Povezanost sindroma niskog trijodtironina , proteinsko energetske pothranjenosti i kronične upale sa smrtnošću prevalentnih dijaliznih bolesnika

This prospective study in prevalent dialysis patients investigated prognostic properties of low triiodothyronine syndrome, protein-energy wasting and chronic inflammation. Ninety-four prevalent dialysis patients were followed-up for a median of 39 months. Demographic, anthropometric and biochemical parameters were collected at baseline. Univariate and multivariate analysis was done using Cox regression analysis. ROC curve analysis using survival status as a classification variable was performed with the goal of determining optimal cut-off values for numerical variables. In our population, low total triiodothyronine (hazard ratio (HR) 2.19, p=0.038), catheter as vascular access (HR 2.76, p=0.023), higher vintage (HR 1.01, p=0.014) and higher Charlson comorbidity index (HR 1.28, p=0.017) were statistically significantly associated with inferior survival. In our group of steady-state dialysis patients, total triiodothyronine seemed to be the strongest predictor of inferior survival among thyroid hormones. Taking this parameter into account, it was possible to identify patients at an increased risk of death even after adjustment for other prognostically relevant variables. However, after further adjustment for significant risk factors, the impact of C-reactive protein and albumin on survival disappeared due to the overlapping prognostic properties. We concluded that triiodothyronine was an independent prognostic factor in our study group.Cilj je bio istražiti prognostička svojstva sindroma niskog trijodtironina, proteinsko energetske pothranjenosti i kronične upale te drugih poznatih rizičnih čimbenika sa smrtnošću prevalentnih dijaliznih bolesnika. Ukupno 94 prevalentnih dijaliznih bolesnika prospektivno je praćeno kroz medijan od 39 mjeseci. Na početku istraživanja sakupljeni su demografski, antropometrijski i biokemijski parametri. Učinjena je univarijatna te multivarijatna analiza primjenom Coxove regresijske analize. Kako bismo odredili optimalne granične vrijednosti numeričkih varijabla primijenjena je ROC analiza krivulje koristeći preživljenje kao klasifikacijsku varijablu. U našoj populaciji bolesnika su nizak ukupni trijodtironin (hazard ratio (HR) 2,19; p=0,038), kateter kao vaskularni pristup (HR 2,76; p=0,023), duži vintage (HR 1,01; p=0,014) i viši Charlson indeks komorbiditeta (HR 1,28; p=0,017) bili statistički značajno povezani s lošijim preživljenjem. U našoj skupini stabilnih dijaliznih bolesnika ukupni trijodtironin je među hormonima štitnjače bio najjači predskazatelj lošijeg preživljenja. Također, i nakon prilagodbe za druge prognostički značajne varijable vrijednost trijodtironina se i dalje može koristiti u prognozi bolesnika na dijalizi. Nakon daljnje analize prilagođene za druge značajne čimbenike rizika utjecaj C-reaktivnog proteina i albumina na smrtnost je nestao zbog prognostičkih svojstava koja se podudaraju. Zaključno, smatramo da je ukupni trijodtironin bio neovisan prognostički čimbenik u našoj skupini bolesnika

Tunnelled haemodialysis catheter and haemodialysis outcomes: a retrospective cohort study in Zagreb, Croatia

OBJECTIVES: Studies have reported that the tunnelled dialysis catheter (TDC) is associated with inferior haemodialysis (HD) patient survival, in comparison with arteriovenous fistula (AVF). Since many cofactors may also affect survival of HD patients, it is unclear whether the greater risk for survival arises from TDC per se, or from associated conditions. Therefore, the aim of this study was to determine, in a multivariate analysis, the long-term outcome of HD patients, with respect to vascular access (VA). ----- DESIGN: Retrospective cohort study. ----- PARTICIPANTS: This retrospective cohort study included all 156 patients with a TDC admitted at University Hospital Merkur, from 2010 to 2012. The control group consisted of 97 patients dialysed via AVF. The groups were matched according to dialysis unit and time of VA placement. The site of choice for the placement of the TDC was the right jugular vein. Kaplan-Meier analysis with log-rank test was used to assess patient survival. Multivariate Cox regression analysis was used to determine independent variables associated with patient survival. ----- PRIMARY OUTCOME MEASURES: Patient survival with respect to VA. ----- RESULTS: The cumulative 1-year survival of patients who were dialysed exclusively via TDC was 86.4% and of those who were dialysed exclusively via AVF, survival was 97.1% (p=0.002). In multivariate Cox regression analysis, male sex and older age were independently negatively associated with the survival of HD patients, while shorter HD vintage before the creation of the observed VA, hypertensive renal disease and glomerulonephritis were positively associated with survival. TDC was an independent risk factor for survival of HD patients (HR 23.0, 95% CI 6.2 to 85.3). ----- CONCLUSION: TDC may be an independent negative risk factor for HD patient survival

The Association of Low Triiodothyronine Syndrome, Protein-Energy Wasting and Chronic Inflammation with Mortality in Prevalent Dialysis Patients

This prospective study in prevalent dialysis patients investigated prognostic properties of low triiodothyronine syndrome, protein-energy wasting and chronic inflammation. Ninety-four prevalent dialysis patients were followed-up for a median of 39 months. Demographic, anthropometric and biochemical parameters were collected at baseline. Univariate and multivariate analysis was done using Cox regression analysis. ROC curve analysis using survival status as a classification variable was performed with the goal of determining optimal cut-off values for numerical variables. In our population, low total triiodothyronine (hazard ratio (HR) 2.19, p=0.038), catheter as vascular access (HR 2.76, p=0.023), higher vintage (HR 1.01, p=0.014) and higher Charlson comorbidity index (HR 1.28, p=0.017) were statistically significantly associated with inferior survival. In our group of steady-state dialysis patients, total triiodothyronine seemed to be the strongest predictor of inferior survival among thyroid hormones. Taking this parameter into account, it was possible to identify patients at an increased risk of death even after adjustment for other prognostically relevant variables. However, after further adjustment for significant risk factors, the impact of C-reactive protein and albumin on survival disappeared due to the overlapping prognostic properties. We concluded that triiodothyronine was an independent prognostic factor in our study group