Variability of laboratory parameters is associated with frailty markers and predicts non-cardiac mortality in hemodialysis patients

Nakazato, Yuichi; Kurane, R; Hirose, Satoru; Watanabe, Akira; Shimoyama, Hiromi

doi:10.1007/s10157-015-1108-0

Cited by 24 publications

(34 citation statements)

References 18 publications

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“…This agrees with previous studies on the value of SNa and its changes as a predictor of outcome by Nakazato et al [8] and is also in line with previous published literature that showed variability of SNa to reflect impaired mobility, and associate with older age, anemia, hypoalbuminemia and hyponatremia per se [1,7,8,10].…”

Section: Discussionsupporting

confidence: 82%

“…The prognostic value of variability of clinical and laboratory markers such as blood pressure and hemoglobin has been investigated and established in the dialysis population [8,[14][15][16][23][24][25][26]. However, to the best of our knowledge the variability of SNa and its relationship to outcomes including the comparison of various metrics of variability is novel.…”

Section: Discussionmentioning

confidence: 99%

“…It was also shown that an instability of SNa for dialysis patients associated with lower survival even in the absence of hyponatremia [8]. Despite the pivotal physiological role of hyponatremia, the relationship between SNa variability and adverse outcomes such as mortality has not been assessed in sufficient details in the dialysis population.…”

Section: Introductionmentioning

confidence: 99%

“…Despite the pivotal physiological role of hyponatremia, the relationship between SNa variability and adverse outcomes such as mortality has not been assessed in sufficient details in the dialysis population. It had been claimed that longitudinal assessments of SNa, focusing on its variability, may add additional diagnostic information beyond cross-sectional assessments in the dialysis population [8].…”

Section: Introductionmentioning

confidence: 99%

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Increased Mortality Associated with Higher Pre-Dialysis Serum Sodium Variability: Results of the International MONitoring Dialysis Outcome Initiative

Kooman

Sande

et al. 2018

Am J Nephrol

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Background: Low serum sodium (SNa) is associated with an increased mortality in chronic hemodialysis (HD) patients. Dialysis patients are thought to have an individual pre-dialysis SNa set-point, yet there is evidence for variability of pre-dialysis SNa in individual patient. In this study, we explored the association of several SNa variability metrics with all-cause mortality in a large patient population from the international MONitoring Dialysis Outcomes (MONDO) Initiative. Methods: All adult incident patients from the MONDO database with more than 5 SNa measurements during the first year on HD were included. All patients were required to survive the first year on HD (defined as the baseline). During the subsequent 2 years of follow-up, all-cause mortality was recorded. The following variability indicators were calculated during baseline: mean SNa and its SD; average real variability (ARV, average the absolute distance of the 2 consecutive SNa measurements), and average directional range (DR, the difference between minimum and maximum values). We used Cox Proportional hazard model with bivariate spline terms to analyze the joint association of SNa and SD, ARV and DR, respectively, with all-cause mortality. While conducting the multivariate Cox regression analyses, patients were stratified into 3 groups of DR (Negative DR: –20≤ DR ≤ –6, Null DR: –6< DR < 6 and Positive DR: 6≤ DR ≤20) with the Null DR as the reference group. Results: We included 20,216 patients in the study. A SNa ≤135 mEq/L was observed to be the strongest predictor of evaluated mortality risk. Higher SNa variability (quantified as SD, ARV, and DR) was also associated with an increased mortality irrespective of SNa levels. When compared with higher SD or ARV, greater DR showed a stronger association with an elevated risk of death. Controlling the Cox Proportional hazard models for additional parameters showed consistent results. Conclusion: Higher SNa variability associated with increased all-cause mortality at all levels of SNa. DR of SNa showed the strongest association with mortality and may constitute a Simple and novel prognostic indicator, easily applicable at the bedside.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Increased Mortality Associated with Higher Pre-Dialysis Serum Sodium Variability: Results of the International MONitoring Dialysis Outcome Initiative

Kooman

Sande

et al. 2018

Am J Nephrol

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“…All data are presented as the mean ± standard deviation or % ( n ) unless otherwise noted . Differences between the two groups were examined using a Student's t ‐test or χ 2 ‐test where appropriate.…”

Section: Methodsmentioning

confidence: 89%

Diabetic nephropathy is associated with frailty in patients with chronic hemodialysis

Kakio

Uchida

Takeuchi

et al. 2018

Geriatrics Gerontology Int

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Aim Since 1998, the leading cause of chronic hemodialysis in Japan has been diabetic nephropathy. Diabetes mellitus is known to be a risk factor for frailty, but it still remains unknown whether diabetic nephropathy is associated with frailty in chronic dialysis patients. The authors carried out the present study to reveal the association between frailty and diabetic nephropathy in chronic hemodialysis patients. Methods A total of 355 patients who were on hemodialysis were recruited. Participants were divided into two groups of either patients who suffered diabetic nephropathy with end‐stage renal disease (DN group, n = 150) or not (Non‐DN group, n = 205). The authors investigated the difference of the prevalence of frailty between the two groups. Furthermore, the authors examined the risk factors for frailty. Results The prevalence of frailty in the DN group was significantly higher than that in the Non‐DN group (28.0% vs 16.5%, P = 0.0161). To evaluate the association between frailty and its risk factors, we compared frail patients (n = 71) and non‐frail patients (n = 262). After adjusting their interrelationships by using multivariate logistic regression analysis, diabetic nephropathy was determined as a significant risk factor for frailty. Conclusions The authors found the close association between frailty and diabetic nephropathy in chronic hemodialysis patients. Geriatr Gerontol Int 2018; 18: 1597–1602.

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Association of Visit-to-Visit Variability in Kidney Function and Serum Electrolyte Indexes With Risk of Adverse Clinical Outcomes Among Patients With Heart Failure With Preserved Ejection Fraction

Segar

Patel

et al. 2020

JAMA Cardiol

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and abnormalities in serum electrolyte levels are associated with poor clinical outcomes in patients with heart failure with preserved ejection fraction (HFpEF), the association of visit-to-visit variability in such laboratory measures with long-term outcomes is unclear.OBJECTIVE To evaluate the associations of visit-to-visit variability in indexes of kidney function (creatinine and blood urea nitrogen [BUN] levels) and serum electrolyte (sodium, chloride, and potassium) with the risk of adverse clinical outcomes among patients with chronic, stable HFpEF. DESIGN, SETTING, AND PARTICIPANTSThis cohort analysis used data from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial. All participants with 3 or more serial laboratory measurements who were event free within the first 4 months of enrollment were included. Data were analyzed from March 1, 2019, to January 31, 2020. MAIN OUTCOMES AND MEASURESAdjusted associations between indexes of variability in serum laboratory measurements during the first 4 months of follow-up and risk of the primary composite outcome (a composite of aborted cardiac arrest, hospitalization for heart failure, or cardiovascular death) and all-cause mortality were assessed using Cox proportional hazards regression models. RESULTSOf the 3445 patients enrolled in the TOPCAT trial (mean [SD] age, 68-69 [10] years; 49.7%-51.5% female), 2479 (BUN) to 3195 (potassium) were analyzed, depending on availability of serial measurements. Participants with higher laboratory variability in kidney function parameters were older, had more comorbidities, and had more severe symptoms of HFpEF. Higher visit-to-visit variability in BUN (hazard ratio [HR] per 1-SD higher average successive variability [ASV], 1.21; 95% CI, 1.10-1.33) and creatinine (HR per 1-SD higher ASV, 1.13; 95% CI, 1.04-1.22) were independently associated with a higher risk of the primary composite outcome as well as mortality independent of other baseline confounders, changes in kidney function, changes in medication dosages, and variability in other cardiometabolic parameters (systolic blood pressure and body mass index). The higher risk associated with greater variability in kidney function was consistent across subgroups of patients stratified by the presence of chronic kidney disease (CKD) at baseline (CKD: HR per 1-SD higher ASV, 1.39; 95% CI, 1.16-1.67 and no CKD: HR per 1-SD higher ASV, 1.13; 95% CI, 1.01-1.27), among placebo and spironolactone treatment arms separately (spironolactone arm: 1.30; 95% CI, 1.03-1.65 and placebo arm: HR per 1-SD higher ASV, 1.27; 95% CI, 1.04-1.56). Among serum electrolytes, variability in sodium and potassium measures were also significantly associated with a higher risk of primary composite events (sodium: HR per 1-SD higher ASV, 1.14; 95% CI, 1.01-1.30 and potassium: HR per 1-SD higher ASV, 1.21; 95% CI, 1.02-1.44). CONCLUSIONS AND RELEVANCEIn HFpEF, visit-to-visit variability in laboratory indexes of kidney function and serum electrolytes is common ...

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Variability of laboratory parameters is associated with frailty markers and predicts non-cardiac mortality in hemodialysis patients

Abstract: The variability of several blood parameters had a significant impact on all-cause and non-cardiac mortality. The levels of the variabilities were most likely related to poor physical conditions of the patients.

Cited by 24 publications

References 18 publications

Increased Mortality Associated with Higher Pre-Dialysis Serum Sodium Variability: Results of the International MONitoring Dialysis Outcome Initiative

Increased Mortality Associated with Higher Pre-Dialysis Serum Sodium Variability: Results of the International MONitoring Dialysis Outcome Initiative

Diabetic nephropathy is associated with frailty in patients with chronic hemodialysis

Association of Visit-to-Visit Variability in Kidney Function and Serum Electrolyte Indexes With Risk of Adverse Clinical Outcomes Among Patients With Heart Failure With Preserved Ejection Fraction

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