Uric acid (UA), a breakdown product of purines, has been associated with mortality in different populations. Less is known about associations between hyperuricemia and mortality in chronic kidney ...disease (CKD) patients, later undergoing hemodialysis (HD), during a long observation period. The aim of this study was to determine the impact of elevated UA levels on long-term (19.5 years) survival of CKD patients.
120 CKD patients (49 female, 71 male) enrolled in our study were observed from their first visit at the patients' nephrology outpatient clinic (NOC). All patients later started HD and were followed until their death or January 1, 2016. UA was measured regularly from venous sampling during NOC visits and HD sessions. Patients with mean UA below 420 µmol/L were defined as normouricemic, patients with mean UA above 420 µmol/L as hyperuricemic. No patients were treated for hyperuricemia. Survival rates were analyzed using Kaplan-Meier survival curves. Cox regression model was used to assess the influence of UA, age, arterial hypertension, diabetes mellitus, total cholesterol, triglycerides, smoking, and body mass index on the survival of our patients.
Mean UA was 383.6 ± 83, range 220 to 710 µmol/L. 86 (71.7%) patients were normouricemic, and 34 (28.3%) hyperuricemic. 43 (50.0%) normouricemic and 28 (82.4%) hyperuricemic patients died. Kaplan-Meier survival analysis showed the risk of death to be higher for hyperuricemic patients (log-rank test; p < 0.0001). With Cox multivariable regression model, the mean UA still remained a predictor of mortality in our patients (p < 0.0001).
The results indicate an association between UA and long-term survival of CKD patients and show that hyperuricemia was directly associated with higher mortality among our patients. .
Stroke and renal dysfunction Hojs Fabjan, Tanja; Hojs, Radovan
European journal of internal medicine,
01/2014, Letnik:
25, Številka:
1
Journal Article
Recenzirano
Abstract Stroke is the most frequent neurological disease and represents a continuously evolving medical and social problem. Chronic kidney disease (CKD) is also an important worldwide public health ...problem. Renal dysfunction carries a substantial risk of cardiovascular morbidity and mortality and an independent, graded association between renal function and cardiovascular events was found. In the last 15 years the link between CKD and cerebrovascular disease has become more apparent. Patients with end stage renal disease treated with maintenance hemodialysis have a much higher incidence of stroke than the general population and stroke is one of the major causes of death in these patients. Nowadays ischemic subtype of stroke is present in approximately 70% of dialysis patients. In population based studies conflicting results have been reported about the association between stroke and CKD before replacement therapy. However, in high risk patients, defined by the presence of either cardiovascular disease or cardiovascular risk factors, different stages of CKD are clearly associated with subsequent stroke. In patients with stroke the exact prevalence of renal dysfunction is not known. Reported prevalence from a few published studies is up to 38% and it is higher than that in age-matched control groups. Furthermore, in patients suffering from stroke renal dysfunction is associated with short and long term mortality. The most effective treatment of stroke in patients with CKD is not known and further studies are needed.
Accumulation of fluid in the lung is the most concerning sequela of volume expansion in patients with ESRD. Lung auscultation is recommended to detect and monitor pulmonary congestion, but its ...reliability in ESRD is unknown.
In a subproject of the ongoing Lung Water by Ultra-Sound Guided Treatment to Prevent Death and Cardiovascular Complications in High Risk ESRD Patients with Cardiomyopathy Trial, we compared a lung ultrasound-guided ultrafiltration prescription policy versus standard care in high-risk patients on hemodialysis. The reliability of peripheral edema was tested as well. This study was on the basis of 1106 pre- and postdialysis lung ultrasound studies (in 79 patients) simultaneous with standardized lung auscultation (crackles at the lung bases) and quantification of peripheral edema.
Lung congestion by crackles, edema, or a combination thereof poorly reflected the severity of congestion as detected by ultrasound B lines in various analyses, including standard regression analysis weighting for repeated measures in individual patients (shared variance of 12% and 4% for crackles and edema, respectively) and κ-statistics (κ ranging from 0.00 to 0.16). In general, auscultation had very low discriminatory power for the diagnosis of mild (area under the receiver operating curve =0.61), moderate (area under the receiver operating curve =0.65), and severe (area under the receiver operating curve =0.68) lung congestion, and the same was true for peripheral edema (receiver operating curve =0.56 or lower) and the combination of the two physical signs.
Lung crackles, either alone or combined with peripheral edema, very poorly reflect interstitial lung edema in patients with ESRD. These findings reinforce the rationale underlying the Lung Water by Ultra-Sound Guided Treatment to Prevent Death and Cardiovascular Complications in High Risk ESRD Patients with Cardiomyopathy Trial, a trial adopting ultrasound B lines as an instrument to guide interventions aimed at mitigating lung congestion in high-risk patients on hemodialysis.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new pathogen that was responsible for the global pandemic that started in Wuhan, China in 2019. It causes COVID-19, manifesting as ...viral pneumonia with concomitant acute respiratory failure and, in certain cases, multiorgan failure and death.
Kidney involvement is common and can be aetiologically heterogeneous. Acute kidney injury is mostly caused indirectly, especially in the context of systemic inflammation, hypoxaemia, hypotension, shock, and increased oxidative stress. Complement activation, tubulointerstitial damage, and endothelial dysfunction with resultant thromboses are also important factors in kidney injury. Histologically, SARS-CoV-2 was found to induce predominant tubulointerstitial changes and in some cases, glomerular changes. In a certain subgroup of patients with the APOL1 high-risk allele variant, a collapsing glomerulopathy, similar to HIV-associated nephropathy, was found. This entity was later named COVID-19-associated nephropathy. In this article, the authors present the pathophysiology behind SARS-CoV-2-related kidney involvement and the development of COVID-19-associated nephropathy.
Pulmonary congestion is a direct result of either general overhydration or cardiac dysfunction. Lung ultrasonography (LUS) with lung B-lines (LUS comets) can be used to assess extravascular lung ...water in patients with end-stage renal disease on hemodialysis or peritoneal dialysis (PD). Subendocardial viability ratio (SEVR) is a pulse wave analysis parameter that is a non-invasive measure of coronary perfusion and is related to cardiac work and oxygen consumption. Our aim was to investigate the association between LUS comets and SEVR in PD patients.
We performed an observational study in 25 PD patients in a single dialysis center. Extravascular lung water was quantified by the number of LUS comets, using a portable ultrasound (US) device. LUS comets were recorded in each intercostal space and defined as hyperechoic US bundles at a narrow base extending from the transducer to the edge of the screen. The sum of LUS comets yields a score reflecting the extent of water accumulation in the lungs. SEVR was determined non-invasively by radial applanation tonometry.
Mean age of patients was 54.7 ± 10.7 years, mean PD vintage 27 ± 33 (1 - 167) months, 60% were men. The mean number of LUS comets was 13 ± 19 (0 - 71), and the mean SEVR was 153 ± 40%. We found a statistically significant negative correlation between the number of LUS comets and SEVR (r = -0.467; p = 0.019). Multiple regression analysis with LUS comets as dependent variable, and SEVR and age as independent variables showed a statistically significant relationship between SEVR and the number of LUS comets (β = -0.467, p = 0.021).
Higher number of LUS comets is associated with lower SEVR in PD patients.
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