1
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O'Lone E, Apple FS, Burton JO, Caskey FJ, Craig JC, de Filippi CR, Forfang D, Hicks KA, Jha V, Mahaffey KW, Mark PB, Rossignol P, Scholes-Robertson N, Jaure A, Viecelli AK, Wang AY, Wheeler DC, White D, Winkelmayer WC, Herzog CA. Defining Myocardial Infarction in trials of people receiving hemodialysis: consensus report from the SONG-HD MI Expert Working group. Kidney Int 2023; 103:1028-1037. [PMID: 37023851 DOI: 10.1016/j.kint.2023.02.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/22/2023] [Accepted: 02/15/2023] [Indexed: 04/08/2023]
Abstract
Cardiovascular disease is the leading cause of death in patients receiving hemodialysis. Currently there is no standardized definition of myocardial infarction (MI) for patients receiving hemodialysis. Through an international consensus process MI was established as the core CVD measure for this population in clinical trials. The Standardised Outcomes in Nephrology Group - Hemodialysis (SONG-HD) initiative convened a multidisciplinary, international working group to address the definition of MI in this population.Based on current evidence, the working group recommends using the 4th Universal Definition of MI with specific caveats with regard to the interpretation of "ischemic symptoms" and performing a baseline 12-lead electrocardiogram to facilitate interpretation of acute changes on subsequent tracings. The working group does not recommend obtaining baseline cardiac troponin values, though does recommend obtaining serial cardiac biomarkers in settings where ischemia is suspected. Application of an evidence-based uniform definition should increase the reliability and accuracy of trial results.
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Affiliation(s)
- E O'Lone
- The University of Sydney, Camperdown, Sydney, Australia.
| | - F S Apple
- Departments of Laboratory Medicine and Pathology, Hennepin Healthcare/Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota
| | - J O Burton
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital Leicester, Leicester, UK
| | - F J Caskey
- Population Health Sciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - J C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - C R de Filippi
- Inova Heart and Vascular Institute, Falls Church, VA, USA
| | - D Forfang
- The National Forum of ESRD Networks, Kidney Patient Advisory Council (KPAC) WI USA
| | - K A Hicks
- Division of Cardiology and Nephrology, Office of Cardiology, Hematology, Endocrinology, and Nephrology, Center for Drug Evaluation and Research (CDER), United States Food and Drug Administration, Silver Spring, Maryland, USA
| | - V Jha
- George Institute of Global Health, UNSW, New Delhi, India; School of Public Health, Imperial College, London, UK; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - K W Mahaffey
- The Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - P B Mark
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - P Rossignol
- Université de Lorraine, Centre d'Investigation Clinique Plurithématique 1433 -INSERM- CHRU de Nancy, Inserm U1116 & FCRIN INI-CRCT (Cardiovascular and RenalClinical Trialists), Vandoeuvre-les-Nancy, France; Medical specialties and nephrology -hemodialysis departments, Princess Grace Hospital, and Monaco Private Hemodialysis Centre, Monaco, Monaco
| | - N Scholes-Robertson
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - A Jaure
- The University of Sydney, Camperdown, Sydney, Australia; Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - A K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - A Y Wang
- Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - D C Wheeler
- University College London, London, United Kingdom
| | - D White
- American Association of Kidney Patients, Tampa, Florida
| | - W C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - C A Herzog
- Chronic Disease Research Group, Hennepin Healthcare Research Institute,Minneapolis, Minnesota; Division of Cardiology, Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, Minnesota
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2
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Tomura M, Hamasaki Y, Komaru Y, Miyamoto Y, Matsuura R, Matsumoto A, Doi K, Kume H, Nangaku M. Prognostic significance of concentric left ventricular hypertrophy at peritoneal dialysis initiation. BMC Nephrol 2021; 22:135. [PMID: 33863299 PMCID: PMC8052641 DOI: 10.1186/s12882-021-02321-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 03/24/2021] [Indexed: 01/19/2023] Open
Abstract
Background Concentric left ventricular hypertrophy (cLVH) is a common left ventricular geometric pattern in patients undergoing maintenance dialysis, including peritoneal dialysis (PD). The relationship between cLVH at PD initiation and the prognosis of patients remains unclear, however. This study aimed to investigate the impact of cLVH at PD initiation on patient survival and major adverse cardiovascular events (MACE). Methods The retrospective cohort study included 131 patients who underwent echocardiography during the PD initiation period. Based on echocardiographic measurements, cLVH was defined as a condition with increased LV mass index and increased relative wall thickness. The relationship between cLVH and the prognosis was assessed. Results Concentric LVH was identified in 29 patients (22%) at PD initiation, and patient survival, MACE-free survival and PD continuation were significantly reduced in the cLVH group compared with the non-cLVH group. In the Cox regression analysis, cLVH was demonstrated as an independent risk factor of mortality (HR [95%CI]: 3.32 [1.13–9.70]) for all patients. For patients over 65 years old, cLVH was significantly associated with mortality and MACE (HR [95%CI]: 3.51 [1.06–11.58] and 2.97 [1.26–7.01], respectively). Serum albumin at PD initiation was independently correlated with cLVH. Conclusions In our study, cLVH at PD initiation was independently associated with survival in all patients and with both survival and MACE in elderly patients. Evaluation of LV geometry at PD initiation might therefore help identify high-risk patients. Further studies involving larger numbers of patients are needed to confirm the findings from this study and clarify whether treatment interventions for factors such as nutrition status could ameliorate cLVH and improve patient outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02321-1.
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Affiliation(s)
- Misato Tomura
- Hemodialysis and Apheresis, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, Japan
| | - Yoshifumi Hamasaki
- Hemodialysis and Apheresis, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, Japan.
| | - Yohei Komaru
- Hemodialysis and Apheresis, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, Japan
| | - Yoshihisa Miyamoto
- Hemodialysis and Apheresis, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, Japan
| | - Ryo Matsuura
- Hemodialysis and Apheresis, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, Japan
| | | | - Kent Doi
- Acute Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Haruki Kume
- Urology, The University of Tokyo Hospital, Tokyo, Japan
| | - Masaomi Nangaku
- Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
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3
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Chiang CY, Huang SC, Chen M, Shih JY, Hong CS, Wu NC, Ho CH, Wu CC, Chen ZC, Chang WT. Effects of renal impairment on cardiac remodeling and clinical outcomes after myocardial infarction. Int J Med Sci 2021; 18:2842-2848. [PMID: 34220312 PMCID: PMC8241772 DOI: 10.7150/ijms.61891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/23/2021] [Indexed: 11/25/2022] Open
Abstract
How renal function influences post-acute myocardial infarction (AMI) cardiac remodeling and outcomes remains unclear. This study evaluated the impact of levels of renal impairment on drug therapy, echocardiographic parameters, and outcomes in patients with AMI undergoing percutaneous coronary intervention (PCI). A total of 611 patients diagnosed with AMI underwent successful PCI, and two echocardiographic examinations were performed within 1 year after AMI. Patients were categorized according to Group 1: severely impaired estimated glomerular filtration rate (eGFR)<30, Group 2: mildly impaired 30≤eGFR<60, Group 3: potentially at risk 60≤eGFR<90 and normal eGFR≥90 ml/min/1.73 m2. During the 5-year follow-up period, the primary endpoints were cardiovascular mortality and outcomes. Patients with worse renal function (eGFR<30) were older and had a higher prevalence of hypertension and diabetes, but relatively few were smokers or had hyperlipidemia. Despite more patients with lesions of the left anterior descending artery, those with worse renal function received suboptimal guideline-directed medical therapy (GDMT). Notably, patients with worse renal function presented with worse left ventricular function at baseline and subsequent follow-up. Kaplan-Meier analysis revealed increased cardiovascular death, development of heart failure, recurrent AMI and revascularization in patients with worse renal function. Notably, as focusing on patients with ST elevation MI, the similar findings were observed. In multivariable Cox regression, impaired renal function showed the most significant hazard ratio in cardiovascular death. Collectively, in AMI patients receiving PCI, outcome differences are renal function dependent. We found that patients with worse renal function received less GDMT and presented with worse cardiovascular outcomes. These patients require more attention.
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Affiliation(s)
- Chun-Yen Chiang
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan.,Department of Optometry, Chung Hwa University of Medical Technology, Rende District, Tainan
| | - Sheng-Chung Huang
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan
| | - Michael Chen
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan
| | - Jhih-Yuan Shih
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan.,Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan
| | - Chon-Seng Hong
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan
| | - Nan-Chun Wu
- Division of Cardiovascular Surgery, Department of Surgery, Chi Mei Medical Center, Tainan.,Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan
| | - Chung-Han Ho
- Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan.,Department of Hospital and Health Care Administration, Chi-Mei Medical Center, Tainan
| | - Chia Chun Wu
- Department of Hospital and Health Care Administration, Chi-Mei Medical Center, Tainan.,Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan
| | - Zhih-Cherng Chen
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan.,Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan
| | - Wei-Ting Chang
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan.,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan
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4
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Lemos Cerqueira T, Fartolino Guerrero A, Pérez Fermin CK, Wang R, Balbino EE, Breeze JL, Gonzalez Mego P, Argentina Silva D, Omer WE, Vandevelde NM. The Use of Aspirin to Reduce the Risk of Thrombotic Events in Patients With End-Stage Renal Disease: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e10516. [PMID: 30093367 PMCID: PMC6107730 DOI: 10.2196/10516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/25/2018] [Accepted: 05/28/2018] [Indexed: 12/23/2022] Open
Abstract
Background End-stage renal disease (ESRD) is the last stage of chronic kidney disease, mainly caused by type 2 diabetes mellitus and characterized by an increased mortality risk related to cardiovascular disease. Low-dose aspirin (acetylsalicylic acid or ASA) seems to effectively prevent cardiovascular events in patients with ESRD. However, the number of interventional studies in this population remains limited and the mechanisms of aspirin-related bleeding remain poorly understood. Aspirin’s efficacy and safety may be modified by the presence of type 2 diabetes mellitus or platelet hyperreactivity. Objective The overall objective of this protocol is to (1) evaluate aspirin’s safety and efficacy in reducing the risk of thrombotic events in patients with ESRD on hemodialysis and (2) examine whether aspirin’s efficacy is modified by the presence of type 2 diabetes mellitus or platelet hyperreactivity. Specifically, the primary objective is to compare the 12-month rate of any thrombotic event (cardiac death, nonfatal myocardial infarction, nonfatal stroke, arteriovenous fistula thrombosis) and Thrombolysis in Myocardial Infarction (TIMI) major bleeding in patients treated with aspirin compared to those on placebo. Secondary objectives are to test for effect modification of treatment by the presence of type 2 diabetes mellitus or platelet hyperreactivity and compare the rate of TIMI minor bleeding between treatment groups. Methods We developed a protocol for a phase 2 randomized, single-center, placebo-controlled, triple-blind, superiority clinical trial to assess the prophylactic efficacy and safety of aspirin in patients with ESRD and on hemodialysis. It follows the ethical principles of the Declaration of Helsinki of the World Medical Association. A total of 342 participants would be enrolled over 12 months at a large dialysis center. Patients will be randomized in a 1:1 ratio and stratified by presence of type 2 diabetes mellitus and platelet hyperreactivity to receive either oral aspirin (100 mg/d) or placebo for a treatment period of 12 months. An intention-to-treat statistical analysis will be performed. Results The randomized clinical trial will be performed after approval by the ethical committee of the participating center and registration at ClinicalTrials.gov. Conclusions We provide a protocol for a randomized controlled trial to evaluate the safety and efficacy of treatment with aspirin to reduce the risk of thrombotic events. In addition, such a study would further our understanding of the mechanism of aspirin-related bleeding and help identify subgroups of best-responders and patients with a higher risk of adverse events. Registered Report Identifier RR1-10.2196/10516
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Affiliation(s)
- Tiago Lemos Cerqueira
- Betim Nephrology Unit, Associaçao Evangélica Beneficente de Minas Gerais, Belo Horizonte, Brazil.,Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States.,Dresden International University, Dresden, Germany
| | - Armando Fartolino Guerrero
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States.,Family Health Strategy, São Paulo Municipal Health Department, São Paulo, Brazil
| | - Clara Krystal Pérez Fermin
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States.,Hematology-Oncology Unit, Hospital Infantil Regional Universitario Dr Arturo Grullón, Santiago De Los Caballeros, Dominican Republic
| | - Ricardo Wang
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States.,Cardiology Department, Santa Casa de Belo Horizonte, Unimed Belo Horizonte, Belo Horizonte, Brazil
| | - Evelin Elfriede Balbino
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States.,Agência Nacional de Vigilância Sanitária, Brasilia, Brazil
| | - Janis L Breeze
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, United States.,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University, Boston, MA, United States
| | - Paola Gonzalez Mego
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States.,Suiza Laboratory, Lima, Peru
| | - Daniele Argentina Silva
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States.,Faculdades Souza Marques, Rio de Janeiro, Brazil
| | - Walid Ezzeldin Omer
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States.,Hearing & Balance Unit, Hamad Medical Corporation, Doha, Qatar
| | - Nathalie Monique Vandevelde
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States.,Department of Quality of Medical Laboratories, Scientific Institute of Public Health, Brussels, Belgium
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5
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Abuzeid W, Iwanochko RM, Wang X, Kim SJ, Husain M, Lee DS. Prognostic impact of SPECT-MPI after renal transplantation. J Nucl Cardiol 2017; 24:295-303. [PMID: 27663251 DOI: 10.1007/s12350-016-0547-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 05/05/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND While renal transplantation is increasingly performed for end-stage renal disease, there is a paucity of data on cardiac screening and prognostication post-transplant. We determined the prognostic value of SPECT-MPI in a cohort who underwent renal transplantation. METHODS Among 4933 renal transplant recipients identified from the Canadian Organ Replacement Register, we examined outcomes of patients who underwent SPECT-MPI in Ontario, Canada. We determined morbidity and mortality using hospitalization and vital statistics registries, according to SPECT-MPI findings. RESULTS We studied 282 renal transplant recipients (median age 46 years [25th, 75th percentile 37, 58]) with detailed SPECT-MPI results available, followed for a median of 5.7 (3.3, 7.7) years. Among those undergoing SPECT-MPI (66% pharmacologic stress), 41% had an abnormal summed stress score (SSS > 0) and 31% demonstrated abnormal summed difference score (SDS > 0). Rates of cardiovascular death were 0.4 per 100 person-years among those with normal stress perfusion (SSS = 0) and 0.4 per 100 person-years with SDS = 0. After adjusting for age, sex, prior myocardial infarction (MI), and cardiac risk factors, an SSS ≥ 4 conferred increased risk of cardiovascular death or cardiovascular hospitalization with adjusted hazard ratios of 2.52 (95% CI 1.41, 4.52, P = .002) for SSS 4-6 and 2.61 (95% CI 1.52, 4.49, P < .001) for SSS ≥ 7. SDS was a significant predictor of cardiovascular death or hospitalization, with adjusted hazard ratios of 2.96 (95% CI 1.72, 5.09, P < .001) for SDS 4-6 and 3.26 (95% CI 1.64, 6.50, P < .001) for SDS ≥ 7. CONCLUSION Among renal transplant recipients, SPECT-MPI predicted risk of cardiovascular death and cardiovascular hospitalization events.
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Affiliation(s)
- Wael Abuzeid
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Robert M Iwanochko
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Robert J. Burns Nuclear Cardiology Laboratory and Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - Xuesong Wang
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - S Joseph Kim
- University of Toronto, Toronto, ON, Canada
- Division of Nephrology, University Health Network, Toronto, ON, Canada
| | - Mansoor Husain
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Robert J. Burns Nuclear Cardiology Laboratory and Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
- Ted Rogers Centre for Heart Research, Toronto, ON, Canada
| | - Douglas S Lee
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.
- University of Toronto, Toronto, ON, Canada.
- Robert J. Burns Nuclear Cardiology Laboratory and Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada.
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
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6
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Khater NA, Selim SA, Abd El-Baset SA, Abd El Hameed SH. Therapeutic effect of mesenchymal stem cells on experimentally induced hypertensive cardiomyopathy in adult albino rats. Ultrastruct Pathol 2016; 41:36-50. [PMID: 28029272 DOI: 10.1080/01913123.2016.1260080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hypertensive heart diseases affect millions of people worldwide. We aimed to investigate the hypertensive left ventricular histological changes and assess the effectiveness of bone marrow derived mesenchymal stem cells (MSCs) therapy in the treatment of hypertensive cardiomyopathy. Adult male albino rats were assigned into two groups: group I (control), group II (Experimental) subdivided into subgroup IIa (hypertensive) and subgroup IIb (stem cell therapy). Left ventricles (LVs) were processed for light and electron microscope. Mallory's trichrome and immunostaining for caspase-3 and desmin were carried out. Hypertension caused left ventricular histological and immunohistochemical changes that had been effectively improved by MSCs therapy.
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Affiliation(s)
- Nariman A Khater
- a Department of Histology and Cell Biology, Faculty of Medicine , Zagazig University , Zagazig , Egypt
| | - Sally A Selim
- a Department of Histology and Cell Biology, Faculty of Medicine , Zagazig University , Zagazig , Egypt
| | - Samia A Abd El-Baset
- a Department of Histology and Cell Biology, Faculty of Medicine , Zagazig University , Zagazig , Egypt
| | - Samar H Abd El Hameed
- a Department of Histology and Cell Biology, Faculty of Medicine , Zagazig University , Zagazig , Egypt
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7
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Michel A, Martín-Pérez M, Ruigómez A, García Rodríguez LA. Incidence and risk factors for severe renal impairment after first diagnosis of heart failure: A cohort and nested case–control study in UK general practice. Int J Cardiol 2016; 207:252-7. [DOI: 10.1016/j.ijcard.2016.01.167] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/14/2015] [Accepted: 01/09/2016] [Indexed: 01/05/2023]
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8
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Hassanien AA, Majeed A, Watt H. Retrospective observational study examining indications for hospitalisation among haemodialysis patients at one of the Ministry of Health Hospitals in Makkah, Saudi Arabia. JRSM Open 2014; 5:2054270414547146. [PMID: 25383197 PMCID: PMC4221914 DOI: 10.1177/2054270414547146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives To examine the indications for hospitalisations among haemodialysis patients. Design A retrospective observational study. Setting Alnoor Kidney Centre in Al Noor Specialist Hospital, Makkah City, Saudi Arabia, which is a Ministry of Health hospital. Participants Participants were prevalent patients with end-stage renal disease on regular haemodialysis in 2011, who had received haemodialysis for more than three months. Each patient was followed up retrospectively, from the first date of initiating haemodialysis to the end of 2011. Main outcome measures (i) The primary reasons for hospital admissions and (ii) risk factors that increase the number of hospital admissions and which increase length of stay in hospital. Results The primary reasons for hospital admissions associated with increases in the length of stay in hospital were diseases of the circulatory system (which increased hospital bed days by 70%; 95% CI: 11–161%; p value = 0.01 compared to all other reasons). The risk factors that increased the number of hospital admissions per patient-year at risk were increasing age (incidence rate ratio [IRR] = 1.02 per 1 year of age; 95% CI: 1.01–1.03; p value = < 0.0001); receiving haemodialysis through a catheter compared to arteriovenous fistula (IRR = 2.55; 95% CI: 1.14–4.97; p value = 0.001) and diabetes as a cause of renal disease compared to hypertension (IRR = 1.84; 95% CI: 1.29–2.63; p value = 0.001). Conclusion Indications for hospitalisation and consequences of practices related to hospitalisation for haemodialysis patients should be studied in further research to provide a comprehensive evidence-based management policy for haemodialysis patients in Saudi Arabia.
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Affiliation(s)
- Amal A Hassanien
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Azeem Majeed
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Hilary Watt
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
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9
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Danielson K, Beshara S, Qureshi AR, Heimbürger O, Lindholm B, Hansson M, Hylander B, Germanis G, Stenvinkel P, Barany P. Delta-He: a novel marker of inflammation predicting mortality and ESA response in peritoneal dialysis patients. Clin Kidney J 2014; 7:275-81. [PMID: 25852889 PMCID: PMC4377757 DOI: 10.1093/ckj/sfu038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 04/15/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Inflammation impairs erythropoiesis, iron availability and is associated with a higher mortality risk in patients with end-stage renal disease. We studied the associations between Delta-He [the difference between the reticulocyte haemoglobin content (Ret-He) and erythrocyte haemoglobin content], a suggested marker of iron availability, and markers of inflammation, iron status, response to erythropoiesis-stimulating agents (ESAs) and mortality in prevalent peritoneal dialysis (PD) patients. METHODS Eighty-two PD patients were followed weekly for 12 weeks with an additional follow-up of 36 months. Delta-He, Ret-He and high-sensitivity C-reactive protein (hs-CRP) were measured weekly and interleukin-6 (IL-6) and iron markers every fourth week. Mortality risk was assessed by Cox proportional hazards model adjusting for potential confounding factors. The relationships between ESA response, inflammatory markers, iron markers and Delta-He were evaluated in the PD patients. The relationship between Delta-He and iron markers was analysed in 87 healthy subjects. RESULTS Delta-He correlated with IL-6 (rho = 0.48, P < 0.001), hs-CRP (rho = 0.36, P < 0.001) and ESA hyporesponsivess index (EHRI; rho = -0.44, P < 0.001) in the PD patients. Delta-He did not correlate with iron markers in PD patients nor in healthy subjects. The mean Delta-He levels were significantly different between the tertiles of EHRI (P < 0.01). Delta-He was associated with all-cause mortality risk in PD patients after adjusting for age, gender, hs-CRP, comorbidity and nutritional status [OR 0.70 (0.51-0.96), P < 0.05]. CONCLUSIONS Delta-He independently predicts all-cause mortality in PD patients after adjusting for potential confounders and is a predictor of ESA response in PD patients.
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Affiliation(s)
- Kristin Danielson
- Institution of Laboratory Medicine , Karolinska Institutet , Stockholm , Sweden
| | - Soheir Beshara
- Institution of Laboratory Medicine , Karolinska Institutet , Stockholm , Sweden
| | - Abdul Rashid Qureshi
- Division of Baxter Novum, CLINTEC, Department of Clinical Science, Intervention and Technology , Karolinska Institutet , Stockholm , Sweden ; Renal Medicine, CLINTEC , Karolinska institutet , Stockholm , Sweden
| | - Olof Heimbürger
- Renal Medicine, CLINTEC , Karolinska institutet , Stockholm , Sweden
| | - Bengt Lindholm
- Division of Baxter Novum, CLINTEC, Department of Clinical Science, Intervention and Technology , Karolinska Institutet , Stockholm , Sweden ; Renal Medicine, CLINTEC , Karolinska institutet , Stockholm , Sweden
| | - Magnus Hansson
- Institution of Laboratory Medicine , Karolinska Institutet , Stockholm , Sweden
| | - Britta Hylander
- Renal Medicine, CLINTEC , Karolinska institutet , Stockholm , Sweden
| | - Guna Germanis
- Clinical Sciences, Danderyd Hospital , Karolinska Institutet , Stockholm , Sweden
| | - Peter Stenvinkel
- Renal Medicine, CLINTEC , Karolinska institutet , Stockholm , Sweden
| | - Peter Barany
- Renal Medicine, CLINTEC , Karolinska institutet , Stockholm , Sweden
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10
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Bang K, Kim MG, Byeon N, Kim Y, Jeong JC, Ro H, Oh YK, Min SI, Ha J, Cho W, Yang J, Ahn C. Current Management for Patients on the Waiting List of Deceased Donor Kidney Transplantation in Korea. ACTA ACUST UNITED AC 2010. [DOI: 10.4285/jkstn.2010.24.4.272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Kitae Bang
- Department of Internal Medicine, Eulji University of Medicine, Daejeon, Korea
| | - Myung-gyu Kim
- Transplantation Center, Seoul National University Hospital, Seoul, Korea
| | - Nyeonim Byeon
- Transplantation Center, Seoul National University Hospital, Seoul, Korea
| | - Yoonjung Kim
- Transplantation Center, Seoul National University Hospital, Seoul, Korea
| | - Jong Cheol Jeong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Han Ro
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yun Kyu Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-il Min
- Transplantation Center, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jongwon Ha
- Transplantation Center, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - WonHyun Cho
- Department of Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Jaeseok Yang
- Transplantation Center, Seoul National University Hospital, Seoul, Korea
- Transplantation Research Institute, Seoul National University, Seoul, Korea
| | - Curie Ahn
- Transplantation Center, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Transplantation Research Institute, Seoul National University, Seoul, Korea
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11
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Rodríguez-García M, Gómez-Alonso C, Naves-Díaz M, Diaz-Lopez JB, Diaz-Corte C, Cannata-Andía JB. Vascular calcifications, vertebral fractures and mortality in haemodialysis patients. Nephrol Dial Transplant 2008; 24:239-46. [PMID: 18725376 PMCID: PMC2639312 DOI: 10.1093/ndt/gfn466] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Vascular calcifications and the bone fractures caused by abnormal bone fragility, also called osteoporotic fractures, are frequent complications associated with chronic kidney diseases (CKD). The aim of this study was to investigate the association between vascular calcifications, osteoporotic bone fractures and survival in haemodialysis (HD) patients. METHODS A total of 193 HD patients were followed up to 2 years. Vascular calcifications and osteoporotic vertebral fractures (quoted just as vertebral fractures in the text) were assessed by thoracic, lumbar spine, pelvic and hand X-rays and graded according to their severity. Clinical, biochemical and therapeutic data gathered during the total time spent on HD were collected. RESULTS The prevalence of aortic calcifications was higher in HD patients than in a random-based general population (79% versus 37.5%, P < 0.001). Total time on any renal replacement therapy (RRT) and diabetes were positively associated with a higher prevalence of vascular calcifications. In addition to these factors, time on HD was also positively associated with the severity of vascular calcifications, and higher haemoglobin levels were associated with a lower prevalence of severe vascular calcifications in large and medium calibre arteries. The prevalence of vertebral fractures in HD patients was similar to that of the general population (26.5% versus 24.1%). Age and time on HD showed a positive and statistically significant association with the prevalence of vertebral fractures. Vascular calcifications in the medium calibre arteries were associated with a higher rate of prevalent vertebral fractures. In women, severe vascular calcifications and vertebral fractures were positively associated with mortality [RR = 3.2 (1.0-10.0) and RR = 4.8 (1.7-13.4), respectively]. CONCLUSIONS Positive associations between vascular calcifications, vertebral fractures and mortality have been found in patients on HD.
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Affiliation(s)
| | | | | | | | - Carmen Diaz-Corte
- Nephrology Unit, Instituto Reina Sofia de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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12
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Abstract
Renal transplantation is the preferred therapeutic option for patients with end-stage renal disease. Survival rates are much higher in patients who receive a transplant. Patients with renal failure have significant concomitant medical conditions, such as cardiovascular disease. This article provides an overview of the important issues to be considered in patients undergoing renal transplant, and discusses the anaesthetic management of these patients.
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Affiliation(s)
- H SarinKapoor
- Department of Anaesthesiology and Intensive Care, Fortis Hospital, Amritsar, India.
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13
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Al-Absi AI, Wall BM, Aslam N, Mangold TA, Lamar KD, Wan JY, D'Cruz IA. Predictors of Mortality in End-Stage Renal Disease Patients with Mitral Annulus Calcification. Am J Med Sci 2006; 331:124-30. [PMID: 16538072 DOI: 10.1097/00000441-200603000-00003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Mitral annulus calcification (MAC) is an independent predictor of cardiovascular mortality in the general population. The purpose of the current historical cohort study is to assess risk factors for long-term mortality in end-stage renal disease (ESRD) patients with MAC (n = 30; age, 62 +/- 2 yr), as compared to ESRD patients without MAC (n = 30; age, 63 +/- 2 yr). Additional analysis compared ESRD patients with MAC to non-ESRD patients with MAC (n = 32; age, 66 +/- 2 yr). METHODS The groups included age-matched male patients followed at a single center. Long-term survival was assessed by Kaplan-Meier analysis. Regular and stepwise Cox proportional hazards models were used to determine risk factors for mortality. RESULTS There was a similarly high prevalence of cardiovascular complications, including hypertension, coronary artery disease, left ventricular hypertrophy, atrial fibrillation, and congestive heart failure, in all three groups. Median survival time was significantly longer in non-ESRD patients (90 months), compared with the ESRD with MAC (45 months) and ESRD without MAC (45 months) patients (log-rank test; P < 0.001). With stepwise Cox proportional hazards model, including ESRD patients with MAC and ESRD patients without MAC, increased calcium x phosphate product, decreased serum creatinine concentration, and the presence of coronary artery disease and lower extremity amputations were independent predictors of mortality for patients with ESRD. With stepwise Cox proportional hazards model, including ESRD patients with MAC and non-ESRD patients with MAC, the presence of ESRD, atrial fibrillation, diabetes, aortic valve calcification, coronary artery disease, and tricuspid regurgitation were independent predictors of mortality. CONCLUSION The mortality rate was high in ESRD patients, approximately 15% per year. After accounting for baseline cardiovascular disease and traditional risk factors, the presence of MAC did not confer additional risk for mortality.
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Affiliation(s)
- A I Al-Absi
- Department of Medicine, Divisions of Nephrology and Cardiology, Veterans Affairs Medical Center, Memphis, Tennessee 38104, USA
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14
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Dussol B, Bonnet JL, Sampol J, Savin B, De La Forte C, Mundler O, Habib G, Morange S, Barrau K, Loundoun A, Vacher-Coponat H, Berland Y. Prognostic value of inducible myocardial ischemia in predicting cardiovascular events after renal transplantation. Kidney Int 2005; 66:1633-9. [PMID: 15458460 DOI: 10.1111/j.1523-1755.2004.00929.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aims of the present study were to determine the prevalence of inducible myocardial ischemia (IMI) in renal transplant recipients (RTR) more than 50 years old, to identify predictors of IMI, and to search for its prognostic value. METHODS Among the 377 renal transplantations performed between 1989 and 1998 in a single institution, 120 were done in patients > or =50 years old, and 97 were recruited for the study. During the last quarter of 1998, all of them underwent an exercise test (EST), an exercise-thallium 201 single photon emission computed tomography coupled with dipyridamole (SPECT), and 81% of them had a dobutamine stress echocardiography (DSE). Patients with IMI subsequently underwent coronary angiography to detect coronary stenosis. RESULTS IMI was present in 12 of the 97 patients (10%). The diagnosis was evidenced by EST in four cases, by SPECT in 11 cases, and DSE in three cases. Five of these 12 patients (42%) had significant coronary artery stenosis (> or =50%). Multivariate analysis of several pre- and post-transplant variables evidenced acute rejection and left ventricular hypertrophy as significant correlates of IMI (both P < 0.03). Patients were prospectively followed-up for 48 months for the occurrence of major cardiovascular events. Kaplan-Meier analysis revealed a significant increase in cardiovascular events in the IMI group (P < 0.0001). In addition, the Cox proportional hazards model revealed that IMI and diabetes mellitus had an independent significant effect on the occurrence of major cardiovascular events. CONCLUSION IMI was present in 10% of RTR aged > or =50 years, and was predicted by acute rejection and left ventricular hypertrophy. IMI had a strong effect on major cardiovascular events in this population.
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Affiliation(s)
- Bertrand Dussol
- Service de Néphrologie et Hémodialyse, Hôpital de la Conception, Marseille, France.
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15
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Hypertension in Patients on Renal Replacement Therapy. Hypertension 2005. [DOI: 10.1016/b978-0-7216-0258-5.50143-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Obialo CI, Sharda S, Goyal S, Ofili EO, Oduwole A, Gray N. Ability of troponin T to predict angiographic coronary artery disease in patients with chronic kidney disease. Am J Cardiol 2004; 94:834-6. [PMID: 15374805 DOI: 10.1016/j.amjcard.2004.05.075] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2004] [Revised: 05/05/2004] [Accepted: 05/05/2004] [Indexed: 11/29/2022]
Abstract
Association between angiographic coronary artery disease and cardiac troponin T levels has been observed in patients with normal kidney function; however, this association remains unsettled in patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD). Over a 12-month period we retrospectively reviewed coronary angiograms (CAs) performed in 194 hospitalized patients with presumed acute myocardial injury. About 50% of the ESRD and 30% of the CKD patients had normal CAs. Troponin T levels significantly correlated with CAs in patients with normal kidney function (r = 0.4, p = 0.005) but not in ESRD and CKD patients (r = 0.2, p = NS, respectively).
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Affiliation(s)
- Chamberlain I Obialo
- Department of Medicine, Morehouse School of Medicine, Grady Memorial Hospital, 720 West View Drive SW, Atlanta, GA 30310, USA.
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17
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Oflaz H, Turkmen A, Kocaman O, Erdogan D, Meric M, Oncul A, Koylan N, Yilmaz E, Yilmaz C, Selcukbiricik F, Kasikcioglu E, Sever MS. Is there a relation between duration of cyclosporine usage and right and left ventricular function in renal transplant patients? Tissue Doppler Echocardiography study. Transplant Proc 2004; 36:1380-4. [PMID: 15251337 DOI: 10.1016/j.transproceed.2004.04.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Our aim was to investigate the effect of cyclosporine (CsA), which is commonly used in renal transplant patients and causes myocardial fibrosis and elevated arterial tension, on cardiac function. METHODS Sixty-six renal transplant patients (RTPs) and 25 healthy controls were included in the study. Renal transplantation patients were divided according to time of CsA exposure: group 1 (0 to 36 months); group 2 (36 to 72 months) and group 3 (> 72 months). Systolic peak velocity (Sm, mitral; St, tricuspid) and mitral early (e)/late (a) (Me/a) and tricuspid e/a (Te/a) waves of the right and the left ventricles were measured by pulse-wave (PW) Doppler used for tissue Doppler imaging of both ventricles as well as the ventricle free wall near to the lateral tricuspid and the posterior mitral leaflets. The measurements included conventional diastolic early (E) and late (A) waves and deceleration time (DT) of the E wave, isovolumetric relaxation time (IVRT) of both ventricles, as well as left ventricular systolic ejection fraction (EF). RESULTS There were no statistically significant differences between the groups with regard to demographic, clinical, and most biochemical characteristics. Left ventricular EF was normal in all groups; there were no statistically significant differences. IVRT and DT of left ventricle and right ventricle DT values were similar among RTPs. On the other hand, values were found to be increased in RTP groups compared with the control group. E/A ratio, Me/a Te/a of both ventricles were similar among RTPs. However, these values were found to be decreased in RTP groups compared with the control group. CONCLUSIONS Although left ventricular systolic functions were normal in all groups, there were statistically significant impairments of biventricular diastolic function parameters among renal transplant recipients compared with the control group.
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Affiliation(s)
- H Oflaz
- Department of Cardiology, Capa, Istanbul
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18
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Khan S, Tighiouart H, Kalra A, Raman G, Rohrer RJ, Pereira BJG. Resource utilization among kidney transplant recipients. Kidney Int 2003; 64:657-64. [PMID: 12846763 DOI: 10.1046/j.1523-1755.2003.00102.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hospitalization consumes a significant portion of the end-stage renal disease (ESRD) program, which includes kidney transplant recipients. Identification of kidney transplant recipients at risk of increased resource utilization could lead to appropriate interventions to attenuate the complications related to kidney transplant, which may reduce resource utilization. METHODS This retrospective cohort study of kidney transplant recipients was performed to identify risk factors for hospital utilization. The study population consisted of patients who received kidney transplant at our center between October 1990 and September 1999 and were followed in the outpatient clinic. RESULTS Of the 220 patients, 171 (78%) were hospitalized during a median follow-up of 36 months. The number of hospitalizations, hospital days, and outpatient visits per patient-year at risk were 1.1, 6.3, and 21.6, respectively. Infection episodes were the leading cause of hospitalization. In a multivariate regression analysis, cytomegalovirus (CMV)-positive status of donor (RR 1.58; 95% CI 1.15, 2.18) and a higher number of hospital days during the transplant hospitalization (RR 1.10 per 7 days increase; 95% CI 1.03, 1.19) were associated with a higher risk of hospitalization, while higher serum albumin (RR 0.84 per 0.5 g/dL increase; 95% CI 0.73, 0.97), higher hematocrit (RR 0.95 per 1% increase; 95% CI 0.92, 0.98), higher glomerular filtration rate (GFR) (RR 0.91 per 10 mL/min/1.73 m2; 95% CI 0.85, 0.99), and an increased interval since transplant (RR 0.84 per 6 months increase; 95% CI 0.75, 0.93) were associated with a lower risk of hospitalization. CMV-positive status of the donor (RR 1.11; 95% CI 1.00, 1.21) and presence of cardiovascular disease (RR 1.12; 95% CI 1.00, 1.24) were associated with a higher risk of outpatient visits, while Caucasian race (RR 0.82; 95% CI 0.73, 0.94), higher serum albumin (RR 0.88 per 0.5 g/dL increase; 95% CI 0.84, 0.93), higher hematocrit (RR 0.96 per 1% increase; 95% CI 0.95, 0.97), and an increased interval since transplant (RR 0.79 per 6 months increase; 95% CI 0.76, 0.83) were associated with a lower risk of outpatient visits. CONCLUSION Identification of risk factors associated with increase resource utilization among kidney transplant recipients could aid in the development of targeted interventions to improve clinical and economic outcomes.
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Affiliation(s)
- Samina Khan
- Division of Nephrology, Department of Medicine, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.
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19
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Burke SK, Dillon MA, Hemken DE, Rezabek MS, Balwit JM. Meta-analysis of the effect of sevelamer on phosphorus, calcium, PTH, and serum lipids in dialysis patients. ADVANCES IN RENAL REPLACEMENT THERAPY 2003; 10:133-45. [PMID: 12879374 DOI: 10.1053/jarr.2003.50016] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hyperphosphatemia and dyslipidemia are common clinically significant conditions in end-stage renal disease (ESRD). Hyperphosphatemia management is essential; however, use of calcium-based phosphate binder has been associated with elevated risk of cardiac calcification in ESRD, increasing risks for cardiovascular disease and death. An alternative to calcium-based phosphate binders is sevelamer hydrochloride, a calcium-free, metal-free, nonabsorbed polymer that binds phosphate effectively. We conducted a meta-analysis on the effects of sevelamer hydrochloride on parameters of mineral metabolism (serum phosphorous, calcium, Ca x P, and iPTH) and the lipid profile (total, LDL, HDL, and non-HDL cholesterol, and triglycerides) in dialysis patients. After application of inclusion/exclusion criteria, 17 core studies were statistically analyzed to determine the sevelamer treatment effect on the study parameters as demonstrated by simple, n-weighted, and inverse variance-weighted mean changes. Analysis of inverse variance-weighted mean changes indicated that sevelamer treatment was associated with a 2.14 mg/dL drop in serum phosphorus (P <.001), no significant overall effect on calcium (0.09 mg/dL, P =.364), significant decline in Ca x P product (15.91 mg(2)/dL(2), P <.001), 35.99 pg/mL reduction in iPTH (P =.026), significant reduction in total cholesterol (30.58 mg/dL, P <.001), 31.38 mg/dL drop in LDL cholesterol (P <.001), significant increase in HDL cholesterol (4.09 mg/dL, P =.008), and a significant reduction in triglycerides (22.04 mg/dL, P x.001). This meta-analysis suggests that sevelamer offers a dual therapeutic benefit in dialysis patients-a population at high risk for cardiovascular disease-by improving phosphorus control and the lipid profile, without altering serum calcium.
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Affiliation(s)
- Steven K Burke
- Genzyme Corporation, 153 Second Avenue, Waltham, MA 02451, USA.
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20
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Abstract
Patients with end-stage renal disease (ESRD) who are on renal replacement therapy (RRT) usually have a certain number of comorbid factors. Cardiovascular diseases are the most common comorbidities and the most common causes of mortality in ESRD patients. Noncardiovascular comorbid factors including nutrition also have impact on survival of ESRD patients on RRT. There are scarce data regarding comorbidity in developing countries. Available data have shown that hypertension, diabetes, and various cardiovascular disorders are the leading comorbidities. Improvement in outcome for ESRD patients would depend on improving quality in RRT as well as a better understanding and management of comorbid conditions.
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Affiliation(s)
- Somchai Eiam-Ong
- King Chulalongkorn Memorial Hospital and Queen Saovabha Memorial Institute, Bangkok, Thailand
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21
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Danovitch GM, Hariharan S, Pirsch JD, Rush D, Roth D, Ramos E, Starling RC, Cangro C, Weir MR. Management of the waiting list for cadaveric kidney transplants: report of a survey and recommendations by the Clinical Practice Guidelines Committee of the American Society of Transplantation. J Am Soc Nephrol 2002; 13:528-535. [PMID: 11805184 DOI: 10.1681/asn.v132528] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The Clinical Practice Guidelines Committee of the American Society of Transplantation developed a survey to review the policies of kidney transplant programs in the United States with respect to the management of the steadily expanding waiting list for cadaveric kidneys. The survey was sent to 287 centers, and 192 (67%) responded. The survey indicated that regular follow-up monitoring, most frequently on an annual basis, is required by the majority (71%) of programs. Patients considered to be at high risk and candidates for combined kidney-pancreas transplantation may be monitored more frequently. Annual screening for coronary artery disease is typically required for asymptomatic patients considered to be at high risk for covert disease. Noninvasive techniques are typically used, and a designated cardiologist is usually available to the transplant program. The dialysis nephrologist or the potential transplant recipient is expected to inform the transplant program of intercurrent events that may affect transplant candidacy. Standard health maintenance screening is required, together with the routine updating of serologic and other blood tests that may be relevant to the posttransplant course. Smaller transplant programs (<100 patients on the waiting list) are more likely to maintain closer contact with the wait-listed patients and to attempt to influence their treatment during dialysis and are less likely to cancel transplants because of unanticipated pretransplant medical problems. The work load necessitated by the follow-up monitoring of wait-listed patients was assessed and, in the absence of specific evidence-based information, a series of recommendations were developed to reflect current standards of practice and to suggest future research initiatives.
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Affiliation(s)
- Gabriel M Danovitch
- *Division of Nephrology, University of California, Los Angeles, School of Medicine, Los Angeles, California; Division of Nephrology; Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Surgery, University of Wisconsin Hospital, Madison, Wisconsin; Health Science Center, Winnipeg, Manitoba; Division of Nephrology, University of Miami, Miami, Florida; Division of Nephrology, University of Maryland, Baltimore, Maryland; and Division of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Sundaram Hariharan
- *Division of Nephrology, University of California, Los Angeles, School of Medicine, Los Angeles, California; Division of Nephrology; Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Surgery, University of Wisconsin Hospital, Madison, Wisconsin; Health Science Center, Winnipeg, Manitoba; Division of Nephrology, University of Miami, Miami, Florida; Division of Nephrology, University of Maryland, Baltimore, Maryland; and Division of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | | | - David Rush
- *Division of Nephrology, University of California, Los Angeles, School of Medicine, Los Angeles, California; Division of Nephrology; Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Surgery, University of Wisconsin Hospital, Madison, Wisconsin; Health Science Center, Winnipeg, Manitoba; Division of Nephrology, University of Miami, Miami, Florida; Division of Nephrology, University of Maryland, Baltimore, Maryland; and Division of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - David Roth
- *Division of Nephrology, University of California, Los Angeles, School of Medicine, Los Angeles, California; Division of Nephrology; Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Surgery, University of Wisconsin Hospital, Madison, Wisconsin; Health Science Center, Winnipeg, Manitoba; Division of Nephrology, University of Miami, Miami, Florida; Division of Nephrology, University of Maryland, Baltimore, Maryland; and Division of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Emilio Ramos
- *Division of Nephrology, University of California, Los Angeles, School of Medicine, Los Angeles, California; Division of Nephrology; Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Surgery, University of Wisconsin Hospital, Madison, Wisconsin; Health Science Center, Winnipeg, Manitoba; Division of Nephrology, University of Miami, Miami, Florida; Division of Nephrology, University of Maryland, Baltimore, Maryland; and Division of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Randall C Starling
- *Division of Nephrology, University of California, Los Angeles, School of Medicine, Los Angeles, California; Division of Nephrology; Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Surgery, University of Wisconsin Hospital, Madison, Wisconsin; Health Science Center, Winnipeg, Manitoba; Division of Nephrology, University of Miami, Miami, Florida; Division of Nephrology, University of Maryland, Baltimore, Maryland; and Division of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Chuck Cangro
- *Division of Nephrology, University of California, Los Angeles, School of Medicine, Los Angeles, California; Division of Nephrology; Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Surgery, University of Wisconsin Hospital, Madison, Wisconsin; Health Science Center, Winnipeg, Manitoba; Division of Nephrology, University of Miami, Miami, Florida; Division of Nephrology, University of Maryland, Baltimore, Maryland; and Division of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Mattthew R Weir
- *Division of Nephrology, University of California, Los Angeles, School of Medicine, Los Angeles, California; Division of Nephrology; Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Surgery, University of Wisconsin Hospital, Madison, Wisconsin; Health Science Center, Winnipeg, Manitoba; Division of Nephrology, University of Miami, Miami, Florida; Division of Nephrology, University of Maryland, Baltimore, Maryland; and Division of Cardiology, Cleveland Clinic, Cleveland, Ohio
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