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Mbadu Lelo S, Musungayi Kajingulu FP, Makulo JR, Mayamba Nlandu Y, Busanga Bukabau J, Koso Mbulupasu P, Luzayadio Longo A, Losa Luse JN, Momeme Mokoli V, Kiswaya Sumaili E, Mangani Nseka N. 25 [OH] Vitamin D and Intact Parathyroid Hormone in Congolese Hemodialysis Patients: Evaluation of KDIGO Targets. Int J Nephrol Renovasc Dis 2024; 17:71-79. [PMID: 38405026 PMCID: PMC10887870 DOI: 10.2147/ijnrd.s440809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/14/2024] [Indexed: 02/27/2024] Open
Abstract
Background Data on 25 [OH] vitamin D and intact parathyroid hormone [iPTH] in hemodialysis patients are very limited in sub-Saharan African countries. The present study aimed to assess the magnitude of hypovitaminosis D, and to evaluate the achievement of iPTH KDIGO 2017 targets among chronic hemodialysis patients followed in Kinshasa. Methods We conducted a multicenter cross-sectional study in 6 hospitals in Kinshasa. All patients followed on hemodialysis for more than 3 months were included. Hypovitaminosis D was defined as <30 ng/mL (insufficiency = 20-29 ng/mL; deficiency if <20 ng/mL) and the targets for iPTH values were based on the 2017 KDIGO guidelines. The determinants for hypovitaminosis D were evaluated by logistic regression. Results 251 patients [mean age 56 ± 14 years, 72.5% men, 63% hypertensive, 31% diabetic, 100% supplemented with native 25 [OH] vitamin D + CaCO3 were included. Hypovitaminosis D was found in 79.7% (deficiency 47.4%) and was associated with the male gender aOR 2.7 [1.4-5.2], p = 0.004, the low-permeability dialyzer 2.2 [1.1-4.2], p = 0.025 and anemia 3.9 [1.2-12.7], p = 0.022. Only 40% of patients with 25 [OH] vitamin D deficiency had iPTH according to KDIGO targets vs 6% of patients with severe hyperparathyroidism (iPTH > 600 pg/mL), 45% with levels between 16 and 150 pg/mL and 9% a iPTH ≤ 15 pg/mL. Conclusion Despite a sunny environment, a large proportion of Congolese hemodialysis patients have hypovitaminosis D, in particular a deficiency. Among them, less than half have target iPTH values. These results show the benefit of regular monitoring of these parameters in order to optimize treatment.
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Affiliation(s)
- Samuel Mbadu Lelo
- Hemodialysis Center, Division of Nephrology, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
- Hemodialysis Center, Ngaliema Medical Center, Kinshasa, Democratic Republic of the Congo
| | - François-Pantaléon Musungayi Kajingulu
- Hemodialysis Center, Division of Nephrology, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
- Dialysis Center, HJ Hospital, Kinshasa, Democratic Republic of the Congo
- Department of Internal Medicine, Saint-Joseph Hospital, Kinshasa, Democratic Republic of the Congo
| | - Jean-Robert Makulo
- Hemodialysis Center, Division of Nephrology, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
- Hemodialysis Center, Ngaliema Medical Center, Kinshasa, Democratic Republic of the Congo
| | - Yannick Mayamba Nlandu
- Hemodialysis Center, Division of Nephrology, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
- Hemodialysis Center, Centre Médical de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Justine Busanga Bukabau
- Hemodialysis Center, Division of Nephrology, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
- Hemodialysis Center, Centre Médical de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Pierre Koso Mbulupasu
- Hemodialysis Center, Division of Nephrology, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
- Department of Internal Medicine, Clinique Ngaliema, Kinshasa, Democratic Republic of the Congo
| | - Augustin Luzayadio Longo
- Hemodialysis Center, Division of Nephrology, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Jeanine Nina Losa Luse
- Hemodialysis Center, Hôpital Général de Référence de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Vieux Momeme Mokoli
- Hemodialysis Center, Division of Nephrology, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
- Hemodialysis Center, Ngaliema Medical Center, Kinshasa, Democratic Republic of the Congo
| | - Ernest Kiswaya Sumaili
- Hemodialysis Center, Division of Nephrology, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Nazaire Mangani Nseka
- Hemodialysis Center, Division of Nephrology, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
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Torreggiani M, Fois A, Njandjo L, Longhitano E, Chatrenet A, Esposito C, Fessi H, Piccoli GB. Toward an individualized determination of dialysis adequacy: a narrative review with special emphasis on incremental hemodialysis. Expert Rev Mol Diagn 2021; 21:1119-1137. [PMID: 34595991 DOI: 10.1080/14737159.2021.1987216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The search for the 'perfect' renal replacement therapy has been paralleled by the search for the perfect biomarkers for assessing dialysis adequacy. Three main families of markers have been assessed: small molecules (prototype: urea); middle molecules (prototype β2-microglobulin); comprehensive and nutritional markers (prototype of the simplified assessment, albumin levels; composite indexes as malnutrition-inflammation score). After an era of standardization of dialysis treatment, personalized dialysis schedules are increasingly proposed, challenging the dogma of thrice-weekly hemodialysis. AREAS COVERED In this review, we describe the advantages and limitations of the approaches mentioned above, focusing on the open questions regarding personalized schedules and incremental hemodialysis. EXPERT OPINION In the era of personalized dialysis, the assessment of dialysis adequacy should be likewise personalized, due to the limits of 'one size fits all' approaches. We have tried to summarize some of the relevant issues regarding the determination of dialysis adequacy, attempting to adapt them to an elderly, highly comorbidity population, which would probably benefit from tailor-made dialysis prescriptions. While no single biomarker allows precisely tailoring the dialysis dose, we suggest using a combination of clinical and biological markers to prescribe dialysis according to comorbidity, life expectancy, residual kidney function, and small and medium-size molecule depuration.
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Affiliation(s)
| | - Antioco Fois
- Nèphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France
| | - Linda Njandjo
- Nèphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France
| | - Elisa Longhitano
- Department of Clinical and Experimental Medicine, Unit of Nephrology and Dialysis, A.o.u. "G. Martino," University of Messina, Messina, Italy
| | - Antoine Chatrenet
- Nèphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France.,Laboratory "Movement, Interactions, Performance" (EA 4334), Le Mans University, Le Mans, France
| | - Ciro Esposito
- Nephrology and Dialysis, ICS Maugeri S.p.A. Sb, Pavia, Italy.,Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Hafedh Fessi
- Department of Nephrology, Hospital Tenon, Paris, France
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Tennankore KK, Nadeau-Fredette AC, Vinson AJ. Survival comparisons in home hemodialysis: Understanding the present and looking to the future. Nephrol Ther 2021; 17S:S64-S70. [PMID: 33910701 DOI: 10.1016/j.nephro.2020.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/13/2020] [Indexed: 10/21/2022]
Abstract
A number of studies have compared relative survival for home hemodialysis patients (including longer hours/more frequent schedules) and other forms of renal replacement therapy. While informative, many of these studies have been limited by issues pertaining to their observational design including selection bias and residual confounding. Furthermore the few randomized controlled trials that have been conducted have been underpowered to detect a survival difference. Finally, in the face of a growing recognition of the value of patient-important outcomes beyond survival, the focus of comparisons between dialysis modalities may be changing. In this review, we will discuss the determinants of survival for patients receiving home hemodialysis and address the various studies that have compared relative survival for differing home hemodialysis schedules to each of in-center hemodialysis, peritoneal dialysis and transplantation. We will conclude this review by discussing whether there is an ongoing role for survival analyses in home hemodialysis.
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Affiliation(s)
- Karthik K Tennankore
- Dalhousie University/Nova Scotia Health Authority, 5082 Dickson Building, 5820, University Avenue, NS B3H 1V8 Halifax, Canada.
| | | | - Amanda J Vinson
- Dalhousie University/Nova Scotia Health Authority, 5082 Dickson Building, 5820, University Avenue, NS B3H 1V8 Halifax, Canada
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Zsom L, Zsom M, Abdul Salim S, Fülöp T. Subjective global assessment of nutrition, dialysis quality, and the theory of the scientific method in Nephrology practice. Artif Organs 2020; 44:1021-1030. [PMID: 33617092 DOI: 10.1111/aor.13762] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022]
Abstract
In an era of evidence-based medicine and dialysis performance measures, there is strong motivation to find specific, objective, quantifiable, and reproducible parameters to characterize the clinical condition of chronic kidney disease patients and to present population-wide statistics that may describe quality of care in dialysis centers. Yet, in the last three decades, several studies demonstrated that while parameters including Kt/V urea, serum phosphorus, parathyroid hormone, serum cholesterol fulfill all these criteria, efforts to optimize these lab parameters failed to improve survival on dialysis. However, subjective assessments of nutrition including subjective global assessment and malnutrition-inflammation score, while not ideally suited for statistical analysis and not optimal from the point of view of scientific methodology due to their general, semi-quantifiable, subjective nature have, nevertheless, proved themselves as some of the strongest predictors of clinical outcomes in the dialysis population. Where does this paradox leave us? We propose that a deeper understanding of relevance of these variables in the dialysis population may improve appreciation of the clinical situation of individual patients and may result in a paradigm shift from dialysis adequacy to quality dialysis.
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Affiliation(s)
- Lajos Zsom
- Cegléd Dialysis Unit, Fresenius Medical Care, Cegléd, Hungary
| | - Marianna Zsom
- Department of Medicine, Szent Rókus Hospital, Baja, Hungary
| | - Sohail Abdul Salim
- Department of Medicine, Nephrology Division, University of Mississippi Medical Center, Jackson, MS, USA
| | - Tibor Fülöp
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA.,Department of Medicine, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
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Smyth B, Zuo L, Gray NA, Chan CT, de Zoysa JR, Hong D, Rogers K, Wang J, Cass A, Gallagher M, Perkovic V, Jardine M. No evidence of a legacy effect on survival following randomization to extended hours dialysis in the ACTIVE Dialysis trial. Nephrology (Carlton) 2020; 25:792-800. [PMID: 32500957 DOI: 10.1111/nep.13737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/01/2020] [Accepted: 05/15/2020] [Indexed: 11/28/2022]
Abstract
AIM Extended hours haemodialysis is associated with superior survival to standard hours. However, residual confounding limits the interpretation of this observation. We aimed to determine the effect of a period of extended hours dialysis on long-term survival among participants in the ACTIVE Dialysis trial. METHODS Two-hundred maintenance haemodialysis recipients were randomized to extended hours dialysis (median 24 h/wk) or standard hours dialysis (median 12 h/wk) for 12 months. Further pre-specified observational follow up occurred at 24, 36 and 60 months. Vital status and modality of renal replacement therapy were ascertained. RESULTS Over the 5 years, 38 participants died, 30 received a renal transplant, and 6 were lost to follow up. Total weekly dialysis hours did not differ between standard and extended groups during the follow-up period (14.1 hours [95%CI 13.4-14.8] vs 14.8 hours [95%CI 14.1-15.6]; P = .16). There was no difference in all-cause mortality (hazard ratio for extended hours 0.91 [95%CI 0.48-1.72]; P = .77). Similar results were obtained after censoring participants at transplantation, and after adjusting for potential confounding variables. Subgroup analysis did not reveal differences in treatment effect by region, dialysis setting or vintage (P-interaction .51, .54, .12, respectively). CONCLUSION Twelve months of extended hours dialysis did not improve long-term survival nor affect dialysis hours after the intervention period. An urgent need remains to further define the optimal dialysis intensity across the broad range of dialysis recipients.
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Affiliation(s)
- Brendan Smyth
- Renal and Metabolic Division, The George Institute for Global Health and University of New South Wales, Sydney, New South Wales, Australia.,Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Renal Medicine, St George Hospital, Sydney, New South Wales, Australia
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Nicholas A Gray
- Renal Department, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.,Sunshine Coast Clinical School, University of Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Christopher T Chan
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Janak R de Zoysa
- Renal Services, North Shore Hospital, Auckland, New Zealand.,Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Daqing Hong
- Renal Department, Sichuan Provincial People's Hospital, Chengdu, China.,School of Medicine, University of Electronic Science and Technology of China Medical School, Chengdu, China
| | - Kris Rogers
- Renal and Metabolic Division, The George Institute for Global Health and University of New South Wales, Sydney, New South Wales, Australia.,Graduate School of Health, University of Technology, Sydney, New South Wales, Australia
| | - Jia Wang
- School of Medicine, University of Electronic Science and Technology of China Medical School, Chengdu, China.,General Practice Department, Sichuan Provincial People's Hospital, Chengdu, China
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, North Territory, Australia
| | - Martin Gallagher
- Renal and Metabolic Division, The George Institute for Global Health and University of New South Wales, Sydney, New South Wales, Australia.,Renal Unit, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Vlado Perkovic
- Renal and Metabolic Division, The George Institute for Global Health and University of New South Wales, Sydney, New South Wales, Australia
| | - Meg Jardine
- Renal and Metabolic Division, The George Institute for Global Health and University of New South Wales, Sydney, New South Wales, Australia.,Renal Unit, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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