3 research outputs found
Povezanost sindroma niskog trijodtironina , proteinsko energetske pothranjenosti i kroniÄne upale sa smrtnoÅ”Äu 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 prognostiÄka svojstva sindroma niskog trijodtironina, proteinsko energetske pothranjenosti i kroniÄne upale te drugih poznatih riziÄnih Äimbenika sa smrtnoÅ”Äu prevalentnih dijaliznih bolesnika. Ukupno 94 prevalentnih dijaliznih bolesnika prospektivno je praÄeno kroz medijan od 39 mjeseci. Na poÄetku istraživanja sakupljeni su demografski, antropometrijski i biokemijski parametri. UÄinjena je univarijatna te multivarijatna analiza primjenom Coxove regresijske analize. Kako bismo odredili optimalne graniÄne vrijednosti numeriÄkih varijabla primijenjena je ROC analiza krivulje koristeÄi preživljenje kao klasifikacijsku varijablu. U naÅ”oj 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 viÅ”i Charlson indeks komorbiditeta (HR 1,28; p=0,017) bili statistiÄki znaÄajno povezani s loÅ”ijim preživljenjem. U naÅ”oj skupini stabilnih dijaliznih bolesnika ukupni trijodtironin je meÄu hormonima Å”titnjaÄe bio najjaÄi predskazatelj loÅ”ijeg preživljenja. TakoÄer, i nakon prilagodbe za druge prognostiÄki znaÄajne varijable vrijednost trijodtironina se i dalje može koristiti u prognozi bolesnika na dijalizi. Nakon daljnje analize prilagoÄene za druge znaÄajne Äimbenike rizika utjecaj C-reaktivnog proteina i albumina na smrtnost je nestao zbog prognostiÄkih svojstava koja se podudaraju. ZakljuÄno, smatramo da je ukupni trijodtironin bio neovisan prognostiÄki Äimbenik u naÅ”oj 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