Background: CKD is a significant cause of morbidity, cardiovascular and all-cause mortality. CHA2DS2-VASc is a score used in patients with atrial fibrillation to predict thromboembolic risk; it also appears to be useful to predict mortality risk. The aim of the study was to evaluate CHA2DS2-VASc scores as a tool for predicting one-year mortality after hemodialysis is started and for identifying factors associated with higher mortality. Methods: Retrospective analysis of patients who started hemodialysis between January 2014 and December 2019 in Centro Hospitalar Universitário Lisboa Norte. We evaluated mortality within one year of hemodialysis initiation. The CHA2DS2-VASc score was calculated at the start of hemodialysis. Results: Of 856 patients analyzed, their mean age was 68.3 ± 15.5 years and the majority were male (61.1%) and Caucasian (84.5%). Mortality within one-year after starting hemodialysis was 17.8% (n = 152). The CHA2DS2-VASc score was significantly higher (4.4 ± 1.7 vs. 3.5 ± 1.8, p < 0.001) in patients who died and satisfactorily predicted the one-year risk of mortality (AUC 0.646, 95% CI 0.6–0.7, p < 0.001), with a sensitivity of 71.7%, a specificity of 49.1%, a positive predictive value of 23.9% and a negative predictive value of 89.2%. In the multivariate analysis, CHA2DS2-VASc ≥3.5 (adjusted HR 2.24 95% CI (1.48–3.37), p < 0.001) and central venous catheter at dialysis initiation (adjusted HR 3.06 95% CI (1.93–4.85)) were significant predictors of one-year mortality. Conclusion: A CHA2DS2-VASc score ≥3.5 and central venous catheter at hemodialysis initiation were predictors of one-year mortality, allowing for risk stratification in hemodialysis patients.
Background and Aims
A reliable vascular access (VA) is required for patients receiving chronic hemodialysis (HD) treatment. VA choice is complex and must consider patient characteristics, predicted patency and risk of primary failure. Vascular mapping (VM) by duplex doppler ultrasonography (DUS) can aid in the planning of which VA to place. Peripheral artery disease (PAD) is associated with higher AVF failure and can be assessed by calculating the ankle-brachial index (ABI). Muscle strength is independently associated with mortality risk and can be evaluated with handgrip strength (HGS). This study aims to describe and analyze clinical anthropometric and laboratory characteristics of patients referred for vascular mapping prior to VA creation and to correlate VM data, HGS, and ABI.
Method
Prospective analysis of all adult patients with CKD who were referred for VM, at a tertiary center, between March 2021 and August 2021. No patients were excluded. Preoperative DUS by a single experienced nephrologist was carried out. HGS was measured using a Hand Dynamometer and PAD was defined as ABI<0.9. According to distal vasculature size (<2mm) sub-groups were analyzed.
Results
80 patients were included and 67.5% were male, mean age 65.7 ± 14.7 years and 51.3% were on Renal Replacement Therapy (RRT). Twelve (15%) participants had PAD. HGS was higher in dominant arm (20.5 ± 12.0 kg vs 18.8 ± 11.2 kg). Fifty-eight (72.5%) patients had vessels smaller than 2 mm in diameter. There were no significant differences between groups concerning demographic and comorbidities (diabetes, PAD). HGS was significantly higher in patients who had vessels greater than or equal to 2 mm in diameter (26.1 ± 15.5 kg vs 18.4 ± 9.7 kg, p = 0.010).
Conclusion
Greater HGS was associated with more developed distal vessels. Low HGS might be an indirect sign of poor vascular characteristics, which might help predict the outcomes of VA creation and maturation.
Background and Aims
Portugal has one of the highest incidences and prevalence of end-stage kidney disease in Europe, with haemodialysis (HD) being the most common modality of renal replacement therapy. The aim of our study was to analyse a cohort of patients who started HD in a large tertiary care hospital in Lisbon and describe the evolution of the patient characteristics throughout the studied years.
Method
This study was a retrospective analysis of all adult individuals who started HD between January of 2014 and December of 2019 in tertiary care hospital in Lisbon. Data was attained from individual electronic clinical records. The primary outcome was mortality. Statistical significance was defined as a P-value lower than 0.05.
Results
We included 1122 patients (mean age 64.9 ±16.8 years, 21.2% at least 80 years old; 60.9% male and 79.7% caucasian). At HD start, mean eGFR was 8.98 ±5.66mL/min/1.73 m2 and the vascular access was a central venous catheter in 56.0%, an arteriovenous fistula in 40.6% and an arteriovenous graft in 3.4%. The number of patients that started HD per year was variable between 169-204 and the percentage of elderly patients increased throughout the years. There was a trend of initiating dialysis with progressively lower eGFR. The percentage of patients with central venous catheter increased. In total 392 patients died (7.5% within the first 90 days of starting HD). Mortality rate within the first 90 days and first year declined from 2015 to 2019. As expected mortality was higher in older patients (Fig. 1), as well as in patients that started HD with a central venous catheter (Fig. 2).
Conclusion
We describe a large cohort of Portuguese patients that started HD between 2014-2019 that correlates well with the available recent data from the national and european registries. There was a greater percentage of patients initiating HD by catheter, which was associated with higher mortality, Although, considering the increase in elderly patients starting HD, their underlying comorbidities might impair vascular access placement and also have an impact on mortality. Additionally, despite the increase in elderly patients, mortality within the first 90 days and first year declined, highlighting the quality of care provided, in addition to a better acknowledgment and referal to conservative care.
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