Could albumin level explain the higher mortality in hemodialysis patients with pulmonary hypertension?

Autor: Silméia Garcia Zannati-Bazan, Ana Cláudia Kochi, Luis Cuadrado Martin, Jacqueline Costa Teixeira Caramori, Hugo Hyung Bok Yoo, Beatriz Bojikian Matsubara, Roberto Jorge da Silva Franco, Lidiane Silva Rodrigues-Telini, Pasqual Barretti, Thais Helena Abrahão Thomaz Queluz
Přispěvatelé: Universidade Estadual Paulista (Unesp)
Jazyk: angličtina
Rok vydání: 2012
Předmět:
Male
correlation analysis
proportional hazards model
retrospective study
medicine.medical_treatment
Comorbidity
lcsh:RC870-923
Gastroenterology
End-stage renal disease
Prevalence
echocardiography
Medicine
pathophysiology
Univariate analysis
heart ventricle hypertrophy
adult
heart left ventricle filling
Middle Aged
Survival Rate
aged
female
risk factor
Nephrology
Hemodialysis
Female
albumin blood level
Brazil
Research Article
survival rate
medicine.medical_specialty
Hypertension
Pulmonary
Prognostic
Risk Assessment
End stage renal disease
Pulmonary hypertension
hazard assessment
Renal Dialysis
Internal medicine
follow up
hypervolemia
Humans
extracellular fluid
human
Renal Insufficiency
Chronic
Risk factor
Survival rate
Serum Albumin
business.industry
Proportional hazards model
vascular access
hemodialysis patient
heart ventricle wall
logistic regression analysis
medicine.disease
lcsh:Diseases of the genitourinary system. Urology
major clinical study
mortality
Survival Analysis
Surgery
heart size
Relative risk
prognosis
business
Zdroj: BMC Nephrology, Vol 13, Iss 1, p 80 (2012)
BMC Nephrology
Scopus
Repositório Institucional da UNESP
Universidade Estadual Paulista (UNESP)
instacron:UNESP
ISSN: 1471-2369
Popis: Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:26:54Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:31:44Z : No. of bitstreams: 1 2-s2.0-84864510746.pdf: 274160 bytes, checksum: dcd3b5e90752c938a89d8fa48f8c7362 (MD5) Made available in DSpace on 2014-05-27T11:26:54Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-08-08 Background: The pathogenesis of pulmonary hypertension (PH) in hemodialysis is still unclear. The aim of thisstudy was to identify the risk factors associated with the presence of PH in chronic hemodialysis patients and toverify whether these factors might explain the highest mortality among them.Methods: We conducted a retrospective study of hemodialysis patients who started treatment from August 2001to October 2007 and were followed up until April 2011 in a Brazilian referral medical school. According to theresults of echocardiography examination, patients were allocated in two groups: those with PH and those withoutPH. Clinical parameters, site and type of vascular access, bioimpedance, and laboratorial findings were comparedbetween the groups and a logistic regression model was elaborated. Actuarial survival curves were constructed andhazard risk to death was evaluated by Cox regression analysis.Results: PH > 35 mmHg was found in 23 (30.6%) of the 75 patients studied. The groups differed in extracellularwater, ventricular thickness, left atrium diameter, and ventricular filling. In a univariate analysis, extracellular waterwas associated with PH (relative risk = 1.194; 95% CI of 1.006 1.416; p = 0.042); nevertheless, in a multiple model,only left atrium enlargement was independently associated with PH (relative risk =1.172; 95% CI of 1.010 1.359;p = 0.036). PH (hazard risk = 3.008; 95% CI of 1.285 7.043; p = 0.011) and age (hazard risk of 1.034 per year of age;95% CI of 1.000 7.068; p = 0.047) were significantly associated with mortality in a multiple Cox regression analysis.However, when albumin was taken in account the only statistically significant association was between albuminlevel and mortality (hazard risk = 0.342 per g/dL; 95% CI of 0.119 0.984; p = 0.047) while the presence of PH lost itsstatistical significance (p = 0.184). Mortality was higher in patients with PH (47.8% vs 25%) who also had astatistically worse survival after the sixth year of follow up.Conclusions: PH in hemodialysis patients is associated with parameters of volume overload that sheds light on itspathophysiology. Mortality is higher in hemodialysis patients with PH and the low albumin level can explain thisassociation.© 2012 Greenfield et al.; licensee BioMed Central Ltd. Division of Pulmonology Botucatu School of Medicine State University of São Paulo UNESP, Botucatu, SP Division of Nephrology Botucatu School of Medicine State University of São Paulo UNESP, Botucatu, SP Division of Cardiology Botucatu School of Medicine State University of São Paulo UNESP, Botucatu, SP Division of Pulmonology Botucatu School of Medicine State University of São Paulo UNESP, Botucatu, SP Division of Nephrology Botucatu School of Medicine State University of São Paulo UNESP, Botucatu, SP Division of Cardiology Botucatu School of Medicine State University of São Paulo UNESP, Botucatu, SP
Databáze: OpenAIRE
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