BACKGROUND/AIMS: Brain natriuretic peptide (BNP) levels are known to be elevated in patients with chronic kidney disease (CKD) and normal heart function. Therefore, the present study was performed to examine the effectiveness of BNP level in diagnosing heart failure in patients with CKD and to determine its effects on survival rate and prognosis. METHODS: A total of 182 patients with CKD who visited the hospital due to dyspnea of NYHA class II were included in the study. BNP levels were measured and echocardiography was performed to divide the subjects into groups with and without heart failure. Their BNP levels, clinical courses, and survival rates were analyzed retrospectively. RESULTS: When BNP level was > or =858.5 pg/mL in CKD patients, heart failure could be diagnosed with sensitivity and specificity of 77% and 72%, respectively. Survival rate of the group with BNP levels of > or =858.8 pg/mL was significantly lower than that of the group with BNP level below this threshold (p=0.012) and multivariate analysis showed that BNP level, age, and sex affected survival rate in the group with BNP level > or =858.8 pg/mL. CONCLUSIONS: BNP levels of patients with CKD showed a positive correlation with creatinine levels, and the critical point of BNP level for diagnosis of heart failure was 858.5 pg/mL. As the survival rate in patients with BNP level above the critical point was significantly low, this level was a useful indicator for predicting their prognosis. Care should be taken in interpreting BNP level because patients with stage 5 CKD may show a high concentration of BNP without heart failure.
Aged ; Cohort Studies ; Female ; Heart Failure/blood/complications/*diagnosis ; Humans ; Kidney Diseases/*blood/complications/mortality ; Male ; Middle Aged ; Natriuretic Peptide, Brain/*blood ; Predictive Value of Tests ; Retrospective Studies ; Survival Rate

This study evaluated the significance of aortic calcification index (ACI), an estimate of abdominal aortic calcification by plain abdominal computed tomography (CT), in terms of left ventricular (LV) diastolic dysfunction, mortality, and nonfatal cardiovascular (CV) events in chronic hemodialysis patients. Hemodialysis patients who took both an abdominal CT and echocardiography were divided into a low-ACI group (n = 64) and a high-ACI group (n = 64). The high-ACI group was significantly older, had a longer dialysis vintage and higher comorbidity indices, and more patients had a previous history of CV disease than the low-ACI group. The ACI was negatively correlated with LV end-diastolic volume or LV stroke volume, and was positively correlated with the ratio of peak early transmitral flow velocity to peak early diastolic mitral annular velocity (E/E' ratio), a marker of LV diastolic function. The E/E' ratio was independently associated with the ACI. The event-free survival rates for mortality and nonfatal CV events were significantly lower in the high-ACI group compared with those in the low-ACI group, and the ACI was an independent predictor for all-cause deaths and nonfatal CV events. In conclusion, ACI is significantly associated with diastolic dysfunction and predicts all-cause mortality and nonfatal CV events in hemodialysis patients.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Aorta, Abdominal ; Blood Flow Velocity ; Blood Pressure ; Calcinosis/*etiology ; Cardiovascular Diseases/*complications ; Disease-Free Survival ; Echocardiography ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Kidney Failure, Chronic/*complications/mortality ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Regression Analysis ; Renal Dialysis ; Risk Factors ; Tomography, X-Ray Computed ; Ventricular Dysfunction, Left/complications/*physiopathology

Although oxidized low-density lipoprotein (LDL) and lysophosphatidylcholine (LPC) have been proposed as important mediators of the atherosclerosis, the long-term contribution to the risk of cardiovascular disease (CVD) in hemodialysis patients has not been evaluated. This study investigated the relation between oxidized LDL and LPC levels with long term risk of CVD. Plasma oxidized LDL and LPC levels were determined in 69 Korean hemodialysis patients as a prospective observational study for 5 yr. During the observation period, 18 cardiovascular events (26.1%) occurred including 6 deaths among the hemodialysis patients. The low LPC level group (< or = 254 microM/L, median value) had much more increased risk of CVD compared to the high LPC level group (> 254 microM/L) (P = 0.01). However, serum levels of oxidized LDL were not significantly different between groups with and without CVD. In adjusted Cox analysis, previous CVD, (hazard ratio [HR], 5.68; 95% confidence interval [CI], 1.94-16.63, P = 0.002) and low LPC level (HR, 3.45; 95% CI, 1.04-11.42, P = 0.04) were significant independent risk factors for development of CVD. It is suggested that low LPC, but not oxidized LDL, is associated with increased risk of CVD among a group of Korean hemodialysis patients.
Adult ; Aged ; Asian Continental Ancestry Group ; Cardiovascular Diseases/*diagnosis/etiology/mortality ; Case-Control Studies ; Female ; Follow-Up Studies ; Humans ; Kidney Failure, Chronic/blood/complications/diagnosis ; Lipoproteins, LDL/*blood ; Lysophosphatidylcholines/*blood ; Male ; Middle Aged ; Proportional Hazards Models ; Prospective Studies ; Renal Dialysis ; Republic of Korea ; Risk Factors

Postoperative acute renal failure is a major problem in surgical patients and may result from varieties of prerenal, renal, and postrenal causes. Mortality of this disorder was distressingly high despite improvement in dialysis and intensive general care. Clinical data from 31 patients with postoperative acute renal failure treated between 1989 and 1993 were reviwed. The results were summerized as follows: 1) There were 16 men and 15 women with a median age of 49 years. Twenty one(6896) of 31 patients were over 50 years old. 2) General surgery 14 cases(45%), cardiac surgery 11 cases(35%), neurologic surgery 3 cases, orthopedic surgery 2 cases and gynecologic surgery 1 case were performed. 3) Preoperative clinical characteristics were over 50 years old in 21 cases(68%), antibiotics in 9 cases(29%), infections in 6 cases, hypertention in 5 cases, diabetes mellitus in 4 cases, radiocontrast agent in 3 cases, jaundice in 3 cases, cardiovascular disease in 3 cases, emergeney operation in 10 cases(32%), and trauma in 4 cases. 4) Perioperative hypotension was 9 cases(29%) and massive blood transfusion was 20 cases(65%). Fourteen of the 31 patients(45%) received intraoperative diuretics, and twenty of 31 patients(66%) received diuretics within 24 hours after operation. 5) Enflurane(66%) was the most commonly used anesthetic, followed by intravenous anesthetics(16%), isoflurane(10%), and halothane(10%). 6) When acute renal failure was diagnosed, urinalysis showed gross or microhematuria in 27 cases (87%), pyuria in 10 cases(32%), and proteinuria in 21 cases(68%). Urine specific gravity in 7 patients(23%) were below 1.010. Routine CBC showed anemia less than 10 g/dl in 16 cases(52%), and thrombocytopenia less than 50,000/mm in 10 cases(32%). During postoperative period blood chemistry showed elevated BUN in most of the cases. BUN levels in 20 cases(65%) were above 60 mg/dl and serum creatinine levels in 26 cases(84%) were above 3mg/dl. Serum sodium levels in 4 cases were below 125 mEq/L and serum potassium levels in 11 cases(35%) were above 6 mEq/L. 7) Nineteen(61%) of 31 patients were nonoliguric type, nine(29%) were oliguric type and three(10%) were anuric type. Fourteen(45%) of 31 patients underwent hemodialysis. 8) Postoperative complications were developed in 25 cases(81%) and pulmonary complications were most common. 9) Median time interval between onset of acute renal failure and death was 18 days(rang to 45 days) and. median time to recovery was 24 days(range, 3 to 72 days). 10) Twenty(6496) of 31 patients were died. Main causes of death were respiratary failure, cardiac failure and sepsis. The high mortality rate was seen in patients with abdceninal operation(79%), postoperative complications(80%), over 50 years old(71%) and oliguric(78%) or anuric(100%) renal failure.
Acute Kidney Injury* ; Anemia ; Anti-Bacterial Agents ; Blood Transfusion ; Cardiovascular Diseases ; Cause of Death ; Chemistry ; Contrast Media ; Creatinine ; Diabetes Mellitus ; Dialysis ; Diuretics ; Female ; Gynecologic Surgical Procedures ; Heart Failure ; Humans ; Hypotension ; Jaundice ; Male ; Middle Aged ; Mortality ; Orthopedics ; Postoperative Complications ; Postoperative Period ; Potassium ; Proteinuria ; Pyuria ; Renal Dialysis ; Renal Insufficiency ; Sepsis ; Sodium ; Specific Gravity ; Thoracic Surgery ; Thrombocytopenia ; Urinalysis