17 th Annual Meeting of JSHDF, Sept 3-4, 2011

Transcription

1 17 th Annual Meeting of JSHDF, Sept 3-4, 2011 Sug Kyun Shin 1, JY Moon 2, SW Han 3, DH Yang 4, SH Lee 2, HC Park 5, JK Kim 6 and YI Jo 7 1 Nephrology, NHIC Ilsan Hospital, 2 Kyunghee University Hospital at Gangdong, 3 Hanyang University Guri Hospital, 4 Bundang CHA Hospital, 5 Yonsei University Gangnam Severance Hospital, 7 Konkuk University Hospital; 6 Department of ENT, Konkuk University Hospital; Seoul, KOREA

2 Background-(1) It is well recognized that malnutrition is one of the main factors affecting morbidity and mortality in dialysis patients. Multiple factors may contribute to the development of malnutrition in patients with ESRD. - Alterations in taste and smell??? In elderly people in the general population, poor odor perception is associated with lower nutrient intake.

3 Background-(2) Although research into olfactory function in patients with ESRD is limited, olfactory function seems to be decreased in ESRD patients.

4 Griep MI et al. NDT 1997;12:

5 Background-(3) In patients with ESRD, impaired olfactory function may be associated with alterations in taste and smell and malnutrition? Raff AC et al. AJKD 2008;52:

6 Smell Score according to SGA * * p<0.001 vs. healthy controls * * Raff AC et al. AJKD 2008;52:

7 Background-(4) The cause of olfactory dysfunction in ESRD??? The effect of dialysis on olfactory function in ESRD??? Only a few researches about olfactorydys function in ESRD have been reported.

8 Smell Studies in Pts with ESRD, CKD, TXN Authors Year Journal No. of Subjects 1 Raff et al AJKD Controls 18, HD 31 2 Jo et al KJN Controls 20, CKD 20, HD 28, PD 22 3 Fransnelli et al Am J Rhinol Controls 15, CKD 15, HD 49 4 Griepet al NDT Controls 101, CKD 19, HD 38, PD 16, TXN 28 5 Corwin et al Neuropsychol. Controls 15, HD 14 6 Conrad et al Nephron Controls 10, HD 15 7 Vremanet al Nephron Controls 48, CKD 7, HD 26 8 Schiffman et al Physiol Behav Controls 16, HD 11

9 Griep MI et al. NDT 1997;12:

10 Smell Scores in Pre-dialysis & Dialysis Pts. Jo YI et al. Kor J Nephrol 2002;21:

11 Distribution of Total Kt/V and Smell Scores R= P= Jo YI et al. Kor J Nephrol 2002;21:

12 Background-(5) Previous cross-sectional studies showed that. (1) Olfactory function is impaired in ESRD patients. (2) Odor perception of ESRD patients receiving dialysis may be not differ with that of healthy controls. (3) Odor perception is fully restored to that of healthy controls after renal transplantation.

13 Background-(6) These findings of previous studies suggest that. (1) Decreased olfactory function in ESRD is due to uremic toxins. (2) Impaired olfactory function is fully reversible with complete resolution of the uremic state. However, there was no prospective study following initiation of dialysis on olfactory function in ESRD patients.

14 Purpose This prospective observational study was designed to clarify the effect of dialysis on olfactory function of ESRD patients who initiate maintenance HD or PD.

15 Subjects & Methods A multicenter, prospective, observational study. Subjects : 71 ESRD patients who initiated dialysis from 2010 through 2011 at 6 hospitals. - Hemodialysis: n=34, age 58.3± Peritoneal dialysis: n=37, age 56.3±15.5

16 Study Design Smell test by CC-SIT : 0, 3, 6 months. Kt/V urea, i-pth : 0, 3, 6 months. Other routine laboratory study : monthly.

17 CC-SIT: Cross-Cultural Smell Identification Test

18 Inclusion Criteria 1. ESRD patients who initiated dialysis (hemodialysis or peritoneal dialysis) from 2010 through Intact mental status.

19 Exclusion Criteria 1. Obstructions in the nasal cavity 2. Inability to breath freely through the nostril. 3. Maxillary sinusitis. 4. Upper respiratory infection. 5. Cognitive deficits. 6. Alcohol abuse.

20 Statistical Analysis Expressed in mean±sd. SPSS 18.0 Analysis: (1) Parameteric test: Student t-test (2) Non-parametric test (Comparison of CC-SIT scores over times): Wilcoxon s Matched-Pairs Signed-Rank Test (3) Correlation: Pearson analysis.

21 Results

22 Baseline Characteristics-(1) HD PD p No. of Subjects (n) Male [n(%)] 17 (50.0%) 17 (44.4%) n.s. Age (years) 58.3± ±15.5 n.s. Causes of ESRD [n(%)] DM 19 (56.3%) 17 (47.2%) n.s. Hypertension 6 (18.7%) 11 (27.8%) n.s. Chronic GN 3 (6.3%) 2 (5.6%) n.s. Others/ Unknown 6 (18.7%) 7 (19.4%) n.s. Smoking status Current smoking (%) 43.7% 35.2% n.s.

23 Baseline Characteristics-(2) HD PD p Serum Cr (mg/dl) 7.1± ±3.0 n.s. egfr-mdrd (ml/min/1.73m 2 ) 7.8± ±4.9 n.s. Serum albumin (mg/dl) 3.3± ±0.4 n.s. Total cholesterol (mg/dl) 122.6± ±48.2 n.s. Hb (g/dl) 9.8± ±1.2 n.s. Ca (mg/dl) 7.7± ±0.9 n.s. P (mg/dl) 4.6± ±1.1 n.s. i-pth (pg/ml) 94.5± ±132.6 n.s. hs-crp (mg/dl) 0.3± ±0.1 n.s. HbA1C (%) 7.9± ±1.5 n.s.

24 Changes of Laboratory Results Over Time 0 month 3 month 6 month egfr-mdrd (ml/min/1.73m 2 ) 9.5± ± ±4.4 Kt/V urea (-) 1.3± ±0.8 Serum albumin (mg/dl) 2.9± ± ±0.2 Total cholesterol (mg/dl) 150.5± ± ±38.4 Hb (g/dl) 9.8± ± ±1.3 Ca (mg/dl) 8.2± ± ±0.5 P (mg/dl) 4.9± ± ±0.5 i-pth (pg/ml) 223.0± ± ±188.0 hs-crp (mg/dl) 0.3± ± ±0.2 HbA1C (%) 7.2± ± ±1.8

25 Smell Score at baseline: measured by CC-SIT Smell score Smell score at baseline = 8.2±2.3

26 Distribution of Smell Score according to GFR Smell score egfr-mdrd (ml/min/1.73m 2 )

27 Distribution of Smell Score according to Age Smell score Age (years) R= P= 0.002

28 Smell Score and Nutritional Status Albumin Total cholesterol

29 Smell Score according to Variable Factors Gender Diabetes Smell score Male p= Female Smell score DM p= Non-DM

30 Changes of Smell Score following Dialysis Smell score Baseline 3 month 6 month * Duration of dialysis * p=0.007 vs. baseline p=0.006 vs. baseline

31 Changes of Smell Score: HD vs. PD CC-SIT score at baseline Smell score HD p= PD Smell score Baseline 3 month 6 month * * p=0.043 vs. baseline of HD p=0.006 vs. baseline of HD p=0.036 vs. baseline of PD PD (n=36) HD (n=16)

32 Changes of Smell Score: DM vs. Non-DM CC-SIT score at baseline Smell score DM p= Non-DM

33 Changes of Smell Score: 60 vs. >60 yr-old CC-SIT score at baseline Smell score yr p= >60 yr * * p=0.011 vs. baseline of >60 yr p=0.018 vs. 3 month of >60 yr

34 Changes of Smell Score: Male vs. Female CC-SIT score at baseline Smell score Male Female * * p=0.041 vs. male at 6 mon

35 Summary-(1) 1. This study was the first prospective study on olfactory function in ESRD patients. 2. In the ESRD patients not receiving dialysis, (1) smell score which was measured by CC-SIT was negatively correlated with ages (r=-0.179, p=0.02). (2) there was no correlation between smell score and egfr-mdrd, serum albumin or cholesterol level. (3) smell scores were not differ between DM and non-dm patients and between male and female.

36 Summary-(2) 3. Smell scores of ESRD patients increased significantly after initiation of hemodialysis and peritoneal dialysis. 4. Improvement of smell scores following dialysis had no relation to gender, diabetes, or age.

37 Limitation Relatively small sample size. Not age- & sex-matched. Prospective, but no randomized controlled study. No longitudinal prospective study.

38 Conclusions These results suggest that. (1) Smell disturbance in patients with ESRD could be recovered by initiation of dialysis. (2) Recovery of olfactory function may be associated with removal of uremic toxin by adequate dialysis. Prospective longitudinal research is required to clarify whether recovery of olfactory function contribute to better outcomes of morbidity and mortality in ESRD patients.