Systemic chronic inflammation in end-stage renal disease patients and possible treatment approaches

Systemic chronic inflammation (SCI) is a common feature of chronic kidney disease (CKD) which is most pronounced in dialysis patients. SCI is associated with cardiovascular pathology, various comorbid conditions and high mortality risk in dialysis patients. The existing dialysis methods are ineffective for removing substances involved in SCI (medium molecular uremic toxins: cytokines, growth factors, adiponectin, hormones, and other substances). The dialysis technology development has always aimed to create the membranes that will be as close as possible to the natural glomerular membrane. Currently, Middle Cut-Off membranes have been created. The use of Middle Cut-Off membranes is implemented in a new method of dialysis therapy entitled expanded hemodialysis (HDx). Further studies will determine the expected perspective of these membranes and HDx in the treatment of dialysis patients

Predictors of cardiovascular disease in peritoneal dialysis patients: A Prospective longitudinal cohort study

The present study aimed to investigate the incidence rate and possible predictors of cardiovascular disease (CVD) in end-stage renal disease (ESRD) patients treated with continuous ambulatory peritoneal dialysis (CAPD). Methods. This prospective longitudinal cohort study included 133 ESRD patients treated with CAPD between 2012 and 2019. The study was conducted in two phases. In the first phase, key patient demographic, clinical, and laboratory data, including the incidence of cardiovascular disease, were collected at baseline. In the second phase, an assessment of potential predictors of CVD in PD patients was performed. Baseline patient characteristics were used as potential predictors in this study. The mean duration of the prospective study was 28.2 ± 7.1 months, corresponding to 249.2 patient-years. Univariate and multivariate Cox proportional hazard regression and ROC analysis were performed to estimate predictors of CVD events. The primary end-point (newly diagnosed cardiovascular disease) was determined at the end of the study. Statistical processing of the results obtained was performed with "MedCalc," version 19.3 (Ostend, Belgium). Results. One hundred and three PD patients were included in the final analysis. During the study period, a significant increase (by 82%) in the frequency of all CVDs was observed (р < 0.0001), more than twice as frequent in heart failure (HF) (р < 0.0001) and atrial fibrillation (AF) (р= 0.0156). The primary endpoint was observed in 49 events: newly diagnosed HF in 21 (20.4%) patients, coronary artery disease in 9 (8.7%) patients, AF in 7 (6.8%) patients, acute myocardial infarction in 5 (4.9%) patients, another coronary heart disease in 7 (6.8%) patients. The incidence rate of CVD and HF was 19.66 and 8.43 per 100 patient-years, respectively. Multivariate Cox regression analysis indicated that hyperhydration (HR=4.2; 95% CI: 2,.2 - 7.3), diabetes mellitus as the primary cause of ESRD (HR=2.5; 95% CI: 1.3 - 4.3), history of MRSA colonization (HR=1.4; 95% CI: 1.2 - 1.7) and age (HR=1.03; 95% CI: 1.004 - 1.05) are independent predictors of all new-onset cardiovascular events in ESRD patients, treated with CAPD. ​A total of 44 patients (42.7%) died during the study period. The incidence rates of all-cause mortality were 17.67 per 100 patient-years. The most common cause of mortality was CVD, accounting for 50.0% of all events (8.82 per 100 patient-years). Conclusions. This prospective longitudinal study demonstrates that treatment with PD is associated with an increased incidence of CVD. Hyperhydration, diabetes mellitus, history of MRSA colonization, and age over 55 years are independent predictors of new-onset CVD in PD patients

Do we need new scales for assessing the risk of thromboembolic events and bleeding for patients with chronic kidney disease?

Chronic kidney disease (CKD) is a global health problem. Patients with CKD have an increased risk of thromboembolic complications and bleeding. It remains difficult to determine the benefits and risks of antiplatelet and anticoagulant therapy in patients with CKD, so an individualized risk assessment of each patient should be mandatory. To date, there are no specialized scales for assessing the risk of thromboembolic events and bleeding, which are focused on patients with CKD and take into account all the features of the course of CKD and the specific factors of their occurrence. In this work, we decided to conduct a detailed assessment of the accuracy of the currently accepted risk scales for thromboembolic events and bleeding in patients with CKD

Activation of chronic inflammation and comorbidity in end-stage renal disease patients treated with continuous ambulatory peritoneal dialysis.

The aim of the work was to determine the blood serum pro-inflammatory cytokine profile and to study their relationship with comorbidity and mortality in end-stage renal disease (ESRD) patients treated with continuous ambulatory peritoneal dialysis (CAPD). Ninety three ESRD patients treated with CAPD during 2012-2019 were included in the cohort prospective open study. The study was conducted in two stages. At the first stage, the determination of TNF-α and IL-6 levels was conducted and study of comorbidity, its quantitative assessment, baseline clinical and laboratory parameters was made. A modified polymorbidity index (MPI) which determined the quantitative assessment of comorbidity was calculated as the number of diseases per one patient excluding ESRD and its reasons. At the second stage, considering the baseline values of the studied cytokines, a prospective study of the dynamics of the prevalence of comorbid pathology, the value of MPI and mortality rate was carried out. The average duration of prospective follow-up was 26.4±6.8 months. Serum cytokines levels were determined by ELISA. Statistical analysis was performed by using "MedCalc", version 19.1.7. (Ostend, Belgium). Serum levels of TNF-α and IL-6 were significantly higher in PD-patients with 5 or more comorbid diseases. Levels of TNF-α&gt;13.0 pg/ml have a negative effect on the dynamics of prevalence of heart failure (HF) and coronary heart disease (CHD), number of comorbid conditions in CAPD-patients. The proportion of the dead with a level of TNF-α&gt;13.0 pg/ml was by three times higher, and deaths from cardiovascular events are almost by 10 times higher than patients who had a level of TNF-α≤13.0 pg/ml. Serum levels of IL-6&gt;23.4 pg/ml are associated with a significant increase in number of comorbid conditions, prevalence of bacterial infections and overall and infectious mortality. Independent predictors of comorbidity and overall mortality in patients with ESRD who are treated with CAPD are serum levels of TNF-α, IL-6 and albumin. Serum levels of TNF-α and albumin are predictors of fatal cardiovascular events, and serum levels of IL-6 are predictors of fatal infectious events

Nutritional status and survival of End-Stage Renal Disease patients treated with continuous ambulatory peritoneal dialysis

The objective of the work was to study the survival peculiarities ofend-stage renal disease patients treated with continuous ambulatory peritoneal dialysis (CAPD) depending on the nutritional status and informative markers associated with it. Methods. 105 ESRD patients who received CAPD treatment during 2012 - 2017 years at the Kyiv Scientific and Practical Center of Nephrology and Dialysis, which is the clinical base of the State Institution "Institute of Nephrology National Academy of Medical Sciences of Ukraine" were included in the cohort prospective open study. The survival analysis was carried out both in the studied population as a whole and in groups depending on the nutritional status (NS) indicators defined basing on the calculation of the subjective global assessment (SGA) points: the first group (n = 51) consisted of patients without malnutrition, the second group (n = 30) - patients with a mild degree of malnutrition, the third group (n = 13) - patients with a moderate degree of malnutrition, and the fourth group (n = 11) - patients with a severe degree of malnutrition. The survival analysis was conducted both in the groups in compliance with NS, and depending on the informational markers associated with NS, in particular, albumin, body mass index (BMI), residual renal function (RRF). Survival were calculated using the Kaplan-Meier method, and the difference between survival rates was analyzed using the log-rank test and χ². The starting date of peritoneal dialysis treatment was considered as the starting point of the monitoring. The difference was considered to be accurate at p <0.05. Analyzed cases were included till January 7, 2019. The event risk assessment was carried out with the probability of relative risk (RR) values calculating their confidence intervals (95% CI). Results.Forty-three (40.95%) patients died during the current analysis, 17 patients were switched to the hemodialysis (HD), 4 patients had undergone kidney transplantations. Cardiovascular disease was the leading cause of death (41.9%), the second cause of death by frequency was bacterial infections (20.9%). Longer monitoring periods death rate was significantly higher in patients of group with an average (11/84.6% vs 14/27.45%, p <0.0001; RR - 3.08; 95% CI: 1.8 -5.09)and a mild degree of nutritional disorders (ND) (11/84.6% vs 11/36.7%, p = 0.0018, RR - 2.3, 95% CI: 1.36-3.89) compared with normal NS.Similarly, the percentage of died patients with a severe ND degree was significantly higher than those with a normal nutritional status (7/63.6% vs. 14/27.45%, p = 0.0091, RR - 2.31, 95% CI: 1.23 - 4.35). The cumulative survival during the 1- year amounted to 90% of patients for 3 and 5 years - 64% and 41%, respectively. It was found that the survival rate of PD patients is credibly higher in groups with normal NS ormild ND degree than patients of group with a moderate or severe degree of nutritional disorders (χ2 = 22,9; df = 3; p = 0,00004). The cumulative survival for 1 and 3 years was 97%, 98%, 70%, 81% and 76%, 70%, 24%, 36% in groups of patients without nutritional disorder, with mild nutritional disorders, moderate and severe disorders, respectively. The cumulative survival with serum albumin level 24 kg/m2 was apparently higher than those with an indicatorBMI ≤ 24 kg/m2, and it was in 1 and 3 years 94% vs 86% and 79% vs 47%, respectively (p = 0.00321, log-rank test). Veritable differences have been registered in the cumulative frequencies of survivors depending on RRF value: the survival rate was significantly higher among patients with RRF ≥ 5 ml/min/1.73 m² and significantly lower among patients with RRF <2 ml/min/1.73 m2 (χ² = 17.4; df = 2; p = 0.00016). Conclusions.Thus, our studyfound that serum albumin level, BMI and RRF magnitude are the markers for the survival of ESRD patientstreated with PD. Veritable difference between the survival of patients depending on the nutritional status was stated. Three-year cumulative survival with mild degree of malnutrition group was twice as high as in severe nutritional disorders and it was 70% vs 36% (p <0.001). The relative risk of death from all causes increases by 3.1 and 2.32 times for moderate and severe nutritional disorders patients compared to the patients group with normal NS

COMORBIDITY AND SURVIVAL OF PATIENTS WITH CHRONIC KIDNEY DISEAS STAGE 5 D

Annual expansion of dialysis population, high mortality, considerable expenses on specialized medical care are evoked the medical community to research comorbidities, that undoubtedly has an influence on course of chronic kidney disease VD stage (CKD VD st.) and prognosis. Aim. The aim of this study was to investigate the prevalence and structure of comorbid conditions in patients with CKDVD stage, and determinate the relation between comorbidities and survival rate in dialysis population. Materials and methods. It was studied the prevalence and structure of comorbidities among 204 patients with CKD VD st. (125 on hemodialysis [HD], 51 on peritoneal dialysis [PD], and 28 on hemodiafiltration [HDF]). All recorded concomitant diseases with its incidence data and coand polymorbidity indices were analyzed in consideration of renal replacement therapy (RRT). The survival rates were assessed in according with indices of comorbidity by Kaplan - Mayer methodology. Results. The performed analysis was demonstrated that in almost single patient had no mononosologicalpathology. The numbers of concomitant diseases were 3,55, 3,3 и 3,4 3,3per patient on HD, HDF and PD, respectively, without significant relation with RRT modality. In according with the study results the most common comorbid conditions, irrespective from RRT modality, were anaemia (88%), arterial hypertension (86%), and secondary hyperparathyroidism (40%). The proposed modified index of polymorbidities was revealed as the universal marker of survival rate in patients with CKD VD st. Conclusion. Thus the considerable prevalence of comorbid conditions in population ofpatients with CKD VD st. irrespective of RRT modality has significant negative effect on prognosis

THE PREDICTORS OF HOSPITALIZATION IN HEMODIALYSIS PATIENTS

Summary. The aim of the present research was to identify predictors of hospitalization hemodialysis (HD) patients. Materials and methods. The study involved 186 HD patients (49,38±0,94 у.) between Jan 2013 and Jan 2014. We studied the evolution of laboratory and treatment parameters, including dry body-weight, ultrafiltration, mean blood pressure, plasma albumin, Hb, absolute lymphocyte count, absolute neutrophil count, neutrophil-to-lymphocyte ratio, “hemoglobin variability ” all patients. The HD patients were divided for 2 groups: I group of outpatients (n=103), II group of hospitalized patients (n=83). Data from 83 hospitalized patients were compared with non-hospitalized patients. Laboratory and treatment parameters were assessed at least 3 months prior to admission. Results. We found that hospitalization was 45,29±4,20 days, frequency of hospitalization 1,46±0,07. The likelihood of frequency and duration a hospitalization increased with patient age (p<0,05). Hospitalizations were preceded by a decrease level albumin, a decline in Hb concentration, a decrease absolute lymphocyte count, increase in the neutrophil-to-lymphocyte ratio, a reduction ultrafiltration. The hozpitalization of patients with “stable hemoglobin ” was significantly lower than in patients with “low of hemoglobin variability”(p<0,005). Conclusions. Patients whose noted these parameters should be monitored, thus, it may be useful to identify risk factors for hospitalization

DISTURBANCES OF NUTRINIONAL STATUS IN PATIENTS TREATED BY PERITONEAL DIALYSIS: THE ROLE OF CHRONIC INFLAMMATION

this work is devoted to the problem of malnutrition in patients who are treated by peritoneal dialysis, also the role of chronic inflammation was described

DISTURBANCES OF NUTRINIONAL STATUS IN PATIENTS TREATED BY PERITONEAL DIALYSIS

this work is devoted to the problem of malnutrition in patients who are treated by peritoneal dialysis, the main causes of violations of nutritional status were observed, and also the classification of protein-energy malnutrition was described