Purpose
Hyperuricemia has been associated with higher mortality in the general population, but less is known about CKD patients. The aim of our study was to determine the impact of elevated serum ...uric acid on cardiovascular mortality of CKD patients who later progress to hemodialysis.
Methods
In this retrospective study, 120 CKD patients (entire population of patients with ESKD on January 1st, 2012) were observed from their first visit at the Nephrology outpatient clinic, while transitioning to hemodialysis, and until their death or January 1, 2016. After non-cardiovascular death exclusion, 83 CKD patients (33 female, 50 male) were left for further analysis. The average time of observation was 8.8 ± 4.2 years. Serum uric acid was measured regularly (every 3 months). No patients were treated for hyperuricemia. Mean uric acid of 420 µmol/L was set as a cut-off between normouricemic and hyperuricemic patients as per the laboratory’s reference values. Survival rates were analyzed using Kaplan–Meier survival curves. Three Cox regression models were used to assess the influence of uric acid on survival.
Results
Mean uric acid was 379.8 ± 71.6 µmol/L (range 220–574). Sixty-three (75.9%) patients were normouricemic and 20 (24.1%) were hyperuricemic. Cholesterol was the only variable to show statistically significant difference (
p
= 0.004) between the groups. Bivariate analysis revealed an association between death and age, hyperuricemia, arterial hypertension, and history of cardiovascular disease. Kaplan–Meier survival analysis showed higher risk of cardiovascular death for hyperuricemic patients (log rank test;
p
< 0.0005). In Cox regression models, hyperuricemia remained a predictor of cardiovascular mortality (SE = 0.500, Exp(
B
) = 14.120, 95% CI 5.297–37.640) in our patients next to age and arterial hypertension.
Conclusion
The results indicate an association between hyperuricemia and cardiovascular mortality in CKD patients who transition to hemodialysis.
Monitoring of arteriovenous (AV) fistula to detect hemodynamically important stenosis is crucial for the prevention of AV fistula thrombosis. The aim of our study was to analyze the importance of ...dialysis dose (Kt/V) during online postdilution hemodiafiltration (HDF) for early detection of AV fistula stenosis.
Hemodialysis patients with AV fistula were included in this study. We compared a group of 44 patients who have undergone fistulography and subsequently percutaneous transluminal angioplasty (PTA) of significant AV fistula stenosis (active group) with a group of 44 age- and sex-matched patients without PTA (control group). Observational time in both groups was the same.
All patients had postdilution online HDF using a F5008 dialysis machine, which can measure online single-pool Kt/V. All data were analyzed during the performance of 2056 HDF procedures. In the active group, we found statistically significantly lower values of Kt/V, all 8 weeks before PTA. In the active group, there was a significant improvement in Kt/V in the first (p < 0.001) and second week (p = 0.049) after PTA. Three and 8 weeks after PTA, we did not find any statistically significant difference in Kt/V between both groups (p = 0.114; p = 0.058). Patients in the active group had statistically significantly lower substitution volumes and blood pump flow rates during HDF over the whole observation period before and after PTA. In contrast, there were no differences in venous pressure in the dialysis circuit between both groups throughout the observation period.
In hemodialysis patients with AV fistula, treated with online HDF, routine measurements of Kt/V during each HDF are a beneficial, quick, and straightforward method for early detection of hemodynamically significant AV fistula stenosis.
Carotid‐femoral pulse wave velocity (cfPWV) is an important predictor of cardiovascular events in the general population and also in hemodialysis (HD) patients. In the general population, cfPWV is ...strongly associated with age and blood pressure (BP). The best timing and method of BP measurement in HD patients is uncertain. Ambulatory blood pressure measurements (ABPM) have been used to better define the relationship between BP, target organ damage, and outcomes in HD patients. The aim of this study was to determine the possible association between cfPWV, cardiovascular risk factors, single BP measurements, and 48‐hour ABPM in chronic HD patients. Thirty‐three HD patients (22 men, 11 women) were included. After the end of the mid‐week HD session, BP was measured, arterial stiffness was estimated by cfPWV, and 48‐hour ABPM was performed. The mean systolic and diastolic BP readings before cfPWV measurement were 136/79 mm Hg, and the mean 48‐hour systolic and diastolic BP readings were 131/76 mm Hg. The mean and range of the cfPWV measurements were 8.31 ± 2.35 m/s and 5.18–16.53 m/s, respectively. Using regression analysis, no association between cfPWV and BP before PWV measurements was found. A statistically significant correlation between cfPWV and 48‐hour systolic and diastolic ABPM was found. Using multiple regression analysis (including age, sex, smoking, diabetes, body mass index, total cholesterol, low‐ and high‐density lipoprotein cholesterol, triglycerides, C‐reactive protein, albumin, phosphorus, calcium, and iPTH) 48‐hour systolic (P < 0.001) and diastolic ABPM (P < 0.005) still remain significantly associated with cfPWV. Only 48‐hour ABPM was associated with cfPWV in HD patients in our study. We found no relationship between cfPWV and other cardiovascular risk factors.
Acute kidney injury (AKI) is common in critically ill patients and is associated with high morbidity and mortality. The availability of several biomarkers of kidney injury offers new tools for its ...early recognition and management. The early identification of high-risk patients provides an opportunity to develop strategies for the prevention, early diagnosis and treatment of AKI. Despite progress in critical care medicine over the past decade, the treatment strategies for AKI in critically ill patients, such as when to start renal replacement therapy, remain controversial. A recently proposed risk prediction score for AKI, based on routinely available clinical variables, presents a new means of identifying patients at high risk of AKI.
•AKI occurs frequently (range 20 to 70% depend on diagnostic settings) in hospitalized critically ill patients at the ICU.•Critically ill patients requiring RRT have high mortality, around 50%.•In clinical practice, individual-adjusted form of RRT therapy is necessary for AKI patients.•AKI biomarkers lack sufficient validity to ultimately impact clinical decision making.•The risk prediction score for AKI present new tool for clinicians to identify the patients at high risk to develop AKI.
In a healthy individual, ammonia is converted to urea in the liver. Urea is then transported through the bloodstream and then excreted into the urine by the kidneys. In patients with chronic kidney ...disease (CKD), the accumulated urea is degraded by salivary urease into ammonia, which is then excreted by breathing. Breath ammonia can therefore be used for detecting the increased nitrogen-bearing wastes. In our pilot study, an electrochemical sensor was used to measure and analyze breath ammonia in healthy volunteers and patients with CKD.
In our study, 8 patients with CKD (stages 4 and 5) and 6 healthy volunteers were enrolled. All participants were nonsmokers and without pulmonary or liver disease. One controlled breath sample was collected from each participant. Immediately after the sample was collected, a gas analyzer was used for measuring breath ammonia in our participants.
Mean creatinine value of CKD patients was 455.2 ± 294.1 µmol/L and 62.1 ± 7.5 µmol/L for healthy volunteers. Breath ammonia levels (3.32 ± 2.19 ppm vs. 0.49 ± 0.08 ppm; p = 0.003) and measured electric current (4.33 ± 0.25 mA vs. 4.01 ± 0.01 mA; p = 0.003) were significantly higher in the CKD group.
The results of our pilot study show that breath monitoring of ammonia can be a simple, useful, fast, and noninvasive tool for detection of advanced kidney impairment. .
Background. Estimation of the glomerular filtration rate (GFR) is essential for the evaluation of patients with chronic kidney disease (CKD). Recently, serum cystatin C was proposed as a new ...endogenous marker of GFR and in our study its diagnostic accuracy was compared with that of other markers of GFR. Methods. In this study, 164 patients with CKD stages 2–3 (GFR 30–89 ml/min/1.73 m2), who had performed 51Cr-labelled ethylenediaminetetra-acetic acid clearance, were enrolled. In each patient, serum creatinine and serum cystatin C were determined. Creatinine clearance was calculated using the Cockcroft–Gault (C&G) and the modification of diet in renal disease (MDRD) formulas. Results. The mean 51CrEDTA clearance was 57 ml/min/1.73 m2, the mean serum creatinine 149 μmol/l and the mean serum cystatin C 1.74 mg/l. We found significant correlation between 51CrEDTA clearance and serum creatinine (R = −0.666), serum cystatin C (R = −0.792), reciprocal of serum creatinine (R = 0.628), reciprocal of serum cystatin C (R = 0.753) and calculated creatinine clearance from the formulas C&G (R = 0.515) and MDRD formulas (R = 0.716). The receiver operating characteristic (ROC) curve analysis (cut-off for GFR 60 ml/min/1.73 m2) showed that serum cystatin C had a significantly higher diagnostic accuracy than serum creatinine (P = 0.04) and calculated creatinine clearance from the C&G formula (P<0.0001), though only in female patients. No difference in diagnostic accuracy was found between serum cystatin C and creatinine clearance calculated from the MDRD formula. Conclusions. Our results indicate that serum cystatin C is a reliable marker of GFR in patients with mildly to moderately impaired kidney function and has a higher diagnostic accuracy than serum creatinine and calculated creatinine clearance from the C&G formula in female patients.
Data on paricalcitol lowering albuminuria and proteinuria already exist; however, it is unclear how paricalcitol withdrawal affects both. Forty‐two nondialysis chronic kidney disease (CKD) patients ...(29 men) aged 62.3 ± 12 years completed the study. CKD patients with proteinuria and intact parathyroid hormone ≥65 pg/mL received paricalcitol (1 μg/day po) for 6 months. After paricalcitol withdrawal we followed them for 6 more months. Paricalcitol treatment significantly reduced urinary albumin/creatinine ratio (UACR), 24‐hour albuminuria (24hA), and 24‐hour proteinuria (24hP). Six months after drug withdrawal UACR increased significantly, 24hA and 24hP did not change significantly. Serum creatinine and cystatin C significantly increased during treatment, and estimated glomerular filtration rate (eGFR) decreased. After drug withdrawal serum creatinine, cystatin C, and eGFR did not change significantly. In conclusion, 6‐month paricalcitol treatment (1 μg/day) in nondialysis CKD patients significantly reduced albuminuria and proteinuria. Six months after paricalcitol withdrawal 24hA and 24hP did not change significantly. Kidney function decreased during paricalcitol treatment; after paricalcitol withdrawal it remained stable. The unaltered values of 24hA, 24hP, and kidney function after paricalcitol withdrawal could be a delayed effect of paricalcitol treatment.
PDF
