High serum magnesium levels are associated with favorable prognoses in diabetic hemodialysis patients, retrospective observational study

Seasonal variation in predialysis systolic blood pressure and cardiovascular events in patients on maintenance hemodialysis

Predialysis systolic blood pressure (SBP) in patients on hemodialysis (HD) consistently followed a seasonal pattern, reaching a peak in winter and nadir in summer, similar to blood pressure in the general population. However, the relationship between seasonal variations in predialysis SBP and clinical outcomes is still under-investigated in Japanese patients on HD. This retrospective cohort study included 307 Japanese patients undergoing HD for >1 year in three dialysis clinics and evaluated the association between the standard deviation (SD) of predialysis SBP and clinical outcomes, including major adverse cardiovascular events (MACEs; cardiovascular death, nonfatal myocardial infarction or unstable angina, stroke, heart failure, and other severe cardiovascular events requiring hospitalization) with 2.5 years follow-up. The SD of predialysis SBP was 8.2 (6.4-10.9) mmHg. In the model fully adjusted for the SD of predialysis SBP, predialysis SBP, age, sex, HD vintage, Charlson comorbidity index, ultrafiltration rate, renin-angiotensin system inhibitors, corrected calcium, phosphorus, human atrial natriuretic peptide, C-reactive protein, albumin, hemoglobin, body mass index, normalized protein catabolism rate, and intradialytic SBP decline, Cox regression analyses showed that a higher SD of predialysis SBP (per 10 mmHg) was significantly associated with increased MACE risk (hazard ratio [HR], 1.89; 95% confidence interval [95% CI], 1.07-3.36) and all-cause hospitalization (HR, 1.57; 95% CI, 1.07-2.30). Therefore, greater seasonal variations in predialysis SBP were associated with worse clinical outcomes, including MACEs and all-cause hospitalization. Whether interventions to reduce seasonal variations in predialysis SBP will improve the prognosis of Japanese patients on HD must be investigated further.

Mean annual intradialytic blood pressure decline and cardiovascular events in Japanese patients on maintenance hemodialysis

An intradialytic systolic blood pressure (SBP) decline, which defines intradialytic hypotension, may be associated with higher all-cause mortality. However, in Japanese patients on hemodialysis (HD), the association between intradialytic SBP decline and patient outcomes is unclear. This retrospective cohort study included 307 Japanese patients undergoing HD over 1 year in three dialysis clinics and evaluated the association between the mean annual intradialytic SBP decline (predialysis SBP-nadir intradialytic SBP) and clinical outcomes, including major adverse cardiovascular events (MACEs; cardiovascular death, nonfatal myocardial infarction or unstable angina, stroke, heart failure, and other severe cardiovascular events requiring hospitalization) by following up for 2 years. The mean annual intradialytic SBP decline was 24.2 (25-75th percentile, 18.3-35.0) mmHg. In the model fully adjusted for intradialytic SBP decline tertile group (T1, <20.4 mmHg; T2, 20.4 to <29.9 mmHg; T3, ≥29.9 mmHg), predialysis SBP, age, sex, HD vintage, Charlson comorbidity index, ultrafiltration rate, use of renin-angiotensin system inhibitors, corrected calcium, phosphorus, human atrial natriuretic peptide, geriatric nutritional risk index, normalized protein catabolism rate, C-reactive protein, hemoglobin, and use of pressor agents, Cox regression analyses showed that the hazard ratio (HR) was significantly higher for T3 than for T1 for MACEs (HR, 2.38; 95% confidence interval 1.12-5.09) and all-cause hospitalization (HR, 1.68; 95% confidence interval 1.03-2.74). Therefore, in Japanese patients on HD, a greater intradialytic SBP decline was associated with worse clinical outcomes. Further studies are warranted to investigate whether interventions to attenuate the intradialytic SBP decline will improve the prognosis of Japanese patients on HD.

Associations between the serum magnesium and all-cause or cardiovascular mortality in chronic kidney disease and end-stage renal disease patients: A meta-analysis

BACKGROUND

Some studies have found that hypomagnesemia is associated with vascular calcification, atherosclerosis, and cardiovascular disease, which may lead to increased mortality in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) who need to maintain hemodialysis (HD). However, the conclusion of these studies remain controversial.

METHODS

Relevant literature was retrieved from the database of Cochrane library, PubMed, EMBASE, and CNKI until December 2020, without any language restrictions. The data was analyzed using the Stata 12.0 software.

RESULTS

A total of 31 studies were included, involving 205436 participants. The results showed that after multivariable adjusted, hypomagnesemia was significant associated with the risk of all-cause mortality in patients with CKD and end-stage renal disease (ESRD) (hazard ratios [HR] 1.955; 95% confidence interval (95% CI) 1.511-2.528; P = .000; hypomagnesemia vs normal magnesium or hypermagnesemia). In contrast, in patients with CKD and ESRD, hypermagnesemia was negatively correlated with all-cause mortality (HR 0.873; 95% CI 0.793-0.960; P = .005) (per unit increase). Moreover, in the adjusted model, it was observed that hypermagnesemia was significantly associated with a reduced risk of cardiovascular death (HR 0.598; 95% CI 0.094-1.102, P = .020). In addition, subgroup analysis found that hypomagnesemia was closely related to the increase of all-cause mortality in HD patients (HR 1.799; 95% CI 1.375-2.354; P = .000) (hypomagnesemia vs normal magnesium or hypermagnesemia).

CONCLUSION

Our results show that hypomagnesemia is significantly associated with cardiovascular and all-cause mortality in maintenance HD patients. Further studies should be conducted to evaluate the benefits of magnesium correction in maintenance dialysis patients with hypomagnesemia.

Analysis of inflammatory factor levels in serum and risk factors in patients with chronic renal failure undergoing maintenance hemodialysis

PURPOSE

To investigate the therapeutic effect of maintenance hemodialysis in patients with chronic renal failure and summarize the analysis of inflammatory factors in serum, and the risk factors in patients with chronic renal failure undergoing maintenance hemodialysis.

METHODS

A total of 50 patients with chronic renal failure undergoing maintenance hemodialysis who were admitted to our hospital from January 2017 to January 2019 were selected as the research subjects to analyze the therapeutic effects and complications of maintenance hemodialysis of these patients, compare the changes of inflammatory factor levels in serum such as interleukin-2 (IL-2), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) and renal function indicators such as creatinine, urea nitrogen, and urinary albumin clearance, and analyze the risk factors of maintenance hemodialysis in patients with chronic renal failure by multivariate logistic factor analysis.

RESULTS

The effective rate of maintenance hemodialysis in patients with chronic renal failure was 64% (32 cases). After dialysis, urea nitrogen, urinary albumin and creatinine clearance were significantly decreased (P < 0.05). As for the complications, 10 patients died, and 8 patients had infection. The levels of inflammatory factors in serum, such as IL-2, hs CRP were significantly decreased after maintenance hemodialysis (P < 0.05), and the difference was statistically significant. The results of multivariate logistic factor analysis showed that high capacity load and anemia were independent risk factors for death in patients with chronic renal failure undergoing maintenance hemodialysis. Simultaneously, diabetes mellitus, central venous catheterization, and hypoalbuminemia were independent risk factors for infection in patients with chronic renal failure undergoing maintenance hemodialysis.

CONCLUSION

The level of inflammatory factors in the serum of patients with chronic renal failure after maintenance hemodialysis was significantly reduced. The risk factors of death and infection include hypertension, anemia, diabetes, etc. In contrast, the independent risk factors of death were anemia and high capacity load, and the independent risk factors of infection were diabetes, hypoalbuminemia, and central venous catheterization.