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Fan X, Li J, Bi ZY, Liang W, Wang FJ. Cause of death and influencing factors of chronic renal failure on maintenance hemodialysis. Pak J Med Sci 2023; 39:1378-1382. [PMID: 37680805 PMCID: PMC10480753 DOI: 10.12669/pjms.39.5.7037] [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: 08/23/2022] [Revised: 05/19/2023] [Accepted: 05/28/2023] [Indexed: 09/09/2023] Open
Abstract
Objective To investigate the causes of death in patients with chronic renal failure (CRF) on maintenance hemodialysis and its influencing factors. Methods This is a retrospective study. A total of 300 patients with chronic renal failure undergoing maintenance hemodialysis who were admitted to the Affiliated Hospital of Hebei University from March 2020 to October 2022 were selected as subjects. Various information of patients were collected. In addition, 80 dead patients in this group were investigated for the cause of death, including cardiovascular and cerebrovascular diseases, infections, multi organ failure, and other causes, and the death-related conditions of cardiovascular and cerebrovascular diseases, such as triglyceridr,,total cholesterol, and in blood lipid levels were analyzed. Results Among the 80 dead patients, cardiovascular and cerebrovascular diseases accounted for a higher proportion of death (66%). Univariate Logistic regression analysis showed that advanced age, plasma homocysteine, blood parathyroid hormone, hyperphosphatemia, hypertension, high volume load and left ventricular hypertrophy were risk factors for death in patients with chronic renal failure on maintenance hemodialysis. Multivariate Logistic regression analysis showed that high volume load, left ventricular hypertrophy and anemia were risk factors for death on maintenance hemodialysis. The levels of hemoglobin (HGB) and high-density lipoprotein (HDL) in patients who died of cardiovascular and cerebrovascular diseases were significantly lower than those in the non-cardio-cerebrovascular death group (P=0.00), and the levels of serum phosphorus, TG and TC were significantly higher than those in the non-cardio-cerebrovascular death group (P, P=0.00; TG, P=0.02; TC, P=0.01). Conclusion Cardiovascular and cerebrovascular diseases are the leading cause of death in patients with chronic renal failure on maintenance hemodialysis. Adequate dialysis and normal hemoglobin levels are favorable protective factors.
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Affiliation(s)
- Xing Fan
- Xing Fan Department of Nephrology, Affiliated Hospital of Hebei University, Baoding 071000, Hebei China. Key Laboratory of Bone Metabolism and Physiology in Chronic Kidney Disease of Hebei Province, Baoding 071000, Hebei China
| | - Jing Li
- Jing Li Department of Nephrology, Affiliated Hospital of Hebei University, Baoding 071000, Hebei China. Key Laboratory of Bone Metabolism and Physiology in Chronic Kidney Disease of Hebei Province, Baoding 071000, Hebei China
| | - Zhao-yu Bi
- Zhao-yu Bi Department of Internal Medicine, Affiliated Hospital of Hebei University, Baoding 071000, Hebei China. Key Laboratory of Bone Metabolism and Physiology in Chronic Kidney Disease of Hebei Province, Baoding 071000, Hebei China
| | - Wei Liang
- Wei Liang Department of Nephrology, Affiliated Hospital of Hebei University, Baoding 071000, Hebei China. Key Laboratory of Bone Metabolism and Physiology in Chronic Kidney Disease of Hebei Province, Baoding 071000, Hebei China
| | - Feng-juan Wang
- Feng-juan Wang Supply Room, Affiliated Hospital of Hebei University, Baoding 071000, Hebei China. Key Laboratory of Bone Metabolism and Physiology in Chronic Kidney Disease of Hebei Province, Baoding 071000, Hebei China
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Farah Yusuf Mohamud M, Nur Adan F, Osman Omar Jeele M, Ahmed MAM. Major cardiovascular events and associated factors among routine hemodialysis patients with end-stage renal disease at tertiary care hospital in Somalia. Front Med (Lausanne) 2023; 10:1086359. [PMID: 37275357 PMCID: PMC10235611 DOI: 10.3389/fmed.2023.1086359] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/11/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Cardiovascular complications are the most significant cause of death in patients undergoing routine hemodialysi (HD) with end-stage renal disease (ESRD). The main objective of this study is to determine the significant cardiac events and risk factors in patients undergoing routine hemodialysis in Somalia. Methods We carried out a cross-sectional retrospective study in a single dialysis center in Somalia. Two hundred out of 224 were included. All of them had ESRD and were on hemodialysis during the study period between May and October 2021. The records of all patients were reviewed, and the following parameters were analyzed socio-demographic factors, risk factors for cardiovascular disease, and the presence of cardiovascular diseases. Results The mean age was 54 ± 17.5 years (range 18-88 years), and 106 (53%) patients were males. The prevalence of a cardiovascular disease among hemodialysis patients was 29.5%. Moreover, the distribution of cardiovascular diseases was different; heart failure was the most common, about 27.1%, followed by coronary artery disease (17%), pericarditis and pericardial-effusion (13.6%), dysrhythmia (10.2%), cerebrovascular-accident (8.5%), and peripheral vascular disease (3.4%). About 176 (88%) participants had at least one modifiable cardiovascular risk factor. The most common modifiable cardiovascular risk factor was hypertension (n = 45, 25.1%), followed by anemia (n = 28, 15.6%) and diabetes (n = 26, 14.5%). Younger (18-30) participants were six times less likely to have cardiovascular events among hemodialysis than older age 0.4 (0.11-1.12). Conclusion Low prevalence rate of cardiovascular complications was confirmed in ESRD patients receiving hemodialysis in the main HD center in Somalia. Diabetes, anemia, and hypertension were the highest significant risk factors for CVD in HD patients with ESRD in Somalia.
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Affiliation(s)
| | - Faduma Nur Adan
- Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
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He X, Liu Y. Effects of arteriovenous fistulas and central venous catheters on the cardiac function and prognosis of patients on maintenance hemodialysis. Pak J Med Sci 2023; 39:780-784. [PMID: 37250573 PMCID: PMC10214819 DOI: 10.12669/pjms.39.3.7151] [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: 09/09/2022] [Revised: 09/20/2022] [Accepted: 02/28/2023] [Indexed: 11/02/2023] Open
Abstract
Objective To investigate the effects of arteriovenous fistulas (AVFs) and central venous catheters (CVCs) on the left ventricular function (LVF) and prognosis of maintenance hemodialysis (MHD) patients. Methods This retrospective cohort study included 270 patients (139 with AVF and 131 with CVC) undergoing dialysis with newly established vascular access in the blood purification center of Nanhua hospital, University of South China, from January 2019 to April 2021. Dialysis efficiencies, LVF indexes, and one-year prognoses were compared. Results At six and twelve months after the establishment of vascular access, the mean urea clearances (Kt/V) and urea reduction ratio (URR) between the AVF- and the CVC-group were similar (P>0.05). The mean LVF values between the two groups were also similar before the establishment of vascular access (P>0.05), but the mean values of left ventricular end diastolic diameter (LVEDd), interventricular septal thickness (IVSTd), and left ventricular posterior wall thickness (LVPWT) in the AVF-group were higher than those in the CVC-group one year later, and mean early (E) and late (A) diastolic mitral velocities, E/A, and ejection fraction (EF) were lower than those in the CVC-group (P<0.05). The incidence of left ventricular hypertrophy and systolic dysfunction in the AVF-group was higher than that in the CVC-group (P<0.05). The hospitalization rate of AVF-group (23.02%) was lower than that of the CVC-group (49.61%) (P<0.05). Conclusion Both AVF and CVC can achieve appropriate dialysis effects in MHD patients. AVF has a negative impact on cardiac function while CVC has a high hospitalization rate.
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Affiliation(s)
- Xufeng He
- Xufeng He Nanhua Hospital, University of South China, Health School of Nuclear Industry, Hengyang 421002, Hunan Province, P.R. China
| | - Yang Liu
- Yang Liu, Department of Hemodialysis Room, Nanhua hospital, University of South China, Hengyang 421002, Hunan Province, P.R. China
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Prognostic Value of the Controlling Nutritional Status (CONUT) Score in Patients at Dialysis Initiation. Nutrients 2022; 14:nu14112317. [PMID: 35684116 PMCID: PMC9182995 DOI: 10.3390/nu14112317] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 02/05/2023] Open
Abstract
Protein-energy wasting (PEW) is common in patients with chronic kidney disease (CKD), and affects their prognosis. The Controlling Nutritional Status (CONUT) score is a nutritional screening tool calculated using only blood test data. This study aimed to investigate the prognostic value of CONUT score in patients just initiating dialysis. A total of 311 CKD patients who stably initiated dialysis were enrolled. Only 27 (8.7%) patients were classified as having normal nutritional status. The CONUT score was also independently correlated with elevated C-reactive protein levels (β = 0.485, p < 0.0001). During the median follow-up of 37 months, 100 patients (32.2%) died. The CONUT score was an independent predictor of all-cause mortality (adjusted hazard ratio 1.13, 95% confidence interval 1.04−1.22, p < 0.0024). As model discrimination, the addition of the CONUT score to a prediction model based on established risk factors significantly improved net reclassification improvement (0.285, p = 0.028) and integrated discrimination improvement (0.025, p = 0.023). The CONUT score might be a simplified surrogate marker of the PEW with clinical utility and could predict all-cause mortality, in addition to improving the predictability in CKD patients just initiating dialysis. The CONUT score also could predict infectious-disease mortality.
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Ahmed C, Kendi F, Gebran N, Barcebal C, Dahmani K, El Houni A, Budruddin M. Use of Recombinant Human Parathyroid Hormone to Treat Hungry Bone Syndrome in Hemodialysis Patient. Oman Med J 2020; 35:e164. [PMID: 32904907 PMCID: PMC7459415 DOI: 10.5001/omj.2020.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/04/2019] [Indexed: 11/23/2022] Open
Abstract
We report the case of a 35-year-old female with end-stage renal disease on hemodialysis for nine years. She was diagnosed with secondary hyperparathyroidism complicated with a brown tumor in the mandible. After medical therapy failed, she underwent total parathyroidectomy (PTX), which was complicated by severe and prolonged hypocalcemia (hungry bone syndrome). Post-surgery, she required prolonged and frequent intravenous calcium and a high dose of vitamin D resulting in frequent admission with symptomatic hypocalcemia. Her serum magnesium was noted to be in the normal range. She continued to be hypocalcemic for nearly eight months post-surgery despite the intensive treatment. Recombinant human parathyroid hormone (teriparatide) 20 mg daily resulted in normalization of calcium within two weeks. The use of parathyroid hormone proved to be an effective treatment approach in this case. Proper pre-operative preparation and subtotal PTX with an adequate dose of vitamin D and calcium supplement may have been a rational option for this case.
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Affiliation(s)
- Chaaban Ahmed
- Department of Nephrology, Tawam Hospital in affiliation with John Hopkins, Al Ain, UAE
| | - Fatima Kendi
- Department of Nephrology, Tawam Hospital in affiliation with John Hopkins, Al Ain, UAE
| | - Nicole Gebran
- Department of Nephrology, Tawam Hospital in affiliation with John Hopkins, Al Ain, UAE
| | | | - Khalid Dahmani
- Department of Nephrology, Tawam Hospital in affiliation with John Hopkins, Al Ain, UAE
| | - Ali El Houni
- Department of Nephrology, Tawam Hospital in affiliation with John Hopkins, Al Ain, UAE
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Wang Q, Cui Y, Yogendranath P, Wang N. Blood pressure and heart rate variability are linked with hyperphosphatemia in chronic kidney disease patients. Chronobiol Int 2018; 35:1329-1334. [PMID: 29947550 DOI: 10.1080/07420528.2018.1486850] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Hyperphosphatemia is a common complication of chronic kidney disease (CKD) and is associated with cardiovascular disease (CVD), which has contributed to an increase in mortality of CKD patients. The onset of CVD often varies by time-of-day. Acute myocardial infarction or ventricular arrhythmia occurs most frequently during early morning. Blood pressure (BP) and heart rate circadian rhythms account for the diurnal variations in CVD. Preservation of normal circadian time structure from the cardiomyocyte level to the whole organ system is essential for cardiovascular health and CVD prevention. Independent risk factors, such as reduced heart rate variability (HRV) and increased BP variability (BPV), are particularly prevalent in patients with CKD. Analysis of HRV is an important clinical tool for characterizing cardiac autonomic status, and reduced HRV has prognostic significance for various types of CVD. Circadian BP rhythms are classified as extreme dipper, dipper, non-dipper or riser. It has been reported that nocturnal riser BP pattern contributes to cardiovascular threats. Previous studies have indicated that the circadian rhythm of serum phosphate in CKD patients is consistent with the general population, with the highest diurnal value observed in the early morning hours, followed by a progressive decrease to the lowest value of the day, which occurs around 11:00 am. Rhythm abnormalities have become the main therapeutic target for treating CVD in CKD patients. It has been reported that high levels of serum phosphate are associated with reduced HRV and increased BPV in CKD patients. However, the mechanisms related to interactions between hyperphosphatemia, HRV and BPV have not been fully elucidated. This review focuses on the evidence and discusses the potential mechanisms related to the effects of hyperphosphatemia on HRV and BPV.
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Affiliation(s)
- Qingting Wang
- a Department of Nephrology , the First Affiliated Hospital of Nanjing Medical University , Nanjing , China
| | - Ying Cui
- a Department of Nephrology , the First Affiliated Hospital of Nanjing Medical University , Nanjing , China
| | - Purrunsing Yogendranath
- a Department of Nephrology , the First Affiliated Hospital of Nanjing Medical University , Nanjing , China
| | - Ningning Wang
- a Department of Nephrology , the First Affiliated Hospital of Nanjing Medical University , Nanjing , China
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Lim CTS, Kalaiselvam T, Kitan N, Goh BL. Clinical course after parathyroidectomy in adults with end-stage renal disease on maintenance dialysis. Clin Kidney J 2017; 11:265-269. [PMID: 29644069 PMCID: PMC5887517 DOI: 10.1093/ckj/sfx086] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/19/2017] [Indexed: 12/28/2022] Open
Abstract
Background Parathyroidectomy (PTX) is done in cases of secondary hyperparathyroidism from chronic kidney disease to improve renal osteodystrophy. Despite this widespread practice, clinical outcomes regarding the benefits of this procedure are still lacking. Most studies in the literature have opted to report the laboratory outcome instead. Our study aimed to evaluate the postoperative clinical course for patients who had undergone total PTX without autoimplantation. Methods and results All patients who underwent PTX between January 2010 and February 2014 in a tertiary referral center were included in this study and followed up for 12 months. Laboratory outcome parameters include various preoperative and postoperative serial measurements of laboratory parameters. Patients’ hospitalizations and mortality records post-PTX were also retrieved and recorded. In all, 90 patients were included in this study. The mean age was 48 ± 18 years. The majority of the patients (54.4%) were male and 90% were on hemodialysis. The mean duration of dialysis was 8.0 ± 5.0 years. Indications for PTX were symptomatic bone pain (95.6%), fractures (3.3%) and calciphylaxis (1.1%). Mean preoperative values for serum calcium, phosphate, alkaline phosphatase and intact parathyroid hormone (iPTH) were 2.40 ± 0.23mmol/L, 1.92 ± 0.51 mmol/L, 689.60 ± 708.50 U/L and 311.90 ± 171.94 pmol/L, respectively. The majority (92.2%) had all four glands removed and 92.2% of the glands showed hyperplasic changes. One year after PTX, 90 patients (100%) had serum iPTH <8 pmol/L and 28 patients (31%) had unmeasurable iPTH levels. A total of 15% of patients had hospitalizations for various reasons and of these, 50% were within 90 days. The mean hospital stay was 14.4 ± 18.6 days. The mortality rate was 4.4% and of these, 25% were in first 30 days. Causes of death were mainly from sepsis (75%) and acute coronary syndrome (25%). One patient (1.1%) had a relapse. Conclusions Even though PTX markedly reduces postoperative serum iPTH levels, it carries with it significant risk of morbidity and mortality.
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Affiliation(s)
- Christopher Thiam Seong Lim
- Department of Nephrology, Serdang Hospital, Malaysia.,Department of Medicine, Faculty of Medicine, Universiti Putra Malaysia, Malaysia
| | - Thevandra Kalaiselvam
- Department of Nephrology, Serdang Hospital, Malaysia.,Department of Medicine, Faculty of Medicine, Universiti Putra Malaysia, Malaysia
| | | | - Bak Leong Goh
- Department of Nephrology, Serdang Hospital, Malaysia.,Clinical Research Center, Serdang Hospital, Malaysia
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Lim CTS, R R, A S MZF. Risk profiles of referred chronic kidney disease patients in a tertiary nephrology centre. Pak J Med Sci 2016; 32:27-30. [PMID: 27022339 PMCID: PMC4795882 DOI: 10.12669/pjms.321.8214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To determine the risk profile of chronic kidney disease (CKD) patients. Methods: This is an observational cross sectional study involving 130 patients for which data was collected prospectively.. Sixty five subjects with an estimated glomerular filtration rate (eGFR) below 120 ml/min/1.73 m2 were recruited via random sampling technique from nephrology clinic in a tertiary nephrology referral center. Medical history, demographic data, urinary and serum biochemistry tests were obtained. Results: Most of the CKD patients who were referred to the nephrology clinic were asymptomatic. The most common laboratory abnormalities noted among CKD patients were proteinuria, anaemia and hyperkalaemia. Advancing age, pre-existing morbidities such as diabetes mellitus, hypertension and overweight are characteristics that are strongly associated with the referred CKD patients. Conclusions: Most of the referred CKD patients are in advanced age with diabetes, hypertension and overweight. Majority of the CKD remained asymptomatic despite in the advance stage of CKD. This strongly calls for cost effective screening for population at risk.
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Affiliation(s)
- Christopher Thiam Seong Lim
- Christopher Thiam Seong Lim, Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Raihan R
- Raihan R, Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Mohd Zharif Fikri A S
- Mohd Zharif Fikri A.S, Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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