Impact of initial blood pressure on the mortality of diabetics undergoing renal replacement therapy

Abderrahim, E.; Zouaghi, K.; Kheder, A; Cherif, Mejda; Boubaker, Karima; Mahfoudhi, M.; Hedri, H.; Ounissi, M.; Hamida, F. Ben; Moussa, F Ben; Abdallah, T. Ben; Younsi, F. El; Kâaroud, H.; Boussaid, S.; Goucha, Rim; Maı̈z, H. Ben

doi:10.1016/j.transproceed.2004.07.014

Cited by 3 publications

(6 citation statements)

References 11 publications

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“…The 32 studies included in this review represent a combined population of 1 083 264 new dialysis starters and 283 277 person‐years of observation for early mortality. The characteristics of these studies are shown in Table .…”

Section: Resultsmentioning

confidence: 99%

“…The characteristics of these studies are shown in Table . Studies originating in North America accounted for the majority of observations (12 studies, population: 831559), while the remaining observations originated in Europe (10 studies, population: 93 815 patients), Asia (four studies, combined population of 46 421 patients), Australia‐New Zealand (one study; population: 23 658), Africa (three studies, population: population of 530 patients), and South America (one study, 395 participants). There was also one multinational study , involving developed countries with 86 886 participants.…”

Section: Resultsmentioning

confidence: 99%

“…The summary of quality assessment of studies is presented in Appendix S1. Overall, 13 studies (combined population 967 282) , were judged to be at low risk of bias (high quality) and 19 (combined population 115 982) at high risk of bias (low quality). The main contributory factor for being assessed at high risk of bias included reliance on registry data where the completion of entries in the registry where uncertain , restricting participation to selected groups such as the elderly and diabetic subjects , studies with high probability of acute cases being included in the cohort , eligibility criteria of study participants or the source population unclear , method of outcome ascertainment not fully described , exclusion of eligible patients , and possible selective reporting of outcomes with high numbers of censoring events other than all‐cause mortality .…”

Section: Resultsmentioning

confidence: 99%

“…Three studies recruited their first patient in the 1970s , three in the 1980s , nine in the 1990s , and 16 in the period after 2000s . One study did not specify when their first patient was recruited .…”

Section: Resultsmentioning

confidence: 99%

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Early Mortality Rates After Commencement of Maintenance Hemodialysis: A Systematic Review and Meta‐Analysis

Hazara

Bhandari

2019

Ther Apher Dial

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Mortality rates are reported to be high soon after the commencement of maintenance HD for ESRD. Our aim was to estimate early mortality rates (deaths within 180 days of starting therapy), through a systematic review of literature, in this patient population. Medline and EMBASE were searched for publications between 1 January 1985 and 31 December 2017. Observational studies reporting deaths involving adults commencing HD were included. The Quality in Prognosis Studies tool was used to assess risk of bias in studies. Crude mortality rates (expressed in 100 person-years) and age-standardized mortality ratios (SMR) were calculated. Meta-analyses of these rates were conducted for studies with lowest risk of bias (i.e. highest quality). In total, 32 studies were included (combined population: 1 083 264) representing 283 277 person-years of observation; median follow-up: 90 days. Mortality rates ranged between 12.8 and 55.6 per 100 person-years. Cardiovascular causes accounted for the majority of early deaths. Meta-analysis of high-quality studies showed an overall crude mortality rate of 32.6 per 100 person-years (95% CI 32.4-32.8). This equates to 16.3% mortality in first 180 days of starting HD. Six highquality studies contained sufficient data for calculation of SMR. Meta-analysis of SMRs showed that patients starting HD therapy sustain 8.8 times higher mortality rates compared to the general population. We have combined the results of high-quality studies to produce new estimates of early mortality rates after commencement of HD therapy. This information can help relay more reliable prognostic information to this patient population.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Early Mortality Rates After Commencement of Maintenance Hemodialysis: A Systematic Review and Meta‐Analysis

Hazara

Bhandari

2019

Ther Apher Dial

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“…BP amplitudes (pulse pressure) and fluctuation between dialysis sessions have been found to have a particular impact on elevated risk [3] . However, no clear threshold values as targets for antihypertensive therapy have been currently defined in HD patients and no guidelines are available for antihypertensive therapy in these patients since BP has not been found to predict outcome in some studies [4] . Recent literature regarding BP variability show an association with atherosclerotic complications [5] .…”

Section: Introductionmentioning

confidence: 99%

Dialysis-Associated Hypertension Treated with Telmisartan – DiaTel: A Pilot, Placebo-Controlled, Cross-Over, Randomized Trial

et al. 2013

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Treatment of hypertension in hemodialysis (HD) patients is characterised by lack of evidence for both the blood pressure (BP) target goal and the recommended drug class to use. Telmisartan, an Angiotensin receptor blocker (ARB) that is metabolised in the liver and not excreted via HD extracorporeal circuit might be particularly suitable for HD patients. We designed and conducted a randomised, placebo-controlled, double-blind and cross-over trial for treatment of dialysis–associated hypertension with telmisartan 80 mg once daily or placebo on top of standard antihypertensive treatment excluding other Renin-Angiotensin-System (RAS) blockers. In 29 patients after randomization we analysed BP after a treatment period of 8 weeks, while 13 started with telmisartan and 16 with placebo; after 8 weeks 11 continued with telmisartan and 12 with placebo after cross-over, respectively. Patients exhibited a significant reduction of systolic pre-HD BP from 141.9±21.8 before to 131.3±17.3 mmHg after the first treatment period with telmisartan or placebo. However, no average significant influence of telmisartan was observed compared to placebo. The latter may be due to a large inter-individual variability of BP responses reaching from a 40 mmHg decrease under placebo to 40 mmHg increase under telmisartan. Antihypertensive co-medication was changed for clinical reasons in 7 out of 21 patients with no significant difference between telmisartan and placebo groups. Our starting hypothesis, that telmisartan on top of standard therapy lowers systolic office BP in HD patients could not be confirmed. In conclusion, this small trial indicates that testing antihypertensive drug efficacy in HD patients is challenging due to complicated standardization of concomitant medication and other confounding factors, e.g. volume status, salt load and neurohormonal activation, that influence BP control in HD patients.Trial Registration Clinicaltrialsregister.eu 2005-005021-60

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Age, Gender and Diabetes as Risk Factors for Early Mortality in Dialysis Patients: A Systematic Review

Hazara

Bhandari

2021

Clin Med Res

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To study the impact of age, gender, and presence of diabetes (any type) on the risk of early deaths (180-day mortality) in patients starting long-term hemodialysis (HD) therapy.Design: Systematic review of the literature.Setting: Out-patient (non-hospitalized), community-based HD therapy world-wide.Participants: Patients with advanced chronic kidney disease (CKD) starting long-term HD treatment for end-stage renal disease (ESRD).Methods: Medline and EMBASE were searched for studies published between 1/1/1985 and 12/31/2017. Observational studies involving adult subjects commencing HD were included. Data extracted included population characteristics and settings. In addition, patient or treatment related factors studied with reference to their relationship with the risk of early mortality were documented. The Quality in Prognosis Studies tool was used to assess risk of bias in individual studies. Findings were summarized, and a narrative account was drawn. Results:Included were 26 studies (combined population 1,098,769; representing 287,085 personyears of observation for early mortality). There were 17 cohort and 9 case-control studies. Risk of bias was low in 13 and high in a further 13 studies. Patients who died in the early period were older than those who survived. Mortality rates increased with advancing age. Female gender was associated with slightly increased early mortality rates in larger and higher quality studies. The available data showed conflicting results in relation to the association of diabetes and risk of early mortality.Conclusions: This systematic review evaluated the impact of key demographic and co-morbid factors on risk of early mortality in patients starting maintenance HD. The information could help in delivering more tailored prognostic information and planning of future interventions.

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Impact of initial blood pressure on the mortality of diabetics undergoing renal replacement therapy

Cited by 3 publications

References 11 publications

Early Mortality Rates After Commencement of Maintenance Hemodialysis: A Systematic Review and Meta‐Analysis

Early Mortality Rates After Commencement of Maintenance Hemodialysis: A Systematic Review and Meta‐Analysis

Dialysis-Associated Hypertension Treated with Telmisartan – DiaTel: A Pilot, Placebo-Controlled, Cross-Over, Randomized Trial

Age, Gender and Diabetes as Risk Factors for Early Mortality in Dialysis Patients: A Systematic Review

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