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Mokoli VM, Sumaili EK, Lepira FB, Makulo JRR, Bukabau JB, Osa Izeidi PP, Luse JL, Mukendi SK, Mashinda DK, Nseka NM. Impact of residual urine volume decline on the survival of chronic hemodialysis patients in Kinshasa. BMC Nephrol 2016; 17:182. [PMID: 27871253 PMCID: PMC5117615 DOI: 10.1186/s12882-016-0401-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 11/15/2016] [Indexed: 12/29/2022] Open
Abstract
Background Despite the multiple benefits of maintaining residual urine volume (RUV) in hemodialysis (HD), there is limited data from Sub-Saharan Africa. The aim of this study was to assess the impact of RUV decline on the survival of HD patients. Methods In a retrospective cohort study, 250 consecutive chronic HD patients (mean age 52.5 years; 68.8% male, median HD duration 6 months) from two hospitals in the city of Kinshasa were studied, between January 2007 and July 2013. The primary outcome was lost RUV. Preserved or lost RUV was defined as decline RUV < 25 (median decline) or ≥ 25 ml/day/month, respectively. The second endpoint was survival (time-to death). Survival curves were built using the Kaplan-Meier methods. We used Log-rank test to compare survival curves. Predictors of mortality were assessed by Cox proportional hazards regression models. Results The cumulative incidence of patients with RUV decline was 52, 4%. The median (IQR) decline in RUV was 25 (20.8–33.3) ml/day/month in the population studied, 56.7 (43.3–116.7) in patients deceased versus 12.9 (8.3–16.7) in survivor patients (p < 0.001). Overall mortality was 78 per 1000 patient years (17 per 1000 in preserved vs 61 per 1000 lost RUV). Forty six patients (18.4%) died from withdrawal of HD due to financial constraints. The Median survival was 17 months in the whole group while, a significant difference was shown between lost (10 months, n = 119) vs preserved RUV group (30 months, n = 131; p = 0001). Multivariate Cox proportional hazards models showed that, decreased RUV (adjusted HR 5.35, 95% CI [2.73–10.51], p < 0.001), financial status (aHR 2.23, [1.11–4.46], p = 0.024), hypervolemia (a HR 2.00, [1.17–3.40], p = 0.011), lacking ACEI (aHR 2.48, [1.40–4.40], p = 0.002) or beta blocker use (aHR 4.04, [1.42–11.54], p = 0.009), central venous catheter (aHR 6.26, [1.71–22.95], p = 0.006), serum albumin (aHR 0.93, [0.89–0.96], p < 0.001) and hemoglobin (aHR 0.73, [0.63–0.84], p < 0.001) had emerged as the independent predictors of all-cause mortality. Conclusion More than half of HD patients in this cohort study experienced fast RUV decline which contributed substantially to increase mortality, highlighting the need for its prevention and management.
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Affiliation(s)
- Vieux Momeme Mokoli
- Division of Nephrology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo. .,Hemodialysis Unit of Ngaliema Medical Center, Kinshasa, Democratic Republic of the Congo.
| | - Ernest Kiswaya Sumaili
- Division of Nephrology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Jean Robert Rissassy Makulo
- Division of Nephrology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.,Hemodialysis Unit of Ngaliema Medical Center, Kinshasa, Democratic Republic of the Congo
| | | | | | - Jeannine Losa Luse
- Hemodialysis Unit of Provincial General Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Stéphane Kalambay Mukendi
- Hemodialysis Unit of Provincial General Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Nazaire Mangani Nseka
- Division of Nephrology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Mokoli VM, Bukabau JB, Izeidi PPO, Luse JL, Mukendi SK, Mashinda DK, Makulo JRR, Sumaili EK, Lepira FB, Nseka NM. [Predictors of physical incapacity degree to chronic hemodialysis patients in Kinshasa : Key role of the residual diuresis]. Nephrol Ther 2016; 12:530-535. [PMID: 27789324 DOI: 10.1016/j.nephro.2016.06.004] [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: 04/06/2016] [Revised: 05/25/2016] [Accepted: 06/13/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Identifying predictors of physical incapacity degree in patients on chronic hemodialysis in Kinshasa. METHODS Bicentric analytical study, between January 2007 and July 2013. Degree of physical handicap was evaluated at 6months of hemodialysis based on the scale of Rosser. Logistic regression sought the predictors of no or light physical incapacity (Rosser<3) vs. moderate to maximum (Rosser≥3). P was set at 0.05. RESULTS One hundred twenty-seven patients (127) patients received at least 6months of hemodialysis (53.3±11years; 73.2 % male), 79 (62.2 %) had no or light incapacity and 48 (37.8 %) moderate to maximum. Predictors of lower physical incapacity in univaried analysis were: secured funding, high socioeconomic level, lack of diabetes mellitus, high body weight, normal systolic and diastolic blood pressure, residual diuresis 3months later, hemoglobin and hematocrit, low comorbidity, arteriovenous fistula, erythropoietin, at least 12hours of hemodialysis per week and lack of intradialytic complications. After logistic regression, a high residual diuresis 3months of hemodialysis has proved an independent predictor of lower physical Incapacity (aOR 0.998; P=0.024) next to the lack of diabetes mellitus (aOR 0.239; P=0.024), good control of systolic (aOR 0.958; P=0.013) and diastolic (aOR 1.089; P=0.003) blood pressure and the use of erythropoietin (aOR 5.687; P=0.004). CONCLUSION Preserving residual diuresis is associated with lower physical incapacity and must be integrated in the management in hemodialysis.
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Affiliation(s)
- Vieux Momeme Mokoli
- Service de néphrologie, université de Kinshasa, cliniques universitaires de Kinshasa, BP 123, Kin XI, République Démocratique de Kinshasa; Unité d'hémodialyse, Ngaliema Medical Center, BP 969, Kin I, République Démocratique de Kinshasa.
| | - Justine Busanga Bukabau
- Service de néphrologie, université de Kinshasa, cliniques universitaires de Kinshasa, BP 123, Kin XI, République Démocratique de Kinshasa
| | - Patrick Parmba Osa Izeidi
- Service de néphrologie, université de Kinshasa, cliniques universitaires de Kinshasa, BP 123, Kin XI, République Démocratique de Kinshasa
| | - Jeanine Losa Luse
- Unité d'hémodialyse, hôpital général provincial de référence de Kinshasa, BP 169, Kin I, République Démocratique de Kinshasa
| | - Stéphane Kalambay Mukendi
- Unité d'hémodialyse, hôpital général provincial de référence de Kinshasa, BP 169, Kin I, République Démocratique de Kinshasa
| | - Désiré Kulimba Mashinda
- École de santé publique, université de Kinshasa, BP 11850, Kin I, République Démocratique de Kinshasa
| | - Jean Robert Rissassy Makulo
- Service de néphrologie, université de Kinshasa, cliniques universitaires de Kinshasa, BP 123, Kin XI, République Démocratique de Kinshasa; Unité d'hémodialyse, Ngaliema Medical Center, BP 969, Kin I, République Démocratique de Kinshasa
| | - Ernest Kiswaya Sumaili
- Service de néphrologie, université de Kinshasa, cliniques universitaires de Kinshasa, BP 123, Kin XI, République Démocratique de Kinshasa
| | - François Bompeka Lepira
- Service de néphrologie, université de Kinshasa, cliniques universitaires de Kinshasa, BP 123, Kin XI, République Démocratique de Kinshasa
| | - Nazaire Mangani Nseka
- Service de néphrologie, université de Kinshasa, cliniques universitaires de Kinshasa, BP 123, Kin XI, République Démocratique de Kinshasa
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Effect of continuous blood purification on concentrations of plasma vasoactive substances and cardiac function in endotoxic shock. Pediatr Crit Care Med 2012; 13:e377-82. [PMID: 23034457 DOI: 10.1097/pcc.0b013e31825b84ce] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To evaluate the effect of continuous blood purification on cardiac function and plasma vasoactive substances in endotoxic shock in piglets. DESIGN This was a randomized controlled trial in an animal laboratory in a tertiary care pediatric center. MATERIALS AND METHODS Twenty-three healthy Shanghai white piglets weighing 8-14 kg were randomly assigned to one of the four groups: control group (n = 5), continuous blood purification without lipopolysaccharide infusion group (continuous blood purification, n = 6), lipopolysaccharide-induced endotoxin shock without continuous blood purification group (lipopolysaccharide, n = 6), and lipopolysaccharide-induced endotoxin shock with continuous blood purification group (continuous blood purification/lipopolysaccharide, n = 6). INTERVENTIONS The lipopolysaccharide and continuous blood purification/lipopolysaccharide groups were injected intravenously with Escherichia coli endotoxin to induce septic shock. The continuous blood purification and continuous blood purification/lipopolysaccharide groups received continuous venovenous hemodiafiltration right after model establishment. At baseline state (T0), following the injection of lipopolysaccharide (T), 1 hr later (T1), 3 hrs later (T3), and 5 hrs later (T5) after model establishment, clinical systemic inflammatory response syndrome parameters, hemodynamic indexes, and plasma concentration of vasoactive substances were obtained. Plasma concentration of dopamine was measured by enzyme-linked immunosorbent assay (DSL Company) and endothelin-1 by enzyme-linked immunosorbent assay (R&D Company). Nitric oxide synthase activity was measured by chromatometry (Nanjing Jiancheng Bioengineering Institute, China). MEASUREMENTS AND MAIN RESULTS In continuous blood purification/lipopolysaccharide group, after treatment with CPB, heart rate decreased significantly (p < .05) and pulse contour cardiac index, systematic vascular resistance index, and stroke volume index increased significantly (p < .05) when compared with lipopolysaccharide and continuous blood purification groups. After treatment with continuous blood purification, dopamine and endothelin-1 level increased and nitric oxide synthase activities decreased in continuous blood purification/lipopolysaccharide group when compared with the lipopolysaccharide group. In the continuous blood purification/lipopolysaccharide group, improvement in hemodynamic indexes was strongly correlated with increases in plasma dopamine and endothelin-1 level and decreases in nitric oxide synthase activity (r > .9, p < .05). CONCLUSIONS The adverse cardiovascular effects of lipopolysaccharide-induced endotoxin shock can be improved by continuous blood purification. Improvement is correlated with increases in the concentration of plasma vasoactive substances (endothelin and dopamine) and decreases in nitric oxide synthase activity.
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Ricci Z, Ronco C. Kidney diseases beyond nephrology: intensive care. Nephrol Dial Transplant 2009; 24:391-5. [PMID: 19144895 DOI: 10.1093/ndt/gfn740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Zaccaria Ricci
- Department of Paediatric Cardiosurgery, Bambino Gesù Hospital, Rome, Italy.
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Ueda S, Nishio K, Akai Y, Fukushima H, Ueyama T, Kawai Y, Masui K, Yoshioka A, Okuchi K. Prognostic value of increased plasma levels of brain natriuretic peptide in patients with septic shock. Shock 2006; 26:134-9. [PMID: 16878020 DOI: 10.1097/01.shk.0000226266.99960.d0] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Our objective was to investigate the plasma levels of brain and atrial natriuretic peptides (BNP and ANP, respectively) in patients with septic shock/severe sepsis and to study the association of BNP and ANP levels with hemodynamic parameters, severity of the disease, and prognosis of those patients. This is a prospective case series study of 22 patients with septic shock, 11 patients with severe sepsis, and 20 healthy volunteers at the Department of Emergency and Critical Care Medicine, Nara Medical University Hospital, Japan. Blood collection was performed on admission and on days 1, 2, and 4. Plasma BNP and ANP levels were measured by radioimmunoassay. Right atrial pressure, mean pulmonary arterial pressure, pulmonary arterial wedge pressure, and left ventricular stroke work index were determined using a thermodilution catheter. Acute Physiological and Chronic Health Evaluation II scores were calculated. Plasma levels of BNP and ANP were markedly elevated in patients with septic shock/severe sepsis compared with controls (BNP, 7 +/- 0.3 pg mL; ANP, 13 +/- 1 pg mL). In patients with septic shock, both BNP and ANP peaked on day 2 (BNP, 987 +/- 160 pg mL; ANP, 103 +/- 17 pg mL). Plasma levels of BNP on day 2 in patients with septic shock significantly correlated with right atrial pressure (r = 0.744, P < 0.01), mean pulmonary arterial pressure (r = 0.670, P < 0.01), pulmonary arterial wedge pressure (r = 0.709, P < 0.01), left ventricular stroke work index (r = -0.552, P < 0.05), Acute Physiological and Chronic Health Evaluation II score (r = 0.581, P < 0.01), and poor prognosis (P < 0.05). The optimal cutoff point for predicting mortality in patients with septic shock was a BNP level of 650 pg mL on day 2, in which sensitivity and specificity were 92% and 80%, respectively. Increased plasma levels of BNP may reflect not only the severity of myocardial depression but also the disease severity and could be of prognostic value in patients with septic shock.
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Affiliation(s)
- Shiro Ueda
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan
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Sturgess DJ, Marwick TH, Joyce CJ, Venkatesh B. B-type natriuretic peptide concentrations and myocardial dysfunction in critical illness. Anaesth Intensive Care 2006; 34:151-63. [PMID: 16617635 DOI: 10.1177/0310057x0603400218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
B-type natriuretic peptide (BNP) is the first biomarker of proven value in screening for left ventricular dysfunction. The availability of point-of-care testing has escalated clinical interest and the resultant research is defining a role for BNP in the investigation and treatment of critically ill patients. This review was undertaken with the aim of collecting and assimilating current evidence regarding the use of BNP assay in the evaluation of myocardial dysfunction in critically ill humans. The information is presented in a format based upon organ system and disease category. BNP assay has been studied in a spectrum of clinical conditions ranging from acute dyspnoea to subarachnoid haemorrhage. Its role in diagnosis, assessment of disease severity, risk stratification and prognostic evaluation of cardiac dysfunction appears promising, but requires further elaboration. The heterogeneity of the critically ill population appears to warrant a range of cut-off values. Research addressing progressive changes in BNP concentration is hindered by infrequent assay and appears unlikely to reflect the critically ill patient's rapidly changing haemodynamics. Multi-marker strategies may prove valuable in prognostication and evaluation of therapy in a greater variety of illnesses. Scant data exist regarding the use of BNP assay to alter therapy or outcome. It appears that BNP assay offers complementary information to conventional approaches for the evaluation of cardiac dysfunction. Continued research should augment the validity of BNP assay in the evaluation of myocardial function in patients with life-threatening illness.
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Affiliation(s)
- D J Sturgess
- Department of Intensive Care, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia
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Phua J, Jason P, Lim TK, Keang LT, Lee KH, Hoe LK. B-type natriuretic peptide: Issues for the intensivist and pulmonologist. Crit Care Med 2005; 33:2094-13. [PMID: 16148485 DOI: 10.1097/01.ccm.0000178351.03327.9f] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP), although promising as biomarkers for heart failure, are affected by multiple confounders. The purpose of this article is to review the literature on the utility of BNP and NT-proBNP as biomarkers, with a focus on their role in critical illness and pulmonary diseases. DATA SOURCE Published articles on BNP and NT-proBNP. DATA ANALYSIS Multiple disorders in the intensive care unit cause elevated BNP and NT-proBNP levels, including cardiac diseases, shock, pulmonary hypertension, acute respiratory distress syndrome, acute pulmonary embolism, chronic obstructive pulmonary disease, renal failure, and other conditions. CONCLUSIONS Intensivists and pulmonologists should understand that BNP and NT-proBNP levels might be raised to different degrees not only in heart failure but also in critical illness and various pulmonary diseases; in these situations, BNP and NT-proBNP may also serve as markers of severity and prognosis.
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Affiliation(s)
- Jason Phua
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore
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