Is the measurement of tissue advanced glycosylation products by skin autofluorescence associated with mortality in patients treated by peritoneal dialysis?

Background: Advanced glycosylated end-products (AGEs) have been shown to cause cardiovascular disease, and tissue AGE accumulation can be measured by skin autofluorescence (SAF). AGEs are cleared by the kidney, and thus accumulate in dialysis patients. However, as the results of SAF measurements in peritoneal dialysis patients (PD) have been ambiguous, we examined the association between mortality and SAF. Methods: We reviewed SAF measurements in PD patients attending a university associated PD program, along with standard measurements of dialysis adequacy and peritoneal membrane function. Results: We studied 341 prevalent PD patients, 61.9% male, mean age 61.2 ± 16 years, and 31.4% of all patients died during a median follow-up of 27.2 (23.3–36.3) months. Patients who died were older, mean age 72 ± 10.5 years, were more often diabetic (60.7%), and had higher median SAF 3.8 (3.2–4.5) AU. On logistic regression, mortality was independently associated with age (odds ratio (OR) 1.1 (95% confidence limits 1.06–1.16), diabetes OR 10.1 (3.1–33.4), SAF OR 3.3 (1.8–6.2), all p < 0.001, and male gender OR 5.2 (1.6–17.4), p = 0.007; and negatively associated with weight OR 0.91 (0.86–0.95), p < 0.001, normalised nitrogen appearance rate (nPNA) OR 0.05 (0.01–0.4), p = 0.005 and mean arterial blood pressure (MAP) OR 0.96 (0.93–0.96), p = 0.03. Conclusions: In this observational study, SAF was independently associated with mortality. However, other factors were also associated with mortality, including age, diabetes and malnutrition which have all been reported to affect SAF measurements. Thus, the additional predictive value of measuring SAF compared to standard risk factors for mortality remains to be determined. Graphical abstract: [Figure not available: see fulltext.]

Effect of Ultrafiltration Rate in Long Interdialytic Interval Hemodialysis Session versus Average Weekly Ultrafiltration Rate on Mortality Rate and Adverse Cardiovascular Outcomes in Maintenance Hemodialysis Patients

Objective: Cardiovascular events are more commonly observed during hemodialysis sessions after a long interdialytic interval compared to average weekly hemodialysis sessions, and ultrafiltration rate (UFR) was reported to be associated with cardiovascular outcomes. Whether the UFR during hemodialysis sessions after a long interdialytic interval is a better predictor of cardiovascular outcome than the average weekly UFR is unknown. Methods: The charts of patients aged >18 years with end-stage renal disease that received hemodialysis treatment Siriraj Hospital during January 2008 to December 2017 were retrospectively reviewed. Results: Two hundred and forty-one patients (52.8% females) were included. During the median time follow-up of 54 months, the rate of adverse cardiovascular outcomes was 7.26 events/100-patient-years, and the mortality rate was 8.40 deaths/100-patient-years. Mean UFR was significantly higher in the long interdialytic interval hemodialysis sessions than in the average weekly UFR sessions (14.07±5.29 vs.13.13±5.14 ml/h/kg, p13 ml/hour/kg subgroup was 1.29 (95% CI: 0.65-2.56) and 1.05 (95% CI: 0.55-2.03) in the long interdialytic interval hemodialysis sessions and the average weekly UFR, respectively. The adjusted HR for adverse cardiovascular outcome in the UFR >13 ml/h/kg subgroup was 1.32 (95% CI: 0.64-2.80) and 0.72 (95% CI: 0.36-1.35) in the long interdialytic interval hemodialysis sessions and the average weekly UFR, respectively. Conclusion: This study revealed the UFR in long interdialytic hemodialysis sessions to be more strongly associated with adverse cardiovascular outcomes and all-cause mortality than the average weekly UFR

Assessment of Volume Status in Chronic Hemodialysis: Comparison of Lung Ultrasound to Clinical Practice and Bioimpedance

Objective: To compare LUS with other volume assessment methods, and to verify the prognostic value of LUS in Thai chronic HD patients. Materials and Methods: We conducted a prospective cohort study in 36 chronic HD patients. Volume status before the HD session was evaluated by physical examinations, bioimpedance analysis (BIA), and ultrasound lung comets (ULCs). Mortality and morbidities were recorded during a 1-year follow-up period. Results: The degree of lung fluid accumulation was assessed by summation of the number of ULCs, and was classified into 3 groups: mild-to-moderate (ULC60) in 11.1%, 77.8%, and 11.1% of the patients, respectively. Either clinical edema or lung crackle had low sensitivity (20-32%) to detect extravascular lung water excess in patient with mild-to-moderate ULC and severe ULC. Overhydration assessed by BIA was found in 75% and 64.3% of patients with mild-to-moderate and severe ULC, respecively.  In patients with very severe ULC, the admission rate due to volume overload was significantly higher, there was also a trend of increased mortality, as well as intradialytic complications. Conclusion: Clinical assessment and BIA have limited value in determining extravascular fluid excess in the lung. Lung ultrasound is a useful tool to detect subclinical pulmonary congestion. The long-term outcome by using LUS-guided fluid management needs larger population studies