Risk Factors for Mortality in Hemodialysis Patients: Two-Year Follow-Up Study

Abstract

Background. End-stage renal disease (ESRD) patients under hemodialysis (HD) have high mortality rate. Inflammation, dyslipidemia, disturbances in erythropoiesis, iron metabolism, endothelial function, and nutritional status have been reported in these patients. Our aim was to identify any significant association of death with these disturbances, by performing a two-year follow-up study. Methods and Results. A large set of data was obtained from 189 HD patients (55.0% male; 66.4 ± 13.9 years old), including hematological data, lipid profile, iron metabolism, nutritional, inflammatory, and endothelial (dys)function markers, and dialysis adequacy. Results. 35 patients (18.5%) died along the follow-up period. Our data showed that the type of vascular access, C-reactive protein (CRP), and triglycerides (TG) are significant predictors of death. The risk of death was higher in patients using central venous catheter (CVC) (Hazard ratio [HR] =3.03, 95% CI = 1.49–6.13), with higher CRP levels (fourth quartile), compared with those with lower levels (first quartile) (HR = 17.3, 95% CI = 2.40–124.9). Patients with higher TG levels (fourth quartile) presented a lower risk of death, compared with those with the lower TG levels (first quartile) (HR = 0.18, 95% CI = 0.05–0.58). Conclusions. The use of CVC, high CRP, and low TG values seem to be independent risk factors for mortality in HD patients.

The HIF System Response to ESA Therapy in CKD‐Anemia

“…The best predictors for ESA response appear to be IL-6 and CRP [88,89]. Studies conducted by our group showed that HD patients with poorer response to ESA present higher levels of pro-inflammatory cytokines [90,91]; moreover, in studies using a rat model of chronic renal failure, we found that the severity of the inflammatory state was related to the reduction in the rHuEPO response [92].…”

Cardiovascular risk in patients undergoing maintenance hemodialysis with Helixone® membrane: a multicenter randomized study

“…It may have several potential causes including bacterial contamination of the dialyzer, dialyzing membrane incompatibility, and vascular access. 26,27 Our results suggest that a long-term use of Helixone® membranes is associated with a decrease in CRP levels. However, the effect of other factors such as the time on maintenance dialysis or simultaneous pharmacological treatment cannot be excluded.…”

Renal risk‐benefit determinants of recombinant human erythropoietin therapy in the remnant kidney rat model – hypertension, anaemia, inflammation and drug dose

“…Inflammation, another common feature of CKD patients can induce functional iron deficiency due to its stimulatory effect on hepcidin synthesis, which is the major regulator of iron homeostasis. In the current study, no alterations, eventually evoked by inflammation, were observed in iron metabolism that could influence erythropoiesis (data not shown).…”