Atherosclerosis-calcification score and predictors of intra-dialytic hypotension
| Autor: | Yaser Aly Ammar |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
medicine.medical_specialty Multivariate analysis endocrine system diseases Anemia medicine.medical_treatment Hemodynamics Coronary Artery Disease Renal Dialysis Risk Factors Internal medicine medicine Humans Vascular Calcification Dialysis business.industry Intra-dialytic hypotension nutritional and metabolic diseases General Medicine Maintenance hemodialysis medicine.disease Atherosclerosis Nephrology Cardiology Vascular pathology Hypotension business Calcification |
| Zdroj: | Clinical nephrology. 96(3) |
| ISSN: | 0301-0430 |
| Popis: | Background Intra-dialytic hypotension episodes (ID-Hypos) cause significant reduction of dialysis efficiency and increased cardiovascular morbimortality. Atherosclerosis and vascular calcification are two closely inter-related processes that occur prematurely and progress aggressively in maintenance hemodialysis (MHD) patients. Aims To study the predictors of ID-Hypos, particularly a novel combined atherosclerosis-calcification score (CACS) (0 to 6) obtained by adding the atherosclerosis score (AS) to a modified abdominal aortic calcification score (AACS), each ranging 0 to 3. Materials and methods In 60 adult MHD patients, AS was derived from ankle-brachial index and carotid ultrasound. AACS was modified from Kauppila score applied on lateral abdominal plain radiographs. The number of sessions complicated by ≥ 1 ID-Hypos over 14 weeks was recorded and correlated with CACS, ultrafiltration rate (UFR), and other hemodynamic and laboratory parameters. Results Patients developed a median of 10.5 ID-Hypos (IQR 5.75 - 14). The number of ID-Hypos had a statistically significant positive correlation with CACS (r = 0.291, p = 0.024), but not with its individual components. AACS had a statistically significant positive correlation with s. phosphorus and calcium-phosphorus product. On multivariate analysis, the most significant independent predictors of ID-Hypos were high UFR, high CACS, and low hemoglobin. Serum C-reactive protein had a positive correlation with ID-Hypos that was lost in the adjusted models. Conclusion High UFR, CACS, and anemia are significant predictors of ID-Hypos. CACS may help in quantifying vascular pathology and characterizing MHD patients at highest risk for ID-Hypos, those who would be prioritized for potential preventive measures like biocompatible membranes or hemodiafiltration. A background of chronic inflammation may underlie and link patient-related ID-Hypos risk factors. |
| Databáze: | OpenAIRE |
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