Warfarın increases the risk of vascular calcification in haemodialysis patients a multicenter case-control study

57th ERA-EDTA CongressERA, EDT

A multicenter study of the clinical, laboratory characteristics and potential prognostic factors in patients with aa amyloidosis on hemodialysis

Introduction While light chain (AL) amyloidosis is more common in western countries, the most common type of amyloidosis is amyloid A (AA) amyloidosis in Eastern Mediterranean Region, including Turkey. Although worse prognosis has been attributed to the AL amyloidosis, AA amyloidosis can be related to higher mortality under renal replacement therapies. However, there are no sufficient data regarding etiology, clinical presentation, and prognostic factors of AA amyloidosis. The objective of our study is to evaluate the clinical, laboratory characteristics, and possible predictive factors related to mortality in patients with AA amyloidosis undergoing hemodialysis (HD). Methods This multicenter, cross-sectional study was a retrospective analysis of 2100 patients on HD. It was carried out in 14 selected HD centers throughout Turkey. Thirty-two patients with biopsy-proven AA amyloidosis and thirty-two control patients without AA amyloidosis undergoing HD were included between October 2018 and October 2019. There was no significant difference between the groups in terms of age and dialysis vintage. Causes of AA amyloidosis, treatment (colchicine and/or anti-interleukin 1 [IL] treatment), and the number of familial Mediterranean fever (FMF) attacks in the last year in case of FMF, systolic and diastolic blood pressures, biochemical values such as mean CRP, hemoglobin, serum albumin, phosphorus, calcium, PTH, ferritin, transferrin saturation, total cholesterol levels, EPO dose, erythropoietin-stimulating agents resistance index, interdialytic fluid intake, body mass indexes, heparin dosage, UF volume, and Kt/V data in the last year were collected by retrospective review of medical records. Findings Prevalence of AA amyloidosis was found to be 1.87% in HD centers. In amyloidosis and control groups, 56% and 53% were male, mean age was 54 +/- 11 and 53 +/- 11 years, and mean dialysis vintage was 104 +/- 94 and 107 +/- 95 months, respectively. FMF was the most common cause of AA amyloidosis (59.5%). All FMF patients received colchicine and the mean colchicine dose was 0.70 +/- 0.30 mg/day. 26.3% of FMF patients were unresponsive to colchicine and anti-IL-1 treatment was used in these patients. In AA amyloid and control groups, erythropoietin-stimulating agents resistance index were 7.88 +/- 3.78 and 5.41 +/- 3.06 IU/kg/week/g/dl, respectively (p = 0.008). Additionally, higher CRP values (18.78 +/- 18.74 and 10.61 +/- 10.47 mg/L, p = 0.037), lower phosphorus (4.68 +/- 0.73 vs. 5.25 +/- 1.04 mg/dl, p = 0.014), total cholesterol (135 +/- 42 vs. 174 +/- 39 mg/dl, p < 0.01), and serum albumin (3.67 +/- 0.49 mg/dl, 4.03 +/- 0.22, p < 0.01) were observed in patients with AA amyloidosis compared to the control group. Discussion In this study, we found that long-term prognostic factors including higher inflammation, malnutritional parameters, and higher erythropoietin-stimulating agents resistance index were more frequent in AA amyloidosis patients under HD treatment

European Best Practice Guideline on Kidney Donor and Recipient Evaluation and Perioperative Care

Caring for kidney transplant recipients (KTRs) requires specialized knowledge in areas as varied as nephrology, immunology, pharmacology, endocrinology, infectious disease, and cardiology. In this context of increasing complexity coupled with an exponential growth in medical literature, clinical practice guidelines (CPGs) aim at helping clini-cians and other caregivers to deliver evidence-based medicine and thereby, to improve patient outcomes. Furthermore, guidelines also help to expose gaps in our knowledge, and thereby suggest areas where additional research is needed

A MULTICENTER STUDY OF THE CLINICAL, LABORATORY CHARACTERISTICS AND POTENTIAL PROGNOSTIC FACTORS IN PATIENTS WITH AA AMYLOIDOSIS ON HEMODIALYSIS

57th ERA-EDTA Congress -- JUN 06-09, 2020 -- ELECTR NETWORKWOS: 000562392100332[No abstract available]ERA, EDT

WARFARIN INCREASES THE RISK OF VASCULAR CALCIFICATION IN HAEMODIALYSIS PATIENTS: A MULTICENTER CASE-CONTROL STUDY

57th ERA-EDTA Congress -- JUN 06-09, 2020 -- ELECTR NETWORKUstuner, Evren/0000-0003-0932-1508; Sadioglu, Rezzan Eren/0000-0001-9761-0320WOS: 000562392100273[No abstract available]ERA, EDT

Warfarin is associated with the risk of vascular calcification in abdominal aorta in hemodialysis patients: a multicenter case-control study

Background/aim: Vascular calcifications (VCs), recognized risk factor for increased mortality, are highly prevalent in hemodialysis (HD) patients. We aimed to investigate the relation between VC and warfarin use with plain radiography. Materials and methods: VCs were assessed using Adragao (radial and digital) and Kauppila (aortic) scores in 76 HD patients from six centers. Out of a total 711 HD patients, there were 32 (4.5%) who had been treated with warfarin for at least 1 year, and we included 44 control patients. Results: Of the patients, 47% were females, the mean age was 66 +/- 9 years, 23% were diabetics, the mean dialysis vintage was 68 +/- 38 months. In warfarin group, median Kauppila score was higher than in control group [11 vs 6.5, (25%-75% percentile, 5 vs. 15), p = 0.032] and the percentage of the patients with a Kauppila score of >6 was higher, as well (76.6% vs. 50%; p = 0.029). Median Adragao score was not significantly different between the two groups [7 vs. 6, (%25,%75 percentile 6 vs. 8), p = 0.17]. Logistic regression analysis revealed that warfarin treatment was independently associated with Kauppila scores of >6 (OR 3.60, 95% CI 1.18-10.9, p = 0.024). Conclusion: In this study, we found that warfarin is associated to vascular calcifications, especially in aorta of HD patients