Could albumin level explain the higher mortality in hemodialysis patients with pulmonary hypertension?
Autor(a) principal: | |
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Data de Publicação: | 2012 |
Outros Autores: | , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNESP |
Texto Completo: | http://dx.doi.org/10.1186/1471-2369-13-80 http://hdl.handle.net/11449/73483 |
Resumo: | 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. |
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Could albumin level explain the higher mortality in hemodialysis patients with pulmonary hypertension?End-stage renal diseaseHemodialysisPrognosticPulmonary hypertensionadultagedalbumin blood levelcorrelation analysisechocardiographyextracellular fluidfemalefollow uphazard assessmentheart left ventricle fillingheart sizeheart ventricle hypertrophyheart ventricle wallhemodialysis patienthumanhypervolemialogistic regression analysismajor clinical studymalemortalitypathophysiologyprognosisproportional hazards modelpulmonary hypertensionretrospective studyrisk assessmentrisk factorsurvival ratevascular accessBrazilComorbidityFemaleHumansHypertension, PulmonaryMaleMiddle AgedPrevalenceRenal DialysisRenal Insufficiency, ChronicRisk AssessmentSerum AlbuminSurvival AnalysisSurvival RateBackground: 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, SPDivision of Nephrology Botucatu School of Medicine State University of São Paulo UNESP, Botucatu, SPDivision of Cardiology Botucatu School of Medicine State University of São Paulo UNESP, Botucatu, SPDivision of Pulmonology Botucatu School of Medicine State University of São Paulo UNESP, Botucatu, SPDivision of Nephrology Botucatu School of Medicine State University of São Paulo UNESP, Botucatu, SPDivision of Cardiology Botucatu School of Medicine State University of São Paulo UNESP, Botucatu, SPUniversidade Estadual Paulista (Unesp)Yoo, Hugo Hyung Bok [UNESP]Martin, Luis Cuadrado [UNESP]Kochi, Ana Claudia [UNESP]Rodrigues-Telini, Lidiane Silva [UNESP]Barretti, Pasqual [UNESP]Caramori, Jacqueline Socorro Costa Teixeira [UNESP]Matsubara, Beatriz Bojikian [UNESP]Zannati-Bazan, Silméia Garcia [UNESP]Franco, Roberto Jorge da Silva [UNESP]Queluz, Thais Helena Abrahão Thomaz [UNESP]2014-05-27T11:26:54Z2014-05-27T11:26:54Z2012-08-08info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://dx.doi.org/10.1186/1471-2369-13-80BMC Nephrology, v. 13, n. 1, 2012.1471-2369http://hdl.handle.net/11449/7348310.1186/1471-2369-13-802-s2.0-848645107462-s2.0-84864510746.pdf322829482722962054964119838934796990977122340795709593355785515149232031684466150000-0003-4979-4836Scopusreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengBMC Nephrology2.3951,098info:eu-repo/semantics/openAccess2023-12-28T06:16:21Zoai:repositorio.unesp.br:11449/73483Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462023-12-28T06:16:21Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
Could albumin level explain the higher mortality in hemodialysis patients with pulmonary hypertension? |
title |
Could albumin level explain the higher mortality in hemodialysis patients with pulmonary hypertension? |
spellingShingle |
Could albumin level explain the higher mortality in hemodialysis patients with pulmonary hypertension? Yoo, Hugo Hyung Bok [UNESP] End-stage renal disease Hemodialysis Prognostic Pulmonary hypertension adult aged albumin blood level correlation analysis echocardiography extracellular fluid female follow up hazard assessment heart left ventricle filling heart size heart ventricle hypertrophy heart ventricle wall hemodialysis patient human hypervolemia logistic regression analysis major clinical study male mortality pathophysiology prognosis proportional hazards model pulmonary hypertension retrospective study risk assessment risk factor survival rate vascular access Brazil Comorbidity Female Humans Hypertension, Pulmonary Male Middle Aged Prevalence Renal Dialysis Renal Insufficiency, Chronic Risk Assessment Serum Albumin Survival Analysis Survival Rate |
title_short |
Could albumin level explain the higher mortality in hemodialysis patients with pulmonary hypertension? |
title_full |
Could albumin level explain the higher mortality in hemodialysis patients with pulmonary hypertension? |
title_fullStr |
Could albumin level explain the higher mortality in hemodialysis patients with pulmonary hypertension? |
title_full_unstemmed |
Could albumin level explain the higher mortality in hemodialysis patients with pulmonary hypertension? |
title_sort |
Could albumin level explain the higher mortality in hemodialysis patients with pulmonary hypertension? |
author |
Yoo, Hugo Hyung Bok [UNESP] |
author_facet |
Yoo, Hugo Hyung Bok [UNESP] Martin, Luis Cuadrado [UNESP] Kochi, Ana Claudia [UNESP] Rodrigues-Telini, Lidiane Silva [UNESP] Barretti, Pasqual [UNESP] Caramori, Jacqueline Socorro Costa Teixeira [UNESP] Matsubara, Beatriz Bojikian [UNESP] Zannati-Bazan, Silméia Garcia [UNESP] Franco, Roberto Jorge da Silva [UNESP] Queluz, Thais Helena Abrahão Thomaz [UNESP] |
author_role |
author |
author2 |
Martin, Luis Cuadrado [UNESP] Kochi, Ana Claudia [UNESP] Rodrigues-Telini, Lidiane Silva [UNESP] Barretti, Pasqual [UNESP] Caramori, Jacqueline Socorro Costa Teixeira [UNESP] Matsubara, Beatriz Bojikian [UNESP] Zannati-Bazan, Silméia Garcia [UNESP] Franco, Roberto Jorge da Silva [UNESP] Queluz, Thais Helena Abrahão Thomaz [UNESP] |
author2_role |
author author author author author author author author author |
dc.contributor.none.fl_str_mv |
Universidade Estadual Paulista (Unesp) |
dc.contributor.author.fl_str_mv |
Yoo, Hugo Hyung Bok [UNESP] Martin, Luis Cuadrado [UNESP] Kochi, Ana Claudia [UNESP] Rodrigues-Telini, Lidiane Silva [UNESP] Barretti, Pasqual [UNESP] Caramori, Jacqueline Socorro Costa Teixeira [UNESP] Matsubara, Beatriz Bojikian [UNESP] Zannati-Bazan, Silméia Garcia [UNESP] Franco, Roberto Jorge da Silva [UNESP] Queluz, Thais Helena Abrahão Thomaz [UNESP] |
dc.subject.por.fl_str_mv |
End-stage renal disease Hemodialysis Prognostic Pulmonary hypertension adult aged albumin blood level correlation analysis echocardiography extracellular fluid female follow up hazard assessment heart left ventricle filling heart size heart ventricle hypertrophy heart ventricle wall hemodialysis patient human hypervolemia logistic regression analysis major clinical study male mortality pathophysiology prognosis proportional hazards model pulmonary hypertension retrospective study risk assessment risk factor survival rate vascular access Brazil Comorbidity Female Humans Hypertension, Pulmonary Male Middle Aged Prevalence Renal Dialysis Renal Insufficiency, Chronic Risk Assessment Serum Albumin Survival Analysis Survival Rate |
topic |
End-stage renal disease Hemodialysis Prognostic Pulmonary hypertension adult aged albumin blood level correlation analysis echocardiography extracellular fluid female follow up hazard assessment heart left ventricle filling heart size heart ventricle hypertrophy heart ventricle wall hemodialysis patient human hypervolemia logistic regression analysis major clinical study male mortality pathophysiology prognosis proportional hazards model pulmonary hypertension retrospective study risk assessment risk factor survival rate vascular access Brazil Comorbidity Female Humans Hypertension, Pulmonary Male Middle Aged Prevalence Renal Dialysis Renal Insufficiency, Chronic Risk Assessment Serum Albumin Survival Analysis Survival Rate |
description |
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. |
publishDate |
2012 |
dc.date.none.fl_str_mv |
2012-08-08 2014-05-27T11:26:54Z 2014-05-27T11:26:54Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.1186/1471-2369-13-80 BMC Nephrology, v. 13, n. 1, 2012. 1471-2369 http://hdl.handle.net/11449/73483 10.1186/1471-2369-13-80 2-s2.0-84864510746 2-s2.0-84864510746.pdf 3228294827229620 5496411983893479 6990977122340795 7095933557855151 4923203168446615 0000-0003-4979-4836 |
url |
http://dx.doi.org/10.1186/1471-2369-13-80 http://hdl.handle.net/11449/73483 |
identifier_str_mv |
BMC Nephrology, v. 13, n. 1, 2012. 1471-2369 10.1186/1471-2369-13-80 2-s2.0-84864510746 2-s2.0-84864510746.pdf 3228294827229620 5496411983893479 6990977122340795 7095933557855151 4923203168446615 0000-0003-4979-4836 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
BMC Nephrology 2.395 1,098 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.source.none.fl_str_mv |
Scopus reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
instname_str |
Universidade Estadual Paulista (UNESP) |
instacron_str |
UNESP |
institution |
UNESP |
reponame_str |
Repositório Institucional da UNESP |
collection |
Repositório Institucional da UNESP |
repository.name.fl_str_mv |
Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
repository.mail.fl_str_mv |
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1799965432715673600 |