The first few months of hemodialysis (HD) are associated with a higher risk of mortality. Protein-energy malnutrition is a demonstrated major risk factor for mortality in this population. The ...C-Reactive Protein to Albumin ratio (CAR) has also been associated with increased mortality risk. The aim of this study was to determine the predictive value of CAR for six-month mortality in incident HD patients.
Retrospective analysis of incident HD patients between January 2014 and December 2019. CAR was calculated at the start of HD. We analyzed six-month mortality. A Cox regression was performed to predict six-month mortality and the discriminatory ability of CAR was determined using the receiver operating characteristic (ROC) curve.
A total of 787 patients were analyzed (mean age 68.34 ± 15.5 years and 60.6% male). The 6-month mortality was 13.8% (n = 109). Patients who died were significantly older (p < 0.001), had more cardiovascular disease (p = 0.010), had central venous catheter at the start of HD (p < 0.001), lower parathyroid hormone (PTH) level (p = 0.014) and higher CAR (p = 0.015). The AUC for mortality prediction was 0.706 (95% CI (0.65-0.76), p < 0.001). The optimal CAR cutoff was ≥0.5, HR 5.36 (95% CI 3.21-8.96, p < 0.001).
We demonstrated that higher CAR was significantly associated with a higher mortality risk in the first six months of HD, highlighting the prognostic importance of malnutrition and inflammation in patients starting chronic HD.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background: CKD is a significant cause of morbidity, cardiovascular and all-cause mortality. CHA2DS2-VASc is a score used in patients with atrial fibrillation to predict thromboembolic risk; it also ...appears to be useful to predict mortality risk. The aim of the study was to evaluate CHA2DS2-VASc scores as a tool for predicting one-year mortality after hemodialysis is started and for identifying factors associated with higher mortality. Methods: Retrospective analysis of patients who started hemodialysis between January 2014 and December 2019 in Centro Hospitalar Universitário Lisboa Norte. We evaluated mortality within one year of hemodialysis initiation. The CHA2DS2-VASc score was calculated at the start of hemodialysis. Results: Of 856 patients analyzed, their mean age was 68.3 ± 15.5 years and the majority were male (61.1%) and Caucasian (84.5%). Mortality within one-year after starting hemodialysis was 17.8% (n = 152). The CHA2DS2-VASc score was significantly higher (4.4 ± 1.7 vs. 3.5 ± 1.8, p < 0.001) in patients who died and satisfactorily predicted the one-year risk of mortality (AUC 0.646, 95% CI 0.6–0.7, p < 0.001), with a sensitivity of 71.7%, a specificity of 49.1%, a positive predictive value of 23.9% and a negative predictive value of 89.2%. In the multivariate analysis, CHA2DS2-VASc ≥3.5 (adjusted HR 2.24 95% CI (1.48–3.37), p < 0.001) and central venous catheter at dialysis initiation (adjusted HR 3.06 95% CI (1.93–4.85)) were significant predictors of one-year mortality. Conclusion: A CHA2DS2-VASc score ≥3.5 and central venous catheter at hemodialysis initiation were predictors of one-year mortality, allowing for risk stratification in hemodialysis patients.
Acute kidney injury (AKI) is associated with increased short-term mortality of septic patients; however, the exact influence of AKI on long-term mortality in such patients has not yet been ...determined.
We retrospectively evaluated the impact of AKI, defined by the "Risk, Injury, Failure, Loss of kidney function, End-stage kidney disease" (RIFLE) classification based on creatinine criteria, on 2-year mortality in a cohort of 234 hospital surviving septic patients who had been hospitalized at the Infectious Disease Intensive Care Unit of our Hospital.
Mean-follow-up was 21 +/- 6.4 months. During this period, 32 patients (13.7%) died. At 6 months, 1 and 2 years of follow-up, the cumulative probability of death of patients with previous AKI was 8.3, 16.9 and 34.2%, respectively, as compared with 2.2, 6 and 8.9% in patients without previous AKI (log-rank, P < 0.0001). In the univariate analysis, age (hazard ratio 1.4, 95% CI 1.2-1.7, P < 0.0001), as well as pre-existing cardiovascular disease (hazard ratio 3.6, 95% CI 1.4-9.4, P = 0.009), illness severity as evaluated by nonrenal APACHE II (hazard ratio 1.3, 95% CI 1.1-1.6, P = 0.002), and previous AKI (hazard ratio 4.2, 95% CI 2.1-8.5, P < 0.0001) were associated with increased 2-year mortality, while gender, race, pre-existing hypertension, cirrhosis, HIV infection, neoplasm, and baseline glomerular filtration rate did not. In the multivariate analysis, however, only previous AKI (hazard ratio 3.2, 95% CI 1.6-6.5, P = 0.001) and age (hazard ratio 1.4, 95% CI 1.2-1.6, P < 0.0001) emerged as independent predictors of 2-year mortality.
Acute kidney injury had a negative impact on long-term mortality of patients with sepsis.
Abstract
Background and Aims
Chronic kidney disease (CKD) is a leading cause of morbidity and mortality worldwide, with African descendants being at increased risk of occurrence and progression to ...end-stage renal disease (ESRD). However, the burden of CKD and ESRD in African continent is still largely conjectural and access to treatment of CKD is restricted in those countries. Africa contributes to <10% of the total renal replacement therapy (RRT) patients worldwide, mainly due to the high costs associated. The purpose of this analysis was to describe the clinical characteristics and outcomes of patients from African Countries of Portuguese Official Language (ACPOL) who integrated the HD program of a tertiary hospital in Portugal.
Method
Retrospective analysis of 126 African patients who integrated the HD program of a tertiary hospital in Portugal, between January 2015 and December 2019. Last follow-up was ascertained in January 2021.
Results
Mean age was 49.9 ± 14.1 years, and 53.6% were male (n = 71). Hypertension was a comorbidity in 96.0% (n = 121). Twenty-one patients came from Angola (16.7%), 53 from Cape Verde (42.1%), 23 from Guinea-Bissau (18.3%), 20 from Saint Thomas and Prince (15.9%), and 9 from Mozambique (7.1%). Motive for referral to Portugal was RRT requirement in 93.7% of the cases (n = 118) and vascular access (VA) dysfunction in 6.3% (n = 8); these 8 patients with VA dysfunction were already on hemodialysis program before their evacuation to Portugal and they were mainly from Cape Verde (n = 4), Angola (n = 3), and one patient from Guinea-Bissau. At arrival, patients who initiated HD in our unit had mean serum creatinine 9.4 ± 4.4 mg/dL, urea 182.5 ± 109.1 mg/dL, Hb 9.6 ± 1.7 g/dL, serum albumin 3.6 ± 0.6 g/dL, PTH 491.7 ± 392.6 pg/mL. Patients referred due to VA dysfunction had mean Hb 10.1 ± 1.8 g/dL, serum albumin 3.7 ± 1.0 g/dL, PTH 918.9 ± 541.6 pg/mL. There were no statistically significant differences in both groups concerning country of origin, although hypoalbuminemia was more frequent in patients from Saint Thomas and Prince (50%) and Angola (42.9%). All patients started HD with a central venous catheter (CVC). During follow-up, CVC remained the vascular access in 51.6% (n = 65), arteriovenous fistula in 42.9% (n = 54), and arteriovenous graft in 5.6% patients (n = 7). Nine patients had exhaustion of VA for HD. Mean follow-up time was 70.5 ± 41.3 months, 1.6% of the patients transitioned to peritoneal dialysis (n = 2) and 15.1% were submitted to renal transplantation (n = 18). The mortality rate during follow-up was 14.3% (n = 18).
Conclusion
There are few studies about African patients undergoing HD and this is the first study presenting the clinical characteristics and outcomes of hemodialysis patients from ACPOL. These are young patients, almost all with hypertension, with a high prevalence of anemia, malnutrition, and secondary hyperparathyroidism. All patients started HD with CVC and several presented multiple access dysfunction. These data reinforce the urgent need of improvement and investment in African countries’ healthcare, especially on what concerns the ESRD, as it contributes to serious consequences in these patients’ survival and quality of life. With the cooperation protocol, Portugal provides these patients with RRT, treatment of the CKD complications, VA care, possibility of peritoneal dialysis and renal transplantation, ultimately improving their chance of survival and quality of life.
A 74-year-old woman with diabetes mellitus, chronic renal failure requiring haemodialysis, and peripheral vascular disease conditioning critical limb ischaemia underwent endovascular ...revascularisation and amputation of two gangrenous toes.
Abstract
Background and Aims
Portugal has one of the highest incidences and prevalence of end-stage kidney disease in Europe, with haemodialysis (HD) being the most common modality of renal ...replacement therapy. The aim of our study was to analyse a cohort of patients who started HD in a large tertiary care hospital in Lisbon and describe the evolution of the patient characteristics throughout the studied years.
Method
This study was a retrospective analysis of all adult individuals who started HD between January of 2014 and December of 2019 in tertiary care hospital in Lisbon. Data was attained from individual electronic clinical records. The primary outcome was mortality. Statistical significance was defined as a P-value lower than 0.05.
Results
We included 1122 patients (mean age 64.9 ±16.8 years, 21.2% at least 80 years old; 60.9% male and 79.7% caucasian). At HD start, mean eGFR was 8.98 ±5.66mL/min/1.73 m2 and the vascular access was a central venous catheter in 56.0%, an arteriovenous fistula in 40.6% and an arteriovenous graft in 3.4%. The number of patients that started HD per year was variable between 169-204 and the percentage of elderly patients increased throughout the years. There was a trend of initiating dialysis with progressively lower eGFR. The percentage of patients with central venous catheter increased. In total 392 patients died (7.5% within the first 90 days of starting HD). Mortality rate within the first 90 days and first year declined from 2015 to 2019. As expected mortality was higher in older patients (Fig. 1), as well as in patients that started HD with a central venous catheter (Fig. 2).
Conclusion
We describe a large cohort of Portuguese patients that started HD between 2014-2019 that correlates well with the available recent data from the national and european registries. There was a greater percentage of patients initiating HD by catheter, which was associated with higher mortality, Although, considering the increase in elderly patients starting HD, their underlying comorbidities might impair vascular access placement and also have an impact on mortality. Additionally, despite the increase in elderly patients, mortality within the first 90 days and first year declined, highlighting the quality of care provided, in addition to a better acknowledgment and referal to conservative care.
Abstract Background and Aims Mortality within the first year after dialysis start is estimated to be 20-30%, and it is mostly due to cardiovascular disease. Prognostic assessment after starting ...hemodialysis is challenging. Clark et al. developed the Recovery and Death Outcome risk score, which accurately predicted the likelihood of renal recovery to dialysis independence and of death within 1 year after discharge from in-hospital dialysis initiation. These models can be used at discharge or soon after patients start outpatient dialysis. We aimed to validate the Death Outcome risk score to predict one-year mortality after dialysis start in our population. Method .Retrospective analysis of hospitalized patients who initiated hemodialysis in a tertiary care hospital (Unidade Local de Saúde Santa Maria), from January 1st of 2016 to December 31st of 2019, and were discharged to outpatient dialysis. The risk of death within one year of discharge was calculated according to the ReDO score. We evaluated all-cause mortality within one year of hospital discharge. We classified patients into death outcome risk groups (labeled D1 to D4) according to the ReDO predictive score. Cox regression method was used to determine if the risk score was predictive of mortality within the first year after discharge. The discriminatory ability for the ReDO score to predict mortality was determined using the receiver operating characteristic (ROC) curve. Results 369 patients were included, with a mean age of 71.1 ± 14.3 years. The majority were male (59.9%, n = 221) and 87% were Caucasian (n = 321). The median Charlson score was 7 ± 3. The mortality rate within one year after discharge was 22.2% (n = 82). The one-year survival was significantly lower in patients with the highest probability of death (D4 = 61.3% vs. D3 = 67.6% vs. D2 = 81.3% vs. D4 = 97.3%, p < 0.001). The ReDO Death score accurately predicted the one-year risk of mortality, with an area under the ROC curve of 0.741, 95% CI (0.687–0.794), p < 0.001 (Fig. 1). The optimal REDO Death risk cut-off was >30%, with a hazard ratio of 6.57 95% CI (3.48–12.2), p < 0.001 for one year risk of death, with a sensitivity of 78.0% and specificity of 60.6%. Conclusion We validated the ReDO score for 1-year mortality prediction after starting hemodialysis during hospitalization in a Portuguese population. This score can be used as a tool to inform goals of care discussion at the time of transition to out-of-hospital care, involving the in-hospital nephrology care team, the patient, and, if applicable, the future care team, as it can enlighten clinical decisions and, in some cases, lead to better end-of-life planning.
Objective
To determine risk factors for in-hospital mortality in elderly patients with acute kidney injury (AKI) requiring dialysis.
Introduction
AKI requiring dialysis is frequent in elderly and is ...associated with an increased intra-hospital mortality. With the growing number of older individuals among hospitalized patients with AKI demands a thorough investigation of the factors that contribute to their mortality to improve outcomes.
Methods
We performed a retrospective analysis of patients older than 80 years, admitted due to AKI requiring dialysis between January 2016 and December 2017. Patients who need intensive-care units (ICU) admission were excluded. The primary outcome was all-cause in-hospital mortality.
Results
A total of 154 patients were evaluated. The mean age was 85.3 ± 4.0 years and 76 patients (49.4%) were male. The overall mortality rate was 26.6%. On the multivariate analysis, serum albumin (OR 0.42 95% CI 0.21–0.85,
p
0.016), C reactive protein/albumin ratio (OR 1.04 95% CI 0.99–1.09, and renal function recovery (OR 018 95% CI 0.49–0.65,
p
0.009) were the factors associated with higher in-hospital mortality.
Conclusions
Lower albumin level, higher C reactive protein/albumin ratio at admission, and absence of renal function recovery are associated with increased in-hospital mortality’s risk in elderly with acute kidney injury requiring dialysis.
Abstract
BACKGROUND AND AIMS
Chronic kidney disease (CKD) is a significant cause of morbidity, cardiovascular and all-cause mortality. CHA2DS2VASc is a score system used in patients with atrial ...fibrillation to predict thromboembolic risk. However, it also appears to be useful to predict mortality risk. The aim of the study was to evaluate the CHA2D2SVASc score as a tool to predict 1-year mortality after starting haemodialysis and identify factors associated with higher mortality.
METHOD
Retrospective analysis of patients who started haemodialysis between January of 2014 and December of 2019 at Centro Hospitalar Universitário Lisboa Norte. We evaluated mortality within 1 year of starting haemodialysis. The CHA2D2SVASc score was calculated at the start of haemodialysis. Variables were submitted to univariate and multivariate analysis to determine factors predictive of 1-year mortality after HD start. We assessed the logistic regression method of the CHA2DS2VASc to predict 1-year mortality and the discriminatory ability was determined using the receiver operating characteristic curve.
RESULTS
Of 856 patients analyzed, the mean age was 68.3 ± 15.5 years, the majority were male (61.1%) and Caucasian (84.5%). Mortality within 1 year after haemodialysis started was 17.8% (n = 152). The CHA2D2SVASc score was significantly higher (4.4 ± 1.7 versus 3.5 ± 1.8; P < .001) in patients who died and accurately predicted the 1-year risk of mortality {AUC: 0.646, 95% confidence interval (95% CI) 0.6–0.7; P < .001}, with a sensitivity 71.7% and specificity of 49.1%, a positive predictive value of 23.9% and a negative predictive value of 89.2%. In the multivariate analysis, CHA2D2SVASc ≥3.5 (adjusted OR: 2.24, 95% CI 1.48–3.37; P < .001 and central venous catheter at dialysis start (adjusted HR: 3.06, 95% CI 1.93–4.85) were significant predictors of 1-year mortality.
CONCLUSION
CHA2D2SVASc score ≥ 3.5 and central venous catheter at haemodialysis start were predictors of 1-year mortality, allowing for risk stratification in haemodialysis patients.
Abstract
BACKGROUND AND AIMS
The prevalence of chronic kidney disease (CKD) is growing worldwide and ranges from 8% to 16%. Mortality rates are higher in the first few months of haemodialysis (HD). ...Protein-energy malnutrition has been demonstrated to be a major risk factor for mortality in this population. The C-Reactive Protein to Albumin ratio (CAR) has been associated with increased mortality risk. We aimed to evaluate if CAR could be used to predict 6-month mortality in incident HD patients.
METHOD
Retrospective analysis of CKD patients who initiated chronic HD between January of 2014 and December of 2019 in a tertiary-care hospital in Portugal. CAR was calculated at HD start. We analyzed 6-month mortality. Variables were submitted to univariate and multivariate analysis to determine factors predictive of 6-month mortality after HD start. We assessed the logistic regression method of the CAR to predict 6-month mortality and the discriminatory ability was determined using the receiver operating characteristic (ROC) curve.
RESULTS
A total of 787 patients were analyzed (mean age 68.34 ± 15.5 years and 60.6% male). The 6-month mortality was 13.8% (n = 109). Patients who died were significantly older 76.50 ± 11.39 versus 67.29 ± 15.52 years; P < 0.001, OR: 1.055 (1.035–1.074); P < 0.001, aOR: 1.058 (1.030–1.086); P < 0.001, had more frequently cardiovascular disease 65.1% versus 46.1%; P < 0.001, OR: 2.192 (1.437–3.342); P < 0.001, aOR: 2.210 (1.210–4.037); P = 0.010, central venous catheter at HD start 83.5% versus 58.3%; P < 0.001, OR: 3.622 (2.136–6.142); P < 0.001, aOR: 3.090 (1.584–6.026); P < 0.001, lower PTH 229.44 ± 170.50 versus 365.95 ± 415.80; P = 0.006, OR: 0.998 (0.996–0.999); P < 0.001, aOR: 0.998 (0.997–1.000); P = 0.014 and higher CAR 2.85 ± 3.85 versus 1.36 ± 2.44; P < 0.001, OR: 1.159 (1.086–1.236); P < 0.001, aOR: 1.126 (1.023–1.239); P = 0.015. The AUC for mortality prediction was of 0.706 95% confidence interval (0.65–0.76); P < 0.001. The optimal CAR cut-off was >0.5, with an odds ratio of 5.362 (95% CI 3.208–8.963; P < 0.001).
CONCLUSION
In our study, we demonstrated that higher CAR was independently associated with a higher mortality rate in the first 6 months of starting HD, highlighting the prognostic importance of malnutrition and inflammation in patients starting chronic HD.
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