Cardiovascular risk factors in hemodialysis patients : results from baseline data of kaleidoscopic approaches to patients with end-stage renal disease study

Introduction: Arteriovenous fistulas are a preferred choice for hemodialysis access in chronickidney disease patients. There is increased adoption of arteriovenous fistula creation in Nepal.Our objective is to study various arteriovenous fistulas that have been created in our center.
Methods: This is a descriptive cross-sectional study conducted in a tertiary care hospital includingall cases of arteriovenous fistula creation from January 2018 to December 2019. We obtained theethical clearance from the institutional review committee of Kathmandu University School ofMedical sciences. Convenient sampling method was used. Detailed vascular mapping and colordoppler ultrasonography was done in the bilateral upper limb as preoperative preparation and tochoose a site for arteriovenous fistula creation. Data were entered into the Statistical Package for theSocial Sciences version 20 for analysis.
Results: Among 50 patients, the most common location was brachiobasilic 20 (40%) patients followedby brachiocephalic 18 (36%), radiocephalic 11 (22%), and arteriovenous graft between the brachialartery and axillary vein 1 (2%). The mean duration of hospital stay was 1.44 days. Three (6%) patientsrequired re-intervention, all within 24 hours. Two (4%) patients had a failure of arteriovenous fistularequiring the creation of a new arteriovenous fistula.
Conclusions: Brachiobasilic was the most common location for arteriovenous fistula creation.Reintervention was not common.

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Study of Arteriovenous Fistula Cases in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

The burden of chronic kidney disease (CKD) is increasing worldwide. Renal replacement therapy is the lifesaving treatment modality in end-stage renal disease. Among various renal replacement modalities, hemodialysis (HD) is widely preferred one. Intradialytic complications are common and mostly inevitable. This study was conducted to determine pattern of intradialytic complications and its associated factors. This is a cross-sectional study conducted for six months duration among all CKD patients who were undergoing maintenance HD in B. P. Koirala Institute of Health Sciences, Dharan, Nepal. Of 228 patients, most were male 141 (61.8%) with median age 50 years (22-77). In this study, diabetic nephropathy (38.2%) was the most common etiology of CKD. Among 228 patients, complications were noted in 133 (58.3%) patients. Common complications were chills and rigor (44.3%), backache (30.7%), and hypotension (27.2%) in the study patients. Intradialytic complications were significantly associated with increasing age (P <0.001) and irregular HD (P <0.001). The common complications among CKD patient undergoing maintenance HD were chills, backache, and hypotension. Increasing age and irregular HD were significantly associated with intradialytic complications.

Spectrum of complications in chronic kidney disease patients undergoing maintenance hemodialysis: An experience of a tertiary care center in Nepal.

Background & Objectives: The cardiovascular complications including morbidity and mortality remains alarmingly high in all stages of chronic kidney disease. Although patients with chronic kidney disease share many of the similar risk factors for cardiovascular disease as the general population, there are a number of uremia related risk factors, such as anemia and alterations in calcium/phosphorus metabolism that also play a role in promoting cardiovascular disease. The objective of the study was to study the cardiovascular complications in end stage renal disease patients on maintenance hemodialysis. Materials & Methods: It is a hospital based cross-sectional observational study conducted at College of Medical Science - teaching Hospital. Hundred patients (n=100) with a diagnosis of end stage renal disease (irrespective of the underlying cause), and those who were on hemodialysis support were studied over a period of one year. Results: One hundred end stage renal disease patients were analyzed. Cardiovascular disease was present in 74% (n=74). the mean age of the patient who had cardiovascular disease was 59.36+14.337 years. The three major causes of end stage renal disease in the study population were hypertension (35%) followed by diabetes(31%) and chronic glomerulonephritis (14%). On electrocardiogram, left ventricular hypertrophy was a major finding 64% (n=64) followed by arrhythmias 30% (n=30). On echocardiography, left ventricular hypertrophy was found in 49% (n=49) followed by left ventricular diastolic dysfunction 38% (n=38). On subgroup analysis, left ventricular hypertrophy was found statistically significant with calcium and phosphorus product > 55 mg2/dl2 (p=0.01). Similarly left ventricular systolic dysfunction, regional wall motion abnormalities and st-t changes was found statistically significant with anemia; p=0.006, p=0.0004 and p=0.02 respectively. Conclusion: Prevalence of cardiovascular complications were common in end stage renal disease patients receiving maintenance hemodialysis. Anemia, calcium and phosphorus product > 55 mg2/dl2 were their independent risk factors.

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Cardiovascular complications in end stage renal disease in a tertiary hospital in Nepal

Estimation of serum aminotransferase levels play important role in the diagnosis and monitoring of hepatic diseases. Studies suggest that in patients with chronic kidney disease, especially in those under hemodialysis, the reference ranges of the serum aminotransferases might not be reflective of hepatic function. Due to this, diagnosis and management of liver diseases in such patients becomes quite challenging. This study aims to estimate and compare serum aminotransferases levels of hemodialysis patients and healthy controls. Seventy-five patients undergoing hemodialysis in Nepal Medical College Teaching Hospital for at least three months were included in the study as cases and apparently healthy individuals with no active illness and regular medication use for the past three months and were recruited as controls. Predialysis blood samples were drawn and were analyzed for serum aminotransferases and other blood parameters. The median serum AST and ALT values for hemodialysis patients were 15 U/L and 21 U/L, while for the healthy controls, it was 30 U/L and 36 U/L and the differences were statistically significant (p < 0.001). Among the hemodialysis patients, serum AST was positively correlated with eGFR (ρ = 0.247, p = 0.033) and negatively correlated with serum creatinine levels (ρ = -0.307, p = 0.007). Hence, serum aminotransferases levels were found to be low in patients with impaired kidney function compared to those with normal kidney function.

https://www.nepjol.info/index.php/nmcj/article/download/56054/41903

Serum Aminotransferases in Chronic Kidney Disease Patients: A Hospital based Comparative Study

The risk of cardiovascular disease is higher in chronic kidney disease patients compared to the general population and its impact is higher in developing countries compared to the developed countries. With this background in mind, we aimed to evaluate the prevalence of different cardiovascular risk factors in patients on maintenance hemodialysis in a tertiary care center. Chronic kidney disease patients aged 18 years and above who were under maintenance hemodialysis in the hemodialysis unit of Nepal Medical College were included in the study. Pre-dialysis venous blood samples from the participants were collected and analyzed for serum calcium, phosphorus, total protein, albumin and hemoglobin. Calcium phosphate product was calculated. Out of 100 study participants, 52% were male and 48% were female. Age-wise distribution showed 38% of the participants were below 40 years. The mean age of the participants was 45.86 ± 14.4 years. Ninety-three percent had hypertension and 29% had diabetes mellitus. Hypocalcemia was present in 80%, hyperphosphatemia was seen among 81% and high calcium phosphate product was present in 33% of the participants. Low hemoglobin (< 10gm/dL) was found in 86%. The cardiovascular risk trend in the Nepalese chronic kidney disease population is fairly different compared to the western population. Participants were younger. Prevalence of hypertension and diabetes was high. The high prevalence of anemia might be due to unaffordability of the participants for regular erythropoietin therapy. Inadequately managed hyperphosphatemia despite the widespread use of phosphorus binders, is still a major clinical challenge in patients on hemodialysis.

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D. N. Manandhar

Papers

Prevalence of Cardiovascular Risk Factors among Chronic Kidney Disease Patients Undergoing Hemodialysis in a Tertiary Care Center, Kathmandu, Nepal