ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO1162

The Accumulation of Various Uremic Retention Solutes Is Associated with Early Mortality After Starting Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Arai, Yohei, Department of Nephrology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
  • Shioji, Shingo, Department of Nephrology, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa, Japan
  • Tanaka, Hiroyuki, Department of Nephrology, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa, Japan
  • Noguchi, Haruka, Department of Nephrology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
  • Chinen, Miria, Department of Nephrology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
  • Mikako, Suzuki, Department of Nephrology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
  • Kondo, Isao, Department of Nephrology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
  • Sakamoto, Emi, Department of Nephrology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
  • Niikura, Takahito, Department of Nephrology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
  • Suzuki, Minami, Department of Nephrology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
  • Katagiri, Daisuke, Department of Nephrology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
  • Hinoshita, Fumihiko, Department of Nephrology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
Background

Uremic retention solutes (URS) generally accumulate in patients with end-stage renal disease (ESRD). Many of these URS have been shown to exert unfavorable biological activity resulting in poor prognosis. Although some kinds of URS before starting hemodialysis (HD) has been proven to be a risk factor for early mortality after starting HD, it remains unknown whether excess accumulation of various URS is associated with further worse prognosis after starting HD according to the degree.

Methods

We conducted a retrospective cohort study to investigate the association between the accumulation of various URS and early mortality after starting HD. The cohort consisted of adult patients who started HD for ESRD at the National Center for Global Health and Medicine from 2010 to 2019. To evaluate the accumulation of various URS, the uremic score was specifically defined as a total number of measurable variables related with uremia in clinical practice; blood urea nitrogen (BUN) >100 mg/dl, change in anion gap corrected for albumin (ΔAG) >5 mmol/l and β2-microglobulin (β2MG) >20 mg/l before starting HD. The primary outcome was death within a year of the start of HD. The hazard ratio for one score increase in the uremic score was calculated using Cox proportional hazard models with adjustments for baseline characteristics. Moreover, we investigated underlying characteristics related with these variables using logistic regression.

Results

We enrolled 206 patients (males, 76%). During a mean follow-up of 344 days, the primary outcome was observed in 16 patients. The uremic score was significantly associated with the primary outcome (hazard ratio: 1.97, 95% confidence interval 1.19-3.27; adjusted hazard ratio: 4.82, 95% confidence interval 1.97-11.7). Patients with high BUN had a lower frequency of cardiovascular disease. High ΔAG and β2MG were associated with hypoalbuminemia respectively. Moreover, patients with high ΔAG were relatively young and had a lower frequency of diabetes.

Conclusion

The accumulation of various URS is associated with early mortality after starting HD.