Cardiovascular Disease in Dialysis Patients

Jegatheesan, Dev; Yang, Wenling; Krishnasamy, Rathika; Hawley, Carmel M.; Johnson, David W.

doi:10.5772/intechopen.70362

Cited by 4 publications

(6 citation statements)

References 190 publications

(199 reference statements)

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“…It has been shown in various studies that CVD is the predominant cause of death in nearly 40% of cases of MHD. 24,25 In addition to increased morbidity and mortality, daily performance in form of ADL and IADL may also be lower in patients on MHD leading to poor quality of life. This functional impairment in MHD patients stays underdiagnosed as monitoring ADL is not a routine practice in our country.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of functional impairment and mortality in patients on maintenance hemodialysis

Jain,

Bansal,

Saxena

et al. 2023

Seminars in Dialysis

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IntroductionNumerous factors impact the mortality and functional abilities of patients with end‐stage renal disease (ESRD) receiving maintenance hemodialysis (MHD). We aimed to determine the mortality rate at 1 year of MHD, identify predictors of mortality, and assess functional impairments concerning activities of daily living (ADLs) and instrumental ADL (IADL).MethodsOur study was prospective, observational cohort study that enrolled patients receiving MHD. We collected demographic, clinical, and laboratory data. We also assessed ADLs and IADLs for daily performance.ResultsOur study included 167 patients with a mean age of 51.6 ± 13.1 years, and 56.9% were male. Of these, 80 (47.9%) were diabetic, and 145 (86.8%) were hypertensive. The mortality rate after 1 year of MHD was 10.8%, and cardiovascular causes accounted for over 70% of total deaths. Sudden cardiac death was the most frequent cause (38.9%), followed by cardiogenic shock (22.2%). Older age and low parathormone levels (<300 pg/mL) were significantly associated with higher mortality rates. Mean ADL and IADL scores were 4.5 ± 1.3 and 6.3 ± 2.7, respectively. Eighteen (10.8%) and 56 (33.5%) patients had low ADL and IADL scores, respectively. Although statistically insignificant, a higher proportion of non‐survivors exhibited low IADL and ADL scores. Older age, longer diabetes duration, and higher BMI levels were significantly associated with lower IADL scores.ConclusionsOlder age and suppressed PTH levels are predictors of mortality in ESRD patients receiving MHD. These patients require regular follow‐ups to rule out cardiovascular morbidity. Functional impairment is prevalent but remains underdiagnosed in MHD patients. It should be monitored regularly to improve quality of life in ESRD.

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Section: Discussionmentioning

confidence: 99%

“…CVD is known to be prevalent in the MHD population and affects nearly 60% of the patients. It has been shown in various studies that CVD is the predominant cause of death in nearly 40% of cases of MHD 24,25 …”

Section: Discussionmentioning

confidence: 99%

Predictors of functional impairment and mortality in patients on maintenance hemodialysis

Jain,

Bansal,

Saxena

et al. 2023

Seminars in Dialysis

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“…Thus, fructosamine and glycated albumin, can be used for better evaluation of glycemic control in ESRD patients. [15] High levels of HbA1c, but not the fasting blood glucose (FBG) in the non-diabetics are independent risk factors for developing chronic kidney disease (CKD). [16] Geva et al (2019) found that the impaired FBG, but not the HbA1c was independently related to future development of hypertension.…”

Section: Discussionmentioning

confidence: 99%

Glycated Haemoglobin and Cardiovascular Complications in Non-Diabetic Haemodialysis Patients

salem

Nawara

Awadalla

et al. 2022

Preprint

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Background Cardiovascular disease is considered a common cause of morbidity and mortality in patients with end-stage renal disease on hemodialysis. Elevated levels of glycated hemoglobin (HbA1c) are associated with CVD in diabetic patients. However, there is lack of information regarding HbA1c and CVD risk in non-diabetic HD patients. This study aims to investigate the relationship between glycated hemoglobin levels and the risk for CVD in non-diabetic HD patients. Methods A prospective, cross-sectional study, which included 60 non-diabetic HD patients, 30 patients taking erythrocyte stimulating agents (ESA), and 30 patients with no-ESA. Each group was subdivided according to the presence or absence of CVD. All participants were subjected to full history taking, clinical examination, and laboratory investigations. Results Non-diabetic HD patients with CVD had higher mean ± SD HbA1c% (5.8 ± 0.2) and HOMA-IR (4.7 ± 0.7), than those with no-CVD (5.5 ± 0.3), and (4.2 ± 0.3) (p ˂0.05). Non-diabetic HD patients with CVD had longer dialysis duration, lower serum albumin, and HDL, but higher total cholesterol, CRP, Hb%, HbA1c%, and insulin resistance than those with no-CVD. HD patients who received higher doses of ESA therapy mean ± SD (80.8 ± 22.4) IU/Kg/Week had significantly lower HbA1c% (˂5%) than those who received lower doses (53.9 ± 23.8), who had HbA1c% (≥ 5.5–6%) (p˂0.05). There was a significantly positive correlation between the presence of CVD in HD patients and the HbA1c% levels (r = 0.492) (p˂0.05). Conclusion HbA1c can predict CVD in non-diabetic HD patients, and its lower levels are associated with lower CVD.

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“…CKD–mineral and bone disorders (CKD-MBD) are non-traditional cardiovascular risk factors [ 4 ] defined as a systemic disorders characterized by laboratory abnormalities [calcium, phosphate, parathyroid hormone (PTH) or vitamin D], bone and/or vascular alterations or other soft tissue calcification [ 5 , 6 ]. Many studies have shown that both high and low levels of serum calcium, phosphate and PTH are associated with an increased risk of mortality [ 7–14 ].…”

Section: Introductionmentioning

confidence: 99%

“…Diabetes is considered a traditional risk factor for cardiovascular events and mortality in dialysis patients [ 4 ]; in fact, diabetic patients on haemodialysis have double the relative risk of all-cause and cardiovascular mortality versus non-diabetic patients [ 17 ]. In addition, diabetes is associated with a higher prevalence of vascular calcification [ 18 , 19 ], especially in peripheral arteries [ 20 , 21 ], regardless of mineral and bone metabolism abnormalities and time on dialysis [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Mineral and bone metabolism markers and mortality in diabetic patients on haemodialysis

Martín-Carro

Navarro‐González

Ortíz

et al. 2023

Nephrology Dialysis Transplantation

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Background Diabetic patients on haemodialysis have a higher risk of mortality than non-diabetic patients. The aim of this COSMOS analysis was to assess whether bone and mineral laboratory values (calcium, phosphorus, and PTH) contribute to such risk. Methods COSMOS is a multicentre, open-cohort, 3-year prospective study, which includes 6797 patients from 227 randomly selected dialysis centres from 20 European countries. The association between mortality and calcium, phosphate or PTH was assessed using Cox proportional hazard regression models using both penalized splines smoothing and categorization according to KDIGO guidelines. The effect modification of the association between the relative risk of mortality and serum calcium, phosphate or PTH by diabetes was assessed. Results There was a statistically significant effect modification of the association between the relative risk of mortality and serum PTH by diabetes (p = 0.011). The slope of the curve of the association between increasing values of PTH and relative risk of mortality was steeper for diabetic compared with non-diabetic patients, mainly for high levels of PTH. In addition, high serum PTH (> 9 times the normal values) was significantly associated with a higher relative risk of mortality in diabetic patients but not in non-diabetic patients (1.53[95%CI:1.07-2.19] and 1.17[95%CI:0.91-1.52]). No significant effect modification of the association between the relative risk of mortality and serum calcium or phosphate by diabetes was found (p = 0.2 and p = 0.059, respectively). Conclusion The results show a different association of PTH with the relative risk of mortality in diabetic and non-diabetic patients. These findings could have relevant implications for the diagnosis and treatment of CKD-MBD.

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Cardiovascular Disease in Dialysis Patients

Cited by 4 publications

References 190 publications

Predictors of functional impairment and mortality in patients on maintenance hemodialysis

Predictors of functional impairment and mortality in patients on maintenance hemodialysis

Glycated Haemoglobin and Cardiovascular Complications in Non-Diabetic Haemodialysis Patients

Mineral and bone metabolism markers and mortality in diabetic patients on haemodialysis

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