Association of Dialysis Modality and Cardiovascular Mortality in Incident Dialysis Patients

Johnson, David W.; Dent, Hannah; Hawley, Carmel M.; McDonald, S.; Rosman, Johan B.; Brown, Fiona G.; Bannister, Kym M.; Wiggins, Kathryn J.

doi:10.2215/cjn.01750309

Cited by 92 publications

(88 citation statements)

References 44 publications

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“…Cardiovascular morbidity and mortality among chronic haemodialysis patients is high (19). This well-known fact is confi rmed also in our retrospective study because 12 patients (24 %) died during the follow up.…”

Section: Discussionsupporting

confidence: 83%

Blood pressure impact on left ventricular geometry in chronic haemodialysis patients

Bobocka¹,

Dúbrava²,

Slezák³

et al. 2013

BLL

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Abstract:Aim: Left ventricular hypertrophy in chronic haemodialysis patients is multifactorial. Our aim was to evaluate retrospectively the relationship between 24-h blood pressure monitoring and geometry and function of left ventricle (LV). Patients a methods:We examined 50 patients (men/women 33/17) treated by chronic haemodialysis (>3 months) aged 57.5 years (53-63; median, interquartile range). We measured blood pressure during 24 hours in short interdialytic period using Spacelab monitor 90217. Echocardiography was provided in short interdialytic period. Results: Left ventricular mass index signifi cantly correlated with SBP (tau-b=0.21; p=0.030; 95%CI 0.01-0.42), p=0.018; p=0.009;. SBP, DBP, MAP and PP did add a signifi cant information to the prediction of relative wall thickness. We did not fi nd any relationship between BP and left ventricular ejection fraction, left ventricular enddiastolic diameter and left atrial size. Conclusion:We found out an important 24-hour blood pressure impact on left ventricular relative wall thickness and left ventricular mass index. Left ventricular ejection fraction, left ventricular enddiastolic diameter and left atrial size were not related to 24-hour blood pressure. We did not fi nd a relationship between blood pressure and left ventricular enddiastolic diameter. From all diastolic parameters the strongest association was found between systolic blood pressure in all three phases and ratio of peak early to late diastolic fi lling velocity (Tab. 5, Ref. 19 Cardiovascular complications of haemodialysis treatment are the most common cause of increased morbidity and mortality among these patients (1). Already stage 3 chronic kidney disease patients with glomerular fi ltration rate <60 ml/min/1.73m 2 belongs to the high cardiovascular risk group (2). Echocardiography verifi ed left ventricular concentric or excentric hypertrophy is present at the beginning of haemodialysis treatment in 50-75 %, while during the next course the amount is further increasing (3). Uremic cardiomyopathy is a term used in connection with disturbed left ventricular morphology and funtion in renal failure. It is a myocardial dysfunction, which occured due to long lasting impact of hemodynamic and non-hemodynamic, with uraemia and dialysis associated risk factors. Arterial hypertension, volume overload, anaemia, uremic toxins, hyperparathyroidism and increased sympathetic activity belong to the most dominant risk factors (4). A strong relationship between left ventricular (LV) mass and blood pressure was shown also in a non-uraemic population. To confi rm this relationship in haemodialysis patients is more diffi cult due to many factors affecting LV mass. Blood pressure values obtained by ambulatory or home blood pressure monitoring provide more prognostic information on cardiovascular risk compared to blood pressure values measured during haemodialysis (5, 6).Aim of the retrospective study was to evaluate the impact of blood pressure measured by 24-hour ambulatory blood pressure monitoring (24-h A...

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Section: Discussionsupporting

confidence: 83%

Blood pressure impact on left ventricular geometry in chronic haemodialysis patients

Bobocka¹,

Dúbrava²,

Slezák³

et al. 2013

BLL

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“…23 One previous study reported that NLR43.5 was associated with an increase in the risk of cardiovascular and all-cause mortality in peritoneal dialysis patents. 13 Two studies have subsequently reported NLR 43.76 and 3.72 to be significant and independent (of CRP) predictors of cardiovascular events in pre-dialysis and dialysis-dependent patients, respectively.…”

Section: Discussionmentioning

confidence: 99%

Neutrophil–lymphocyte ratio predicts cardiovascular and all-cause mortality in hemodialysis patients

et al. 2015

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Neutrophil-lymphocyte ratio (NLR) is a marker of systemic inflammation that has been shown to predict mortality in patients with malignancies, ischemic heart disease and peripheral vascular disease. Its prognostic value in hemodialysis patients is unclear. The aims of this study were to: (i) explore the relationship between NLR and other biochemical parameters and (ii) to examine the value of NLR as a predictor of cardiovascular and all-cause mortality in hemodialysis patients. The study included all the incident hemodialysis patients from a single center between 2007 and 2012. NLR was calculated using samples obtained 3 months after commencing hemodialysis. One hundred seventy hemodialysis patients were included with a median follow-up of 37 months. There were 54 deaths (32%). NLR was positively correlated with C-reactive protein (r ¼ 0.24, p ¼ 0.0023) and negatively correlated with hemoglobin (r ¼ À0.27, p ¼ 0.00048), albumin (r ¼ À0.23, p ¼ 0.0034) and total cholesterol (r ¼ À0.17, p ¼ 0.049) levels. In multivariate Cox regression, NLR was independently associated with both all-cause mortality (adjusted hazard ratio [HR] 1.4; 95% confidence interval [CI], 1.2-1.6; p 0.0001) and cardiovascular death (HR 1.3, 95% CI 1.1-1.6, p ¼ 0.0032). Other predictors of all-cause mortality were age (HR 1.6 per decade; 95% CI, 1.2-2.1; p ¼ 0.0017), body mass index (HR 0.93; 95% CI, 0.88-0.98; p ¼ 0.0047), albumin (HR 0.91; 95% CI, 0.86-0.97; p ¼ 0.0035) and peripheral vascular disease (HR 2.7; 95% CI, 1.4-5.1; p ¼ 0.0023). NLR is a practical, cost-efficient and easy to use predictor of cardiovascular and all-cause mortality in incident hemodialysis patients.

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“…It also sheds light on the factors that predict insulin resistance in PD patients, showing the role of obesity and adipokines in this population. PD is associated with an increased risk of cardiovascular mortality after the first year (24). Though speculative, it is feared that glucose absorption could explain this outcome by promoting body fat gain and insulin resistance (2,4).…”

Section: Discussionmentioning

confidence: 99%

Insulin Resistance in Nondiabetic Peritoneal Dialysis Patients

Bernardo

Oliveira

Santos³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Insulin resistance has been associated with cardiovascular disease in peritoneal dialysis patients. Few studies have addressed the impact of fast transport status or dialysis prescription on insulin resistance. The aim of this study was to test whether insulin resistance is associated with obesity parameters, peritoneal transport rate, and glucose absorption.Design, setting, participants, & measurements Insulin resistance was evaluated with homeostasis model assessment method (HOMA-IR), additionally corrected by adiponectin (HOMA-AD). Enrolled patients were prevalent nondiabetics attending at Santo António Hospital Peritoneal Dialysis Unit, who were free of hospitalization or infectious events in the previous 3 months (51 patients aged 50.4615.9 years, 59% women). Leptin, adiponectin, insulin-like growth factor-binding protein 1 (IGFBP-1), and daily glucose absorption were also measured. Lean tissue index, fat tissue index (FTI), and relative fat mass (rel.FM) were assessed using multifrequency bioimpedance. Patients were categorized according to dialysate to plasma creatinine ratio at 4 hours, 3.86% peritoneal equilibration test, and obesity parameters.Results Obesity was present in 49% of patients according to rel.FM. HOMA-IR correlated better with FTI than with body mass index. Significant correlations were found in obese, but not in nonobese patients, between HOMA-IR and leptin, leptin/adiponectin ratio (LAR), and IGFBP-1. HOMA-IR correlated with HOMA-AD, but did not correlate with glucose absorption or transport rate. There were no significant differences in insulin resistance indices, glucose absorption, and body composition parameters between fast and nonfast transporters. A total of 18 patients (35.3%) who had insulin resistance presented with higher LAR and rel. FM (7.3 [12.3, interquartile range] versus 0.7 [1.4, interquartile range], P,0.001, and 39.4610.1% versus 27.2611.5%, P=0.002, respectively), lower IGFBP-1 (8.267.2 versus 21.0616.3 ng/ml, P=0.002), but similar glucose absorption and small-solute transport compared with patients without insulin resistance. FTI and LAR were independent correlates of HOMA-IR in multivariate analysis adjusted for glucose absorption and small-solute transport (r=0.82, P,0.001).Conclusions Insulin resistance in nondiabetic peritoneal dialysis patients is associated with obesity and LAR independent of glucose absorption and small-solute transport status. Fast transport status was not associated with higher likelihood of obesity or insulin resistance.

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Association of Dialysis Modality and Cardiovascular Mortality in Incident Dialysis Patients

Cited by 92 publications

References 44 publications

Blood pressure impact on left ventricular geometry in chronic haemodialysis patients

Blood pressure impact on left ventricular geometry in chronic haemodialysis patients

Neutrophil–lymphocyte ratio predicts cardiovascular and all-cause mortality in hemodialysis patients

Insulin Resistance in Nondiabetic Peritoneal Dialysis Patients

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