Prevalence, clinical characteristics, and predictors of peripheral arterial disease in hemodialysis patients: a cross-sectional study.

BACKGROUND: Peripheral arterial disease (PAD) is common in patients with end-stage renal disease on hemodialysis, but is frequently underdiagnosed. The risk factors for PAD are well known within the general population, but they differ somewhat in hemodialysis patients. This study aimed to determine the prevalence of PAD and its risk factors in patients on hemodialysis. METHODS: This cross-sectional study included 156 hemodialysis patients. Comorbidities and laboratory parameters were analyzed. Following clinical examinations, the ankle-brachial index was measured in all patients. PAD was diagnosed based on the clinical findings, ankle-brachial index < 0.9, and PAD symptoms. RESULTS: PAD was present in 55 of 156 (35.3%; 95% CI, 27.7-42.8%) patients. The patients with PAD were significantly older (67 ± 10 years vs. 62 ± 11 years, p = 0.014), more likely to have diabetes mellitus (p = 0.022), and anemia (p = 0.042), and had significantly lower serum albumin (p = 0.005), total cholesterol (p = 0.024), and iron (p = 0.004) levels, higher glucose (p = 0.002) and C-reactive protein (p < 0.001) levels, and lower dialysis adequacies (p = 0.040) than the patients without PAD. Multivariate analysis showed higher C-reactive protein level (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.00-1.06; p = 0.030), vascular access by Hickman catheter (OR, 4.66; 95% CI, 1.03-21.0; p = 0.045), and symptoms of PAD (OR, 5.20; 95% CI, 2.60-10.4; p < 0.001) as independent factors associated with PAD in hemodialysis patients. CONCLUSION: The prevalence of PAD was high among patients with end-stage renal disease on hemodialysis. Symptoms of PAD, higher C-reactive protein levels, and Hickman vascular access were independent predictors of PAD in patients on hemodialysis.

PARAMETERS OF HEMODIALYSIS ADEQUACY AND PATIENTS' SURVIVAL DEPENDING ON TREATMENT MODALITIES.

INTRODUCTION: Retrospective studies showed that hemodiafiltration was associated with a reduced risk of mortality compared with standard hemodialysis in the patients with end-stage renal disease. Recently, a few prospective randomized clinical trials found no advantage in survival with hemodiafiltration as compared with high-flux hemodialysis and low-flux hemodialysis. The aim of this study was to compare the parameters of hemodialysis adequacy and two-year survival of patients depending on the modality of hemodialysis. MATERIAL AND METHODS: A total of 159 hemodialysis patients were divided into 3 groups according to the type of hemodialysis treatment: group A - low-flux hemodialysis, group B - high-flux hemodialysis, and group C - hemodiafiltration. All patients had the same duration of hemodialysis sessions. The analysis included average one-year biochemical parameters, and two-year survival of patients. RESULTS: The patients on hemodiafiltration were significantly younger, they had longer dialysis vintage and higher index of dialysis adequancy as compared with the patients on low-flux hemodialysis and high-flux hemodialysis, but without a difference between the two latter groups. Compared to the patients on low-flux hemodialysis, the patients on hemodiafiltration and high-flux hemodialysis had significantly higher hemoglobin value with less frequent erythropoietin stimulating agent use. According to Kaplan-Meier survival analysis, the patients on hemodiafiltration and high-flux hemodialysis had significantly better two-year survival than the patients on low-flux hemodialysis. Cox proportional hazards model confirmed that high-flux hemodialysis caused a significantly lower relative risk of mortality (56% reduction) compared to low-flux hemodialysis (hazard ratio 0.44; P=0.026), and hemodiafiltration caused a 58% reduction in the relative risk of mortality compared to low-flux dialysis (hazard ratio 0.42; P=0.105), but without a statistical significance. CONCLUSION: This study has demonstrated two-year survival benefit with high-flux hemodialysis and hemodiafiltration compared with low-flux hemodialysis. There was no difference in survival between high-flux hemodialysis and hemodiafiltration groups.

Influence of hemodialysis duration per week on parameters of dialysis adequacy and cardiovascular morbidity.

INTRODUCTION: The optimal length of dialysis is still under debate and current regimen of 12 hours a week is medically acceptable. The aim of this observational study was to confirm the relationship between different length of dialysis per week and the parameters of dialysis adequacy and cardiovascular morbidity. MATERIAL AND METHODS: The study included 206 patients (128 man and 78 females) who were on maintenance hemodialysis for more than 6 months. They were classified into three groups according to the length of dialysis per week: group I (12 hours), group II (15 hours) and group III (≥17.5 hours). RESULTS: Index of dyalysis adequacy values did not differ among the groups (group I, II, III = 1.32 vs. 1.51 vs. 1.42; p>0.05); however, the patients from group III had the best bicarbonate level (group I, II and III = 22.7; 21.4; 17.6 mmol/L; p<0.001). In comparison with group I (12 hours), longer dialysis duration was associated with significantly higher hemoglobin values (12.2 vs. 11.4 vs. 10.5 g/dL), less frequent use of erythropoietin stimulating agents (26.9% vs. 65% vs. 86.3%), lower stimulating agents weekly dose (median in group I, II, III = 2000 vs. 5000 vs. 4000 I.J.), lower stimulating agents resistance index (4.9 vs. 7.8 vs. 8.8), significantly higher level of serum albumin (42.3 vs. 40.7 vs. 38.2 g/dL), total cholesterol (5.1 vs. 4.7 vs. 4.5 mmol/L) and serum calcium level (2.38 vs. 2.42 vs. 2.28 mmol/L), less frequent use of phosphate binders (53.8% vs. 85% vs. 84.4%) and calcitriol (19.2% vs. 65% vs. 50.6%) and lower intact parathyroid hormone level (336 vs. 363 vs. 446 pg/ml). In addition, longer dialysis duration was associated with lower cardiovascular morbidity score (0.52 vs. 1.05 vs. 1.26). CONCLUSION: Duration of dialysis per week above the current standard positively correlates with parameters of hemodialysis adequacy.