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Yu T, Tang W, Hung W, Lee T, Tsai I, Hsuan C, Chen C, Chung F, Lee Y, Wu C. Elevated plasma leptin levels are associated with vascular access dysfunction in patients on maintenance hemodialysis. J Clin Lab Anal 2023; 37:e24974. [PMID: 37840358 PMCID: PMC10681410 DOI: 10.1002/jcla.24974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/16/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Inflammation has been associated with vascular access (VA) dysfunction. The adipocytokine leptin can directly induce pro-inflammatory T helper 1 immune responses and the pathogenesis of chronic inflammation. We explored the association between plasma leptin and VA dysfunction in patients on maintenance hemodialysis (HEMO). METHODS A total of 344 consecutive patients who received anastomosis for VA at a single HEMO center between June 1, 2010 and December 31, 2021 were screened. Of these patients, 267 met the inclusion criteria and were included. ELISA was used to measure circulating levels of leptin. RESULTS The VA dysfunction group had a higher leptin level than the patent VA group. A higher concentration of leptin was independently and significantly associated with an elevated risk of VA dysfunction. Multiple logistic regression analysis showed that leptin, female sex, and hypertension were independently associated with VA dysfunction, even after adjusting for known biomarkers. We then evaluated the ability of leptin, female sex, and hypertension to predict the risk of VA dysfunction, and the area under the curve (AUC) for leptin was 0.626 (p = 0.0001). When leptin, female sex, and hypertension were added to this multivariate model, the AUC increased to 0.679 (p = 0.001) for leptin and hypertension, and 0.690 for leptin, hypertension, and female sex (p = 0.004). In addition, plasma leptin levels were associated with sex, body mass index, and hemoglobin. CONCLUSIONS In addition to the association between leptin and VA dysfunction, hypertension and female sex independently predicted VA dysfunction in patients with HEMO.
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Affiliation(s)
- Teng‐Hung Yu
- Division of Cardiology, Department of Internal MedicineE‐Da Hospital, I‐Shou UniversityKaohsiungTaiwan
- School of Medicine, College of MedicineI‐Shou UniversityKaohsiungTaiwan
| | - Wei‐Hua Tang
- Division of Cardiology, Department of Internal MedicineTaipei Veterans General Hospital, Yuli BranchHualienTaiwan
- Faculty of Medicine, School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Wei‐Chin Hung
- Division of Cardiology, Department of Internal MedicineE‐Da Hospital, I‐Shou UniversityKaohsiungTaiwan
- School of Medicine, College of MedicineI‐Shou UniversityKaohsiungTaiwan
| | - Thung‐Lip Lee
- Division of Cardiology, Department of Internal MedicineE‐Da Hospital, I‐Shou UniversityKaohsiungTaiwan
- School of Medicine for International Students, College of MedicineI‐Shou UniversityKaohsiungTaiwan
| | - I‐Ting Tsai
- School of Medicine, College of MedicineI‐Shou UniversityKaohsiungTaiwan
- Department of EmergencyE‐Da Hospital, I‐Shou UniversityKaohsiungTaiwan
| | - Chin‐Feng Hsuan
- Division of Cardiology, Department of Internal MedicineE‐Da Hospital, I‐Shou UniversityKaohsiungTaiwan
- School of Medicine, College of MedicineI‐Shou UniversityKaohsiungTaiwan
- Division of Cardiology, Department of Internal MedicineE‐Da Dachang Hospital, I‐Shou UniversityKaohsiungTaiwan
| | - Chia‐Chi Chen
- School of Medicine, College of MedicineI‐Shou UniversityKaohsiungTaiwan
- Department of PathologyE‐Da Hospital, I‐Shou UniversityKaohsiungTaiwan
- Department of Physical TherapyI‐Shou UniversityKaohsiungTaiwan
- The School of Chinese Medicine for Post Baccalaureate, College of MedicineI‐Shou UniversityKaohsiungTaiwan
| | - Fu‐Mei Chung
- Division of Cardiology, Department of Internal MedicineE‐Da Hospital, I‐Shou UniversityKaohsiungTaiwan
| | | | - Cheng‐Ching Wu
- Division of Cardiology, Department of Internal MedicineE‐Da Hospital, I‐Shou UniversityKaohsiungTaiwan
- School of Medicine, College of MedicineI‐Shou UniversityKaohsiungTaiwan
- Division of Cardiology, Department of Internal MedicineE‐Da Cancer Hospital, I‐Shou UniversityKaohsiungTaiwan
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Hsieh MY, Cheng CH, Chen CH, Liao MT, Lin CC, Yang TF, Chuang SY, Wu CC. The association of long-term blood pressure variability with hemodialysis access thrombosis. Front Cardiovasc Med 2022; 9:881454. [PMID: 35990946 PMCID: PMC9386040 DOI: 10.3389/fcvm.2022.881454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/18/2022] [Indexed: 11/15/2022] Open
Abstract
Background Blood pressure variability (BPV) is an important risk factor for cardiovascular events in hemodialysis patients. We sought to determine the impact of BPV on hemodialysis access thrombosis. Methods We enrolled 1,011 prevalent hemodialysis patients from 12 hemodialysis centers since January 2018 and followed them until December 2020. Predialysis blood pressure (BP) was assessed at 12-week intervals. The coefficient of variation derived from 36 consecutive BP measurements was used as the metric for variability. The primary outcome was incident hemodialysis access thrombosis. Linear regression models were used to assess factors associated with BPV at baseline. Kaplan-Meier curves of the time until vascular access events were drawn and log-rank tests were calculated. Cox proportional hazards models were performed to assess the association of BPV with incident vascular access events. Results The average coefficient of variance for systolic BPV was 10.9%. BPV was associated with age, body mass index, mean BP, diabetes, coronary and peripheral artery disease, history of access dysfunction, graft access, intradialytic hypotension, and use of antihypertensive medications. There were 194 access thrombosis events and 451 access stenosis events during a median follow-up period of 30 months. After adjustment of potential confounding factors, BPV was associated with increased risk of access thrombosis [hazard ratio = 1.27, 95% confidence interval (CI), 1.18–1.44, per 1 standard deviation increase in BPV]. The patients in the highest BPV quartile had 2.45 times the risk of thrombosis (CI, 1.62–3.70). The association was independent of average BP, intradialytic hypotension, and comorbidities. Similar trends of association were found in the subgroups analyzed. Comparative analysis using a time-varying variable model and different metrics of BPV showed consistent results. Conclusion Our findings underscored the impact of BP fluctuation on vascular access thrombosis.
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Affiliation(s)
- Mu-Yang Hsieh
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | | | - Chiu-Hui Chen
- Hemodialysis Center, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Min-Tsun Liao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Ching Lin
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ten-Fang Yang
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Shao-Yuan Chuang
- Institute of Population Health Science, National Health Research Institutes, Miaoli County, Taiwan
| | - Chih-Cheng Wu
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Center of Quality Management, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
- Institute of Cellular and System Medicine, National Health Research Institutes, Miaoli County, Taiwan
- *Correspondence: Chih-Cheng Wu,
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Zhang X, Xu L, Zhou P, Song D, Wu J, Jia L. Intradialytic BP variability is associated with cardiovascular mortality and hospitalization in HD patients. Ther Apher Dial 2021; 26:624-631. [PMID: 34655281 DOI: 10.1111/1744-9987.13745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/29/2021] [Accepted: 10/13/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Studies showed that pre-dialysis BP variability (BPV) was an independent risk factor of cardiovascular disease (CVD) among HD patients, but which is limited on how intradialytic BPV affects prognosis. METHODS In this study, we designed a retrospective cohort study to examine the association between intradialytic BPV and CVD outcomes in HD patients. A total of 202 patients who underwent HD in our center were included, and all intradialytic BP measurements of November 2017 were obtained from the database. Patients were divided into four groups according to variability independent of the mean (VIM) interquartile. RESULTS The mean age was 62.1 ± 14.3 years, 60.9% were male, and median VIM was 14.75 (12.60-18.59). Multiple-regression analyses showed patients age, dialysis vintage, serum albumin, and the percentage of intradialytic weight gain as significant predictors of VIM (all p values were <0.05). Kaplan-Meier survival curves showed that CVD mortality was greater in patients with higher VIM (p = 0.05), whereas all-cause mortality had no significant difference between the four groups overall (p = 0.149). Furthermore, multivariate regression analyses demonstrated that VIM (HR = 1.091, p < 0.004) and age (HR = 1.059, p = 0.003) were significant independent predictors for CVD death. Logistic-regression models revealed that higher VIM groups were more likely to have CVD-related hospitalization (OR = 1.085, p = 0.030), whereas the association between VIM and all-cause hospitalization was not statistically significant (OR = 1.015, p = 0.669). CONCLUSIONS This retrospective study suggested that higher intradialytic BPV was associated with increasing age, longer dialysis vintage, lower albumin, and greater ultrafiltration; intradialytic BPV could be an effective predictor for CVD mortality and hospitalization in the HD population.
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Affiliation(s)
- Xuelei Zhang
- Department of Nephrology, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Ling Xu
- Department of Urology, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Peiyi Zhou
- Department of Nephrology, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Dongqi Song
- Department of Nephrology, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Jian Wu
- Department of Nephrology, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Lifang Jia
- Department of Nephrology, Daxing Teaching Hospital, Capital Medical University, Beijing, China
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Zheng CM, Chiu YP, Hou YC, Liu YM, Wu MS, Lin YF, Lo YL, Lu KC, Hsu YH, Wang YH. Influence of intradialytic systolic blood pressure changes on arteriovenous access thrombosis in maintenance hemodialysis patients. Int J Clin Pract 2021; 75:e13799. [PMID: 33113231 DOI: 10.1111/ijcp.13799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Arteriovenous access (AV) thrombosis is an important and preventable problem amongst chronic hemodialysis (HD) patients. Systolic blood pressure (SBP) fluctuation relates to higher cardiovascular mortality amongst these patients. We proposed there is a close relation between SBP changes and arteriovenous (AV) access thrombosis. We also determined other risk factors and biochemical parameters related to AV access failure. METHODS 50 HD patients with thrombosis and 50 HD patients without thrombosis were included in the study. Odds ratios and 95% confidence intervals were estimated with multivariate-adjusted logistic regression models to determine the association between potential thrombosis-related risk factors and thrombosis risk. RESULTS Elder adults, women, and patients with AV grafts, lower intradialytic SBP and higher SBP variations during HD sessions had higher incidence of AV access thrombosis. AV access infection and decreased blood flow (BF) velocity were associated with an increased incidence of thrombotic events, whereas the use of anti-thrombotic agents was associated with a decreased incidence of thrombotic events. Further, anaemia, hypoalbuminemia, hyperlipidemia, and impaired mineral metabolism parameters were also found to be associated with AV access thrombosis. CONCLUSIONS Close monitoring and management of intradialytic hypotension and SBP fluctuation in every HD session are important. Some important and novel modifiable risk factors related to AV access thrombosis were identified in this study (eg, AV access infection, decreased BF and abnormal biochemical parameters, etc). Earlier surveillance and modification of these risk factors is crucial to prevent AV access failure in HD patients.
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Affiliation(s)
- Cai-Mei Zheng
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Research Center of Urology and Kidney (TMU-RCUK), School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Ping Chiu
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Chou Hou
- Division of Nephrology, Department of Medicine, Cardinal-Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Yueh-Min Liu
- Department of Nursing, Ching Kuo Institute of Management and Health, Keelung, Taiwan
| | - Mai-Szu Wu
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Research Center of Urology and Kidney (TMU-RCUK), School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yuh-Feng Lin
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Research Center of Urology and Kidney (TMU-RCUK), School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yen-Li Lo
- Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Kuo-Cheng Lu
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
- Division of Nephrology, Department of Medicine, Fu-Jen Catholic University Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Yung-Ho Hsu
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Research Center of Urology and Kidney (TMU-RCUK), School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yuan-Hung Wang
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
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