Heart Disease is the Number One cause of death in patients with chronic kidney disease (CKD) and end stage renal disease (ESRD). CKD and ESRD are often the result of the same chronic disease states, including atherosclerosis, hypertension and diabetes.
Hemodialysis.com presents articles and research publications referable to both heart and kidney disorders.
Research Publications | Kidney Disease and Heart Disease
G.R. Shroff, S.K. Akkinac, M.D. Miedema, R. Madlon-Kay, C.A. Herzoga, B.L. Kasiske
American Journal of Nephrology Vol 35. No.2 (2012)
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Ferenc Sztanek, Ildikó Seres, Mariann Harangi, Lajos Locsey, Js Padra,György J.R. Paragh, László Asztalos, and György ParaghNephrol. Dial. Transplant. first published online January 12, 2012 doi:10.1093/ndt/gfr753
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Author Interview: Matthew Budoff, MD, FACC
Mild and moderate pre-dialysis chronic kidney disease is associated with increased coronary artery calcium
Sion K Roy, Albert Cespedes, Dong Li, Tae-Young Choi, and Matthew J Budoff
Division of Cardiology, Department of Medicine, Los Angeles Biomedical Research Center at Harbor-UCLA Medical Center, Torrance, California, USA
Vasc Health Risk Manag. 2011; 7: 719–724 doi: 10.2147/VHRM.S24536
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Author Interview: Yong Kyun Kim MD
Relationship between erythropoietin resistance index and left ventricular mass and function and cardiovascular events in patients on chronic hemodialysis
Chung, S., Song, H. C., Shin, S. J., Ihm, S.-H., Park, C. S., Kim, H.-Y., Yang, C. W., Kim, Y.-S., Choi, E. J. and Kim, Y. K.
Hemodialysis International. (2011)
doi: 10.1111/j.1542-4758.2011.00644.
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Author Interview: Dr. Antonio Santoro
Is time on cardiopulmonary bypass during cardiac surgery associated with acute kidney injury requiring dialysis?
Elena MANCINI, Fabio CARAMELLI, Marco RANUCCI, Diego SANGIORGI,
Letizia Bacchi REGGIANI, Guido FRASCAROLI, Annalisa ZUCCHELLI,
Antonio BELLASI, Antonio SANTORO
Nephrology, Dialysis and Hypertension Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy;
Cardiosurgery Intensive Care Unit, Policlinico S.Orsola-Malpighi,
Bologna, Italy; Department of Cardiothoracic-Vascular Anesthesia and Intensive Care, IRCCS Policlinico S. Donato, Milan, Italy; Institute of Cardiology, Policlinico S.Orsola-Malpighi, Bologna, Italy; Nephrology and Dialysis, Unit, Azienda Ospedaliera S. Anna,
Ospedale S. Anna, Como, Italy
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Association between cold dialysis and cardiovascular survival in hemodialysis patients
Heng-Jung Hsu, Chiung-Hui Yen, Kuang-Hung Hsu, Chin-Chan Lee, Shu-Ju Chang, I-Wen Wu,
Chiao-Yin Sun, Chia-Chi Chou, Chen-Chao Yu, Ming-Fang Hsieh, Chun-Yu Chen, Chiao-Ying Hsu, Cheng-Hao Weng, Chi-Jen Tsai, and Mai-Szu Wu
Nephrol. Dial. Transplant. (2011) first published online November 5, 2011 doi:10.1093/ndt/gfr615 |
Razavian M, Heeley EL, Perkovic V, Zoungas S, Weekes A, Patel AA, Anderson CS, Chalmers JP, Cass A.
1The George Institute for Global Health, Sydney, Australia.
Nephrol Dial Transplant. 2011 Nov 2. [Epub ahead of print]
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Rivera, R. F., Mircoli, L., Bonforte, G., Torri, V., Monteforte, M., Stella, A. and Genovesi, S.
Hemodialysis International 2011. doi: 10.1111/j.1542-4758.2011.00572.x
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Desai AS, Toto R, Jarolim P, Uno H, Eckardt K-U, Kewalramani R, Levey AS, Lewis EF, McMurray JJV, Parving H-H, Solomon SD, Pfeffer MA.
Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
Am J Kid Dis 2011
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Author Interview: Matthew Budoff, MD
Relationship of Estimated GFR and Coronary Artery Calcification in the CRIC (Chronic Renal Insufficiency Cohort) Study.
Budoff MJ, Rader DJ, Reilly MP, Mohler ER 3rd, Lash J, Yang W, Rosen L, Glenn M, Teal V, Feldman HI; CRIC Study Investigators.Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA.
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Rhonda Spencer-Hwang, DrPH, MPH
Ambient Air Pollutants and Risk of Fatal Coronary Heart Disease Among Kidney Transplant Recipients.
Spencer-Hwang R, Knutsen SF, Soret S, Ghamsary M, Beeson WL, Oda K, Shavlik D, Jaipaul N.
Am J Kidney Dis. 2011 Jul 19.
Department of Epidemiology and Biostatistics, Loma Linda University, Loma Linda, CA. |
Author Interview: Dr. John Coffey
SPECT MIBI imaging for cardiac output and index in end stage renal disease
Coffey JP, Woywodt A, Hill JC.
Department of Nuclear Medicine, Royal Preston Hospital, Fulwood, Preston, UK Department of Renal Medicine, Royal Preston Hospital, Fulwood, Preston, UK.
Hemodial Int. 2011 Jul;15(3):320-5. doi: 10.1111/j.1542-4758.2011.00565.x.
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Weiner DE, Scott TM, Giang LM, Agganis BT, Sorensen EP, Tighiouart H, Sarnak MJ.
Division of Nephrology, Tufts Medical Center, Boston, MA.
Am J Kidney Dis. 2011 Jul 19
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Author Interview: Dr. Florence Sens
Sens F, Schott-Pethelaz AM, Labeeuw M, Colin C, Villar E.
Kidney Int. 2011 Jul 20. doi: 10.1038/ki.2011.233.
1] Department of Nephrology, Hospices Civils de Lyon, Lyon-Sud University Hospital, Pierre Benite, France [2] Pole IMER des Hospices Civils de Lyon, Lyon, France.
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Author Interview: Dr. C. Barrett Bowling, MD
Bowling CB, Feller MA, Mujib M, Pawar PP, Zhang Y, Ekundayo OJ, Aban IB,
Love TE, Sanders PW, Anker SD, Fonarow GC, Ahmed A.
VA Medical Center, Birmingham, Ala., USA.
Am J Nephrol. 2011 Jul 4;34(2):135-141
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Author Interview: Dr. Florian Knoll
Coumarins and survival in incident dialysis patients.
Knoll F, Sturm G, Lamina C, Zitt E, Lins F, Freistätter O, Kronenberg F, Lhotta K, Neyer U.
1Department of Nephrology and Dialysis; Feldkirch Academic Teaching Hospital, Feldkirch, Austria.
Nephrol Dial Transplant. 2011 Jul 18.
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Author Interview: Dr. Margaret Fang
Fang MC, Go AS, Chang Y, Borowsky LH, Pomernacki NK, Udaltsova N, Singer DE.
Department of Medicine, University of California, San Francisco, San Francisco, California.
J Am Coll Cardiol. 2011 Jul 19;58(4):395-401.
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Author Interview: Dr. Daisuke Hachinohe
Management of Non-ST-Segment Elevation Acute Myocardial Infarction in Patients With Chronic Kidney Disease (from the Korea Acute Myocardial Infarction Registry).
Hachinohe D, Jeong MH, Saito S, Ahmed K, Hwang SH, Lee MG, Sim DS, Park KH, Kim JH, Hong YJ, Ahn Y, Kang JC, Kim JH, Chae SC, Kim YJ, Hur SH, Seong IW, Hong TJ, Choi D, Cho MC, Kim CJ, Seung KB, Chung WS, Jang YS, Rha SW, Bae JH, Park SJ; Other Korea Acute Myocardial Infarction Registry Investigators.
Am J Cardiol. 2011 Jul 15;108(2):206-13.
Chonnam National University Hospital, Gwangju, Republic of Korea; Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.
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Author Interview: Dr. Serkan Saygi
Ventricular arrhythmia in dialysis patients: A link with higher hemoglobin levels?
Hemodial Int. 2011 Apr;15(2):250-5. doi: 10.1111/j.1542-4758.2011.00532.x.
Saygi S, Asci G, Dheir H, Duman S, Kayikcioglu M, Yilmaz M, Ozkahya M, Ok E.
Central Hospital, Department of Cardiology, Izmir, Turkey Department of Nephrology, Ege University School of Medicine, Izmir, Turkey Department of Cardiology, Ege University School of Medicine, Izmir, Turkey. |
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Masuda T, Murata M, Honma S, Iwazu Y, Sasaki N, Ogura M, Onishi A, Ando Y, Muto S, Shimada K, Kario K, Kusano E, Asano Y.
1Department of Nephrology, Japanese Red Cross Koga Hospital, Koga, Ibaraki, Japan.
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Predictors and Mortality of Incident Atrial Fibrillation in Hemodialysis Patients
Keiko Nishi, Shouichi Fujimoto, Kazuo Kitamura. Dialysis Division, University of Miyazaki Hospital, Miyazaki, Japan
Background: The prevalence and incidence of atrial fibrillation (AF) in hemodialysis (HD) patients are increased. The purpose of this study is to indentify the risk factors including predictive value of electrocardiographic assessment associated with incident AF and to establish the influence of AF on mortality in patients with maintenance HD. |
Diagnostic Accuracy of Dual-Source 64-Slice Multidetector CT Coronary Angiography for the Evaluation of Coronary Artery Disease in Patient with ESRD
Joon Seok Oh, Joong Kyung Kim, Yong Hoon Sin, Seong Min Kim, Ji-Min Jeon, Yong-Ki Park, Gun Ung Jeon. Internal Medicine, Bong Seng Hospital, Busan, Korea
10:00 AM - 2:30 PM
Background: Invasive coronary angiography remains the gold standard in the diagnosis of coronary artery disease. However, multidetector computed tomography (MDCT) coronary angiography is an emerging technique that is available for the non-invasive detection of coronary artery stenoses.
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Sudden cardiac arrest is the leading cause of death among kidney disease patients on dialysis. Because hardening of the blood vessels due to calcium deposits has been
linked to increased cardiovascular deaths in dialysis patients, national guidelines
recommend lowering the amount of calcium that patients receive from dialysis fluids.
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Kidney Int. 2010 Oct 6
Flythe JE, Kimmel SE, Brunelli SM.
Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Clin J Am Soc Nephrol. 2009 Aug;4(8):1324-30.
Coritsidis G, Sutariya D, Stern A, Gupta G, Carvounis C, Arora R, Balmir S, Acharya A.
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Eleftheriadis T, Liakopoulos V, Antoniadi G, Stefanidis I, Galaktidou G.
Nephrology Department, Medical School, University of Thessaly, Neo Ktirio Mezourlo Hill, 41110, Larissa, Greece
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Iseki K,et al.
Dialysis Unit, University Hospital of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan.
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Blood Purif. 2010 Aug 26;30(2):135-145.
Kanbay M, et al
Department of Internal Medicine, Section of Nephrology, Fatih University School of Medicine, Ankara, Turkey.
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Clin J Am Soc Nephrol. 2010 Aug 12.
van der Velde M, Bakker SJ, de Jong PE, Gansevoort RT.
Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Clin J Am Soc Nephrol. 2010 Jun;5(6):1054-63.
Arneson TJ, Liu J, Qiu Y, Gilbertson DT, Foley RN, Collins AJ.
Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN 55404, USA.
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Tahira P. Alves, et al for the AASK Collaborative Research Group
Journal of the American Society of Nephrology
Volume 21, Issue 7, July 2010
doi: 10.1681/ASN.2009060654
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Mutluay R, Konca C, Erten Y, Pa?ao?lu H, De?er SM, A?irgün C, Derici U, Arinsoy T, Sindel S.
Department of Nephrology, Gazi University Hospital, 06100, Ankara, Turkey. |
Author Interviews: hemodialysis
- Dialysis - ESRD - CKD |
| Predictors of eGFR Decline in Type 2 Diabetes & Preserved Kidney Function: Dr. Chonchol CJASN |
| Tenecteplase for improvement of blood flow in dysfunctional hemodialysis catheters: Dr. Goldman Clin Neph |
| Religious coping, psychological distress and quality of life in hemodialysis: Dr. Carvalho J Psychosom Res. |
| Effect of captopril on recuperation from ischemia/reperfusion-induced AKI Nephrology Dialysis Transplant |
| Restless legs syndrome in dialysis: comparison of hemodialysis & CAPD: Dr. Merlino Neurol Sci. |
| International practice patterns & non-conventional hemodialysis utilization : Dr. Sood BMC Nephrology |
| Decreased PON1 in hemodialyzed & renal transplanted patients. Dr. Paragh Nephrol. Dial. Transplant |
| Preoperative Proteinuria & Long-Term Progression to Chronic Dialysis & Mortality after CABG: Drs. Chao & Ko : PLoS ONE |
| Creatinine generation is reduced in CVHD & predicts mortality: Dr. Wilson: Nephrology Dialysis Transplant |
Importance of normohydration for the long-term survival in hemodialysis : Dr. Wabel
Nephrology Dialysis Transplant |
| Local Tissue Renin-Angiotensin System Activation in Cardiorenal Metabolic Syndrome & Type 2 Diabetes: Dr.Hayden Cardiorenal Med |
| Group I nonreciprocal inhibition in restless legs syndrome secondary to CKD : Dr. Marconi Parkinsonism & Related Disorders |
Low-Dose ESAs and CV Geometry in CKD: Is Darbepoetin-α More Effective than Expected? Dr. Di Lullo
Cardiorenal Med |
Pharmacotherapy to improve outcomes in vascular access surgery: Dr. Jackson
Nephrology Dialysis Transplant |
| Parathyroidectomy for the attainment of NKF-K/DOQI™ and KDIGO recommended values for bone & mineral metabolism in dialysis with uncontrollable secondary hyperparathyroidism. Langenbecks Arch Surg |
| Bisphosphonate Therapy, Death, and Cardiovascular Events Among Female Patients With CKD: Dr. Perkins |
| Losartan prevents the development of the pro-inflammatory monocytes CD14+CD16+ in hemodialysis : Dr. Merino Nephrology Dialysis Transplant |
| Does Dialysis Modality Influence the Oxidative Stress of Uremia? Dr. Capusa Kidney Blood Press Res |
| Treatment of Periodontal Diseases Reduces Inflammation in Hemodialysis : Dr. Siribamrungwong |
| Declining Rates of Deceased Donor Renal Transplantation in the US Over Successive Years of Listing: Dr. Trivedi |
| When Is the Best Moment to Assess the Ankle Brachial Index: Pre- or Post-Hemodialysis?Dr. RM Elias |
| Role of Race and Poverty on Steps to Kidney Transplantation in the Southeastern US |
| Validity & Reliability of the MUST and MST Nutrition Screening Tools in Renal Inpatients : C. Lawson |
| Target-Orientated Algorithm for Regional Citrate-Calcium Anticoagulation in Extracorporeal Therapies: Dr. Brandl |
| Evaluation of bone microarchitecture by HR-pQCT in hemodialysis : Dr. Negri |
| Erectile Dysfunction in Chronic Hemodialysis : Dr. Strippoli |
| Have Renal Dietitians Successfully Implemented Evidence-Based Guidelines Into Practice? E. Joy |
| Regional Citrate Versus Heparin Anticoagulation for CRRT: Drs. Tam & Wu |
| von Willebrand factor predicts mortality in CRRT : Dr. Péquériaux |
| Clinical Outcome of Twice-Weekly Hemodialysis Patients in Shanghai | Dr. Qian |
| Persistently low intact PTH levels predict aortic arch calcification progression in hemodialysis patients : Dr. Song |
| Lack of Awareness among Future Medical Professionals about the Risk of Consuming Hidden Phosphate-Containing Processed Food & Drinks : Dr. Razzaque |
| 51Cr-EDTA plasma & urinary clearance as a measure of residual renal function in dialysis :Dr. Kjaergaard |
| Obesity and Mortality Risk among Younger Dialysis Patients: Dr. Hoogeveen |
| Solar-Assisted Hemodialysis: Dr. Agar |
| Hydrogen sulfide inhibits high glucose-induced matrix protein synthesis by activating AMP-activated protein kinase in renal epithelial cells Drs. Lee & Kasinath |
| Mineral, bone disorders, survival in hemodialysis with & without PKD : Drs. Molnar & Kalantar-Zadeh |
| Hydrogen sulfide inhibits high glucose-induced matrix protein synthesis by activating AMP-activated protein kinase in renal epithelial cells Drs. Lee & Kasinath |
| Mineral, bone disorders, survival in hemodialysis with & without PKD : Drs. Molnar & Kalantar-Zadeh |
| Downregulation of the renal & hepatic hydrogen sulfide-producing enzymes and capacity in CKD - Dr. Vaziri |
| A predictive algorithm for management of anemia in hemodialysis based on ESA pharmacodynamics : Dr. Lines |
| Factors Associated With Intradialytic Systolic Blood Pressure Variability: Dr. Flythe |
| Safety and predictors of complications of renal biopsy in the outpatient setting : Dr. Jiang |
| Heparin induced antibodies in chronic hemodialysis patients and cardiac surgery patients: Dr. Shavit |
| Atrial Fibrillation in Medicare/Medicaid-eligible dialysis patients: Dr. Wetmore |
| Newly identified anorexigenic adipokine nesfatin-1 in hemodialysis patients: J. Saldanha |
| Correction of Post kidney Transplant Anemia Reduces Progression of Allograft Nephropathy: Dr. Choukrou |
| Mild and moderate pre-dialysis CKD is associated with increased coronary artery calcium: Dr. Budoff |
| Endogenous factors modified by hemodialysis and accuracy of blood glucose-measuring device: Dr. Ogawa |
| Narrow-band UVV increases serum vitamin D levels in hemodialysis patients Dr. Ala-Houhala |
| Predicting hospital cost in CKD patients through blood chemistry values: Dr. Bessette |
| Nutritional vitamin D supplementation in hemodialysis: a potential vascular benefit? D. Mason |
| Volume excess in chronic hemodialysis effects of treatment frequency & treatment spacing : Dr. Schneditz |
| Acid reduction with fruits/veges or bicarb attenuates kidney injury in hypertensive nephropathy with reduced GFR |
Predicting Number of US Medical Graduates Entering Adult Nephrology Fellowships
Using Search Terms Dr. Desai |
| Potential influence of sevelamer hydrochloride on responsiveness to ESAs in hemodialysis patients: Dr. Ikee |
| Anemia Management in Dialysis : ESAs vs Transfusions: Clinical & Economic Consequences :Dr. Naci |
| Increased risk of death and de novo chronic kidney disease following reversible acute kidney injury: Dr. Perkins |
| Filtration Markers May Have Prognostic Value Independent of Glomerular Filtration Rate : Dr. Tangri |
| Stopping Renin-Angiotensin System Inhibitors in Chronic Kidney Disease: Predictors of Response |
| Insights into nephrologist training, clinical practice, and dialysis choice: Dr. Mehrotra |
| Early ACE inhibition in Alport syndrome delays renal failure and improves life expectancy: Dr. Gross |
| Blunted insulinemia using high dialysate glucose concentration during hemodialysis : Dr. Schneditz |
| Prevalence of Inadequate Platelet Inhibition by Clopidogrel in Patients Receiving Hemodialysis: Dr. Alexopoulos |
| Live kidney donation: attitudes towards donor approach, motives and factors promoting donation: Dr. Mazaris |
| High-dose ESAs, inflammatory biomarkers, and soluble erythropoietin receptors : Dr. Inrig |
| Association of AKI with Adverse Outcomes in Burned Military Casualties : Dr. Stewart |
| Sodium Intake, ACE Inhibition, and Progression to ESRD Dr. Ruggenenti |
DOPPS Practice Monitor: Update on Trends in US Hemodialysis Care Following Launch of Bundled Payment System and Revisions to ESA Labels January 6 2011 |
Emerging trends in hemodialysis care through August 2011, based on a sample of US dialysis facilities, are included in the latest update to the DOPPS Practice Monitor (DPM, at http://www.dopps.org/DPM), run by the Dialysis Outcomes and Practice Patterns Study (DOPPS) at Arbor Research Collaborative for Health.
Ongoing Changes in the US Dialysis Environment – Recent changes in dialysis payment and regulatory guidance are expected to affect hemodialysis practice. In January 2011, the Centers for Medicare & Medicaid Services (CMS) launched a new Prospective Payment System (PPS) with the intent to control dialysis costs through bundled payments. In June 2011, the FDA approved revised prescribing information for erythropoiesis-stimulating agents (ESAs), used to treat anemia in most dialysis patients. Previously, the label recommended a hemoglobin target range of 10-12 g/dL. The June 2011 update removed the target range, advising instead to start ESA therapy for dialysis patients at hemoglobin less than 10 g/dL, and to reduce or interrupt the dose when the hemoglobin approaches or exceeds 11 g/dL.
Most Recent Trends in Care – Over the August 2010 to August 2011 time period, many hemodialysis practices have remained stable; examples include nutrition measures and hemodialysis treatment time and dose. There have been notable trends in the following practice areas:
- Anemia: Hemoglobin levels have decreased since the June 2011 ESA label update. While the mean hemoglobin level declined by 0.12 g/dL over 12 months from August 2010 to July 2011, it declined in August 2011 by another 0.10 g/dL to 11.26 g/dL. The percentage of patients with hemoglobin levels greater than 12 g/dL declined sharply (from 28% to 23%) in July/August 2011, while the percentage with hemoglobin levels less than 10 g/dL increased slightly from 8.5% to 10% and the percentage with hemoglobin levels less than 9 g/dL remained under 3%.
Mean prescribed epoetin dose (among patients receiving epoetin) decreased by 15%, from 21,100 units/wk to 17,900 units/wk, from August 2010 to August 2011, with the greatest decline in June-August 2011. Epoetin doses at the higher end of the dose range have decreased most notably. IV iron use increased from August 2010 to August 2011 though has recently stabilized. In keeping with greater IV iron use, serum ferritin levels (indicative of iron stores) continue to rise. Serum ferritin concentration exceeded 500 ng/mL in 65% of patients, 800 ng/mL in 34% of patients, and 1,200 ng/mL in 11% of patients in August 2011.
- Mineral & Bone Disorder: In our last report, we noted a 29% increase in serum parathyroid hormone (PTH) levels through April 2011, and differences by race were described. Since then, PTH levels have remained stable or declined slightly in both black and non-black patients. In August 2011, 22% of black patients and 12% of non-black patients had very high PTH values (defined here as PTH >600 pg/mL). The percentage of hemodialysis patients for whom PTH is measured has declined slightly since August 2010. There have been no clear changes in serum calcium or serum phosphorus levels.
- Clinical Outcomes: Preliminary data indicate that the 30-day hospitalization rate has increased somewhat from August 2010 to August 2011. The DPM does not report yet on trends in red blood cell transfusions, as dialysis units are often unaware of transfusions occurring in the inpatient setting. Additional efforts to comprehensively monitor trends in transfusions are warranted. To date mortality rate has not changed appreciably, though further follow-up time is necessary as we continue to track this outcome.
Future monitoring of these trends, confirmation with national data when eventually available, and understanding their effect on clinical outcomes, if any, is required.
DPM data are aggregated across dialysis organizations and facilities. Aggregated trends may not reflect trends in individual dialysis organizations or facilities, and are not intended to provide oversight of performance in individual dialysis organizations or facilities.
Read the rest of the DOPPS Practice Monitor: Update on Trends in US Hemodialysis Care Following Launch of Bundled Payment System and Revisions to ESA Labels Press Release |
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Hemodialysis Research Interview of the Week |
Author Interview: Dr. Len Usvyat PhD
Clinical Systems Database Senior Analyst
Renal Research Institute
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Seasonal Variations in Mortality, Clinical, and Laboratory Parameters in Hemodialysis Patients: A 5-Year Cohort Study.
Usvyat LA, Carter M, Thijssen S, Kooman JP, van der Sande FM, Zabetakis P,
Balter P, Levin NW, Kotanko P.
Clin J Am Soc Nephrol. 2011 Nov 17.
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What are the main findings of the study? |
We found that mortality of hemodialysis patients followed a seasonal pattern over a five year period with the highest mortality in the winter and lowest mortality in the summer months.
We also observed that many clinical and laboratory parameters follow a seasonal pattern in our patient population.
For example, pre-dialysis systolic blood pressures are highest in winter and lowest in summer months; pre-dialysis body temperatures are highest in summer and lowest in winter months.
Neutrophils are highest in winter and lowest in summer suggesting higher inflammatory markers in the winter.
This phenomena was observed in various geographic regions in US.
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Were any of the findings unexpected? |
It has been previously shown that mortality follows seasonal trends in healthy population however these findings were never extended to dialysis patients.
While it was shown that blood pressures tend to follow a seasonal pattern, to the best of our knowledge, it has not been shown that neutrophils or interdialytic weight gains also follow a seasonal pattern.
Additionally, we applied a cosinor analysis to show whether these patterns are statistically significant.
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What should clinicians and patients take away from this study? |
These findings are particularly important in designing studies -- taking season into account is key.
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What recommendations do you have for future studies as a result of your study? |
Further research into understanding the biologic factors that contribute to this seasonality is important.
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