurrence rates were analyzed. The association of hemodialysis duration with occurrence and recurrence of UC of the bladder was analyzed by Cox regression analysis. Survival was evaluated by the Kaplan-Meier method. RESULTS Out of 6266 chronic hemodialysis patients, 52 patients had UC of the bladder after the initiation of hemodialysis for 6 months. The mean age at hemodialysis onset was 55 years (IQR 36, 71). The major complaints were painless gross hematuria and urethral bloody discharge. Tumors were generally large and multifocal. The standardized incidence ratio of UC of the bladder was 43.9 compared with general population, and it was higher in women (76.7) and in the age group 61-65 years (186.6). The mean hemodialysis duration before the diagnosis of bladder cancer was 32 months. 30 (57.7 %) patients received hemodialysis no more than 3 years, 10 (19.2 %) patients received hemodialysis between 3 and 6 years, and 12 (23.1 %) patients received hemodialysis for more than 6 years. CONCLUSION Preoperative shorter hemodialysis duration is a risk factor for the occurrence and recurrence of UC of the bladder in patients undergoing MHD.
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Affiliation(s)
- S-L Liu
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - L Qi
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China.
| | - W-Q Han
- Department of Urology, The Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, 410008, China
| | - B-S Zhu
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - X Zhou
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - S-S Jiang
- Department of Urology, The Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, 410008, China
| | - M-F Chen
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - Y Li
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - W He
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - L-F Liu
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - X-H Hu
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - Y Xie
- Department of Urology, The Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, 410008, China
| | - F-H Zeng
- Department of Urology, The Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, 410008, China
| | - X-B Zu
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
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17
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Tsai MH, Liou HH, Leu JG, Yen MF, Chen HH. Sites of peripheral artery occlusive disease as a predictor for all-cause and cardiovascular mortality in chronic hemodialysis. PLoS One 2015; 10:e0128968. [PMID: 26035831 PMCID: PMC4452767 DOI: 10.1371/journal.pone.0128968] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/04/2015] [Indexed: 12/17/2022] Open
Abstract
Background The ankle—brachial blood pressure (BP) index (ABI) not only indicates the presence of peripheral artery occlusive disease (PAOD) but predicts mortality in patients undergoing hemodialysis (HD). However, whether the site of PAOD can provide additional contribution to predicting mortality have not been investigated yet. Our primary objective was to determine the associations between the site of PAOD and all-cause and cardiovascular mortality in chronic HD (CHD) patients. Methods A retrospective cohort study was conducted to evaluate 444 Taiwanese CHD patients between December 2006 and June 2013. The site of PAOD together with other explanatory variables such as demographic data, body mass index, a history of cardiovascular diseases, HD vintage, biochemical data, and cardiothoracic ratio (CTR) were assessed by the Cox proportional hazards regression model. Results The frequency of PAOD was 14.6% in both legs, 4.9% in the right side only, and 5.1% in the left side only. During the study period, 127 all-cause and 93 cardiovascular deaths occurred. PAOD site was found to have significant predictive power for all-cause mortality with the order of 3.04 (95% CI: 1.56–5.90) hazard ratio on the right side, 2.48 (95% CI: 1.27–4.82) on the left side, and 4.11 (95% CI: 2.76–6.13) on both sides. The corresponding figures for cardiovascular mortality were 3.81 (95% CI: 1.87–7.76) on the right side, 2.76 (95% CI: 1.30–5.82) on the left side, and 3.95 (95% CI: 2.45–6.36) on both sides. After adjustment for other explanatory variables, only right-sided PAOD still remained to have significant predictive power for all-cause and cardiovascular mortality and bilateral PAOD kept the significant association with all-cause mortality. Conclusions The site of PAOD revealed various predictive powers for all-cause and cardiovascular mortality in CHD patients and only right-sided PAOD remained an independent predictor for both types of mortality making allowance for relevant confounding factors.
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Affiliation(s)
- Ming-Hsien Tsai
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- Division of biostatistics, Institutes of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hung-Hsiang Liou
- Division of Nephrology, Department of Medicine, Hsin-Jen Hospital, New Taipei City, Taiwan
| | - Jyh-Gang Leu
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Hsi Chen
- Division of biostatistics, Institutes of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- * E-mail:
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18
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Lai S, Molfino A, Russo GE, Testorio M, Galani A, Innico G, Frassetti N, Pistolesi V, Morabito S, Rossi Fanelli F. Cardiac, Inflammatory and Metabolic Parameters: Hemodialysis versus Peritoneal Dialysis. Cardiorenal Med 2014; 5:20-30. [PMID: 25759697 DOI: 10.1159/000369588] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 11/04/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Mortality in dialysis patients is higher than in the general population, and cardiovascular disease represents the leading cause of death. Hypertension and volume overload are important risk factors for the development of left ventricular hypertrophy (LVH) in hemodialysis (HD) and peritoneal dialysis (PD) patients. Other factors are mainly represented by hyperparathyroidism, vascular calcification, arterial stiffness and inflammation. The aim of this study was to compare blood pressure (BP) and metabolic parameters with cardiovascular changes [cardiothoracic ratio (CTR), aortic arch calcification (AAC) and LV mass index (LVMI)] between PD and HD patients. MATERIALS AND METHODS 45 patients (23 HD and 22 PD patients) were enrolled. BP measurements, echocardiography and chest X-ray were performed in each patient to determine the LVMI and to evaluate the CTR and AAC. Inflammatory indexes, intact parathyroid hormone (iPTH) and arterial blood gas analysis were also evaluated. RESULTS LVMI was higher in PD than HD patients (139 ŷ 19 vs. 104 ŷ 22; p = 0.04). In PD patients, a significant correlation between iPTH, C-reactive protein and the presence of LVH was observed (r = 0.70, p = 0.04; r = 0.70, p = 0.03, respectively). The CTR was increased in PD patients as compared to HD patients, while no significant differences in cardiac calcifications were determined. CONCLUSIONS Our data indicate that HD patients present more effective BP control than PD patients. Adequate fluid and metabolic control are necessary to assess the adequacy of BP, which is strongly correlated with the increase in LVMI and with the increased CTR in dialysis patients. PD is a home therapy and allows a better quality of life, but PD patients may present a further increased cardiovascular risk if not adequately monitored.
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Affiliation(s)
- Silvia Lai
- Department of Clinical Medicine, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Alessio Molfino
- Department of Clinical Medicine, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Gaspare Elios Russo
- Department of Gynecology, Obstetrics and Urological Sciences, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Massimo Testorio
- Department of Gynecology, Obstetrics and Urological Sciences, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Alessandro Galani
- Department of Clinical Medicine, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Georgie Innico
- Department of Gynecology, Obstetrics and Urological Sciences, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Nicla Frassetti
- Department of Clinical Medicine, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Valentina Pistolesi
- Department of Nephrology and Urology, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Santo Morabito
- Department of Nephrology and Urology, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Filippo Rossi Fanelli
- Department of Clinical Medicine, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
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Asakawa T, Joki N, Tanaka Y, Hayashi T, Hase H, Komatsu Y, Ando R, Ikeda M, Inaguma D, Sakaguchi T, Shinoda T, Koiwa F, Negi S, Yamaka T, Shigematsu T. Association between the Hemoglobin Level and Cardiothoracic Ratio in Patients on Incident Dialysis. Cardiorenal Med 2014; 4:189-200. [PMID: 25737683 DOI: 10.1159/000368200] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 08/25/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND/AIM The present study explores associations between hemoglobin (Hb) levels and patients with cardiac enlargement in end-stage kidney disease (ESKD) to help prevent cardiac remodeling during the predialysis phase of chronic kidney disease (CKD). METHODS This cross-sectional study included 2,249 patients with ESKD (age, 67 ± 13 years; male, 67%; diabetic kidney disease, 41%) who started hemodialysis (HD) between January 2006 and October 2013 at eight participating hospitals. We examined associations between Hb levels immediately before the first HD session and cardiothoracic ratios (CTRs). Clinical factors associated with the CTR were also assessed. RESULTS The mean Hb level was 8.7 ± 1.6 g/dl, and the mean and median CTRs were 55.0 and 54.7%, respectively. The correlation between the Hb level and the CTR was linear and negative (r = -0.129, p < 0.001). The mean CTR and the prevalence of patients with a CTR >50% obviously decreased with increasing Hb levels (both p < 0.001 for trend). Univariate logistic regression analysis revealed an approximately 20% reduction in the odds ratio for complicating CTRs >50% per 1 g/dl increase in Hb. Hb levels of <9 g/dl were significantly associated with CTRs >50%. Numerical and categorical Hb remained significantly associated with CTRs >50% after adjusting for confounding variables. CONCLUSIONS Lower Hb levels participate in progressive CTR enlargement in patients with ESKD, and maintaining Hb levels of >9 g/dl might help prevent cardiac remodeling during the predialysis phase of CKD.
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Affiliation(s)
- Takasuke Asakawa
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Nobuhiko Joki
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yuri Tanaka
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Toshihide Hayashi
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Hiroki Hase
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yasuhiro Komatsu
- Department of Nephrology, Division of Internal Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Ryoichi Ando
- Department of Nephrology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Masato Ikeda
- Division of Nephrology and Hypertension, The Jikei University Katsushika Medical Center, Tokyo, Japan
| | - Daijo Inaguma
- Kidney Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | | | - Toshio Shinoda
- Dialysis Center, Kawakita General Hospital, Tokyo, Japan
| | - Fumihiko Koiwa
- Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Shigeo Negi
- Division of Nephrology, Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Toshihiko Yamaka
- Department of Clinical Engineering, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Takashi Shigematsu
- Division of Nephrology, Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
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Impact of living environment on 2-year mortality in elderly maintenance hemodialysis patients. PLoS One 2013; 8:e74358. [PMID: 24058552 PMCID: PMC3776842 DOI: 10.1371/journal.pone.0074358] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 07/31/2013] [Indexed: 12/02/2022] Open
Abstract
Background Studies on risk factors of mortality in elderly patients with hemodialysis usually focus on comorbidities, nutrition, and inflammation. Discussion on the correlation between living environment and mortality of these patients is limited. Methods A total of 256 elderly hemodialysis patients participated in this 2-year prospective observational study. The subjects were divided into 2 subgroups based on whether they were living in Taipei Basin (n = 63) or not (n = 193). Demographic, hematological, nutritional, inflammatory, biochemical, and dialysis-related data were obtained for cross-sectional analysis. Causes of death and mortality rates were also analyzed for each subgroup. Results Patients in the basin group had a higher incidence of combined protein-energy wasting and inflammation than those in the around basin group. At the end of the 2-year follow-up, 68 patients had died. Univariate binary logistic regression analysis revealed that a very advanced age, basin group, serum albumin levels, serum creatinine levels, non-anuria, and the complications of stroke and CAD were associated with 2-year mortality. Meanwhile, log high-sensitivity C-reactive protein (hs-CRP) levels were not associated with 2-year mortality. Multivariate Cox regression analysis revealed that basin group, serum albumin levels, and the complications of stroke and CAD were significant risk factors for 2-year mortality in these patients. Conclusion The results of this study indicate that factors such as living in the Taipei Basin with higher air pollutant levels in elderly hemodialysis patients is associated with protein-energy wasting and inflammation, as well as 2-year mortality. These findings suggest that among this population, living environment is as important as comorbidities and nutrition. Furthermore, air pollution should be getting more attention especially in the overcrowding Basin topography.
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Yang CY, Yang WC, Lin YP. Postdialysis blood pressure rise predicts long-term outcomes in chronic hemodialysis patients: a four-year prospective observational cohort study. BMC Nephrol 2012; 13:12. [PMID: 22414233 PMCID: PMC3320527 DOI: 10.1186/1471-2369-13-12] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 03/14/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The blood pressure (BP) of a proportion of chronic hemodialysis (HD) patients rises after HD. We investigated the influence of postdialysis BP rise on long-term outcomes. METHODS A total of 115 prevalent HD patients were enrolled. Because of the fluctuating nature of predialysis and postdialysis BP, systolic BP (SBP) and diastolic BP before and after HD were recorded from 25 consecutive HD sessions during a 2-month period. Patients were followed for 4 years or until death or withdrawal. RESULTS Kaplan-Meier estimates revealed that patients with average postdialysis SBP rise of more than 5 mmHg were at the highest risk of both cardiovascular and all-cause mortality as compared to those with an average postdialysis SBP change between -5 to 5 mmHg and those with an average postdialysis SBP drop of more than 5 mmHg. Furthermore, multivariate Cox regression analysis indicated that both postdialysis SBP rise of more than 5 mmHg (HR, 3.925 [95% CI, 1.410-10.846], p = 0.008) and high cardiothoracic (CT) ratio of more than 50% (HR, 7.560 [95% CI, 2.048-27.912], p = 0.002) independently predicted all-cause mortality. We also found that patients with an average postdialysis SBP rise were associated with subclinical volume overload, as evidenced by the significantly higher CT ratio (p = 0.008). CONCLUSIONS A postdialysis SBP rise in HD patients independently predicted 4-year cardiovascular and all-cause mortality. Considering postdialysis SBP rise was associated with higher CT ratio, intensive evaluation of cardiac and volume status should be performed in patients with postdialysis SBP rise.
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Affiliation(s)
- Chih-Yu Yang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Wang TY, Hu CJ, Kuo CW, Chen Y, Lin JL, Yang CW, Yen TH. High incidence and recurrence of transitional cell carcinoma in Taiwanese patients with end-stage renal disease. Nephrology (Carlton) 2011; 16:225-31. [PMID: 21272136 DOI: 10.1111/j.1440-1797.2010.01366.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIM This study examines the epidemiology of transitional cell carcinoma (TCC) in end-stage renal disease (ESRD) population from Taiwan, the area with the highest incidence and prevalence of ESRD. METHODS A total of 98 out of 10,890 ESRD patients were referred for management of TCC between 2000 and 2008. Demographic, clinical and laboratory data were collected and patient mortality and tumour recurrence rates were analyzed. RESULTS TCC patients were aged 61.4 ± 10.2 years and 66.3% were female. The average time from initiation of dialysis to tumour detection was 51.2 ± 36.4 months. Hypertensive nephrosclerosis, diabetes mellitus, chronic glomerulonephritis and unknown aetiology accounted for 25.5%, 20.4%, 22.4% and 31.6% of the causes of renal failure, respectively. The aetiology of renal failure for the 31.6% of patients was unclear, but chronic tubulointerstitial nephritis following long-term consumption of Chinese herbs (19.4%) or analgesic compounds (3.1%) was considered in some patients. Almost all (98.0%) patients presented with gross haematuria. Most TCC were in early stage (stage 0, 3.1%; stage I, 56.1%) during diagnosis. At the end of this study, 17 of 98 (17.3%) patients died. Multivariate Cox regression analysis found that age (odds ratio =1.140, 95% confidence interval = 1.049-1.239, P = 0.002) and tumour pain (odds ratio = 0.234, 95% confidence interval = 0.057-0.961, P = 0.044) were significant risk factors for all-cause mortality. Furthermore, 35.7% of TCC recurred during follow up. The 5 year patient and tumour-free survival rates were 72.4% and 14.4%, respectively. CONCLUSION The data shows that Taiwanese patients with ESRD had high incidence (0.9%) and recurrence (35.7%) of TCC.
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Affiliation(s)
- Tsung-Yang Wang
- Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
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Yen TH, Lin JL, Lin-Tan DT, Hsu CW. Association between body mass and mortality in maintenance hemodialysis patients. Ther Apher Dial 2010; 14:400-8. [PMID: 20649761 DOI: 10.1111/j.1744-9987.2010.00818.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A total of 959 Taiwanese patients undergoing maintenance hemodialysis-102 underweight (BMI < 18.5 kg/m(2)), 492 normal weight (BMI 18.5-22.9 kg/m(2)), 187 overweight (BMI 23.0-24.9 kg/m(2)), and 178 obese (BMI >or= 25 kg/m(2)) were recruited into this three-year, multicenter longitudinal study. It was found initially that the underweight group had more females, longer hemodialysis durations, less use of a biocompatible membrane (BCM) dialyzer, higher erythropoietin doses and Kt/V(urea), and lower white blood cell counts, hemoglobin, serum creatinine and phosphate, and high sensitivity C-reactive protein (hsCRP) than other groups (P < 0.001). Furthermore, a chi(2)-test demonstrated that underweight patients had poorer nutrition (P = 0.023), but less systemic inflammation (P < 0.001) than other groups. A stepwise multiple linear regression analysis established that age, sex, diabetes mellitus, hemodialysis duration, use of BCM dialyzer, Kt/V(urea), creatinine, high-density lipoprotein cholesterol, and hsCRP were significant risk factors associated with BMI (P < 0.001-0.002). After three years, 149 (15.5%) patients had died, including 22 of 102 (21.6%) underweight patients, 64 of 492 (13.0%) normal weight patients, 38 of 187 (20.3%) overweight patients, and 25 of 178 (15.5%) obese patients. The primary causes of mortality were cardiovascular (52.3%) and infection (39.6%). A multivariate Cox regression analysis revealed that age, diabetes mellitus, BMI, albumin, hsCRP, and cardiothoracic ratio were significant risk factors associated with all-cause mortality over three years (P < 0.001-0.022). Finally, Kaplan-Meier analysis confirmed that underweight patients suffer higher mortality than other groups (Log rank, P = 0.0392); therefore, the data have demonstrated a survival disadvantage of low BMI in Taiwanese patients undergoing maintenance hemodialysis.
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Affiliation(s)
- Tzung-Hai Yen
- Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.
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Hsu CW, Lin JL, Lin-Tan DT, Yen TH, Chen KH, Huang WH, Ho TC, Huang YL. High-calcium dialysate: a factor associated with inflammation, malnutrition and mortality in non-diabetic maintenance haemodialysis patients. Nephrology (Carlton) 2010; 15:313-20. [PMID: 20470300 DOI: 10.1111/j.1440-1797.2009.01202.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Chronic inflammation, which is common in dialysis patients, often causes malnutrition and even protein-energy wasting. However, the association of high-calcium dialysate with malnutrition and/or inflammation in non-diabetic maintenance haemodialysis patients remains unclear. This study investigated the possible adverse effects of high-calcium dialysate and mortality in this population. METHODS A total of 717 non-diabetic haemodialysis patients participated in this 2 year prospective study. The subjects were categorized into three subgroups based on whether dialysate calcium concentrations were high (3.5 mEq/L), standard (3.0 mEq/L) or low (2.5 mEq/L). Demographic, haematological, nutritional and inflammatory markers, biochemical and dialysis-related data were obtained for cross-sectional analysis. Causes of death and mortality rates were also analyzed for each subgroup. RESULTS Patients with high-calcium dialysate (n = 82) had a higher incidence of malnutrition and inflammation (61.0% vs 44.1% and 43.9%, respectively) than those with standard- and low-calcium dialysate (n = 528 and 107). Backward stepwise multiple regression analysis revealed that high-calcium dialysate was negatively correlated with nutritional index, serum albumin levels, but positively associated with the inflammatory marker of serum ferritin levels. At the end of the 2 year follow up, 45 patients had died. Cox multivariate analysis demonstrated that high-calcium dialysate was a significant associated factor (relative risk 2.765; 95% confidence interval 1.429-5.352) for 2 year all-cause mortality in these patients. CONCLUSION The analytical results indicate that high-calcium dialysate is associated with malnutrition and inflammation as well as 2 year mortality in non-diabetic maintenance haemodialysis patients and the findings suggest that this population, even those with optimal mineral balance, should avoid high-calcium dialysate.
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Affiliation(s)
- Ching-Wei Hsu
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, 199 Tung-Hwa North Road, Taipei 100, Taiwan
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