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Io H, Muto M, Sasaki Y, Ishizaka M, Kano T, Fukuzaki H, Maeda T, Shimizu Y, Nakata J, Suzuki Y. Impact of anemia treatment for left ventricular hypertrophy using long-acting erythropoietin-stimulating agents from the pre-dialysis to maintenance dialysis period in patients with chronic kidney disease, retrospective longitudinal cohort study. BMC Nephrol 2023; 24:74. [PMID: 36966289 PMCID: PMC10039592 DOI: 10.1186/s12882-023-03133-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/21/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Anemia in patients with chronic kidney disease (p-CKDs) may initiate or exacerbate left ventricular hypertrophy (LVH). This study aimed to determine whether treatment using long-acting erythropoietin-stimulating agents (L-ESAs) is independently associated with LVH during the pre-dialysis to maintenance dialysis period in p-CKDs. METHODS Physical and laboratory examinations were performed 120 days before initiating dialysis in p-CKDs (baseline). To evaluate the left ventricular mass index (LVMI) after starting dialysis, the mean hemoglobin (Hb) was defined as the average at the start of dialysis and 6 months after starting dialysis. Changes in the LVMI were observed in three groups according to mean Hb levels (Hb < 10.1, 10.1 < Hb < 11.0, and Hb > 11.0 g/dL for Groups 1, 2, and 3, respectively). LVMI was evaluated using echocardiography at the pre-dialysis, initiation, and maintenance dialysis periods. RESULTS A lower LVMI at dialysis initiation and an improvement in LVMI were detected in the highest tertile group of mean Hb (11.0 g/dl). Consequently, in the high Hb group (Hb level > 11.0 g/dl), LVMI remained low from dialysis initiation until after 6 months.The relationship between Hb and LVMI was not significant; however, a constant correlation with β ≥ 0.4 in the absolute value was maintained. CONCLUSION L-ESAs may correlate with Hb and LVMI after administration, independent of the baseline LVMI and Hb values. These findings have therapeutic implications in the treatment strategies for p-CKDs during the pre-dialysis to maintenance dialysis period.
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Affiliation(s)
- Hiroaki Io
- Department of Nephrology, Juntendo University Nerima Hospital, Takanodai 3-1-10, Nerima-ku, 177-8521, Tokyo, Japan.
- Department of Nephrology, Faculty of Medicine, Juntendo University, Tokyo, Japan.
| | - Masahiro Muto
- Department of Nephrology, Juntendo University Nerima Hospital, Takanodai 3-1-10, Nerima-ku, 177-8521, Tokyo, Japan
- Department of Nephrology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yu Sasaki
- Department of Nephrology, Juntendo University Nerima Hospital, Takanodai 3-1-10, Nerima-ku, 177-8521, Tokyo, Japan
- Department of Nephrology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Masanori Ishizaka
- Department of Nephrology, Juntendo University Nerima Hospital, Takanodai 3-1-10, Nerima-ku, 177-8521, Tokyo, Japan
- Department of Nephrology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Toshiki Kano
- Department of Nephrology, Juntendo University Nerima Hospital, Takanodai 3-1-10, Nerima-ku, 177-8521, Tokyo, Japan
- Department of Nephrology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Haruna Fukuzaki
- Department of Nephrology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Takuya Maeda
- Department of Nephrology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yuki Shimizu
- Department of Nephrology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Junichiro Nakata
- Department of Nephrology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Faculty of Medicine, Juntendo University, Tokyo, Japan
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Yang CH, Chen YS, Moi SH, Chen JB, Wang L, Chuang LY. Machine learning approaches for the mortality risk assessment of patients undergoing hemodialysis. Ther Adv Chronic Dis 2022; 13:20406223221119617. [PMID: 36062293 PMCID: PMC9434675 DOI: 10.1177/20406223221119617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 07/27/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction: Mortality is a major primary endpoint for long-term hemodialysis (HD)
patients. The clinical status of HD patients generally relies on
longitudinal clinical observations such as monthly laboratory examinations
and physical examinations. Methods: A total of 829 HD patients who met the inclusion criteria were analyzed. All
patients were tracked from January 2009 to December 2013. Taken together,
this study performed full-adjusted-Cox proportional hazards (CoxPH),
stepwise-CoxPH, random survival forest (RSF)-CoxPH, and whale optimization
algorithm (WOA)-CoxPH model for the all-cause mortality risk assessment in
HD patients. The model performance between proposed selections of CoxPH
models were evaluated using concordance index. Results: The WOA-CoxPH model obtained the highest concordance index compared with
RSF-CoxPH and typical selection CoxPH model. The eight significant
parameters obtained from the WOA-CoxPH model, including age, diabetes
mellitus (DM), hemoglobin (Hb), albumin, creatinine (Cr), potassium (K),
Kt/V, and cardiothoracic ratio, have also showed significant survival
difference between low- and high-risk characteristics in single-factor
analysis. By integrating the risk characteristics of each single factor,
patients who obtained seven or more risk characteristics of eight selected
parameters were dichotomized as high-risk subgroup, and remaining is
considered as low-risk subgroup. The integrated low- and high-risk subgroup
showed greater discrepancy compared with each single risk factor selected by
WOA-CoxPH model. Conclusion: The study findings revealed WOA-CoxPH model could provide better risk
assessment performance compared with RSF-CoxPH and typical selection CoxPH
model in the HD patients. In summary, patients who had seven or more risk
characteristics of eight selected parameters were at potentially increased
risk of all-cause mortality in HD population.
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Affiliation(s)
- Cheng-Hong Yang
- Department of Information Management, Tainan University of Technology, Tainan
- Department of Electronic Engineering, National Kaohsiung University of Science and Technology, Kaohsiung
- Biomedical Engineering, Kaohsiung Medical University, Kaohsiung
- School of Dentistry, Kaohsiung Medical University, Kaohsiung
- Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung
| | - Yin-Syuan Chen
- Department of Electronic Engineering, National Kaohsiung University of Science and Technology, Kaohsiung
| | - Sin-Hua Moi
- Center of Cancer Program Development, E-Da Cancer Hospital, I-Shou University, Kaohsiung 82445
| | - Jin-Bor Chen
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301
| | - Lin Wang
- Department of Nephrology, Dalian University Affiliated Xinhua Hospital, Dalian, 116001, China
| | - Li-Yeh Chuang
- Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung 84004
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Yang CH, Moi SH, Chuang LY, Chen JB. Higher-order clinical risk factor interaction analysis for overall mortality in maintenance hemodialysis patients. Ther Adv Chronic Dis 2020; 11:2040622320949060. [PMID: 33062235 PMCID: PMC7534064 DOI: 10.1177/2040622320949060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 07/20/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND AIMS In Taiwan, approximately 90% of patients with end-stage renal disease receive maintenance hemodialysis. Although studies have reported the survival predictability of multiclinical factors, the higher-order interactions among these factors have rarely been discussed. Conventional statistical approaches such as regression analysis are inadequate for detecting higher-order interactions. Therefore, this study integrated receiver operating characteristic, logistic regression, and balancing functions for adjusting the ratio in risk classes and classification errors for imbalanced cases and controls using multifactor-dimensionality reduction (MDR-ER) analyses to examine the impact of interaction effects between multiclinical factors on overall mortality in patients on maintenance hemodialysis. METERIALS AND METHODS In total, 781 patients who received outpatient hemodialysis dialysis three times per week before 1 January 2009 were included; their baseline clinical factor and mortality outcome data were retrospectively collected using an approved data protocol (201800595B0). RESULTS Consistent with conventional statistical approaches, the higher-order interaction model could indicate the impact of potential risk combination unique to patients on maintenance hemodialysis on the survival outcome, as described previously. Moreover, the MDR-based higher-order interaction model facilitated higher-order interaction effect detection among multiclinical factors and could determine more detailed mortality risk characteristics combinations. CONCLUSION Therefore, higher-order clinical risk interaction analysis is a reasonable strategy for detecting non-traditional risk factor interaction effects on survival outcome unique to patients on maintenance hemodialysis and thus clinically achieving whole-scale patient care.
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Affiliation(s)
- Cheng-Hong Yang
- Department of Electronic Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung Ph.D. Program in Biomedical Engineering, Kaohsiung Medical University, Kaohsiung Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung
| | - Sin-Hua Moi
- Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung
| | - Li-Yeh Chuang
- Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung 84004
| | - Jin-Bor Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 DaPei Rd, Niao Song Dist, Kaohsiung 83301
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Hayashi T, Tanaka Y, Iwasaki M, Hase H, Yamamoto H, Komatsu Y, Ando R, Ikeda M, Inaguma D, Sakaguchi T, Shinoda T, Koiwa F, Negi S, Yamaka T, Shigematsu T, Joki N. Association of Circulatory Iron Deficiency With an Enlarged Heart in Patients With End-Stage Kidney Disease. J Ren Nutr 2019; 29:39-47. [DOI: 10.1053/j.jrn.2018.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/16/2018] [Accepted: 05/21/2018] [Indexed: 11/11/2022] Open
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Kawamoto S, Kaneko Y, Misawa H, Nagahori K, Kitazawa A, Yoshino A, Takeda T. Lower Hb at the initiation of dialysis does not adversely affect 1-year mortality rate. RENAL REPLACEMENT THERAPY 2018. [DOI: 10.1186/s41100-018-0145-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Risk of cardiovascular mortality predicted by the serum calcium level and calcification score at the initiation of dialysis. Clin Exp Nephrol 2018; 22:957-966. [PMID: 29302867 DOI: 10.1007/s10157-017-1527-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/22/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The relationship between serum corrected calcium (CCa) level and vessel calcification at dialysis initiation and survival has seldom been evaluated. Therefore, we evaluated the efficacy of CCa levels and the calcification score at the initiation of dialysis for predicting all-cause and cardiovascular (CV) mortality in patients with end-stage renal disease (ESRD). METHODS The study group included 407 patients with ESRD, who started hemodialysis between January 2009 and December 2016 at the Red Cross Ishinomaki Hospital. The primary outcomes were the 1- and 3-year all-cause and CV mortality rate, with the association between CCa level and CVD-specific mortality evaluated using the Kaplan-Meier method and Cox proportional hazard regression analysis. RESULTS Patients with a high initial CCa level were at higher risk for CVD-related, but not all-cause, mortality than patients with a low initial CCa level [hazard ratio (HR) 2.81; 95% confidence interval 1.05-7.55]. The HR for CVD-related mortality was also higher for patients with an Agatston vessel calcification score > 2000 (HR 13.9; 95% CI 1.63-118.2). Overall, the 3-year CVD-free rate was 88.2% (range 76.4-94.3%). Higher CCa level was associated with a higher Agatston score and cardiac valve calcification. CONCLUSION High serum CCa levels and an Agatston score > 2000 are independent risk factors of CVD mortality due to advanced vessel calcification.
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Wang TL, Fang YW, Leu JG, Tsai MH. Association between serum aluminum levels and cardiothoracic ratio in patients on chronic hemodialysis. PLoS One 2017; 12:e0190008. [PMID: 29261793 PMCID: PMC5738104 DOI: 10.1371/journal.pone.0190008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/06/2017] [Indexed: 11/18/2022] Open
Abstract
The cardiothoracic ratio (CTR) and serum aluminum levels are both associated with mortality in hemodialysis patients. However, limited data regarding the association between serum aluminum levels and the CTR have been published to date. Therefore, we aimed to elucidate this association in patients on chronic hemodialysis (CHD). We investigated the association between the serum aluminum level and the CTR in CHD in a retrospective cross-sectional study of 547 Taiwanese patients on CHD. The mean age of patients was 62.5±13.2 years, with a mean hemodialysis time of 7.1±5.2 years. Among the patients, 36.9% were diabetic and 47.9% were male. After natural logarithmic transformation (ln(aluminum)), the serum aluminum level exhibited an independent and linear relationship with the CTR (β: 1.40, 95% confidence interval (CI), 0.6–2.2). A high serum aluminum level (≥6 ng/dL) was significantly associated with a CTR >0.5 in the crude analysis (odds ratio (OR): 2.15, 95% CI, 1.52–3.04) and remained significant after multivariable adjustment (OR: 2.45, 95% CI, 1.63–3.67). Moreover, the ln(aluminum) value was significantly associated with a CTR >0.5 (OR: 1.71, 95%CI, 1.28–2.29) in multivariable analysis, indicating a dose effect of aluminum on cardiomegaly. In conclusion, the serum aluminum level was independently associated with cardiac remodeling (elevated CTR) in patients on CHD.
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Affiliation(s)
- Tzu-Lin Wang
- Division of Cardiology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, R.O.C
| | - Yu-Wei Fang
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, R.O.C.,Fu-Jen Catholic University School of Medicine, Taipei, Taiwan, R.O.C
| | - Jyh-Gang Leu
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, R.O.C.,Fu-Jen Catholic University School of Medicine, Taipei, Taiwan, R.O.C
| | - Ming-Hsien Tsai
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, R.O.C.,Fu-Jen Catholic University School of Medicine, Taipei, Taiwan, R.O.C.,Division of Biostatistics, Institutes of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, R.O.C
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8
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Ogata H, Kumasawa J, Fukuma S, Mizobuchi M, Kinugasa E, Fukagawa M, Fukuhara S, Akizawa T. The cardiothoracic ratio and all-cause and cardiovascular disease mortality in patients undergoing maintenance hemodialysis: results of the MBD-5D study. Clin Exp Nephrol 2017; 21:797-806. [PMID: 28508128 PMCID: PMC5648748 DOI: 10.1007/s10157-017-1380-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 01/04/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The cardiothoracic ratio (CTR) is a non-invasive left ventricular hypertrophy index. However, whether CTR associates with cardiovascular disease (CVD) and mortality in hemodialysis (HD) populations is unclear. METHODS Using a Mineral and Bone disorder Outcomes Study for Japanese CKD Stage 5D Patients (MBD-5D Study) subcohort, 2266 prevalent HD patients (age 62.8 years, female 38.0%, HD duration 9.4 years) with secondary hyperparathyroidism (SHPT) whose baseline CTR had been recorded were selected. We evaluated associations between CTR and all-cause death, CVD death, or composite events in HD patients. RESULTS CTR was associated significantly with various background and laboratory characteristics. All-cause death, CVD-related death, and composite events increased across the CTR quartiles (Q). Adjusted hazard risk (HR) for all-cause death was 1.4 (95% confidential interval, 0.9-2.1) in Q2, 1.9 (1.3-2.9) in Q3, and 2.6 (1.7-4.0) in Q4, respectively (Q1 as a reference). The corresponding adjusted HR for CVD-related death was 1.8 (0.8-4.2), 3.1 (1.4-6.8), and 3.5 (1.6-7.9), and that for composite outcome was 1.2 (1.0-1.6), 1.7 (1.3-2.2), and 1.8 (1.5-2.3), respectively. Exploratory analysis revealed that there were relationships between CTR and age, sex, body mass index, comorbidity of CVD, dialysis duration and intact parathyroid hormone, phosphorus, hemoglobin, and usage of phosphate binder [corrected]. CONCLUSION CTR correlated with all-cause death, CVD death, and composite events in HD patients with SHPT.
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Affiliation(s)
- Hiroaki Ogata
- Department of Internal Medicine, Showa University Northern Yokohama Hospital, Chigsaki-chuo 35-1, Tsuzuki, Yokohama, Kanagawa, 224-8503, Japan.
| | - Junji Kumasawa
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,Department of Critical Care Medicine, Sakai City Medical Center, Osaka, Japan.,Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Shingo Fukuma
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan.,Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan
| | - Masahide Mizobuchi
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Eriko Kinugasa
- Department of Internal Medicine, Showa University Northern Yokohama Hospital, Chigsaki-chuo 35-1, Tsuzuki, Yokohama, Kanagawa, 224-8503, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Kanagawa, Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan
| | - Tadao Akizawa
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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Liou KY, Liou HH, Fang YW, Leu JG, Tsai MH. Association between peripheral arterial occlusive disease and cardiothoracic ratio in patients on chronic hemodialysis. Sci Rep 2016; 6:38458. [PMID: 27918569 PMCID: PMC5137470 DOI: 10.1038/srep38458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 11/09/2016] [Indexed: 11/09/2022] Open
Abstract
The cardiothoracic ratio (CTR) and peripheral arterial occlusive disease (PAOD) are related to mortality in hemodialysis patients. However, data on the association between PAOD and CTR are limited. In this study, we aim to elucidate this relationship in patients on chronic hemodialysis. Using a retrospective cross-sectional study of 622 Taiwanese patients, we investigated the association of PAOD and CTR. PAOD was significantly associated with CTR in the crude analysis. The odds ratio (OR) for CTR >0.5 was 1.77 [95% confidence interval (CI), 1.32-2.37], and the odds ratio for CTR >0.6 was 2.18 [95% CI, 1.44-3.30]. After adjusting for confounding variables, this difference continued to exhibit significant predictive power for CTR >0.6 (OR, 1.88; 95% CI, 1.14-3.11), but the predictive power for CTR >0.5 was attenuated (OR, 1.41; 95% CI, 0.98-2.03). In the subgroup analysis, PAOD was an independent factor for CTR >0.6, particularly in elderly and female patients or patients with hemoglobin >10 mg/dl and with no history of cardiovascular disease. In this research, we showed that the detection of PAOD was independently associated with CTR >0.6 in patients on chronic hemodialysis.
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Affiliation(s)
- Kang-Yi Liou
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (R.O.C)
| | - Hung-Hsiang Liou
- Division of Nephrology, Department of Internal Medicine, Hsin-Jen Hospital, New Taipei City, Taiwan (R.O.C)
| | - Yu-Wei Fang
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (R.O.C).,Fu-Jen Catholic University School of Medicine, Taipei, Taiwan (R.O.C)
| | - Jyh-Gang Leu
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (R.O.C).,Fu-Jen Catholic University School of Medicine, Taipei, Taiwan (R.O.C)
| | - Ming-Hsien Tsai
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (R.O.C).,Fu-Jen Catholic University School of Medicine, Taipei, Taiwan (R.O.C).,Division of Biostatistics, Institutes of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (R.O.C)
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Hayashi T, Joki N, Tanaka Y, Hase H. Anaemia and early phase cardiovascular events on haemodialysis. Nephrology (Carlton) 2016; 20 Suppl 4:1-6. [PMID: 26456311 DOI: 10.1111/nep.12642] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 01/30/2023]
Abstract
Although the mechanism of the cardio-renal anaemia syndrome (CRAS) has been elucidated in considerable detail over the past decade, cardiovascular disease (CVD) remains a leading cause of death among patients with end-stage kidney disease (ESKD) undergoing haemodialysis, and these patients' cardiovascular mortality is greater than that of the general population. Recent studies have reported that the CVD risk increases with advancing chronic kidney disease (CKD) stage. Furthermore, the incidence of cardiovascular events is highest during the first week after dialysis initiation, with increased risk in incident haemodialysis patients. This accumulated evidence demonstrates that how patients are managed during the pre-dialysis phase may have important implications on long-term outcomes in ESKD. Anaemia, a non-traditional risk factor for CVD, advances exponentially along with declining kidney function due to insufficient erythropoietin production. Anaemia causes functional abnormalities of the heart, as represented by cardiac hypertrophy, which results from increased cardiac workload induced by an increased preload. Left ventricular hypertrophy (LVH), a traditional risk factor for CVD, is especially associated with advanced CKD stage and could be a major risk factor for cardiovascular complications such as ischaemic heart disease, heart failure, and sudden cardiac death. In ESKD, anaemia develops more severely and requires a higher amount of erythropoiesis-stimulating agent (ESA) therapy before dialysis initiation. This suggests that improvement in anaemia management during the pre-dialysis phase may have a beneficial effect on cardiac hypertrophy and contribute to reducing the CVD risk after initiating haemodialysis.
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Affiliation(s)
- Toshihide Hayashi
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Nobuhiko Joki
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yuri Tanaka
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Hiroki Hase
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
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11
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Kataoka H, Tsuchiya K, Naganuma T, Okazaki M, Komatsu M, Kimura T, Shiohira S, Kawaguchi H, Nitta K. Relationship between anaemia management at haemodialysis initiation and patient prognosis. Nephrology (Carlton) 2016; 20 Suppl 4:14-21. [PMID: 26456159 DOI: 10.1111/nep.12639] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM It has been suggested that anaemia management during a transition period to haemodialysis could influence prognosis. In this paper, we have conducted a retrospective investigation on how Hb levels at haemodialysis initiation in patients with chronic kidney disease (CKD) influence the risk of cerebral infarction and cardiovascular events. METHODS Seventy-two patients who underwent initial haemodialysis between May 2012 and April 2014 were designated as subjects of the study and the patients were divided into a cohort with Hb levels ≥8 g/dL and a cohort with <8 g/dL at haemodialysis initiation. The occurrence of cardiovascular events was analyzed using the Kaplan-Meier method and Cox proportional hazards model. RESULTS The cohort with <8 g/dL Hb levels at haemodialysis initiation demonstrated a tendency toward low dosage of ESA or iron preparation in the pre-haemodialysis (maintenance) phase. Significant incidence of cardiovascular (log rank, P = 0.002) and cerebrovascular (log rank, P = 0.02) events was observed. The results of multivariate analysis of the Cox proportional hazards model indicated that anaemia with <8 g/dL Hb levels at haemodialysis initiation was a significant risk factor for coronary artery (hazard ratio = 12.85, P = 0.003) and cerebrovascular (hazard ratio = 5.11, P = 0.04) diseases post-haemodialysis. CONCLUSION The results of this investigation indicate the possible involvement of low Hb levels at haemodialysis initiation as a factor in cardio- and cerebrovascular events. There, our results suggested that the administration of adequate dosage of iron preparations and ESA in the pre-haemodialysis period could help prevent cardio- and cerebrovascular events.
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Affiliation(s)
- Hiroshi Kataoka
- Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Tsuchiya
- Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan
| | | | | | - Mizuki Komatsu
- Department of Nephrology, Jyoban Hospital, Fukushima, Japan
| | | | - Shunji Shiohira
- Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan.,Department of Nephrology, Jyoban Hospital, Fukushima, Japan
| | | | - Kosaku Nitta
- Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan
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12
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Ito K, Ookawara S, Ueda Y, Miyazawa H, Yamada H, Goto S, Ishii H, Shindo M, Kitano T, Hirai K, Yoshida M, Kaku Y, Hoshino T, Nabata A, Mori H, Yoshida I, Kakei M, Morishita Y, Tabei K. A Higher Cardiothoracic Ratio Is Associated with 2-Year Mortality after Hemodialysis Initiation. NEPHRON EXTRA 2015; 5:100-10. [PMID: 26951636 PMCID: PMC4777940 DOI: 10.1159/000442591] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED A high cardiothoracic ratio (CTR) is indicative of a cardiac disorder. However, few reports have revealed an association between the CTR and mortality in patients starting hemodialysis (HD). METHODS Patients with HD initiation (n = 387; mean age, 66.7 ± 12.7 years) were divided into the following three groups according to their CTR at HD initiation: CTR <50%, 50% ≤ CTR < 55%, and CTR ≥55%. Kaplan-Meier analysis was performed to compare 2-year all-cause mortality among these groups. Furthermore, we investigated the factors affecting their 2-year mortality using a Cox proportional hazard regression analysis. RESULTS Sixty-five patients (17%) died within 2 years after HD initiation. Kaplan-Meier analysis showed that patients with CTR ≥55% had a higher mortality rate than those in the other groups. Cox proportional hazard regression analysis was performed using parameters with p values <0.1 among these three groups [sex, age, presence or absence of ischemic heart disease, hemoglobin levels, serum albumin levels, CTR, body mass index (BMI)] and confounding factors [presence or absence of diabetes mellitus, and estimated glomerular filtration rate (eGFR)]. Age, eGFR, BMI, and CTR ≥55% at HD initiation were identified as factors influencing 2-year mortality. CONCLUSION CTR >55% is one of the most important independent factors to affect 2-year all-cause mortality. Thus, confirming the cardiac condition of patients at HD initiation with a CTR >55% may improve their survival.
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Affiliation(s)
- Kiyonori Ito
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Susumu Ookawara
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yuichiro Ueda
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Haruhisa Miyazawa
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hodaka Yamada
- Endocrinology and Metabolism, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Sawako Goto
- Division of Clinical Nephrology and Rheumatology, Niigata University Medical and Dental Hospital, Japan
| | - Hiroki Ishii
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Mitsutoshi Shindo
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Taisuke Kitano
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Keiji Hirai
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masashi Yoshida
- Endocrinology and Metabolism, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yoshio Kaku
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Taro Hoshino
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Aoi Nabata
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Honami Mori
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | | | - Masafumi Kakei
- Endocrinology and Metabolism, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yoshiyuki Morishita
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kaoru Tabei
- Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan; Minami-Uonuma City Hospital, Niigata, Japan
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13
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Kawahara K, Minakuchi J, Yokota N, Suekane H, Tsuchida K, Kawashima S. Treatment of renal anaemia with erythropoiesis-stimulating agents in predialysis chronic kidney disease patients: Haemoglobin profile during the 6 months before initiation of dialysis. Nephrology (Carlton) 2015; 20 Suppl 4:29-32. [DOI: 10.1111/nep.12647] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2015] [Indexed: 11/30/2022]
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14
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Io H, Aizawa M, Funabiki K, Horikoshi S, Tomino Y. Impact of anaemia treatment for left ventricular remodelling prior to initiation of dialysis in chronic kidney disease patients: Efficacy and stability of long acting erythropoietin stimulating agents. Nephrology (Carlton) 2015; 20 Suppl 4:7-13. [DOI: 10.1111/nep.12640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Hiroaki Io
- Division of Nephrology, Department of Internal Medicine; Juntendo University Faculty of Medicine; Tokyo Japan
| | - Masashi Aizawa
- Division of Nephrology and Hypertension; Juntendo Tokyo Koto Geriatric Medical Center; Tokyo Japan
| | - Kazuhiko Funabiki
- Division of Nephrology and Hypertension; Juntendo Tokyo Koto Geriatric Medical Center; Tokyo Japan
| | - Satoshi Horikoshi
- Division of Nephrology, Department of Internal Medicine; Juntendo University Faculty of Medicine; Tokyo Japan
| | - Yasuhiko Tomino
- Division of Nephrology, Department of Internal Medicine; Juntendo University Faculty of Medicine; Tokyo Japan
- Medical Corporation Showakai; Tokyo Japan
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15
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Koibuchi K, Miyagi M, Arai T, Aoki T, Aikawa A, Sakai K. Comparing the efficacy of continuous erythropoietin receptor activator and darbepoetin Alfa treatments in Japanese patients with chronic kidney disease during the predialysis period: A propensity-matched analysis. Nephrology (Carlton) 2015; 20 Suppl 4:22-8. [DOI: 10.1111/nep.12641] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Kiyoto Koibuchi
- Department of Nephrology and Dialysis; Saiseikai Yokohama-City Eastern Hospital; Kanagawa Japan
| | - Moriatsu Miyagi
- Department of Nephrology and Dialysis; Saiseikai Yokohama-City Eastern Hospital; Kanagawa Japan
| | - Taichi Arai
- Department of Nephrology and Dialysis; Saiseikai Yokohama-City Eastern Hospital; Kanagawa Japan
| | - Toshiyuki Aoki
- Department of Nephrology and Dialysis; Saiseikai Yokohama-City Eastern Hospital; Kanagawa Japan
| | - Atsushi Aikawa
- Department of Nephrology, School of Medicine, Faculty of Medicine; Toho University; Tokyo Japan
| | - Ken Sakai
- Department of Nephrology, School of Medicine, Faculty of Medicine; Toho University; Tokyo Japan
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