Selective Review of Key Perioperative Renal-Electrolyte Disturbances in Chronic Renal Failure Patients

Yee, Jerry; Parasuraman, Raviprasenna; Narins, Robert G.

doi:10.1378/chest.115.suppl_2.149s

Cited by 40 publications

(27 citation statements)

References 37 publications

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“…Banked serum was obtained from the parent study and assayed for sodium, glucose, and creatinine concentration, among other analytes. Subjects with glucose Ն150 mg/dl were excluded, as were subjects with estimated glomerular filtration rate Ͼ2 SD below the population mean; both conditions are associated with reduced serum sodium concentration and/or aberrant water balance independent of central osmoregulation (20,35). Banked genomic DNA was requested from the parent study for three subgroups of subjects: 1) Low sodium-subjects with serum sodium concentration in the lowest decile (i.e., hyponatremic); 2) High sodium-subjects with serum sodium concentration in the highest decile (i.e., hypernatremic); and 3) Mean sodiumsubjects with serum sodium concentration approximating the population mean (i.e., 141 or 142 meq/l).…”

Section: Resultsmentioning

confidence: 99%

“…The MrOS population mean for sodium concentration was 141.4 meq/l; for the Mean sodium group, we selected every third subject when subjects with serum sodium concentration of 141 and 142 meq/l were ordered by serum sodium concentration and then by coded alphanumeric identifier (sodium concentrations were "binned" as integers at the time of reporting by the clinical laboratory). Subjects with glucose Ն150 mg/dl were excluded, as were subjects with estimated glomerular filtration rate Ͼ2 SD below the population mean; both conditions are associated with reduced serum sodium concentration and/or aberrant water balance independent of central osmoregulation (20,35). Genomic DNA from the first 524 MrOS subjects, when ordered by coded subject identifier, was genotyped for AVPR2 copy number.…”

Section: Genotyping-offspring Cohort Of Framingham Heartmentioning

confidence: 99%

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Absence ofAVPR2copy number variation in eunatremic and dysnatremic subjects in non-Hispanic Caucasian populations

Chen

Blakemore

et al. 2010

Physiological Genomics

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Absence of AVPR2 copy number variation in eunatremic and dysnatremic subjects in non-Hispanic Caucasian populations. Physiol Genomics 40: 121-127, 2010. First published December 8, 2009 doi:10.1152/physiolgenomics.00157.2009.-Copy number variation (CNV) is increasingly recognized as a source of phenotypic variation among humans. We hypothesized that a CNV in the human arginine vasopressin receptor-2 gene (AVPR2) would be associated with serum sodium concentration based on the following lines of evidence: 1) the protein product of the AVPR2 gene is essential for renal water conservation; 2) mutations in the AVPR2 gene are associated with aberrant water balance in humans; 3) heritability of serum sodium concentration may be greater in females than in males; 4) the AVPR2 gene is X-linked; and 5) a common CNV spanning the AVPR2 gene was recently described in a non-Hispanic Caucasian population. We developed a highly reproducible assay for AVPR2 CNV. Among 279 subjects with measured serum sodium concentration in the Offspring Cohort of the Framingham Heart Study, no subjects exhibited CNV at the AVPR2 locus. Among 517 subjects in the Osteoporotic Fractures in Men Study (MrOS)-including 152 with hyponatremia and 183 with hypernatremia-no subjects with CNV at the AVPR2 locus were identified. CNV at the AVPR2 locus could not be independently confirmed, and CNV at the AVPR2 gene is unlikely to influence systemic water balance on a population-wide basis in non-Hispanic Caucasian subjects. A novel AVPR2 single nucleotide polymorphism affecting the reporter hybridization site gave rise to an artifactually low copy number signal (i.e., less than unity) in one male African American subject. Reanalysis of the original comparative genomic hybridization data revealed bona fide CNVs flanking-but not incorporating-the AVPR2 gene, consistent with our new genotyping data. osmoregulation; arginine vasopressin; hyponatremia; hypernatremia SYSTEMIC TONICITY IS AMONG the most tightly regulated of physiological parameters. In humans, dysregulated water balance results in neurological dysfunction and death. Even relatively subtle changes in systemic tonicity cause reversible defects in coordination and cognition (26,27). Clinically, water balance is reflected in the serum (or plasma) sodium concentration. Water excess relative to total body sodium content gives rise to hyponatremia, the most prevalent of the electrolyte abnormalities. Hyponatremia complicates a wide range of common medical conditions including congestive heart failure and liver failure and occurs in an unpredictable fashion in response to a number of frequently prescribed medications (reviewed in Refs. 13, 32).In mammals, systemic water balance is regulated via the renal water-conserving role of the hormone arginine vasopressin (AVP). Release of AVP from the posterior pituitary into the circulation is governed by the hypothalamic sensor(s) of systemic osmolality. On reaching the kidney, AVP interacts with arginine vasopressin receptor-2 (the product of the AVPR2 gene) on...

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Section: Resultsmentioning

confidence: 99%

Section: Genotyping-offspring Cohort Of Framingham Heartmentioning

confidence: 99%

Absence ofAVPR2copy number variation in eunatremic and dysnatremic subjects in non-Hispanic Caucasian populations

Chen

Blakemore

et al. 2010

Physiological Genomics

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“…They also suggest that the MAP should be higher than 95 mmHg and CVP above 10 mmHg [10][11][12][13][14][15][16] . These values are favorable to ensure maximal filling pressure of the graft and its fast recovery.…”

Section: Discussionmentioning

confidence: 99%

“…Early graft malfunction has been associated with decreased graft survival and increased recipient complication [1][2][3][4][5] . A lot of studies have examined specific value of the perioperative central venous pressure (CVP) that may reduce the risk of postoperative graft failure ed with increased graft survival and lower patient mortality [13][14][15][16] . It is well known that the most important measure to improve immediate graft function is to maintain an adequate intravascular volume.…”

Section: Introductionmentioning

confidence: 99%

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The Influence of Targeting Central Venous Pressure (CVP) on Early Graft Function after Living Donor Kidney Transplantation

Mijovska¹,

Gavrilovska²,

Srceva-Jovanovski³

et al. 2017

JAS

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Association Between Preoperative Hemodialysis Timing and Postoperative Mortality in Patients With End-stage Kidney Disease

Fielding‐Singh

Vanneman

Grogan

et al. 2022

JAMA

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ImportanceFor patients with end-stage kidney disease treated with hemodialysis, the optimal timing of hemodialysis prior to elective surgical procedures is unknown.ObjectiveTo assess whether a longer interval between hemodialysis and subsequent surgery is associated with higher postoperative mortality in patients with end-stage kidney disease treated with hemodialysis.Design, Setting, and ParticipantsRetrospective cohort study of 1 147 846 procedures among 346 828 Medicare beneficiaries with end-stage kidney disease treated with hemodialysis who underwent surgical procedures between January 1, 2011, and September 30, 2018. Follow-up ended on December 31, 2018.ExposuresOne-, two-, or three-day intervals between the most recent hemodialysis treatment and the surgical procedure. Hemodialysis on the day of the surgical procedure vs no hemodialysis on the day of the surgical procedure.Main Outcomes and MeasuresThe primary outcome was 90-day postoperative mortality. The relationship between the dialysis-to-procedure interval and the primary outcome was modeled using a Cox proportional hazards model.ResultsOf the 1 147 846 surgical procedures among 346 828 patients (median age, 65 years [IQR, 56-73 years]; 495 126 procedures [43.1%] in female patients), 750 163 (65.4%) were performed when the last hemodialysis session occurred 1 day prior to surgery, 285 939 (24.9%) when the last hemodialysis session occurred 2 days prior to surgery, and 111 744 (9.7%) when the last hemodialysis session occurred 3 days prior to surgery. Hemodialysis was also performed on the day of surgery for 193 277 procedures (16.8%). Ninety-day postoperative mortality occurred after 34 944 procedures (3.0%). Longer intervals between the last hemodialysis session and surgery were significantly associated with higher risk of 90-day mortality in a dose-dependent manner (2 days vs 1 day: absolute risk, 4.7% vs 4.2%, absolute risk difference, 0.6% [95% CI, 0.4% to 0.8%], adjusted hazard ratio [HR], 1.14 [95% CI, 1.10 to 1.18]; 3 days vs 1 day: absolute risk, 5.2% vs 4.2%, absolute risk difference, 1.0% [95% CI, 0.8% to 1.2%], adjusted HR, 1.25 [95% CI, 1.19 to 1.31]; and 3 days vs 2 days: absolute risk, 5.2% vs 4.7%, absolute risk difference, 0.4% [95% CI, 0.2% to 0.6%], adjusted HR, 1.09 [95% CI, 1.04 to 1.13]). Undergoing hemodialysis on the same day as surgery was associated with a significantly lower hazard of mortality vs no same-day hemodialysis (absolute risk, 4.0% for same-day hemodialysis vs 4.5% for no same-day hemodialysis; absolute risk difference, −0.5% [95% CI, −0.7% to −0.3%]; adjusted HR, 0.88 [95% CI, 0.84-0.91]). In the analyses that evaluated the interaction between the hemodialysis-to-procedure interval and same-day hemodialysis, undergoing hemodialysis on the day of the procedure significantly attenuated the risk associated with a longer hemodialysis-to-procedure interval (P&lt;.001 for interaction).Conclusions and RelevanceAmong Medicare beneficiaries with end-stage kidney disease, longer intervals between hemodialysis and surgery were significantly associated with higher risk of postoperative mortality, mainly among those who did not receive hemodialysis on the day of surgery. However, the magnitude of the absolute risk differences was small, and the findings are susceptible to residual confounding.

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Selective Review of Key Perioperative Renal-Electrolyte Disturbances in Chronic Renal Failure Patients

Cited by 40 publications

References 37 publications

Absence ofAVPR2copy number variation in eunatremic and dysnatremic subjects in non-Hispanic Caucasian populations

Absence ofAVPR2copy number variation in eunatremic and dysnatremic subjects in non-Hispanic Caucasian populations

The Influence of Targeting Central Venous Pressure (CVP) on Early Graft Function after Living Donor Kidney Transplantation

Association Between Preoperative Hemodialysis Timing and Postoperative Mortality in Patients With End-stage Kidney Disease

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