Association between serum aluminum levels and cardiothoracic ratio in patients on chronic hemodialysis

Wang, Tzu-Lin; Fang, Yu-Wei; Leu, Jyh-Gang; Tsai, Ming-Hsien

doi:10.1371/journal.pone.0190008

Cited by 4 publications

(6 citation statements)

References 40 publications

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“…The average blood aluminum level of the dialysis patients was 1.0 ± 0.4 µg/dL, below the cutoff value set by National Kidney Foundation. As shown in Table 3 [ 14 , 17 , 18 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ], there is a decreasing trend of blood aluminum levels in the dialysis units throughout the world. In the earlier studies, Neiva et al [ 36 ] presented that the mean blood aluminum levels of Brazil hemodialysis patients was 4.5 ± 2.9 µg/dL, and Kazi et al [ 33 ] presented that blood aluminum levels of 22.0 ± 2.5 µg/dL in Pakistan hemodialysis patients.…”

Section: Discussionmentioning

confidence: 99%

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Blood Aluminum Levels in Patients with Hemodialysis and Peritoneal Dialysis

Chuang

Tsai

Wang

et al. 2022

IJERPH

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Background. This retrospective observational study attempted to examine the prevalence of abnormal blood aluminum levels in dialysis patients, and to explore the association of pathogenic factors, such as demographic, clinical, laboratory as well as the use of phosphate binding drugs, drugs for secondary hyperparathyroidism and erythropoiesis-stimulating drugs with the blood aluminum levels. Methods. The study included 1175 patients (874 hemodialysis and 301 peritoneal dialysis), recruited from Chang Gung Memorial Hospital in November 2020. Patients were stratified into two groups by their blood aluminum levels, as normal (<2 µg/dL, n = 1150) or abnormal (≥2 µg/dL, n = 25). Results. The patients aged 60.4 ± 13.2 years and were dialyzed for 8.6 ± 8.1 years. The average blood aluminum level was 1.0 ± 0.4 µg/dL. Patients with abnormal blood aluminum levels received more sevelamer than patients with normal blood aluminum level (p = 0.014). Patients with abnormal blood aluminum levels had higher platelet count (p = 0.001), triglyceride (p < 0.001) and total iron binding capacity (p = 0.003) than patients with normal blood aluminum levels. Moreover, the cardiothoracic ratio was higher in patients with abnormal blood aluminum levels than patients with normal blood aluminum levels (p = 0.003). Conclusions. The prevalence of abnormal blood aluminum levels was low at 2.2%. Nevertheless, the linking of cardiothoracic ratio of more than 0.5 as well as elevated blood platelet count and triglyceride level with blood aluminum levels are interesting, and warranted more researches in this area.

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Section: Discussionmentioning

confidence: 99%

“…At the end, the cardiac stroma exhibited a compensatory enlargement, triggering constant pathological cardiac remodeling. In a study of 547 hemodialysis patients, Wang et al [ 24 ] also identified a significant association between blood aluminum levels and cardiomegaly (cardiothoracic ratio more than 0.5).…”

Section: Discussionmentioning

confidence: 99%

Blood Aluminum Levels in Patients with Hemodialysis and Peritoneal Dialysis

Chuang

Tsai

Wang

et al. 2022

IJERPH

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“…The CTR, which is the ratio of cardiac and thoracic diameters, is estimated according to chest X-ray [26], and is usually regarded as a predictor of left ventricular systolic dysfunction in LTHD patients [27]. We previously reported that CTR was not only related to peripheral arterial disease [28], but also had a negative impact on long-term survival in our LTHD patients [3,29,30].…”

Section: Discussionmentioning

confidence: 99%

Higher Intra-Dialysis Serum Phosphorus Reduction Ratio as a Predictor of Mortality in Patients on Long-Term Hemodialysis

Fang¹,

Leu²,

Tsai³

et al. 2019

Med Sci Monit

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BackgroundRapid shifting between extracellular and intracellular phosphorus can occur during dialysis sessions, which can cause aberrant intracellular signaling in long-term hemodialysis (LTHD) patients. However, the effect of these intra-dialysis fluctuations of phosphorus on clinical outcomes has not been examined. Therefore, we investigated the relationship between intradialysis serum phosphorus reduction ratio (IDSPRR) and mortality in LTHD patients.Material/MethodsThis was a retrospective, observational cohort study to assess the predictive power of IDSPRR (>0.63 vs. ≤0.63) on mortality in a total of 805 LTHD patients. All these fatal events were analyzed using the Cox proportional hazards regression model.ResultsAfter multivariable analysis, baseline IDSPRR higher than 0.63 was significantly predictive of all-cause mortality (hazard ratio [HR]: 1.58; 95% confidence interval [CI]: 1.10–2.26), but not for cardiovascular (CV) mortality (HR: 1.41; 95% CI: 0.91–2.18). However, when time-varied IDSPRRs were applied, a value greater than 0.63 was not only significantly predictive of all-cause mortality (HR: 1.74, 95% CI: 1.16–2.63), but also CV mortality (HR: 2.04, 95% CI: 1.23–3.40).ConclusionsHigh IDSPRR (>0.63) is independently associated with increased all-cause and CV mortality, which shows the negative effect of rapid intracellular phosphorus-shifting on LTHD patients.

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“…Hypoalbuminemia is recognized as a strong predictor of mortality in the CKD population 26 . The final consideration is the hazardous effect of aluminum in cardiac remodeling 7 , 27 , which the cardiotoxicity of aluminum might be attributable to oxidative stress and dysregulation of the intracellular redox system 18 . Some reports have found a significant association between heart damage and aluminum levels 28 , 29 .…”

Section: Discussionmentioning

confidence: 99%

“…Thereafter, hyperparathyroidism might be a mechanism to protect against aluminum-induced osteomalacia, perhaps by increasing bone turnover with elevated alkaline phosphatase levels 31 . Moreover, studies found evidence for aluminum-induced cardiac injury 28 and cardiac complications 29 ; higher aluminum loading in CHD patients was associated with cardiomegaly 7 and cardiothoracic ratio (>0.5) 27 ; cardiotoxicity of aluminum might be attributable to oxidative stress and dysregulation of the intracellular redox system 18 . Such clinical findings in previous studies can support our data.…”

Section: Discussionmentioning

confidence: 99%

Association of Serum Aluminum Levels with Mortality in Patients on Chronic Hemodialysis

Tsai

Fang

Liou

et al. 2018

Sci Rep

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Despite reported evidence on the relationship between higher serum aluminum levels and poor outcomes in patients on chronic hemodialysis (CHD), the acceptable cutoff value of serum aluminum for mortality remains unclear. A retrospective observational cohort study with 636 Taiwanese patients on CHD was conducted to investigate the impact of serum aluminum levels on mortality. The predictors were bivariate serum aluminum level (<6 and ≥6 ng/mL) and the Outcomes were all-cause and cardiovascular (CV) mortality. During the mean follow-up of 5.3 ± 2.9 years, 253 all-cause and 173 CV deaths occurred. Crude analysis showed that a serum aluminum level of ≥6 ng/mL was a significant predictor of all-cause [hazard ratio (HR), 1.80; 95% confidence interval (CI), 1.40–2.23] and CV (HR, 1.84; 95% CI, 1.36–2.50) mortality. After multivariable adjustment, the serum aluminum level of ≥6 ng/mL remained a significant predictor of all-cause mortality (HR, 1.37, 95% CI, 1.05–1.81) but became insignificant for CV mortality (HR, 1.29; 95% CI, 0.92–1.81). Therefore, our study revealed that a serum aluminum level of ≥6 ng/mL was independently associated with all-cause death in patients on CHD, suggesting that early intervention for aluminum level in patients on CHD might be beneficial even in the absence of overt aluminum toxicity.

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Association between serum aluminum levels and cardiothoracic ratio in patients on chronic hemodialysis

Cited by 4 publications

References 40 publications

Blood Aluminum Levels in Patients with Hemodialysis and Peritoneal Dialysis

Blood Aluminum Levels in Patients with Hemodialysis and Peritoneal Dialysis

Higher Intra-Dialysis Serum Phosphorus Reduction Ratio as a Predictor of Mortality in Patients on Long-Term Hemodialysis

Association of Serum Aluminum Levels with Mortality in Patients on Chronic Hemodialysis

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