Predictor of Cardiovascular Risks in End Stage Renal Failure patients on Maintenance Dialysis

Lim, Christopher Thiam Seong; Yap, Xian Hui; Chung, Kuet Jun; Khalid, Mohamad Azrul; Yayha, Norhayati; Latiff, Latiffah Abd; Goh, Bak Leong

doi:10.12669/pjms.316.8039

Cited by 11 publications

(15 citation statements)

References 10 publications

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“…Secondary hyperparathyroidism (SHPT) is a frequently encountered problem in the management of patients with chronic kidney disease (CKD). SHPT has long been associated with poor patient outcomes, including accelerated atherosclerosis and metabolic bone disease [ 1 , 2 ]. Parathyroidectomy (PTX) in end-stage renal failure (ESRF) is an effective method for normalization of calcium and parathyroid metabolism and for improving renal bone disease.…”

Section: Introductionmentioning

confidence: 99%

Clinical course after parathyroidectomy in adults with end-stage renal disease on maintenance dialysis

Lim

Kalaiselvam

Kitan³

et al. 2017

Clinical Kidney Journal

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BackgroundParathyroidectomy (PTX) is done in cases of secondary hyperparathyroidism from chronic kidney disease to improve renal osteodystrophy. Despite this widespread practice, clinical outcomes regarding the benefits of this procedure are still lacking. Most studies in the literature have opted to report the laboratory outcome instead. Our study aimed to evaluate the postoperative clinical course for patients who had undergone total PTX without autoimplantation.Methods and resultsAll patients who underwent PTX between January 2010 and February 2014 in a tertiary referral center were included in this study and followed up for 12 months. Laboratory outcome parameters include various preoperative and postoperative serial measurements of laboratory parameters. Patients’ hospitalizations and mortality records post-PTX were also retrieved and recorded. In all, 90 patients were included in this study. The mean age was 48 ± 18 years. The majority of the patients (54.4%) were male and 90% were on hemodialysis. The mean duration of dialysis was 8.0 ± 5.0 years. Indications for PTX were symptomatic bone pain (95.6%), fractures (3.3%) and calciphylaxis (1.1%). Mean preoperative values for serum calcium, phosphate, alkaline phosphatase and intact parathyroid hormone (iPTH) were 2.40 ± 0.23mmol/L, 1.92 ± 0.51 mmol/L, 689.60 ± 708.50 U/L and 311.90 ± 171.94 pmol/L, respectively. The majority (92.2%) had all four glands removed and 92.2% of the glands showed hyperplasic changes. One year after PTX, 90 patients (100%) had serum iPTH <8 pmol/L and 28 patients (31%) had unmeasurable iPTH levels. A total of 15% of patients had hospitalizations for various reasons and of these, 50% were within 90 days. The mean hospital stay was 14.4 ± 18.6 days. The mortality rate was 4.4% and of these, 25% were in first 30 days. Causes of death were mainly from sepsis (75%) and acute coronary syndrome (25%). One patient (1.1%) had a relapse.ConclusionsEven though PTX markedly reduces postoperative serum iPTH levels, it carries with it significant risk of morbidity and mortality.

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Section: Introductionmentioning

confidence: 99%

Clinical course after parathyroidectomy in adults with end-stage renal disease on maintenance dialysis

Lim

Kalaiselvam

Kitan³

et al. 2017

Clinical Kidney Journal

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“…Although dyslipidemia is an established risk factor for CVDs, high cholesterol levels are a low-risk factor for malnutrition in CONUT. In dialysis patients, there is a concept of “reverse epidemiology”, whereby obesity, hypercholesterolemia, and hypertension appear to be protective features and are associated with a greater survival [ 27 , 28 ]. This may explain why CONUT scores did not predict CVD mortality in this study.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of the Controlling Nutritional Status (CONUT) Score in Patients at Dialysis Initiation

et al. 2022

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Protein-energy wasting (PEW) is common in patients with chronic kidney disease (CKD), and affects their prognosis. The Controlling Nutritional Status (CONUT) score is a nutritional screening tool calculated using only blood test data. This study aimed to investigate the prognostic value of CONUT score in patients just initiating dialysis. A total of 311 CKD patients who stably initiated dialysis were enrolled. Only 27 (8.7%) patients were classified as having normal nutritional status. The CONUT score was also independently correlated with elevated C-reactive protein levels (β = 0.485, p < 0.0001). During the median follow-up of 37 months, 100 patients (32.2%) died. The CONUT score was an independent predictor of all-cause mortality (adjusted hazard ratio 1.13, 95% confidence interval 1.04–1.22, p < 0.0024). As model discrimination, the addition of the CONUT score to a prediction model based on established risk factors significantly improved net reclassification improvement (0.285, p = 0.028) and integrated discrimination improvement (0.025, p = 0.023). The CONUT score might be a simplified surrogate marker of the PEW with clinical utility and could predict all-cause mortality, in addition to improving the predictability in CKD patients just initiating dialysis. The CONUT score also could predict infectious-disease mortality.

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“…In addition, the negative impact of the above on cardiovascular (CVS) risk of patients at various stages of CKD has also been found (El-Mesallamy et al, 2008;Zoccali et al, 2005). CVS morbidity and mortality in peritoneal dialysis (PD) patients is 10-to 30-fold higher than in the general population (Lim et al, 2015). The specific, non-traditional CVS risk factors for dialysis patients such as inflammation and hypoalbuminemia are the components of the protein-energy wasting (PEW) (Fouque et al, 2008;Zoccali et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

“…ADMA (asymmetric dimethylarginine), as a marker of accelerated atherosclerosis and endothelial dysfunction, is nowadays considered to be a good predictor of mortality in dialysis patients (Małgorzewicz et al, 2010;Ravani et al, 2005;Schepers et al, 2011;Scholze et al, 2007). Also, ADMA is postulated to be a link between CKD and CVS disease (Lim et al, 2015). Adipokines such as leptin and adiponectin are adipocyte-specific secretory proteins related to body mass and body fat content.…”

Section: Introductionmentioning

confidence: 99%

Protein-energy wasting and asymmetric dimethylarginine in peritoneal dialysis patients

Małgorzewicz

Heleniak

Lichodziejewska‐Niemierko

et al. 2018

Acta Biochim Pol

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Cardiovascular (CVS) morbidity and mortality in the peritoneal dialysis patients (PD) is 10-30-fold higher than in the general population. A relatively low level of adiponectin and a higher level of leptin are important predictors of vascular complications as well as CVS events in PD patients. The asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, is an important risk factor of CVS morbidity and mortality. It is very important to establish all CVS risk factors in the PD patients to prevent CVS morbidity and mortality in this population. The aim of the study was to determine the plasma concentration of ADMA and adipokines in relation to the protein-energy wasting (PEW) in PD patients.The study was performed in 30 PD patients and in the control group which consisted of 23 healthy volunteers. Plasma levels of hsC-reactive protein, TNF, IL-6, leptin, adiponectin, oxyLDL and ADMA were measured by ELISA method in both groups. The nutritional status was determined by measuring the albumin, body mass index (BMI), the percentage of body fat (%F), lean body mass (LBM) and Subjective Global Assessment Score (SGA). The adequacy of dialysis was estimated by weekly Kt/V. In all PD patients, significantly higher levels of ADMA, leptin, oxyLDL, hsCRP and TNF in comparison to controls were observed. In contrast to well-nourished subjects, patients with PEW, in addition to increased hsCRP, showed significantly higher ADMA. PEW was associated with high levels of ADMA and hsCRP and this could probably be responsible for increased CVS risk in PD patients. The aim of the study was to determine the plasma concentration of ADMA and adipokines in the relation to the protein – energy wasting (PEW) in PD patients. The study was performed in 30 PD and in the control group consisted of 23 healthy volunteers . Plasma levels of hsC-reactive protein, TNF, IL-6, leptin, adiponectin, oxyLDL and ADMA were measured by ELISA methods in both groups. The assessment of nutritional status was determined by the albumin, body mass index (BMI), percentage of body fat (%F), lean body mass (LBM) and Subjective Global Assessment Score (SGA).The adequacy of dialysis was estimated by weekly Kt/V. In all PD patients, significantly higher levels of ADMA, leptin, oxyLDL, hsCRP and TNF in comparison to controls were observed. In contrast to well-nourished subjects, patients with PEW, in addition to increased hsCRP, showed significantly higher ADMA. PEW was associated with high levels of ADMA and hsCRP and this could probably be responsible for increased CVS risk in PD patients.

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Predictor of Cardiovascular Risks in End Stage Renal Failure patients on Maintenance Dialysis

Cited by 11 publications

References 10 publications

Clinical course after parathyroidectomy in adults with end-stage renal disease on maintenance dialysis

Clinical course after parathyroidectomy in adults with end-stage renal disease on maintenance dialysis

Prognostic Value of the Controlling Nutritional Status (CONUT) Score in Patients at Dialysis Initiation

Protein-energy wasting and asymmetric dimethylarginine in peritoneal dialysis patients

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