The importance of hypoalbuminemia in peritoneal dialysis patients: Impact of gender

Oxidation State in Peritoneal Dialysis in Patients with Type 2 Diabetes Mellitus

End-stage renal disease (ESRD) progression is closely related to oxidative stress (OS). The study objective was to determine the oxidant and antioxidant status in peritoneal dialysis (PD) patients with type 2 diabetes mellitus (DM). An analytical cross-sectional study from the PD program was carried out with 62 patients, 22 with and 40 without DM. Lipoperoxides (LPO) levels in patients with DM, 3.74 ± 1.09 mM/L, and without DM, 3.87 ± 0.84 mM/L were found to increase compared to healthy controls (HC) 3.05 ± 0.58 mM/L (p = 0.006). The levels of the oxidative DNA damage marker (8-OH-dG) were found to be significantly increased in patients with DM, 1.71 ng/mL (0.19-71.92) and without DM, 1.05 ng/mL (0.16-68.80) front to 0.15 ng/mL (0.15-0.1624) of HC (p = 0.001). The antioxidant enzyme superoxide dismutase (SOD) activity was found to be significantly increased in patients with DM, 0.37 ± 0.15 U/mL, and without DM, 0.37 ± 0.17 compared to HC, 0.23 ± 0.05 U/mL (p = 0.038). The activity of the enzyme glutathione peroxidase (GPx) showed a significant increase (p < 0.001) in patients with DM, 3.56 ± 2.18 nmol/min/mL, and without DM, 3.28 ± 1.46 nmol/min/mL, contrary to the activity obtained in HC, 1.55 ± 0.34 nmol/min/mL. In conclusion, we found an imbalance of oxidative status in patients undergoing PD with and without DM through the significant increase in LPO oxidants and the marker of oxidative damage in DNA. The activity of the antioxidant enzymes SOD and GPx were significantly increased in patients with and without DM undergoing PD, possibly in an attempt to compensate for the deregulation of oxidants. Antioxidant enzymes could be promising therapeutic strategies as a complement to the management of chronic kidney diseases.

Prognostic properties of hypoalbuminemia in COVID-19 patients: A systematic review and diagnostic meta-analysis

BACKGROUND

Coronavirus disease 2019 (COVID-19) elicits robust inflammatory reaction that may result in a declining albumin serum level. This meta-analysis aimed to evaluate the prognostic properties of hypoalbuminemia for poor prognosis and factors that may influence the relationship.

METHOD

A systematic literature search of PubMed was conducted from inception to April 22, 2021. The main exposure was albumin level below normal range-defined by the included studies. The outcome of interest was composite poor outcome that comprises of mortality, severity, and the requirement of mechanical ventilation or intensive care unit.

RESULTS

There were 6200 patients from 19 studies. Meta-analysis showed that hypoalbuminemia was associated with composite poor outcome (OR 6.97 (95% CI 4.20-11.55), p < 0.001; I2 = 91.3%, p < 0.001). Meta-regression analysis showed that age (p = 0.44), gender (p = 0.76), HT (p = 0.97), DM (p = 0.40), CKD (p = 0.65), liver disease (p = 0.72), and malignancy (p = 0.84) did not affect the association. Subgroup analysis showed that hypoalbuminemia increased mortality (OR 6.26 (95% CI 3.26-12.04), p < 0.001; I2 = 69.6%, p < 0.01) and severity of the disease (OR 7.32 (95%CI 3.94-13.59), p < 0.001; I2 = 92.5%, p < 0.01). Pooled diagnostic analysis of hypoalbuminemia yielded a sensitivity of 0.63 (95% CI 0.52-0.72), specificity of 0.81 (95% CI 0.73-0.87), and AUC of 0.77. The probability of poor outcome was 70% in patients with hypoalbuminemia and 24% in patients with normal albumin level.

CONCLUSION

Hypoalbuminemia was associated with poor prognosis in COVID-19 patients.

Risk factors and outcomes of cardiovascular disease readmission within the first year after dialysis in peritoneal dialysis patients

Background

In the first year of dialysis, patients are vulnerable to cardiovascular disease (CVD) hospitalization, but knowledge regarding the risk factors and long-term outcomes of cardiovascular readmission within the first year after dialysis in incident continuous ambulatory peritoneal dialysis (CAPD) patients is limited.

Methods

This retrospective cohort study was conducted in incident CAPD patients. The demographic characteristics, laboratory parameters, and CVD readmission were collected and analyzed. The primary outcome was all-cause mortality, and the secondary outcomes included CVD mortality, infection-related mortality and technique failure. A logistic regression was used to identify the risk factors associated with CVD readmission within the first year after dialysis. Cox proportional hazards models were used to evaluate the association between CVD readmission and the outcomes.

Results

In total, 1589 peritoneal dialysis (PD) patients were included in this study, of whom 120 (7.6%) patients had at least one episode of CVD readmission within the first year after dialysis initiation. Advanced age, CVD history, and a lower level of serum albumin were independently associated with CVD readmission. CVD readmission within the first year after dialysis was significantly associated with all-cause (HR 2.66, 95%CI 1.91–3.70, p < 0.001) and CVD (HR 3.42, 95%CI 2.20–5.31, p < 0.001) mortality, but not infection-related mortality or technique failure, after adjusting for confounders.

Conclusions

Our findings suggest that an advanced age, a history of CVD, and a lower level of serum albumin were independently associated with CVD readmission. Moreover, CVD readmission was associated with all-cause and cardiovascular mortality in incident CAPD patients.

Peritoneal dialysis outcomes in patients with nephrotic syndrome: a propensity score-matched cohort study

INTRODUCTION

It is unclear whether patients with end-stage renal disease (ESRD) and nephrotic syndrome (NS) can be treated with peritoneal dialysis (PD).

OBJECTIVES

To investigate the outcomes of PD treatment in ESRD patients with or without NS.

METHODS

In this retrospective cohort study, all incident patients with ESRD and NS who started PD from 1 February 2006 to 31 December 2017, were matched with patients without NS using propensity scores based on age, sex, diabetes mellitus status, and serum albumin.

RESULTS

Fifty-three patients in the NS PD group and 53 matched controls were included. The median survival of the NS PD group was comparable to that of the non-NS PD group. An interaction effect was observed between survival time and baseline NS status. Thus, patients' outcomes within and after 1.5 years were analyzed separately. Both mortality (log-rank test, p= .235) and technique failure (log-rank test, p= .543) rates within 1.5 years in patients with NS were comparable to those of the non-NS group. After 1.5 years, however, the NS status at baseline was associated with lower all-cause mortality (p= .020) and lower technique failure (p= .008) rates in PD patients compared with the non-NS group. The multivariable Cox regression analysis showed that compared with the patients in the non-NS PD group, PD patients with NS had both significantly lower all-cause mortality and lower technique failure rate after adjusting for other factors.

CONCLUSIONS

Our study indicates that PD may be considered as a long-term renal replacement therapy for patients with ESRD and baseline NS.

Recurrent Choroidal Detachment in Peritoneal Dialysis Patient with Hypervolemia and Dilutional Hypoalbuminemia: A Case Report

The following presents a case of recurrent choroidal detachments (CD) correlated with changes in serum albumin levels and the patient's fluid status. A 71-year-old female patient presented with a four-day history of blurry vision in her left eye. Pertinent medical history included end-stage renal disease treated with continuous ambulatory peritoneal dialysis. Previously, the patient's left eye was treated for primary angle-closure glaucoma by trabeculectomy. While this resulted in a low baseline intraocular pressure (IOP) of 2-7▒mmHg, the patient never developed any hypotony-related complications for the past six years. After examination, CD was diagnosed and treated with transscleral surgical drainage. The patient further developed two additional episodes of CD in the same eye. All episodes were also associated with bilateral pitting edema, weight gain, and hypoalbuminemia. Thus, the patient was recommended to take a protein supplement and limit her fluid intake. Additionally, the dialysis treatment regimen was altered to achieve greater daily fluid removal. After 12 weeks, there was no recurrent episode of CD, and the patient was clinically stable with a final visual acuity of 20/30 and an IOP of 3▒mmHg. The serum albumin levels improved slightly, and there were no signs of hypervolemia. In this case of recurrent CD, a possible association between the development of CD, hypoalbuminemia, and hypervolemia in patients with end-stage renal disease is demonstrated. Clinicians should be aware that these systemic factors can be tied with recurrent CDs, especially among patients with a low baseline IOP.

The Impact of Malnutrition on 30-Day Postoperative Complications following Surgical Fixation of Distal Radius Fractures

Introduction  Distal radius fractures (DRFs) are increasingly managed surgically among fragility fractures due to prolonged life expectancy and surgical advancements. Yet, malnutrition can impact postoperative outcomes and complications. We sought to determine the impact of malnutrition on open reduction and internal fixation (ORIF) of DRFs during the perioperative and 30-day postoperative periods. Materials and Methods  Using the National Surgical Quality Improvement Program database, all patients who underwent ORIF of a DRF between January 1, 2008, and December 31, 2016, were identified and stratified by preoperative serum albumin levels: normal (≥3.5 g/dL; n = 2,546) or hypoalbuminemia (<3.5 g/dL; n = 439). Demographical and perioperative data were compared. Operative complications were stratified into major and minor complications, and data were analyzed using descriptive statistics and multivariate regression models. Results  Compared with patients with normal levels, a higher proportion of hypoalbuminemia patients had ASA scores > 3 (9.1 vs. 2%) and a longer mean length of stay (3.16 vs. 0.83 days). Hypoalbuminemia patients also had 625% greater odds for developing major complications during the 30-day postoperative period (odds ratio = 7.25; 95% confidence interval: 1.91-27.49). Conclusion  Malnutrition significantly affected outcomes and complications of distal radius ORIF. This study highlights the importance of prevention and treatment of malnutrition in the setting of fragility fractures.