Predictors of cardiovascular disease and mortality in patients with advanced chronic kidney disease

Cardiovascular disease is the leading cause of high mortality in advanced chronic kidney disease (CKD) patients. Treatment and prevention of cardiovascular disease should be in focus to improve prognosis in this high-risk population. The aim of the study was to assess cardiovascular determinants of mortality, to study the effect of diabetes on arterial endothelial function and structure, to evaluate exercise capacity and abdominal aortic calcification (AAC) in patients with advanced CKD, not on dialysis. 210 participants of the Chronic Arterial Disease, quality of life and mortality in chronic KIDney injury -study underwent maximal bicycle ergometry stress test, echocardiography, lateral lumbar radiograph to study AAC score, ultrasound measures of arterial structure and function, and laboratory measures. Determinants of mortality were stress ergometry performance, AAC score, E/e’ ratio of echocardiography, and cardiac biomarkers and albumin. Diabetes was a significant determinant of AAC but did not associate with endothelial dysfunction or increased carotid intima-media thickness. Maximal stress ergometry performance was associated with troponin T (TnT) and AAC. The progression of AAC was rapid and the increment rate was similar in patients transitioning to different modalities of renal replacement therapy. To conclude, stress ergometry performance, AAC, E/e’ of echocardiography, and cardiac biomarkers and albumin predict mortality, and diabetes is associated with AAC in advanced CKD. TnT and AAC are associated with maximal ergometry stress test and AAC progresses at a comparable rate across the CKD treatment groups.Sydän- ja verisuonitautien ja kuolleisuuden ennustekijät loppuvaiheen munuaisten vajaatoimintaa sairastavilla Loppuvaiheen munuaisten vajaatoimintapotilailla sydän- ja verisuonitaudit ovat johtava kuolleisuuden syy. Sydän- ja verisuonitautien hoito ja ennaltaehkäisy tulisi olla keskiössä tämän korkean riskin ryhmän ennusteen parantumiseksi. Tutkimuksessa arvioitiin kuolleisuuteen vaikuttavia sydän- ja verisuonitautitekijöitä, diabeteksen vaikutusta verisuonen sisäkalvon toimintaan ja suonirakenteeseen, suorituskykyä, sekä vatsa-aortan kalkkisuutta ei-dialyysihoitoisessa loppuvaiheen munuaisten vajaatoiminnassa. 210 potilasta osallistui Krooninen valtimotauti, elämänlaatu ja mortaliteetti vaikeaa munuaisten vajaatoimintaa sairastavilla -tutkimukseen. Tutkittaville tehtiin polkupyörärasituskoe, sydämen ultraäänitutkimus, lannerangan röntgenkuvaus aortan kalkkisuuden määrittämiseksi, verisuoniultraäänitutkimus verisuonen rakenteen ja toiminnan tutkimiseksi sekä otettiin laboratoriokokeet. Kuolleisuutta määrittivät suorituskyky, vatsa-aortan kalkkisuus, sydämen ultraäänitutkimuksen E/e’ suhde, sydänmerkkiaineet ja albumiini. Diabetes määritti vatsa-aortan kalkkisuutta merkittävästi, mutta ei ollut yhteydessä verisuonen laajenemiskykyyn eikä kaulavaltimon seinämäpaksuuteen. Maksimaalinen suorituskyky oli yhteydessä troponiini T:hen (TnT) ja vatsa-aortan kalkkisuuteen. Vatsaaortan kalkkisuus kehittyi nopeasti ja kehityksen suuruus oli sama eri keinomunuaishoitomuodoissa. Yhteenvetona todetaan, että suorituskyky, vatsa-aortan kalkkisuus, sydämen ultraäänitutkimuksen E/e’ suhde, sydänmerkkiaineet ja albumiini ennustavat kuolleisuutta, ja diabetes on yhteydessä vatsa-aortan kalkkisuuteen, mutta ei verisuonen laajenemiskykyyn tai sisäkalvopaksuuteen, loppuvaiheen munuaisten vajaatoiminnassa. TnT ja vatsa-aortan kalkkisuus ovat yhteydessä maksimaaliseen suorituskykyyn, ja vatsa-aortan kalkkisuus etenee samalla nopeudella eri munuaiskorvaushoitomuodoissa

Progression of Aortic Calcification in Stage 4-5 Chronic Kidney Disease Patients Transitioning to Dialysis and Transplantation

Background and Aims: Abdominal aortic calcification (AAC) is common in chronic kidney disease (CKD) patients and associated with increased mortality. Comparative data on the AAC score progression in CKD patients transitioning from conservative treatment to different modalities of renal replacement therapy (RRT) are lacking and were examined. Methods: 150 study patients underwent lateral lumbar radiograph to study AAC in the beginning of the study before commencing RRT (AAC1) and at 3 years of follow-up (AAC2). We examined the associations between repeated laboratory tests taken every 3 months, echocardiographic and clinical variables and AAC increment per year (ΔAAC), and the association between ΔAAC and outcomes during follow-up. Results: At the time of AAC2 measurement, 39 patients were on hemodialysis, 39 on peritoneal dialysis, 39 had a transplant, and 33 were on conservative treatment. Median AAC1 was 4.8 (0.5-9.0) and median AAC2 8.0 (1.5-12.0) (p p = 0.19). ΔAAC was independently associated with mean left ventricular mass index (LVMI) (log LVMI: β = 0.97, p = 0.02) and mean phosphorus through follow-up (log phosphorus: β = 1.19, p = 0.02) in the multivariable model. Time to transplantation was associated with Delta AAC in transplant recipients (per month on the waiting list: β = 0.04, p = 0.001). Delta AAC was associated with mortality (HR 1.427, 95% confidence interval 1.044-1.950, p = 0.03). Conclusion: AAC progresses rapidly in patients with CKD, and ΔAAC is similar across the CKD treatment groups including transplant recipients. The increment rate is associated with mortality and in transplant recipients with the time on the transplant waiting list.</p

Maximal Exercise Capacity in Chronic Kidney Disease Stage 4-5 Patients Transitioning to Renal Replacement Therapy or Continuing Conservative Care: A Longitudinal Follow-Up Study

Introduction: Chronic kidney disease (CKD) is associated with impaired maximal exercise capacity (MEC). However, data are scarce on the development of MEC in CKD stage 4-5 patients transitioning to renal replacement therapy (RRT).Methods: We explored the change in MEC measured in watts (Wlast4) with 2 consecutive maximal bicycle stress ergometry tests in 122 CKD stage 4-5 patients transitioning to dialysis and transplantation in an observational follow-up study.Results: Mean age was 58.9 ± 13.9 years and 43 (35.2%) were female. Mean time between the baseline and follow-up ergometry tests was 1,012 ± 327 days and 29 (23.8%) patients had not initiated RRT, 50 (41.0%) were undergoing dialysis, and 43 (35.2%) had received a kidney transplant at the time of the follow-up ergometry test. The mean Wlast4 was 91 ± 37 W and 84 ± 37 W for the baseline and follow-up ergometry tests, respectively (p Conclusion: MEC declined or remained poor in advanced CKD patients transitioning to RRT or continuing conservative care in this observational study. Mean capillary blood bicarbonate was independently associated with the development of MEC.</p

Association of maximal stress ergometry performance with troponin T and abdominal aortic calcification score in advanced chronic kidney disease

Background: Cardiac biomarkers Troponin T (TnT) and N-terminal pro-B-type natriuretic peptide (proBNP) and abdominal aortic calcification score (AAC) are associated with cardiovascular events and mortality in patients with chronic kidney disease (CKD). The effects of cardiac biomarkers and AAC on maximal exercise capacity in CKD are unknown and were studied.Methods: One hundred seventy-four CKD 4-5 patients not on maintenance dialysis underwent maximal bicycle ergometry stress testing, lateral lumbar radiograph to study AAC, echocardiography and biochemical assessments.Results: The subjects with proportional maximal ergometry workload (WMAX%) less than 50% of the expected values had higher TnT, proBNP, AAC, left ventricular end-diastolic diameter, left ventricular mass index, E/e' and pulse pressure, and lower global longitudinal strain compared to the better performing patients. TnT (beta = - 0.09, p = 0.02), AAC (beta = - 1.67, p Conclusions: TnT and AAC are independently associated with maximal ergometry stress test workload in patients with advanced CKD.</p

Dental health assessed using panoramic radiograph and adverse events in chronic kidney disease stage 4-5 patients transitioning to dialysis and transplantation-A prospective cohort study

Background and aimsOral health could potentially be a modifiable risk factor for adverse outcomes in chronic kidney disease (CKD) patients transitioning from predialysis treatment to maintenance dialysis and transplantation. We aimed to study the association between an index of radiographically assessed oral health, Panoramic Tomographic Index (PTI), and cardiovascular and all-cause mortality, major adverse cardiovascular events (MACEs) and episodes of bacteremia and laboratory measurements during a three-year prospective follow-up in CKD stage 4–5 patients not on maintenance dialysis at baseline.MethodsAltogether 190 CKD stage 4–5 patients without maintenance dialysis attended panoramic dental radiographs in the beginning of the study. The patients were followed up for three years or until death. MACEs and episodes of bacteremia were recorded during follow-up. Laboratory sampling for C-reactive protein and leukocytes was repeated tri-monthly.ResultsPTI was not associated with baseline laboratory parameters or C-reactive protein or leukocytes examined as repeated measures through the 3-year follow-up. During follow-up, 22 patients had at least one episode of bacteremia, but only 2 of the bacteremias were considered to be of oral origin. PTI was not associated with incident bacteremia during follow-up. Thirty-six patients died during follow-up including 17 patients due to cardiovascular causes. During follow-up 42 patients were observed with a MACE. PTI was independently associated with all-cause (HR 1.074 95% CI 1.029–1.122, p = 0.001) and cardiovascular (HR 1.105, 95% CI 1.057–1.157, pConclusionsRadiographically assessed dental health is independently associated with all-cause and cardiovascular mortality and MACEs but not with the incidence of bacteremia in CKD stage 4–5 patients transitioning to maintenance dialysis and renal transplantation during follow-up.</p

Interatrial block, P terminal force or fragmented QRS do not predict new-onset atrial fibrillation in patients with severe chronic kidney disease

Background: The prevalence of left atrial enlargement (LAE) and fragmented QRS (fQRS) diagnosed using ECG criteria in patients with severe chronic kidney disease (CKD) is unknown. Furthermore, there is limited data on predicting new-onset atrial fibrillation (AF) with LAE or fQRS in this patient group. Methods: We enrolled 165 consecutive non-dialysis patients with CKD stage 4-5 without prior AF diagnosis between 2013 and 2017 in a prospective follow-up cohort study. LAE was defined as total P-wave duration >= 120ms in lead II >1 biphasic P-waves in leads II, III or aVF; or duration of terminal negative portion of P-wave >40ms or depth of terminal negative portion of P-wave >1mm in lead V-1 from a baseline ECG, respectively. fQRS was defined as the presence of a notched R or S wave or the presence of >= 1 additional R waves (R') or; in the presence of a wide QRS complex (>120ms), >2 notches in R or S waves in two contiguous leads corresponding to a myocardial region, respectively. Results: Mean age of the patients was 59 (SD 14) years, 56/165 (33.9%) were female and the mean estimated glomerular filtration rate was 12.8ml/min/1.73m(2). Altogether 29/165 (17.6%) patients were observed with new-onset AF within median follow-up of 3 [IQR 3, range 2-6] years. At baseline, 137/165 (83.0%) and 144/165 (87.3%) patients were observed with LAE and fQRS, respectively. Furthermore, LAE and fQRS co-existed in 121/165 (73.3%) patients. Neither findings were associated with the risk of new-onset AF within follow-up. Conclusion: The prevalence of LAE and fQRS at baseline in this study on CKD stage 4-5 patients not on dialysis was very high. However, LAE or fQRS failed to predict occurrence of new-onset AF in these patients

Nuorten lääkkeettömät ahdistuksen hallintamenetelmät

Erilaiset mielenterveysongelmat ovat yleisiä nuorilla ja ne ovat lisääntyneet viime vuosikymmenen aikana. Yleisimpiä mielenterveyshäiriöitä nuorilla ovat masennus ja ahdistus. Mielenterveysongelmat voivat olla vakava uhka nuoren kasvulle ja kehitykselle, minkä vuoksi niiden hoito ja hoidon aloitus ajoissa on tärkeää. Nuoren ahdistusoireilua voidaan hoitaa lääkkeellisin ja ei-lääkkeellisin keinoin. Erilaisia lääkkeettömiä ahdistuksen hallintakeinoja voidaan käyttää yksistään tai yhdessä lääkehoidon kanssa. Opinnäytetyön tarkoituksena oli selvittää kirjallisuuskatsauksen avulla nuorten lääkkeettömiä ahdistuksen hallintamenetelmiä. Lääkkeettömillä ahdistuksen itsehoito- ja hallintamenetelmillä tarkoitetaan ei-lääkkeellisiä menetelmiä, joiden avulla ahdistusta voi hallita. Lääkkeettömiä ahdistuksen hallintakeinoja on tutkittu mielenterveyden näkökulmasta vain vähän. Tavoitteena on koota tietoa nuorten ahdistuksen lääkkeettömistä itsehoitomenetelmistä. Tuloksista on hyötyä sekä toimeksiantajamme Kasvunpolku Oy:n työntekijöille sekä Kasvunpolulla asuville nuorille. Lisäksi tuloksista on hyötyä psykiatrisille hoitajille sekä mielenterveyshäiriöitä sairastaville potilaille. Tulosten perusteella hoitajat/ohjaajat osaavat ohjata nuorille erilaisia lääkkeettömiä keinoja ahdistuksen hallintaan. Tutkimustulosten perusteella lääkkeettömiä ahdistuksen hallintamenetelmiä on monia erilaisia. Tulosten perusteella erilaiset lääkkeettömät ahdistuksen hallintakeinot ovat yksinkertaisia ja tehokkaita ahdistuksen hallinnassa. Erilaisia menetelmä ahdistuksen lääkkeettömään itsehoitoon ovat erilaiset keholliset harjoitukset, joita ovat rentoutuminen, jooga, liikunta, mindfulness ja luonnossa oleskelu sekä ajatusharjoitukset, joita ovat meditaatio ja huomion poiskääntäminen. Tutkimusmenetelmänä käytettiin kuvailevaa kirjallisuuskatsausta. Valitulla tutkimuskysymyksellä haettiin tietoa siitä, millaisia lääkkeettömiä ahdistuksen hallintamenetelmiä nuorilla on. Työhömme valikoitiin yhdeksän kansainvälistä tutkimusta, jotka on julkaistu viiden vuoden sisällä. Tutkimukset valittiin Cinahl Complete ja Pubmed -tietokannoista. Aineisto analysoitiin teorialähtöisellä sisällönanalyysillä.Mental health issues are common on young people, and they have been increasing within the past ten years. Mental health issues can be a serious threat for young people’s growth and development, so it is important to get those issues treated on time. The most common mental health issues on young people are anxiety and depression disorders. Anxiety disorders can be treated by pharmacological and non-pharmacological methods, and they could be used independently, or they can also be combined with medical treatment. The purpose of the thesis was to find out non-pharmacological anxiety managements in adolescents. Non-pharmacological methods means that there is not any medication used to manage with anxiety. There is not much research information on that subject from a point of view of mental health. The aim was to gather information about non-pharmacological self-management methods for anxiety in adolescents. The client of the thesis was Kasvunpolku Oy. The results are beneficial for both the employees of Kasvunpolku and the adolescents living in Kasvunpolku. The results are also useful for psychiatric nurses and patients with mental health issues. Based on the results, nurses know how to guide adolescents in various non-pharmacological ways to manage with anxiety. The results are that there are many different non-pharmacological anxiety managements. They are simple, and they have positive effect on anxiety. Different methods for the non-pharmacological self-managements of anxiety are physical exercises, such as mindfulness, yoga, relaxation, sports and being in nature, and thought exercises, such as meditation and diverting attention. The research method in this thesis was descriptive literature review. The selected research question was used to search information on the topic of what non-pharmacological anxiety management methods adolescents had. Nine international studies published within five years were selected to the thesis. The studies were selected from the databases Cinahl Complete and Pubmed. The material was analyzed using theory-oriented content analysis