UK Renal Registry 19th Annual Report: Chapter 5 Survival and Causes of Death in UK Adult Patients on Renal Replacement Therapy in 2015: National and Centre-specific Analyses

Methven, Shona; Steenkamp, Retha; Fraser, Simon

doi:10.1159/000481367

Cited by 53 publications

(39 citation statements)

References 8 publications

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“…That is, CKD or an associated co-morbidity causes both reduced LDLcholesterol levels and an increased risk of death, thus creating a potentially deceptive association between low LDL-cholesterol levels and mortality 107,108 Another possible or complimentary explanation [Au: "for the inverse relationship between LDL-cholesterol levels and all-cause mortality in patients with ESRD"?] is that CKD results in a unique cardiovascular phenotype with fewer deaths due to atherosclerotic processes but more deaths owing to heart failure and sudden cardiac death [110][111][112] . The pathophysiology of these conditions seems to be associated with disturbances of calcium and phosphate metabolism, hypertension, arrhythmogenic electrolyte disorders, hypervolaemia, uraemic toxins and anaemia [113][114][115] .…”

Section: [H1] Lipids and Cardiovascular Diseasementioning

confidence: 99%

Lipid management in patients with chronic kidney disease

Ferro¹,

Mark²,

Kanbay³

et al. 2018

Nat Rev Nephrol

171

142

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Glomerular filtration rate is inversely associated with cardiovascular disease independent of conventional risk factors. An increased risk of cardiovascular disease is present even at minor levels of renal impairment and the risk is highest in patients with endstage renal disease (ESRD) requiring dialysis. Renal dysfunction changes the level, composition, and quality of blood lipids in favour of a more atherogenic profile. Patients with advanced chronic kidney disease or ESRD have a characteristic lipid pattern of hypertriglyceridemia and low HDL-cholesterol levels but normal LDL-cholesterol levels. In the general population, a clear relationship exists between LDL-cholesterol, coronary heart disease and ischaemic stroke. However, in patients with ESRD, LDL-cholesterol seems to show a negative association [Au: with these outcomes?] at below average LDL-cholesterol levels and a flat or weakly positive association with mortality at higher LDL-cholesterol levels. Overall, the available data suggest that lowering of LDL-cholesterol is beneficial for prevention of major atherosclerotic events in patients with chronic kidney disease and in kidney transplant recipient but is not beneficial in patients requiring dialysis. [Au: I've moved the description of the content of your Review to the end of the introduction as per our journal style. To fully reflect the content of your article, please finish off the abstrace with a couple of sentences relating to novel lipid-lowering therapies and the need for reconsideration of the KDIGO guidelines in the light of new data. We have a limit of 200 words for this section.] [Au: I have highlighted suggestions for glossary terms throughout your manuscript with a [G]. Please provide succinct, one-sentence definitions for these specialist terms.] [H1] Introduction Guidelines regarding the management of lipids in patients with chronic kidney disease (CKD) and especially in those with end-stage renal disease (ESRD) are inconsistent in part owing to important deficiencies in the available data. [Au: Edit OK?] In 2013 KDIGO produced a comprehensive clinical practice guideline for lipid management in CKD 1. [Au: I suggest that we cite your original Table 1 (now Table 3) in the discussion of KDIGO recommendations at the end of the review so that the table is included next to this discussion in the final layout rather than in the introduction to the Review.

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Section: [H1] Lipids and Cardiovascular Diseasementioning

confidence: 99%

Lipid management in patients with chronic kidney disease

Ferro¹,

Mark²,

Kanbay³

et al. 2018

Nat Rev Nephrol

171

142

View full text Add to dashboard Cite

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“…In AURORA, the 1-year mortality rate was approximately 14%, and the annual rates of nonfatal MI and stroke were approximately 2 and 1% respectively [24]. Similarly, the UK Renal Registry reported an 11.6% unadjusted 1-year mortality rate among incident HD patients (after 90 days) [25]. Therefore, initial sample size calculations assumed a 3-year primary event rate of 50% (the expected average follow-up in the present trial) in the control group.…”

Section: Powering and Sample Sizementioning

confidence: 96%

“…Based on previous trials and registries (e.g., the AURORA trial [24] and the UK Renal Registry [25]), we expected the main component of the primary outcome would be death. In AURORA, the 1-year mortality rate was approximately 14%, and the annual rates of nonfatal MI and stroke were approximately 2 and 1% respectively [24].…”

Section: Powering and Sample Sizementioning

confidence: 99%

Randomized Trial Comparing Proactive, High-Dose versus Reactive, Low-Dose Intravenous Iron Supplementation in Hemodialysis (PIVOTAL): Study Design and Baseline Data

et al. 2018

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Background: Intravenous (IV) iron supplementation is a standard maintenance treatment for hemodialysis (HD) patients, but the optimum dosing regimen is unknown. Methods: PIVOTAL (Proactive IV irOn Therapy in hemodiALysis patients) is a multicenter, open-label, blinded endpoint, randomized controlled (PROBE) trial. Incident HD adults with a serum ferritin < 400 µg/L and transferrin saturation (TSAT) levels < 30% receiving erythropoiesis-stimulating agents (ESA) were eligible. Enrolled patients were randomized to a proactive, high-dose IV iron arm (iron sucrose 400 mg/month unless ferritin > 700 µg/L and/or TSAT ≥40%) or a reactive, low-dose IV iron arm (iron sucrose administered if ferritin <200 µg/L or TSAT < 20%). We hypothesized that proactive, high-dose IV iron would be noninferior to reactive, low-dose IV iron for the primary outcome of first occurrence of nonfatal myocardial infarction (MI), nonfatal stroke, hospitalization for heart failure or death from any cause. If noninferiority is confirmed with a noninferiority limit of 1.25 for the hazard ratio of the proactive strategy relative to the reactive strategy, a test for superiority will be carried out. Secondary outcomes include infection-related endpoints, ESA dose requirements, and quality-of-life measures. As an event-driven trial, the study will continue until at least 631 primary outcome events have accrued, but the expected duration of follow-up is 2–4 years. Results: Of the 2,589 patients screened across 50 UK sites, 2,141 (83%) were randomized. At baseline, 65.3% were male, the median age was 65 years, and 79% were white. According to eligibility criteria, all patients were on ESA at screening. Prior stroke and MI were present in 8 and 9% of the cohort, respectively, and 44% of patients had diabetes at baseline. Baseline data for the randomized cohort were generally concordant with recent data from the UK Renal Registry. Conclusions: PIVOTAL will provide important information about the optimum dosing of IV iron in HD patients representative of usual clinical practice. Trial Registration: EudraCT number: 2013-002267-25.

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“…Data from the United Kingdom indicate that infection was the cause of 21% of deaths in patients on dialysis in 2017. 47 In the United States, 17.7% of all hospitalizations in patients on hemodialysis in 2013 to 2015 were due to infectious diseases. 48 The physical insult of repeated breaches of the skin's barrier undoubtedly contributes to the high risk of infection in these patients, but disturbances in innate and acquired immunity are also involved, 49 including abnormalities in both B-cell-and T-cell-mediated adaptive immunity.…”

Section: Immune Defects In Patients On Hemodialysismentioning

confidence: 99%