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1. Associations of Cognitive Function and Education Level With All-Cause Mortality in Adults on Hemodialysis: Findings From the COGNITIVE-HD Study

Author

David W. Johnson, Giancarlo Logroscino, R. Fichera, A. Failla, Jörgen Hegbrant, R. Antinoro, M. Meconizzi, A. Bua, Patrizia Natale, D. Rallo, A. Marangelli, A.V. Cagnazzo, S. Messina, Marinella Ruospo, M. Sambati, C. Donatelli, Rosanna Tortelli, F. Grippaldi, Giovanni F.M. Strippoli, G. Matera, Jonathan C. Craig, P. Nasisi, Annalisa Iurillo, D. Bertino, L. Moscardelli, G. Marino, S. Papagni, A. D’Angelo, S. Pagano, Charlotta Wollheim, M. Mantuano, Suetonia C. Palmer, C. Saturno, Germaine Wong, A. Maniscalco, Maria Rosaria Barulli, N. Dambrosio, M. Fici, Marco Murgo, A. Lupo, G. Randazzo, N. Sanfilippo, Marcello Tonelli, Armando Teixeira-Pinto, Clement T. Loy, A. Molino, A. Flammini, G. Latassa, G. Montalto, Letizia Gargano, M. Benevento, S. Campo, E. Boccia, Anita van Zwieten, C. Capostagno, F. Alicino, R. Di Toro Mammarella, F. Pedone, and Valeria Saglimbene

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Population, 030232 urology & nephrology, Cohort Studies, 03 medical and health sciences, Cognition, 0302 clinical medicine, Renal Dialysis, Internal medicine, medicine, Humans, Cognitive Dysfunction, Prospective Studies, 030212 general & internal medicine, Neuropsychological assessment, Mortality, Cognitive decline, education, Prospective cohort study, Dialysis, Aged, Aged, 80 and over, education.field_of_study, medicine.diagnostic_test, Proportional hazards model, business.industry, Middle Aged, 16. Peace & justice, 3. Good health, Nephrology, Educational Status, Kidney Failure, Chronic, Female, Hemodialysis, business
Abstract

Rationale & Objective In the general population, cognitive impairment is associated with increased mortality, and higher levels of education are associated with lower risks for cognitive impairment and mortality. These associations are not well studied in patients receiving long-term hemodialysis and were the focus of the current investigation. Study Design Prospective cohort study. Setting & Participants Adult hemodialysis patients treated in 20 Italian dialysis clinics. Exposures Patients’ cognitive function across 5 domains (memory, attention, executive function, language, and perceptual-motor function), measured using a neuropsychological assessment comprising 10 tests; and patients’ self-reported years of education. Outcome All-cause mortality. Analytical Approach Nested multivariable Cox regression models were used to examine associations of cognition (any domain impaired, number of domains impaired, and global function score from principal components analysis of unadjusted test scores) and education with mortality and whether there were interactions between them. Results 676 (70.6%) patients participated, with a median age of 70.9 years and including 38.8% women. Cognitive impairment was present in 79.4% (527/664; 95% CI, 76.3%-82.5%). During a median follow-up of 3.3 years (1,874 person-years), 206 deaths occurred. Compared to no cognitive impairment, adjusted HRs for mortality were 1.77 (95% CI, 1.07-2.93) for any impairment, 1.48 (95% CI, 0.82-2.68) for 1 domain impaired, 1.88 (95% CI, 1.01-3.53) for 2 domains, and 2.01 (95% CI, 1.14-3.55) for 3 to 5 domains. The adjusted HR was 0.68 (95% CI, 0.51-0.92) per standard deviation increase in global cognitive function score. Compared with primary or lower education, adjusted HRs were 0.79 (95% CI, 0.53-1.20) for lower secondary and 1.13 (95% CI, 0.80-1.59) for upper secondary or higher. The cognition-by-education interaction was not significant (P = 0.7). Limitations Potential selection bias from nonparticipation and missing data; no data for cognitive decline; associations with education were not adjusted for other socioeconomic factors. Conclusions Cognitive impairment is associated with premature mortality in hemodialysis patients. Education does not appear to be associated with mortality.

Published
2019
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2. Dietary Patterns and Mortality in a Multinational Cohort of Adults Receiving Hemodialysis

Author

S. Erkalkan, M.C. Guimont, M. Peñalver, A.R. Scuturdean, S. Dzimira, L. Cermeño, V. Doria, Amparo G. Bernat, R.I. Marian, L. Albarracín, F. Ros, D. Daniewska, R. Gonzalez, D. Grbavac, S. Marone, M. Sambati, M. Grabowska, S. Albitar, M. Martínez, Marietta Török, D. Dumitrache, M. Casanú, J. Corral, J. Farto, A. Diago, M. Lankester, R. Bargna, H. López, Saleem Muhammad Rana, A. Badino, L. Ziombra, Patrizia Natale, C. Engler, M. Lentini Deuscit, G. Randazzo, B. Lococo, M. Capdevila, E. Varga, C. Tursky, Tevfik Ecder, Maria C. Garcia, M. Alonso, M. Simon, P.F. Steri, E. Agapi, M. Acosta, Alina Rodriguez, K.S. Katzarski, Alejandra Jaramillo Garcia, Martin Hansis, A. Całka, A. Maniscalco, A. Ozlu, E. Abrego, M. Piechowska, M. Otero, S. Ongun, S. Messina, L. Baumgart, C.M. Incardona, S. Hint, C. Blasco, S. Menardi, E. Fernnandez, R. Paparone, E. Kiss, E. García, N. Kamin, C. Marinaro, C. Capostagno, G. Corpacci, D. Bischoff, D. Kozicka, G. Valle, J. Kunow, S. Papagni, C.M. Gavra, M. Navarro, D. Florio, A. Orosz, G. Wyrwicz-Zielińska, A. Fernandez, E. Gonzalez, M. López, G. Latassa, R. Fichera, D. Novello, A. Romero, N.A. Millán, O. Da Cruz, C. Recalde, C. Villalba, A. Soto, F. Popescu, P. Vergara, T. Merzouk, G. Scuto, C. Galli, Delia Timofte, J. García, J. Drabik, D.V. Di Benedetto, J.L. Lopez, R. Álvarez, F. Alicino, S. Traver, S. Arentowicz, A. Pajot, A. Buyukkiraz, A. Gutierrez, F. Villalba, S. Luengo, Letizia Gargano, M. Soto, C. Ljubich, S. Grosser, N. Sonmez Turksoz, E. Morales, D. Lopez, B. Vázquez, M. Fóns, A. Toth, F. Montoya, D. Galarce, M.Q. Cunill, J. Leibovich, A. Malimar, S. Grueger, G. Marino, C. Jorge, M. Meconizzi, H. Arslan, C. Moscatelli, S. Bea, J. Vinczene, C. Todaro, L. Petracci, C. Boriceanu, S. Ferrás, C. Strano, M. Popa, F. Ranieri, S.z. Szummer, I. Csaszar, C. Favalli, R. Martinez, D. Bueno, N. Ozveren, A. Guerin, B. Ferreiro, J. Csikos, Elisabeth Fabricius, M. Drobisz, E. Bodurian, A.G.M. Mandita, E. Orero, N. Junqueras, Giovanni F.M. Strippoli, Paolo Felaco, A.M. Murgo, E. Railean, S. Chiarenza, M. Brahim-Bounab, W. Dżugan, J. Ostrowski, R. Ilies, M. Benevento, R. Mocanu, F. Villemain, L. Rosu, A. Wulcan, K. Doskocz, Eduardo Celia, Vanessa Garcia-Larsen, S. Filimon, R. Antinoro, K. Steiner, V. Greco, H.M. Sifil, P. González, P.P. Buta, U. Hark, J. Redl, L. Mitea, A. Robert, C. Romero, Ruben Gelfman, E. Iravul, M. Barb, D.C. Moro, A. Lupo, Armando Teixeira-Pinto, Anna Bednarek-Skublewska, M.L. Popa, J. Santini, J. Carreras, G. Bako, V. Pesqueira, W. Ślizień, I. Leocadio, S. Mitea, S.L. Medrihan, M. Szabo, K. Szentendrey, C.L. Teodoru, P. Soler, R. Munteanu, L. Duzy, J.L. Pizarro, A. Barrera, K. Albert, M. Corbalán, S. Campo, F. Torsello, A. Bua, V. Abujder, Valeria Saglimbene, N. Dambrosio, K. Mengu, I. Lluch, S. Esteller, W. Cruz, J. Goch, G. Peñaloza, A. Failla, G. Cuesta, V. Benages, Angelo M. Murgo, F. Tollis, Charlotta Wollheim, M. Mantuano, J. Mora, R. Celik, C.L. Ardelean, R. Cejas, M.I. Cardo, M. Wypych-Birecka, S. Abal, P. Chávez, A. Ertas, L. Kovacs, M. Fici, C. Focsaner, I. Garcia, A. Peñalba, J. Fernández, A. Mahi, M. Cernadas, J. Saupe, K. Magyar, M. Rapetti, E. Tanase, A. Varga, E. Nattiello, N. Havasi, A. D’Angelo, V. de Sá Martins, O. Hermida, L. López, E. Boccia, C. Riccardi, Y. Saingra, T. Ballester, T. Pinheiro, M. Carro, C. Campos, P. Nasisi, M. Maza, G. di Leo, A. Molino, C. Mato Mira, E. Dragan, A. Maciel, A. Flammini, M. Myślicki, M. Hubeli, Alan D. Lopez, D. Bertino, A. Bereczki, I.S. Dogan, M. Coombes, J. Torres, Katrina L. Campbell, L. Cucuiat, M. Karakaya, G. Montalto, D. Prades, M.J. Soler, P. Bouvier, N. Sanfilippo, S. Morales, L. Alcalde, H. Akbiber, S. Araujo, M. May, Paul Stroumza, V. Aguilera, Z. Ozkan, Marcello Tonelli, D. Cáceres, M. Nitu, P. Rutkowski, Juan Jesus Carrero, S. Pagano, I. Rico, M. Diaconita, Marinella Ruospo, J. Forcano, G. Redondo, Z. Yilmaz, M. Mazur, A. Salerno, I. Vilamajó, David M. Pereira, Suetonia C. Palmer, Manuel Arias, A. Blaga, A. Jaroszynski, E. Nemeth, David W. Johnson, V. Alonso, A. Kosicki, E. Vescovo, E. Bochenska-Nowacka, O.M. Trovato, F. Vera, E. Ros, A. Echavarría, Peter Stenvinkel, C. Saturno, Germaine Wong, Marco A Avila, J. Dayer, M.J. Agost, M. Farré, B. Noroña, I. Ullmann, E. Zajko, C. Donatelli, A. Mike, J.L. Poignet, A. Ramos, M. Roesch, S. Mansilla, P. Worch, E. Geandet, T. Pfab, N. Centurión, M. Gravielle, E. Perez, T. Grzegorczyk, M. Szilvia, A. Coco, J. de Dios Ramiro, L. Moscardelli, S. Narci, C. Villareal, A. Dino, S. Frydelund, P. Ciobotaru, Susanne Hoischen, A. Puglisi, L. Florescu, F. Sagau, Domingo Del Castillo, K. Tolnai, G. Matera, A.R. Mira, Jonathan C. Craig, R. Trioni, A. Baidog, E. Kerekes, S. Laudani, R. Di Toro Mammarella, A. Benmoussa, B. Velez, F. Pedone, E. De Orta, F. Grippaldi, V. Bumbea, A. Milán, S. Tirado, Jörgen Hegbrant, Jan Duława, N. Austa Bel, Elmi Muller, E. Tanyi, I. Herrero, M. Indreies, D. Rallo, C. Garcia, A.V. Cagnazzo, J. Benders, Y. Diaz, M. Olaya, M. Arrigo, L. Bicen, C. Miracle, V. Quispe, L. Aguiar, O. Delicia, A. Hardaman, J. Tajahuerce, M. Chauque, A. Marangelli, E. Marileo, D. Kosa, and G. Carrizo

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, 030232 urology & nephrology, Global Health, 03 medical and health sciences, 0302 clinical medicine, Renal Dialysis, Internal medicine, Cause of Death, Western diet, medicine, Humans, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Dialysis, Cardiovascular mortality, business.industry, Public health, Feeding Behavior, Middle Aged, Diet, Survival Rate, Quartile, Nephrology, Cardiovascular Diseases, Cohort, Kidney Failure, Chronic, Female, Hemodialysis, business, Follow-Up Studies
Abstract

Rationale & Objective Clinical practice guidelines for dietary intake in hemodialysis focus on individual nutrients. Little is known about associations of dietary patterns with survival. We evaluated the associations of dietary patterns with cardiovascular and all-cause mortality among adults treated by hemodialysis. Study Design Prospective cohort study. Setting & Participants 8,110 of 9,757 consecutive adults on hemodialysis (January 2014 to June 2017) treated in a multinational private dialysis network and with analyzable dietary data. Exposures Data-driven dietary patterns based on the GA2LEN food frequency questionnaire. Participants received a score for each identified pattern, with higher scores indicating closer resemblance of their diet to the identified pattern. Quartiles of standardized pattern scores were used as primary exposures. Outcomes Cardiovascular and all-cause mortality. Analytical Approach Principal components analysis with varimax rotation to identify common dietary patterns. Adjusted proportional hazards regression analyses with country as a random effect to estimate the associations between dietary pattern scores and mortality. Associations were expressed as adjusted HRs with 95% CIs, using the lowest quartile score as reference. Results During a median follow-up of 2.7 years (18,666 person-years), there were 2,087 deaths (958 cardiovascular). 2 dietary patterns, “fruit and vegetable” and “Western,” were identified. For the fruit and vegetable dietary pattern score, adjusted HRs, in ascending quartiles, were 0.94 (95% CI, 0.76-1.15), 0.83 (95% CI, 0.66-1.06), and 0.91 (95% CI, 0.69-1.21) for cardiovascular mortality and 0.95 (95% CI, 0.83-1.09), 0.84 (95% CI, 0.71-0.99), and 0.87 (95% CI, 0.72-1.05) for all-cause mortality. For the Western dietary pattern score, the corresponding estimates were 1.10 (95% CI, 0.90-1.35), 1.11 (95% CI, 0.87-1.41), and 1.09 (95% CI, 0.80-1.49) for cardiovascular mortality and 1.01 (95% CI, 0.88-1.16), 1.00 (95% CI, 0.85-1.18), and 1.14 (95% CI, 0.93-1.41) for all-cause mortality. Limitations Self-reported food frequency questionnaire, data-driven approach. Conclusions These findings did not confirm an association between mortality among patients receiving long-term hemodialysis and the extent to which dietary patterns were either high in fruit and vegetables or consistent with a Western diet.

Published
2018

3. Dental Health and Mortality in People With End-Stage Kidney Disease Treated With Hemodialysis: A Multinational Cohort Study

Author

L. Penayo, A. Gutierrez, S. Serrano, Anna Bednarek-Skublewska, C. Riccardi, Letizia Gargano, M. Simon, B. De la Torre, G. Kriza, Patrizia Natale, V. Acosta, M. Yucoswky, G. Decsi, Á. Zsedenyi, V. Nascar, M. Drobisz, Pauline J. Ford, G. Bava, Sz. Szummer, J. Barbas, N. Alonso, Ruben Gelfman, A. Gómez, Jörgen Hegbrant, Jennifer H. Martin, E. Kiss, M. Ghiani, G. Corpacci, C. Saturno, A. Bonelli, N. San Filippo, M. Garcia Gallart, B. Salamone, E. Sena, Germaine Wong, J. Dayer, Jan Duława, A. Mendes, A. Maniscalco, J. Montenegro, L. Kovacs, A. Fernandez, A. Peñalba, M. Cernadas, F. Torsello, J. Csikos, O. Da Cruz, N. Falsitta, V. Avalos, M. Serrano, C. Mato Mira, K. Magyar, Amparo G. Bernat, D. Kosa, G. Carrizo, P. Pellegrino, D. Florio, M. Jofre, A. D’Angelo, R. Vizinho, A. Fortes, R. Fichera, A. Toth, Maria Teresa Botti Rodrigues Santos, G. Cuesta, M. Zapata, M. Lobos, D. Galarce, T. Calderón, A. Caetano, G. Paparella, E. Tanyi, K. Tolnai, Giovanni F.M. Strippoli, G. Di Napoli, E. Boccia, W. Labonia, S. Maestre, Paul Stroumza, A. Paredes Álvarez, D. Rallo, D. Gravac, P.F. Steri, M. De Benedittis, S. Pagano, I. Pinke, M. Paulón, R. Antinoro, Marcello Tonelli, H. Gorena, A. Bereczki, J. Rodriguez, E. Abrego, C. Izidoro, K. Steiner, A. Capelo, Fabio Pellegrini, J. Lopes, Saleem Muhammad Rana, E. Geandet, E. Varga, V. Muñiz, M. Tosi, A. Bora, D. Rubio, Jonathan C. Craig, A. Escobar, J. Redl, O. Hermida, Luc Frantzen, Suetonia C. Palmer, M. Szabo, M. Pinter, V.A. Cagnazzo, Manuel Arias, L. Martins, M. Gravielle, Ö. Bajusz, M. Szilvia, M. Petruzzi, G. Marino, G. Randazzo, R. Di Toro Mammarella, L. Inchaustegui, L. Gianoni, A. Bernat, H. Altman, Zs. Jobba, A. Jaroszynski, E. Zajko, L. Gamín, C. Donatelli, A. Mike, Marinella Ruospo, Charlotta Wollheim, M. Mantuano, C. Madeira, E. Nemeth, L. Moscardelli, Eliete Rodrigues de Almeida, Casper P. Bots, F. Pedone, F. Ros, D. Sousa Mendes, David W. Johnson, S. Claros, M. Meconizzi, Marietta Török, K. Doskocz, Valeria Saglimbene, J. Corral, M. Cisneros, M. Kereszturi, N. Dambrosio, Juan Nin Ferrari, S. Frantzen-Trendel, R. Paparone, A. Lupo, R. Dupuy, Alan D. Lopez, M. Natiello, P. De Rosa, A. Cortesão, J. Vinczene, L. Petracci, C. Boriceanu, M. Camargo, V. Vergara, M. Canteli, L. Gyergyoi, C. Mendieta, R. Toth, G. Chiesura, M. Fici, Michele De Benedittis, Massimo Petruzzi, Zs. Zalai, K. MacGregor, E. Vescovo, J. Szkutnik, R.M. Rodriguez, M. Arijón, A. Kuti, M. Coombes, M. Capdevila, S. Maldera, E. Orero, J. Sieczkarek, Marco Murgo, Domingo Del Castillo, S. Silva Pinheiro, M. Muñiz, A. Coronel, I. Csaszar, Germán Santana Pérez, E. Bochenska-Nowacka, M. Arana, Maria C. Garcia, F. Sanchez, S. Olivera, C. Calderón, C. Cechín, E. Ros, G. Wyrwicz, G. Giannoccaro, A. Flammini, G. Montalto, J. Drabik, K. Albert, S. Cantarella, G. Neme, S. Mansilla, D. Leitão, S. Tirado, V. Siciliano, E. Mojico, R. Oliszewski, Miguel Leal, M. Daud, I. Vilamajó, C. Outerelo, G. Kiss, D. Daniewska, M. Sambati, M. Birecka, Eduardo Celia, G. Valle, K. Nagy, A. Orosz, J. Bequi, and J. García

Subjects
Male, Internationality, medicine.medical_treatment, Dentistry, Oral Health, modifiable risk factor, Cohort Studies, cardiovascular mortality, Cause of Death, end-stage kidney disease, Medicine, Prospective Studies, Prospective cohort study, Aged, 80 and over, hemodialysis, Age Factors, Middle Aged, Treatment Outcome, Nephrology, ORAL-D (Oral Diseases in Hemodialysis) Study, Cardiovascular Diseases, Cohort, all-cause mortality, Female, Hemodialysis, Cohort study, medicine.medical_specialty, Renal failure, dental disease, Oral hygiene, Risk Assessment, Sex Factors, stomatognathic system, Predictive Value of Tests, Renal Dialysis, Internal medicine, Oral and maxillofacial pathology, Confidence Intervals, Humans, Aged, Proportional Hazards Models, business.industry, Proportional hazards model, ORAL-D (Oral Diseases in Hemodialysis) Study, Renal failure, all-cause mortality, cardiovascular mortality, dental disease, end-stage kidney disease, hemodialysis, modifiable risk factor, oral health, oral hygiene, oral hygiene, medicine.disease, Survival Analysis, oral hygeine, stomatognathic diseases, Multivariate Analysis, Kidney Failure, Chronic, business, Kidney disease
Abstract

Background Dental disease is more extensive in adults with chronic kidney disease, but whether dental health and behaviors are associated with survival in the setting of hemodialysis is unknown. Study Design Prospective multinational cohort. Setting & Participants 4,205 adults treated with long-term hemodialysis, 2010 to 2012 (Oral Diseases in Hemodialysis [ORAL-D] Study). Predictors Dental health as assessed by a standardized dental examination using World Health Organization guidelines and personal oral care, including edentulousness; decayed, missing, and filled teeth index; teeth brushing and flossing; and dental health consultation. Outcomes All-cause and cardiovascular mortality at 12 months after dental assessment. Measurements Multivariable-adjusted Cox proportional hazards regression models fitted with shared frailty to account for clustering of mortality risk within countries. Results During a mean follow-up of 22.1 months, 942 deaths occurred, including 477 cardiovascular deaths. Edentulousness (adjusted HR, 1.29; 95% CI, 1.10-1.51) and decayed, missing, or filled teeth score ≥ 14 (adjusted HR, 1.70; 95% CI, 1.33-2.17) were associated with early all-cause mortality, while dental flossing, using mouthwash, brushing teeth daily, spending at least 2 minutes on oral hygiene daily, changing a toothbrush at least every 3 months, and visiting a dentist within the past 6 months (adjusted HRs of 0.52 [95% CI, 0.32-0.85], 0.79 [95% CI, 0.64-0.97], 0.76 [95% CI, 0.58-0.99], 0.84 [95% CI, 0.71-0.99], 0.79 [95% CI, 0.65-0.95], and 0.79 [95% CI, 0.65-0.96], respectively) were associated with better survival. Results for cardiovascular mortality were similar. Limitations Convenience sample of clinics. Conclusions In adults treated with hemodialysis, poorer dental health was associated with early death, whereas preventive dental health practices were associated with longer survival.

Published
2015

4. [The effect of different 'coherent'-type therapeutic plans on bone mineral density and on the incidence of vertebral fractures in advanced osteoporosis]

Author

S, Cristallini, M, Pedetti, C, Donatelli, F, Gregorio, and P, Filipponi

Subjects
Adult, Calcitonin, Analysis of Variance, Incidence, Middle Aged, Fluorides, Fractures, Spontaneous, Bone Density, Humans, Regression Analysis, Spinal Fractures, Calcium, Drug Therapy, Combination, Female, Osteoporosis, Postmenopausal, Aged, Cholecalciferol
Abstract

Fifty patients with advanced osteoporosis were treated for 2 years with calcitonin+fluoride using cyclic therapeutic regimens. We evaluated their efficacy in recovering bone loss and reducing the rate of vertebral crush fractures. Twenty-seven control patients were treated for one year with calcium+vitamin D supplements. In the 59% of patients who responded to calcitonin the gain in bone mass (dual photon absorptiometry) correlated inversely with urine calcium and hydroxyproline excretion and serum osteocalcin. In the 70% responding to calcitonin+fluoride it correlated positively with serum osteocalcin and alkaline phosphatase and inversely with urine calcium and hydroxyproline excretion. Compared to basal value both coherent regimens resulted in a significant increase (calcitonin: 1.92 +/- 1.8%, p0.01; calcitonin+fluoride: 3.7 +/- 1.4%, p0.0005) in spinal bone mass but no significant differences emerged between them. The rate of vertebral crush fractures (radiogrammetry) did not very significantly in any group. The gain in bone mass does not predict the risk of vertebral crush fractures.

Published
1993

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