MO192ASYMPTOMATIC HYPERURICEMIA AS A RISK FACTOR OF OUTCOME IN CARDIORENAL PATIENTS

Objective

The purpose of the study was to evaluate the impact of asymptomatic hyperuricemia on long-term outcome including death, rehospitalization in cardiorenal patients.

Introduction

Hyperuricemia is associated with progression of kidney failure, cardiovascular diseases and cardiorenal syndrome, which represents a significant health burden. There is a growing interes on evaluation of serum acid levels(SUA) as a risk factor in cardiorenal syndrome, because of the evidences that xanthine oxidase inhibitors are satisfactorily useful on cardio and renal protection.

Materials and Methods

This was a descriptive cross–sectional study. A two-years follow up was conducted to determine the outcome in cardiorenal patients. Each patient went through clinical examination with a standard valuation including the determination of uric acid levels. 139 patients (pts) with chronic kidney disease stage 3 from whom 119 had cardiorenal syndrome were included in the study. Statistical analysis was performed by χ2 test, Fisher's exact test and binary logistic regression.

Results

Hyperuricemia was founded in 65.5% of pts determined by acid uric levels higher then 7.2 mg/dl and had a strong assosiation with cardiorenal syndrome,p=0.03.The average age was 56.7 ± 12.5 years. Males were 62.2%% pts, p=0.031. Bivariate analysis revealed a strong relationship between hyperurcemia and cardiovascular components: hypertension p=0.047, diabetes mellitus p=0.021, sex p=0.03, death p=0.051 and rehospitalization in 18 pts, p=0.02. Subsequently binary logistic regression showed that higher acid uric levels even there were not statistically correlated with mortality, were a significant predictor for all-cause death (Odds Ratio [OR] 4.2, 95% confidence interval [CI] 0.87–20.35, p = 0.073).

Conclusions

Asymptomatic hyperuricemia was common and had a powerfull significant association with cardiorenal syndrome.Higher SUA was unconventionally associated with long-term adverse outcomes in these patients, so our efforts should be focused in immediate identification and treatment of this old forbidden marker.

Key words

chromic kidney disease, cardiovascular disease, etc

P1593THE ASSOCIATION BETWEEN THE ANCLE-BRACHIAL INDEX AND MARKERS OF INFLAMATION IN CHRONIC HEMODIALYSIS PATIENTS

Background and Aims

Among hemodialysis patients, peripheral arterial disease (PAD) represents an important health care burden and has been associated with high mortality. The ancle-brachial index (ABI), is a reliable and noninvasive method used to asses PAD. The aim of this study was to evaluate the prevalence of PAD in patients undergoing chronic hemodialysis and the association with inflammation and malnutrition using serum C-reactive protein (CRP) and serum albumin as biomarkers.

Method

The study was conducted at different hemodialysis centers in patients receiving hemodialysis three times a week. We excluded patients with atrial fibrillation or who had been recently hospitalized. The ABI has been used as a diagnostic tool for PAD and measured before a hemodialysis session. A value of ABI less than 0.9 was considered abnormal. To better estimate the impact of malnutrition and inflammation we used the serum albumin, blood lipids values and serum C-reactive protein values defined by calculating the mean of the last three measurements.

Results

A total of 261 ESRD patients on maintenance hemodialysis were enrolled in the study. Mean age was 56.0 (±12) years, 58% were males, and 17.6% were diabetics. Mean time on hemodialysis was 5.9 (±6.7) years, with 24% of patients on dialysis for less than 3 years. Among our patients we found that the prevalence of PAD was 23.4%, of whom 58.1% were men. We found that age, diabetes, duration of hemodialysis, low serum albumin levels and high serum triglyceride levels were risk factors for PAD in hemodialysis patients. The multivariate analysis of our study has shown that a lower level of albumin and higher level of CRP were significantly associated with an ABI less than 0.9 (odds ratio, 4.54; 95% confidence interval, P = 0.017) after adjusting for demographic, clinical, biochemical and medication data. We did not find significant differences in serum calcium, phosphate or PTH levels between patients with PAD and those without it.

Conclusion

In conclusion, the present study showed high prevalence of PAD in patients on hemodialysis. The prevalence was higher in diabetics. Low albumin levels and C-reactive levels were independent risk factors of PAD. We found that early diagnosis and treatment of PAD could help to improve the quality of life of hemodialysed patients and postpone arterial complications in this group of patients.

P1284DIASTOLIC DYSFUNCTION IS A STRONG PREDICTOR OF MORTALITY IN DIALYSIS PATIENTS

Background and Aims

The prevalence of cardiovascular disease in dialysis patients is quite high. This is the leading mortality cause and the main reason for hospital admissions in this population. Diastolic dysfunction is an important predictor of cardiovascular events.

The aim of this study is to calculate the prevalence of diastolic dysfunction (DD) and to identify any significant association of mortality and the grade of DD in chronic dialysis patients with preserved systolic function

Method

This is a prospective study of 310 consecutive patients who were enrolled from 2012-2019. All patients are dialysis dependent for chronic kidney disease (CKD) getting treatment at Nephrology-Dialysis &Transplantation Unit at Hygeia Hospital Tirana. LVH, diastolic dysfunction and cardiac valve pathology contributing to this were diagnosed by transthoracic echocardiography (TTE) criteria. DD was graded as: grade I (mild), grade II (moderate) and grade III (severe). The survival rate was analysed by Kaplan-Meier curves and Cox regression analysis.

Results

Mean age was 51.9±15.6 years; 62.6 % of pts were male, with a mean dialysis vintage of 49 months. 85 % of pts had preserved ejection fraction 50 % or more. LVH was observed in 79.1% of pts. LVED diameter (mm) 52±7 LVESd (mm) 33.7±6.8. Cardiac valve changes were diagnosed as follows: Aortic valve- 35% of patients resulted normal on ultrasound examination, 47% and 17% of pts had leaflet sclerosis and calcifications respectively with normal valve function. 25 % and 7% had some degree of aortic valve regurgitation and stenosis. Mitral valve examination resulted in 9% normal and in 84% of pts with some degree of regurgitation. Arterial hypertension was found in 95.1% of the patients. Diastolic dysfunction was detected in 55% of pts. Of them, 64.5% were deemed to have grade I diastolic dysfunction, 26.7% grade II, 8.7% grade III. During follow up, 25.5% of the patients with DD, died. The analysis of survival curve showed that grade III, 5.2 CI [3.86; 6.64], was associated with higher mortality compared with grade I 11.06 CI [10.01; 12.04] and grade II 11.65 CI [8.5; 14.8], p<0.001.

Conclusion

Diastolic dysfunction is ubiquitous echocardiography finding in patients treated with hemodialysis. Grade of diastolic disfunction tend to predict mortality of dialysis patients. 7-year survival analysis shows grade III to be associated with high mortality rates. A multidisciplinary approach is needed in order to predict, prevent and treat these conditions to improve outcomes.

Renal replacement therapy in Europe: a summary of the 2013 ERA-EDTA Registry Annual Report with a focus on diabetes mellitus

Background

This article provides a summary of the 2013 European Renal Association–European Dialysis and Transplant Association (ERA-EDTA) Registry Annual Report (available at http://www.era-edta-reg.org), with a focus on patients with diabetes mellitus (DM) as the cause of end-stage renal disease (ESRD).

Methods

In 2015, the ERA-EDTA Registry received data on renal replacement therapy (RRT) for ESRD from 49 national or regional renal registries in 34 countries in Europe and bordering the Mediterranean Sea. Individual patient data were provided by 31 registries, while 18 registries provided aggregated data. The total population covered by the participating registries comprised 650 million people.

Results

In total, 72 933 patients started RRT for ESRD within the countries and regions reporting to the ERA-EDTA Registry, resulting in an overall incidence of 112 per million population (pmp). The overall prevalence on 31 December 2013 was 738 pmp (n = 478 990). Patients with DM as the cause of ESRD comprised 24% of the incident RRT patients (26 pmp) and 17% of the prevalent RRT patients (122 pmp). When compared with the USA, the incidence of patients starting RRT pmp secondary to DM in Europe was five times lower and the incidence of RRT due to other causes of ESRD was two times lower. Overall, 19 426 kidney transplants were performed (30 pmp). The 5-year adjusted survival for all RRT patients was 60.9% [95% confidence interval (CI) 60.5–61.3] and 50.6% (95% CI 49.9–51.2) for patients with DM as the cause of ESRD.

Prevalence of microalbuminuria and risk factor analysis in type 2 diabetes patients in Albania: the need for accurate and early diagnosis of diabetic nephropathy

BACKGROUND

Microalbuminuria is often the first sign of renal dysfunction in diabetes. This study aimed to investigate the prevalence of microalbuminuria in Albanian type 2 diabetes patients and its association with other cardiovascular risk factors.

METHODS

Three hundred and twenty-one patients with type 2 diabetes attending, diabetes centers in Albania were enrolled in this cross-sectional, multicenter study. The subjects, aged 40-70 years, had no known proteinuria or other kidney disease. Pregnant women and patients with acute infections were excluded. Data including waist circumference, duration of diabetes and history of hypertension were obtained by questionnaire. Blood samples were drawn after 12 h overnight fasting to measure glycosylated hemoglobin (HbA1c), serum cholesterol, triglyceride and creatinine. Microalbuminuria was assessed using dipstick kits in early morning urine samples.

RESULTS

The prevalence of normoalbuminuria was 56.3%, microalbuminuria 40.8% and macroalbuminuria 2.8%. Systolic and diastolic blood pressure (p<0.01), HbA1c (p<0.01) and fasting plasma glucose (p<0.001) were significantly higher in microalbuminuric than in normoalbuminuric subjects. Independent risk factors for microalbuminuria were duration of diabetes (OR: 2.785, 95% CI: 1.156-3.759), systolic blood pressure (OR: 2.88, 95% CI: 1.85-6.85) and waist circumference (OR: 2.15, 95% CI: 1.01-5.45) in males and poor glycemic control (OR: 4.51, 95% CI: 1.45-13.98), duration of diabetes (OR: 2.568, 95% CI: 1.702-3.778) and waist circumference (OR: 4.87, 95% CI: 1.80-13.11) in females.

CONCLUSIONS

The high proportion of type 2 diabetes patients with microalbuminuria raises implications for health policy in Albania. Screening programs and optimized control of modifiable risk factors are needed to reduce the risk of diabetic nephropathy.

[The relation of hypertension, renal function and cardiovascular events in autosomal dominant polycystic kidney disease]

BACKGROUND

The presence of hypertension in autosomal dominant polycystic kidney disease (ADPKD) appear to be related with progressive renal failure and end-organ damage, including left ventricular hypertrophy (LVH) in these patients. The aim of this study was to evaluate the frequency of hypertension in ADPKD patients and its correlation with renal function, renal structure and its influence in left ventricular wall.

METHODS

Two hundred patients were included in the study. The patients were divided in two groups: first group of 92 patients with normal renal function, and second group of 108 patients with chronic renal failure. All patients performed an abdominal ultrasound and a M-mode echocardiography.

RESULTS

Hypertension was observed in 140 ADPKD patients (70%). Subjects who developed hypertension before age 35 had worse renal survival than those who remained normotensive after age 35 (50 years vs. 62 years; p<0.0001; risk ratio = 4.3). Hypertensive patients had significantly higher serum creatinine concentration than those without hypertension (p<0.001). LVH was present in 56 patients with hypertension (40%) and in 9 normotensive patients (16%) (p<0.005). Patients with LVH had a worse renal survival than those without LVH (p<0.001).

CONCLUSIONS

These findings suggest that hypertension is a serious complication in ADPKD that may lead to both an increased incidence of cardiovascular complications and more rapid progression of renal functional impairment.