Pre-End-Stage Renal Disease Hemoglobin Variability Predicts Post-End-Stage Renal Disease Mortality in Patients Transitioning to Dialysis

Sumida, Keiichi; Diskin, Charles J.; Molnar, Miklos Z.; Potukuchi, Praveen K.; Thomas, Fridtjof; Rhee, Connie M.; Streja, Elani; Yamagata, Kunihiro; Kalantar-Zadeh, Kamyar; Kövesdy, Csaba P.

doi:10.1159/000484356

Cited by 15 publications

(10 citation statements)

References 43 publications

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“…It has been reported that the variability of hemoglobin [29], serum calcium and phosphorus [30], as well as variability of serum potassium levels [9] are closely associated with clinical outcomes. However, few studies have investigated Mg variability in MHD patients.…”

Section: Discussionmentioning

confidence: 99%

Baseline Serum Magnesium Level and Its Variability in Maintenance Hemodialysis Patients: Associations with Mortality

Cai

Luo

et al. 2019

Kidney Blood Press Res

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Background/Aims: The study aimed at investigating the impact of serum magnesium (Mg) baseline level and its variability on mortality in maintenance hemodialysis (MHD) patients. Methods: Eligible patients receiving regular MHD at Ningbo No. 2 Hospital between January 2009 and August 2016 were enrolled and follow-ups were conducted afterwards until death or transplantation. General information, laboratory results, and outcomes of subjects were collected. The relationship between baseline serum Mg level, its coefficient of variation (CV), and all-cause mortality and cardiovascular disease mortality were assessed, respectively. Subjects were divided into groups in 2 manners: by serum Mg level (lower Mg group: serum Mg <1.00 mmol/L, higher Mg group: serum Mg ≥1.00 mmol/L) and by serum Mg CV (high variation group: CV ≥0.149 mmol/L, middle variation group: 0.114 mmol/L ≤ CV < 0.149 mmol/L, and low variation group: CV <0.114 mmol/L). Results: 169 MHD patients were recruited in the study, with mean serum Mg 1.00 ± 0.18 mmol/L, average age 60.20 ± 15.64 years, and median dialysis duration 37.00 (18.30, 77.97) months. During the follow-up, 69 (40.83%) patients died, 24 (34.78%) of which died due to cardiovascular disease. Comparing the two groups, patients in the lower Mg group had a higher all-cause mortality (50.00 vs. 29.33%, p = 0.007). The multivariate Cox regression analysis suggested that lower Mg level was an independent factor for all-cause mortality as well as cardiovascular mortality (HR = 13.268, 95% CI 6.234–28.237, p < 0.001; HR = 12.702, 95% CI 3.737–43.174, p < 0.001, respectively). However, there were no significant statistical differences of all-cause and cardiovascular mortality among these three groups concerning Mg variation. And in the univariate and multivariate Cox regression analysis, serum magnesium CV was not the independent factor for all-cause mortality and cardiovascular mortality. Conclusions: The lower baseline serum magnesium level was associated with all-cause and cardiovascular mortality in MHD patients. However, the variability of magnesium level was not independently associated with the risk of death and further studies need to be conducted.

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Section: Discussionmentioning

confidence: 99%

Baseline Serum Magnesium Level and Its Variability in Maintenance Hemodialysis Patients: Associations with Mortality

Cai

Luo

et al. 2019

Kidney Blood Press Res

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“…Anemia, one of the most common complications of chronic kidney disease (CKD), is one of the major etiologic factors for cardiovascular disease (CVD) risk, which is the most important cause of morbidity and mortality [1]. Positive effects of correction of anemia on cardiovascular abnormalities, especially in left ventricular hypertrophy have been shown.…”

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confidence: 99%

The relationship between hemoglobin variability and oxidative stress and inflammation in CKD

Kuş¹

2019

Ann Clin Anal Med

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Aim: Hemoglobin (Hg) variability, which is frequently seen in patients with chronic kidney disease (CKD) who undergo dialysis, has been shown to be associated with increased mortality and cardiovascular disease (CVD) , but its mechanism remains unclear. Increased oxidative stress and inflammation with uremia lead to the development of anemia. In this context, we aimed to investigate the relationship between Hb variability and oxidative stress and inflammation. Material and Method: The data of 114 patients followed by dialysis service of Gaziantep University were included in this study retrospectively. Myeloperoxidase (MPO), nitrotyrosine (NTY), total antioxidant capacity (TAC), interleukin-6 (IL-6), Hs-CRP, and plasminogen activator inhibitor-1(PAI-1) levels of the patients whom we divided into 6 groups according to their Hg variability were measured. A control group (n = 30) was also formed demographically and clinically appropriate to this group. Results: The mean MPO, NTY, IL-6, Hs-CRP, and PAI-1 levels were higher in the dialysis patients than in the control group, whereas TAC levels were lower. Prooxidant, inflammation and procoagulant activity levels were lower in the Group 6 (Hg>12) and the Group 3 (stable, Hg=11-12 gr/dl) but higher in wide Hg variable group (Group 5) and Group 1 (Hg <12 gr/dl). Discussion: Oxidative stress, inflammation, and procoagulant activity, which are associated with higher CVD and mortality were found to be high in wide Hg variable and anemic groups in patients who underwent dialysis. The present study has a valuable finding in terms of elucidating the possible mechanism of increased mortality in patients with wide variable Hg course.

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“…24 Furthermore, Hb variability in the pre-dialysis period might directly affect a patient's mortality even after dialysis initiation. 25 In the clinical setting, renal anemia progresses according to the progression of CKD stage and frequently improves after HD initiation through the removal of uremic toxins, adequate management of body-fluid status, and ESA administration. In this study, the first measurement of cerebral rSO 2 in patients at the HD initiation phase was performed in the presence of severe anemia.…”

Section: Discussionmentioning

confidence: 99%

Cerebral oxygenation improvement is associated with hemoglobin increase after hemodialysis initiation

Ookawara

Ueda

et al. 2020

Int J Artif Organs

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Introduction: Near-infrared spectroscopy has been used to measure the regional oxygen saturation (rSO2) of the brain, and decreases in cerebral rSO2 have been reported to lead to cognitive impairment in patients undergoing hemodialysis. However, reports about the association between changes in cerebral oxygenation and clinical parameters at hemodialysis initiation, including hemoglobin level, are lacking. Methods: This study included 33 patients at the hemodialysis initiation phase. Cerebral rSO2 was monitored using an INVOS 5100C. Included patients were assessed twice (at hemodialysis initiation and 42.7 ± 20.8 days after the first measurement), and changes in cerebral rSO2 were compared with changes in clinical parameters. Results: Cerebral rSO2 at the second measurement significantly increased compared with that at hemodialysis initiation (57.2 ± 6.8% vs 54.4 ± 8.8%, p < 0.05). Changes in cerebral rSO2 represented a significant correlation with changes in hemoglobin level, pulse rate, and serum albumin level. Multivariate linear regression analysis was performed using significant factors in simple linear regression analysis. Changes in hemoglobin (standardized coefficient: 0.37) and serum albumin (standardized coefficient: 0.45) levels were identified as independent factors influencing the changes in cerebral rSO2. Conclusion: Cerebral rSO2 was low in the presence of low hemoglobin levels at hemodialysis initiation and improved in response to hemoglobin increase in addition to changes in serum albumin levels. Attention should be paid to changes in hemoglobin levels even at hemodialysis initiation to prevent the deterioration of cerebral oxygenation, and this might contribute to the maintenance of cognitive function in patients undergoing hemodialysis.

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Pre-End-Stage Renal Disease Hemoglobin Variability Predicts Post-End-Stage Renal Disease Mortality in Patients Transitioning to Dialysis

Cited by 15 publications

References 43 publications

Baseline Serum Magnesium Level and Its Variability in Maintenance Hemodialysis Patients: Associations with Mortality

Baseline Serum Magnesium Level and Its Variability in Maintenance Hemodialysis Patients: Associations with Mortality

The relationship between hemoglobin variability and oxidative stress and inflammation in CKD

Cerebral oxygenation improvement is associated with hemoglobin increase after hemodialysis initiation

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