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Background/Aims@#Maintaining vascular access (VA) is very important in the management of hemodialysis (HD) patients. Therefore, the identification of risk factors for decreased vascular access flow has clinical relevance. The aim of the present study was to investigate the impact of serum phosphorus (P) on autologous arteriovenous fistula flow in HD patients. @*Methods@#Sixty-two maintenance HD patients who visited the dialysis unit of CHA Bundang Medical Center between November 2016 and December 2017 were included in the study. Serum P levels were obtained every month, and time-averaged serum P was calculated. All patients had left arm arteriovenous fistulas (AVF; side-to-side anastomosis). AVF flow was assessed by Transonic HD 03. Decreased AVF flow was defined as < 600 mL/min. @*Results@#Decreased AVF flow was observed in 14 of 62 patients. In univariate analysis and multivariable analysis, higher serum P had a significant independent association with decreased AVF flow. Advanced age, reduced ejection fraction, low blood flow rate in dialysis, and higher serum calcium were not associated with AVF flow. @*Conclusions@#The present study demonstrated that higher serum P was an independent risk factor for decreased autologous AVF flow in maintenance HD patients. Serial monitoring of serum P may be helpful in stratifying patients by risk of AVF dysfunction, and proper management of serum P levels may be helpful in maintaining flow through autologous AVFs.
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Atypical hemolytic uremic syndrome (aHUS) is a rare syndrome characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute renal injury, which results from uncontrolled complement activation. Delayed diagnosis and treatment of aHUS may result in end-stage renal disease (ESRD) and an associated dependence on dialysis. In extreme cases, it may cause death due to multi-organ failure. Eculizumab, a humanized monoclonal antibody against C5, inhibits the formation of the terminal membrane attack complex and is used to treat aHUS. Here, we report a 46-year-old male patient who suffered from aHUS relapse, despite prior treatment with repeated plasma exchange and hemodialysis. Eculizumab therapy improved his hematologic findings without use of hemodialysis.
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The original article contained an error in Figure 1.
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The original article contained an error in Figure 1.
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BACKGROUND/AIMS: Assessment of fluid status in hemodialysis patents is very important. Overhydration in hemodialysis is associated with generalized edema, cardiovascular complications, and hypertension. The aim of this study was to determine the factors correlated with mortality of hemodialysis patients, assessing body muscle mass and fluid status using bioelectrical impedance analysis (BIA). METHODS: This study enrolled 93 patients who underwent hemodialysis between January 2010 and May 2015 at CHA Bundang Medical Center. Medical records of enrollees up to June 2017 were reviewed retrospectively. These included laboratory results (serum albumin, C-reactive protein [CRP], lipid profile, etc.) and BIA data (extracellular water, intracellular water, total body water, soft lean mass, fat free mass, skeletal muscle mass, etc.). RESULTS: Eleven of 93 patients had expired by May 2017. Among the surviving subjects, mean age was younger, CRP levels were lower, albumin levels were higher, and extracellular water/total body water (ECW/TBW) ratios were lower than in the expired patient group. Kaplan-Meier survival analysis revealed that overhydration (ECW/TBW > 0.4) was associated with higher mortality. CONCLUSIONS: In hemodialysis patients, overhydration is an important factor in mortality, and BIA could be a reliable modality in its assessment. We suggest that, for hemodialysis patients, overhydration is more of a risk factor for mortality than is muscle wasting.
Subject(s)
Humans , Body Water , C-Reactive Protein , Edema , Electric Impedance , Hypertension , Medical Records , Mortality , Muscle, Skeletal , Renal Dialysis , Retrospective Studies , Risk Factors , WaterABSTRACT
BACKGROUND: We investigated the effect of vitamin D deficiency on cardiovascular risk profiles in an Asian population with chronic kidney disease (CKD). METHODS: A total of 210 participants (62 non-dialysis CKD patients and 148 hemodialysis [HD] patients) were enrolled between December 2009 and February 2010. Vitamin D deficiency was determined using the serum 25-hydroxyvitamin D [25(OH)D] concentration. Blood pressure and arterial stiffness were measured. Subjects were divided into groups according to 25(OH)D concentration based on a cut-off of 13.5 ng/mL in non-dialysis CKD patients and 11.3 ng/mL in HD patients. RESULTS: The mean age was 61.7±12.3 years in non-dialysis CKD patients and 57.0±12.7 years in HD patients. In the non-dialysis CKD group, mean estimated glomerular filtration rate (eGFR) was 29.7±15.4 mL/min/1.73 m2. Mean 25(OH)D concentration was 13.6±7.8 ng/mL in non-dialysis CKD patients and 11.3±6.7 ng/mL in HD patients. More than half of the subjects had vitamin D deficiency (67.6% in non-dialysis CKD patients and 80.4% in HD patients). There were no significant differences in systolic blood pressure, pulse pressure, and arterial stiffness between higher and lower 25(OH)D groups among non-dialysis CKD and HD patients. Multivariate analysis revealed that female sex (odds ratio [OR]: 5.890; 95% confidence interval [CI]: 2.597–13.387; p<0.001) and presence of diabetes (OR: 2.434; 95% CI: 1.103–5.370; p=0.028) were significantly associated with lower serum 25(OH)D levels in HD patients. CONCLUSION: The prevalence of vitamin D deficiency was high in both nondialysis CKD patients and HD patients. Serum 25(OH)D concentration was not a significant factor associated with blood pressure and arterial stiffness among non-dialysis CKD and HD patients.