Longitudinal Changes in Protein Carbamylation and Mortality Risk after Initiation of Hemodialysis

Kalim, Sahir; Trottier, Caitlin A.; Wenger, Julia; Wibecan, Josh; Ahmed, Rayhnuma; Ankers, Elizabeth; Karumanchi, S. Ananth; Thadhani, Ravi; Berg, Anders H.

doi:10.2215/cjn.02390316

Cited by 27 publications

(26 citation statements)

References 45 publications

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“…Protein carbamylation , a post translational change due to urea and cyanate exposure, increases in uremia and declines with dialysis. Carbamylated albumin levels fell less in 122 HD patients who died 90–365 days after starting dialysis than it did in 244 matched control patients surviving at least a year . These two groups did not differ in blood urea, Kt / V , normalized protein intake, baseline albumin or carbamylated albumin levels.…”

mentioning

confidence: 82%

Briefly Noted

Sherman¹

2017

Seminars in Dialysis

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mentioning

confidence: 82%

Briefly Noted

Sherman¹

2017

Seminars in Dialysis

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“…For those who had a hemodialysis vintage of < 3 months at baseline ( n = 2), we used blood tests collected three months after hemodialysis initiation. This approach was based on the fact that laboratory variables might be unstable in the first few months after hemodialysis initiation, as previously reported [ 21 , 22 ].…”

Section: Methodsmentioning

confidence: 99%

Additional prognostic value of toe-brachial index beyond ankle-brachial index in hemodialysis patients

et al. 2020

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Background Ankle-brachial index (ABI), the first-line diagnostic test for peripheral artery disease, can be falsely elevated when ankle arteries are incompressible, showing a J-shaped association with mortality. In this situation, toe-brachial index (TBI) is the recommended test. However, whether TBI provides additional prognostic information beyond ABI in patients on hemodialysis is unknown. Methods In this retrospective cohort study of 247 Japanese prevalent hemodialysis patients (mean age 66.8 [SD 11.6] years), we evaluated mortality (116 deaths over a median follow-up of 5.2 years) related to quartiles of ABI and TBI, as well as three categories of low ABI (≤0.9), normal/high ABI (> 0.9) + low TBI (≤0.6), and normal/high ABI + normal TBI (> 0.6) using multivariable Cox models. Results ABI showed a J-shaped association with mortality (adjusted hazard ratio 2.72 [95% CI, 1.52–4.88] in the lowest quartile and 1.59 [95% CI, 0.87–2.90] in the highest quartile vs. the second highest). Lower TBI showed a potentially dose-response association with mortality (e.g., adjusted hazard ratios 2.63 [95% CI, 1.36–5.12] and 2.89 [95% CI, 1.49–5.61] in the lowest two quartiles vs. the highest). When three categories by both ABI and TBI were analyzed, those with low ABI (≤0.9) experienced the highest risk followed by normal/high ABI (> 0.9) + low TBI (≤0.6). Among patients with normal/high ABI (> 0.9), the increased mortality risk in individuals with low TBI (≤0.6) compared to those with normal TBI (> 0.6) were significant (adjusted hazard ratio 1.84 [95% CI, 1.12–3.02]). Conclusions Lower TBI was independently associated with mortality in patients on hemodialysis and has the potential to classify mortality risk in patients with normal/high ABI. Our results support the importance of evaluating TBI in addition to ABI in this clinical population.

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“…However, in contemporary dialysis, we’ve found adequacy measures often fail to demonstrate a mortality association as most patients meet minimum recommendations and, unfortunately, doses beyond these requirements have failed to show significant survival benefit nor improvement in uremic toxin clearance [46–49]. In this context, we have shown that carbamylation levels are indeed stronger predictors of mortality in ESRD patients on hemodialysis than the conventional urea kinetic based markers [7, 50]. Such findings reiterate that carbamylation should not be considered a simple urea equivalent, rather its levels likely integrate multiple pathologic pathways including nutritional status, inflammation, and time averaged solute clearance and accumulation, making it a potent assessment of health risk.…”

Section: Introductionmentioning

confidence: 99%