Frequency, etiology, and outcomes of acute renal failure (Data of Kaunas University of Medicine Hospital in 1995–2006)

The aim of this study was to determine the frequency, etiology, and outcomes of acute renal failure. We retrospectively collected data on all patients (n=1653) who received renal replacement therapy for acute renal failure at the Kaunas University of Medicine Hospital during 1995–2006. The number of patients with acute renal failure increased nine times during the 11-year period. The mean age of patients was 59.76±17.52 years and increased from 44.97±17.1 years in 1995 to 62.84±16.49 years in 2006. The most common causes of acute renal failure were renal (n=646, 39%), prerenal (n=380, 23%), and obstructive (n=145, 9%). The renal replacement therapy was discontinued because of recovery of renal function in 49.9% of cases. The overall hospital mortality rate was 45.1%. Renal function did not recover in 6.7% of patients. The mortality rate over the 11-year period varied from 37.8 to 57.5%. The highest mortality rate was in the neurosurgical (62.3%) and cardiac surgical (61.8%) intensive care units. High mortality rate (more than 50%) was in the groups of patients with acute renal failure that was caused by hepatorenal syndrome, shock, sepsis, and reduced cardiac output

Hemodializuojamų ligonių hospitalizavimo dėl širdies ir kraujagyslių ligų rizikos veiksniai

The aim of this study was to evaluate the risk factors for cardiovascular hospitalization in hemodialysis patients. Materials and methods. A cross-sectional cohort analysis of risk factors during one census month (November) and one-year follow-up for cardiovascular hospitalization rates during 5 consecutive years (2002–2006) in all end-stage renal disease patients hemodialyzed in Kaunas region was carried out. During the census month, we collected data on patient’s age and sex, disability status, comorbidities, anemia control, malnutrition and inflammation, calciumphosphorus metabolism, and patient’s compliance with prescribed medications. We analyzed 559 patients during 1163 patient-years of observation. Patients were considered as new patients every year (1520 cases). Kaplan-Meier method and Cox regression analysis were used to evaluate time to first hospitalization. Results. The mean number of cardiovascular hospitalizations was 0.31 per patient-year at risk, the total days of cardiovascular hospitalizations per patient-year at risk were 3.93, and the mean length of one hospitalization was 13.2±12.9 days. Cardiovascular diseases were the most frequent cause of hospitalization (25% of all hospitalizations). The relative risk of cardiovascular hospitalization increased by 1.03 for every year of age, by 1.7 for worse disability status, by 1.4 for nonadherence to medications, by 1.1 for every additional medication prescribed to the patient. Cardiovascular hospitalization risk was decreased by 0.99 with a 1-g/L rise in hemoglobin level. Conclusions. Older age, worse disability status, patient’s noncompliance with medications, and higher number of medications used were associated with a higher risk for cardiovascular hospitalization. Higher hemoglobin level was associated with a lower risk for cardiovascular hospitalization

Infection-related hospitalization of hemodialysis patients

Infection is an important cause of morbidity and mortality in hemodialysis patients. These patients are frequently hospitalized for infections. The objective of our study was to evaluate hospitalization rate for infections and to determine risk factors for infection-related hospitalizations of hemodialysis patients in Kaunas region, Lithuania. Ambulatory case records of 533 patients with end-stage renal disease, dialyzed in all hemodialysis centers in Kaunas region during the period of 2001–2004, were analyzed. Data on patient’s condition and routine laboratory tests were collected in November of 2001, 2002, and 2003. These patients then were followed up for the next 12 months in order to evaluate infection-related hospitalization rate. All patients were considered new patients every year, and general analysis of three-year data was performed. Statistical analyses were carried out using SPSS (Statistical Package for Social Sciences) and STATISTICA. Univariate statistical analysis was performed comparing the groups of patients that were hospitalized because of infections and were not hospitalized. Relative risk of infection-related hospitalization was estimated using Cox regression evaluating the time to first infection-related hospitalization. The unadjusted infection-related hospitalization rate was 0.2 per patient a year (18% of all hospitalizations). The median length of hospital stay for infections was 11 days. Univariate statistical analysis showed a statistically significant association between infection-related hospitalizations and diabetes (P=0.02); lower hemoglobin (P<0.0001), creatinine (P=0.045), and albumin (P=0.01) concentrations; higher interdialytic weight gain (P=0.01). Multivariate Cox regression analysis revealed that only hemoglobin concentration (P<0.001, RR=0.96), interdialytic weight gain (P=0.002, RR=1.38), and creatinine level (P=0.02, RR=0.99) were important risk factors for infection-related hospitalization [...]

Kraujagyslinės jungtys hemodializei: formavimas, funkcionavimas ir komplikacijos (Kauno medicinos universiteto klinikų duomenys)

Background. There are no data about arteriovenous fistulas (AVF) formation, survival, and complications rate in patients with end-stage renal failure in Lithuania. Material and methods. We analyzed the data of patients (N=272) with end-stage renal failure, dialyzed at the Hospital of Kaunas University of Medicine from January 1, 2000, until March 30, 2010, and identified 368 cases of AVF creation. The patients were divided into two groups: group 1 included the patients with an AVF that functioned for <15 months (n=138) and group 2 included patients with an AVF that functioned for ≥15 months (n=171). Results and conclusions. Less than half (47%) of the patients started planned hemodialysis and 51% of the patients started hemodialysis urgently. The mean time of AVF functioning was 15.43±8.67 months. Age, gender, the kidney disease, and time of AVF maturation had no influence on AVF functioning time. AVFs of the patients who started planned hemodialysis functioned longer as compared to AVFs of the patients who started hemodialysis urgently (P<0.05). Hospitalization time of the patients who started hemodialysis urgently was longer as compared that of the patients who had a matured AVF (37.63±20.55 days vs. 16.54±9.43 days). The first vascular access had better survival than repeated access. AVF survival in patients with ischemic brain vascular disease was worse than in patients without this comorbidity

Influence of anemia on hospitalization and mortality in hemodialysis patients

The objective of our study was to evaluate the influence of anemia on hospitalization and mortality in hemodialysis patients of Kaunas region. We analyzed ambulatory case records of 148 patients dialyzed in all 7 hemodialysis centers of Kaunas region in November 2001. The study consisted of two parts: in the first part data on patient age, gender, primary cause of end-stage renal disease, hemoglobin concentration were collected in November 2001 and in the second part these patients were followed up for 12 months in order to evaluate rate and length of hospitalization, reasons for hospitalization and mortality. At the beginning of the study mean hemoglobin (Hb) value was 101.2±13.8 g/l and more than a half of the patients (59%) had hemoglobin value higher than 100 g/l. Further follow-up of the patients during the year 2002 revealed that hemoglobin level of the patients who died was lower from the patients who followed hemodialysis. Mean hemoglobin of dead and alive patients was 92.4±18.6 g/l and 102.81±12.48 g/l, respectively (p=0.02). Lower hemoglobin concentrations were associated with a 5% higher relative risk of mortality for every 1 g/l decrease in hemoglobin (p=0.027). Analysis showed that mean hemoglobin value was 104.2±11.1 g/l for the patients who were not hospitalized and 99±15.1 g/l for the patients who were hospitalized during the year 2002 (p=0.02). Lower hemoglobin concentrations were associated with a 5% higher relative risk for hospitalization for every 1 g/l decrease in hemoglobin (p=0.027). Patients who had mean hemoglobin value lower than 100g/l were hospitalized more frequently (p=0.01) and for longer period of time (p=0.005) than the patients with hemoglobin higher than 100 g/l. Analysis of the reasons for hospitalizations revealed that every 1 g/l decrease in hemoglobin increases relative risk for hospitalization due infections by 1% (p=0.000)

Estimated average yearly treatment expenditures for hemodialysis patients (Data of Kaunas University of Medicine Hospital in the year 2005)

With increasing number of hemodialysis patients, expenditures for the treatment of hemodialysis patients are rising every year. The objective of our study was to collect and analyze the data on estimated average treatment expenditures, which were covered by State Patients’ Fund, for patients undergoing hemodialysis in Kaunas University of Medicine Hospital in 2005 and the costs of medications paid by patient and to compare with the analogical data of the year 2001. We analyzed ambulatory case records of all 106 patients with end-stage renal disease who were hemodialyzed in Kaunas University of Medicine Hospital from November 1, 2004, to October 31, 2005. Data on medications used and number of hemodialysis procedures and hospitalizations were collected. On average, 2.8±0.4 hemodialysis procedures per patient a week were carried out. Expenditures for hemodialysis procedures were 38 094.12±5003.17 litas (11 041 euros) per patient per year, and this accounted for 63% of all expenditures for hemodialysis patient. Hospitalization rate was 1.4±1.8 per patient a year; expenditures for hospitalizations were 1538.4±1941 litas (446 euros) per patient a year (3% of all expenditures for hemodialysis patients). The mean number of drugs prescribed per patient monthly was 7.7±2.17 including 2.12±1.6 antihypertensive medications. The total costs of drugs reimbursed by State Patients’ Fund were 20 639.82±15 439.3 litas (5983 euros) per patient per year, of which 92% was spent on erythropoietin and intravenous iron. The average expenditures for health insurance of hemodialysis patients were 60 272.35±16 624.18 litas (17 470 euros) per patient a year. One patient had to pay 1.9±1.6 litas for medications per day and 699.71±583.6 litas (203 euros) per year. The comparison of the data gathered in 2001 and 2005 revealed an increase in the total expenditures for hemodialysis patients due to increase in the expenditures for hemodialysis procedures and medications

Prevalence of chronic kidney disease and its risk factors among family practice patients in Lithuania

Background: Early detection of chronic kidney disease (CKD) by the first line is essential. In many countries, serum creatinine measurements are reimbursed in home practice. In Lithuania however, until recently they were not. Therefore, the aim of this study was to assess the prevalence of risk factors of CKD in primary care patients, to evaluate the awareness of family practitioners and, finally, to investigate renal function parameters in patients at risk. Methods: We reviewed the charts of adult patients (n = 4,082) from four home practices in Kaunas and identified patients at increased risk for CKD (severe arterial hypertension, diabetes, cardiovascular disease (CVD), other causes of kidney damage). We noted age and gender in all patients, and renal function measurements performed over the preceding 24 months in the patients at risk. In the second part, we assessed nephrological status (history, clinical characteristics, serum creatinine, dipstick urinalysis and microalbuminuria, estimated glomerular filtration rate (eGFR) by the abbreviated MDRD formula) for those at risk who were referred by their family practitioners. Results: In total, 458 (11.2%) patients had risk factors for CKD. Severe arterial hypertension was found in 62.6% of these patients, diabetes in 20.9%, CVD in 6.2% and 34.5% had a history of kidney damage. Kidney tests had been performed by family practioner in 59% of these patients. Only 30.3% of these patients were referred to the nephrologist and an additional 20.1% came after receiving an invitation letter. eGFR < 60 ml/min/1.73 m(2) was found in 42.9% of these patients, 23.4% had microalbuminuria and 7.8% overt proteinuria. Optimal blood pressure control (< 130/85 mmHg) was achieved in a minority (10.4%). 79.7% had abnormal BMI, 39% used no ACEI/ARB, and 16% were smokers. Kidney dysfunction was associated with a higher prevalence of microalbuminuria and a lower use of ACEI/ARB. Conclusions: Risk factors for CKD were present in 11% of the patients in this primary care cohort. Kidney dysfunction was found in almost half of the patients at risk. However, awareness of this problem by family practitioners was low

Hepcidin serum levels and resistance to recombinant human erythropoietin therapy in hemodialysis patients

Objective: The aim of this study was to analyze the factors that are associated with the response to erythropoiesis-stimulating agents (ESAs) and its association with hospitalization and mortality rates; to evaluate the serum hepcidin level and its associations with iron profile, inflammatory markers, ESAs responsiveness, and mortality; and to determine independent factors affecting ERI and hepcidin. Materials and methods: To evaluate a dose-response effect of ESAs we used the erythropoietin resistance index (ERI). Patients were stratified in two groups: nonresponders and responders (ERI > 15, n = 20, and ERI ≤15 U/kg/week/g per 100 mL, n = 153, respectively). Hematological data, hepcidin levels, iron parameters, inflammatory markers, hospitalization and mortality rates were compared between the groups. Multiple regression analysis was used to determine independent factors affecting ERI and hepcidin. Results: C-reactive protein (CRP) (b = 0.078, P = 0.007), albumin (b = 0.436, P = 0.004), body mass index (b = 0.374, P < 0.001), and hospitalization rate per year (b = 3.017, P < 0.001) were found to be significant determinants of ERI in maintenance hemodialysis (MHD) patients. Inadequate dialysis was associated with higher ERI. Patients with concomitant oncological diseases had higher ERI (31.2 12.4 vs 9.7 8.1 U/kg/week/g per 100 mL, P = 0.002). The hepcidin level was 158.51 162.57 and 120.65 67.28 ng/mL in nonresponders and responders, respectively (P = 0.33). Hepcidin correlated directly with ERI, dose of ESAs, ferritin and inversely with Hb, transferrin saturation, and albumin. ERI (b = 4.869, P = 0.002) and ferritin (b = 0.242, P = 0.003) were found to be significant determinants of hepcidin in MHD patients. The hospitalization rate per year was 2.35 1.8 and 1.04 1.04 in nonresponders and responders, respectively (P = 0.011). [...]

Aluminum concentration in blood of hemodialysis patients and its clinical importance

A multicenter study was performed to investigate the prevalence of abnormal blood contents of aluminum in hemodialysis patients and to clarify the impact of aluminum level on the clinical status of such patients. Material and methods. Two hundred sixty five patients with end-stage renal disease from 7 dialysis centers were enrolled in this study. All patients had undergone standart hemodialysis. Venous blood samples were collected from hemodialysis patients before hemodialysis sessions. Atomic absorption spectrophotometry was applied to measure blood levels of aluminum. Results. Out of hemodialysis patients 24.9% had high blood aluminum (>30 microg/l), and the mean was 27.4±43.8 microg/l in all subjects. The aluminum containing phosphate binder users had significantly higher blood aluminum levels (45.1±102.0 versus 15.4±18.9 microg/l, p30 microg/l)