Uncorrected and Albumin-Corrected Calcium, Phosphorus, and Mortality in Patients Undergoing Maintenance Dialysis

Background/Aims: While systolic blood pressure variability (SBPV) is an independent risk factor for mortality in the general population, its association with outcomes in hemodialysis patients has been less well-investigated. Methods: In this retrospective study, we enrolled 99 eligible HD patients from 2006 to 2016. Predialysis blood pressure measurements obtained over 1-year period were used to determine each patient’s BPV. The standard deviation (SD), the coefficient of variation (CV) and the variation independent of the mean (VIM) were used as metrics of BPV. Results: During a median follow-up period of 68 months, 52 patients died, and cardiovascular disease (31.3%) was the primary cause of death in these patients. After adjusting for covariates, the hazard ratios (HRs) for all-cause and cardiovascular mortality were 1.80 (95% confidence interval (CI) 1.11-2.92) and 1.71 (95% CI 1.01-2.90), respectively, for a one percent increase in CV. Variability in the volume removed per session and predialysis serum albumin and calcium levels were identified as factors associated with BPV. Conclusion: In this study, we demonstrate that greater variability in predialysis SBP is associated with long-term mortality in hemodialysis patients. Controlling volume variation, avoiding hypoalbuminemia and reducing blood calcium levels might reduce SBP variability and thereby improve prognoses in these patients.

Section: Discussionmentioning

confidence: 99%

Variability in Predialysis Systolic Blood Pressure and Long-Term Outcomes in Hemodialysis Patients

Wang

Qin

Fan

et al. 2018

“…In china, the number of ESRD patients receiving PD therapy is rapidly growing in recent years [37]. Patients on long-term dialysis have a significantly increased risk of mortality, and cardiovascular disease (CVD) and infection are most common causes of death in dialysis patients [38,39] have shown a variety of risk factors that predict the outcomes of dialysis patients, including age [40], sex [41], RRF [42], blood pressure [43,44], comorbidity [45], BMI [46][47][48][49], serum ALB [50,51], pre-ALB [52][53][54], TC [55][56][57][58], TG [59,60], VLDL [61], HB [62], Ca, P [63], PTH, ALP [64], UA [65,66], K, CRP [67], dialysis adequacy [68,69], incident peritonitis [70,71] and so on. Much effort has been done to maintain stable blood pressure, correct anemia and electrolyte disturbance as well as ensure dialysis adequacy and prevent peritonitis, in order to improve the long-term outcomes of dialysis patients.…”

Section: Discussionmentioning

confidence: 99%

Association Between Comprehensive Nutritional Scoring System (CNSS) and Outcomes of Continuous Ambulatory Peritoneal Dialysis Patients

Yan

Yang

Xie

et al. 2017

Background/Aims: The presence of protein-energy wasting (PEW) among dialysis patients is a crucial risk factor for outcomes. The complicated pathogenesis of PEW makes it difficult to assess and treat. This single-center retrospective study focuses on the association between nutritional markers and the outcomes of continuous ambulatory peritoneal dialysis(CAPD) patients, aiming to establish a practical comprehensive nutritional scoring system for CAPD patients. Methods: 924 patients who initiated peritoneal dialysis in our center from January 1st,2005 to December 31st,2015 were enrolled. Comprehensive nutritional scoring system(CNSS) was based on items including SGA, BMI, ALB, TC, MAC and TSF. We divide patients into 3 groups according to their CNSS score. Outcomes including mortality, hospitalization days and hospitalization frequency were compared between 3 grades. Results: The CNSS grade correlated significantly with hospitalization days (P<0.05). Both categorized CNSS grade (HR:0.56; 95% CI:0.41-0.78; P = 0.001) and continuous CNSS score (HR:0.87; 95% CI: 0.80-0.94; P = 0.001) independently protect PD patients from all-cause mortality. Conclusion: CNSS provides an integrated scoring system with significant associations with hospitalization and mortality in PD patients. The CNSS grade differentiates patients with malnutritional risk and independently predicts high risk of morbidity and mortality.

“…Hypercalcemia is often reported among serious CKD patients and is linked to elevated cardiovascular disease and increased mortality, especially in endstage renal disease (ESRD) patients since the 2009 KDIGO CKD-MBD guideline [11,12,[34][35][36]. Data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) among patients on hemodialysis for over 6 months suggested a higher risk of cardiovascular and all-cause mortality in patients with Ca concentrations over 10 mg/dL, P levels over 7 mg/dL, and PTH concentrations over 600 pg/mL [4,34].…”

Section: Discussionmentioning

confidence: 99%

“…CKD often manifests as Ca and P metabolism disorder and hyperparathyroidism, promoting the development of chronic kidney disease-mineral bone disorders (CKD-MBD) including cardiovascular disease (CVD) and renal osteodystrophy [9][10][11][12]. CVD is the main cause of death among hemodialysis (HD) patients [13].…”

Section: Introductionmentioning

confidence: 99%

Effect of Ascorbic Acid on Mineral and Bone Disorders in Hemodialysis Patients: a Systematic Review and Meta-Analysis

Huang

Zhu

et al. 2018

Background/Aims: Hemodialysis (HD) patients often have inadequate nutrition, especially with respect to ascorbic acid (AA). It is reported that every HD session may cause a 50%– 75% decrease in plasma AA levels. Some studies have shown that supplementation of AA can change the outcome of chronic kidney disease-mineral bone disorders (CKD-MBD), but the effect of AA on HD patients with CKD-MBD remains controversial. Consequently, we decided to perform a meta-analysis to evaluate the efficacy of AA supplementation in CKD-MBD patients requiring dialysis. Methods: A search was conducted using Pubmed, EMBASE, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure (CNKI), Wanfang database and VIP information database up to April 2018 for all English and Chinese language publications. The main indicators of our study were changes in serum phosphate (P), calcium (Ca) and parathyroid hormone (PTH) levels after AA treatment. The efficacy of AA was evaluated by weighted mean difference (WMD) and confidence intervals (CI). Cardiovascular events, mortality and adverse events reported during the experiment were also noted. Results: In total, 371 patients in six studies were involved in this meta-analysis. Compared to placebo, AA treatment had no positive effect on serum P (353 patients; WMD = -0.05; 95% CI, -0.3 to 0.2; I² = 28%) or PTH levels (275 patients; WMD = -17.04; 95%CI, -63.79 to 29.72; I² = 75%). The pooled mean difference of the change of Ca levels from baseline was higher in the AA therapy group versus placebo (353 patients; WMD = 0.15; 95% CI, 0.01 to 0.3; I² = 0%). No side effects were observed. Conclusion: Our systematic review and meta-analysis does not support prescription of AA to HD patients with CKD-MBD. AA had no positive effect on CKD-MBD patients as it couldn’t influence the serum P or PTH levels but did raise serum Ca levels in the short-term.