Estimation of dialysis patients’ survival through combined approach of small molecule uremic markers

Abstract

Survival rate of dialysis patients is still alarmingly low and various factors may have in it an important role. The purpose of this study was to observe the relationship between the survival of dialysis patients and the serum level of urea, creatinine, and uric acid (UA). Serum urea and creatinine concentrations may express patient's nutritional status and muscle mass, and high UA value may refer to higher risk for cardiovascular events. The idea of combining the concentrations and removal of urea and UA into a single model for predicting the patient's outcome is introduced. The study included 33 hemodialysis patients from Linköping, Sweden and 10 from Tallinn, Estonia. Kaplan-Meier analysis was used for survival analysis. Logistic and Cox regression analysis was applied to create models for predicting patients' three-year survival. It was observed that higher serum UA is significantly related to poor survival in dialysis patients (p = 0.026). A reverse effect was observed in case of urea (p = 0.095). The level of creatinine was not related to survival (p = 0.905). The best logistic regression model for predicting patients' outcome included both UA and urea based parameters (Chi Square 21.0, p = 0.0001). Survival of dialysis patients seems to be determined by a set of causal factors and combined models may have a predictive relevance. A possibility for automatic online monitoring of small molecule uremic markers is proposed. Since the number of participating patients was small, larger studies including more patients and testing the models in independent validation cohort is the future goal.

Uremic Toxins Affecting Cardiovascular Calcification: A Systematic Review

“…Thus, this systematic review suggests that investigating the impact of all uremic toxins on cardiovascular calcification systematically and in a standardized way could reveal those substances that would be most interesting for further research and, thereafter, potentially for drug development aiming to prevent or slow down the development and progression of cardiovascular calcification in CKD. Additionally, studying combinatorial and/or synergistic effects of uremic toxins are of importance as well, since previous studies revealed that combining blood levels of low molecular weight uremic toxins may help to improve the estimated survival of CKD stage 5D patients [85]. Preferentially, this should be done by a systematic approach, using standardized models for analyzing cardiovascular calcification in vitro and ex vivo [86].…”

Visible fluorescence of biological fluids as a renal failure marker: New integrative approach

“…[16][17][18] It seems that the blood concentrations of classical markerscreatinine, urea and uric acid -are good predictors of renal failure at the early stages of disease but can give false signals at the ESRD. 19 Our own data accumulated over the prolonged period of observation (% 4 years) show that by some ESRD patients' blood creatinine and urea concentrations can steadily decrease (during % 2 years) falling sometimes to the normal level shortly before a Pt's death (unpublished).…”