PowerPoint Slides for: High Pulse-Wave Velocity Defines a Very High Cardiovascular Risk Cohort of Dialysis Patients under Age 60

<p><b><i>Background:</i></b> Patients with end-stage renal disease (ESRD) are at a high risk of cardiovascular mortality (CVM). In patients with ESRD, arterial stiffness increases at an earlier age when compared to the general population and this contributes to the overall risk of cardiovascular mortality. The main objective of this study was to clarify the interplay between age and cardiovascular alterations in ESRD. <b><i>Methods:</i></b> Prospective, observational cohort study initiated in April 1987 until the end of 1998 with events recorded until the end of the year 2000 at the F.H. Manhes Hospital Center, Fleury-Mérogis (in the Paris/Ile de France area). <b><i>Results:</i></b> The study population consisted of 278 ESRD patients undergoing dialysis therapy. The mean ± SD age was 53 ± 16 years. The mean pulse-wave velocity (PWV) was ∼11 m/s, with ∼37% of patients having a PWV >12 m/s. During the follow-up period, 91 patients died from CV causes. PWV >12 m/s was associated with CVM in the unadjusted model but lost its prognostic value in patients >60 years (p for interaction = 0.008). In patients ≤60 years, PWV was found to be a strong and independent predictor of CVM with hazards ratio (95% CI) of 14.382 (7.120-29.047), p < 0.001, and it improved the prognostic reclassification of a model containing well-established prognostic variables. According to multivariable regression analysis, aortic PWV was strongly associated with age (R² = 0.37, p < 0.001). <b><i>Conclusion:</i></b> A PWV >12 m/s provides important prognostic information in ESRD patients under 60 years of age, whereas in older patients, its prognostic relevance is lost. These findings are of critical relevance for early intervention guidance and trial end-point/treatment effect interpretation.</p

Supplementary Material for: Patiromer Decreases Serum Potassium and Phosphate Levels in Patients on Hemodialysis

<p><b><i>Background:</i></b> Persistent hyperkalemia (serum potassium (K) ≥5.5 mEq/l) is a common condition in hemodialysis (HD) patients, is associated with increased mortality, and treatment options are limited. The effect of patiromer, a gastrointestinal K binder, on serum K was examined in HD patients. <b><i>Methods:</i></b> Six hyperkalemic HD patients (5 anuric) were admitted to clinical research units for 15 days (1 pretreatment week and 1 patiromer treatment week) and they received a controlled diet with identical meals on corresponding days of pretreatment and treatment weeks. Phosphate (P) binders were discontinued on admission. Patiromer, 12.6 g daily (divided 4.2 g TID with meals), was started on the Monday morning following the last pretreatment week blood sampling. Serum and 24-hour stool samples were collected daily. <b><i>Results:</i></b> Mean ± SE serum K decreased (maximum change per corresponding day, 0.6 ± 0.2 mEq/l, p = 0.009) and fecal K increased 58% on patiromer compared with the pretreatment week. During the pretreatment week, 69.0, 47.6, and 11.9% of patients' serum K values were ≥5.5, ≥6.0, and ≥6.5 mEq/l, respectively. This was reduced to 38.1% (p = 0.009), 11.9% (p < 0.001), and 2.4% (p = 0.2) on patiromer. Following P binder discontinuation, the long interdialytic interval mean ± SE serum P numerically increased from 5.8 ± 0.4 to 7.0 ± 0.5 mg/dl (p = 0.06). On patiromer, P decreased from 7.0 ± 0.5 to 6.2 ± 0.5 mg/dl (p = 0.04). While on patiromer, fecal P numerically increased by 112 ± 72 mg/day (17%; p = 0.1792; range -148 to 344 mg/day). No patient discontinued patiromer because of adverse events (AEs); none had serious AEs. <b><i>Conclusions:</i></b> In 6 hyperkalemic HD patients, patiromer decreased serum K and P levels and increased fecal K.</p