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Antihistamines are widely used to treat pruritus in patients receiving hemodialysis. In a previous cross-sectional study, we reported an association between antihistamine use and the absence of eccentric cardiac hypertrophy in patients receiving hemodialysis. Therefore, in this study, we sought to evaluate the efficacy of antihistamines on all-cause and cardiovascular mortality in patients receiving hemodialysis according to our outpatient dialysis database. We used a propensity score matching method. Among the 389 patients receiving hemodialysis according to our database, we extracted those taking antihistamines and matched them with patients not taking antihistamines using propensity scores based on 38 variables. All-cause mortality and cardiovascular mortality were estimated by the Kaplan-Meier method, and a log-rank test was used to examine the differences between the survival curves. We included 154 patients, or 77 matched pairs, from the entire cohort (c-statistic = 0.78, p < 0.0001). There were no differences in any background factor between the antihistamine and non-antihistamine group. During the mean observational period of 5.4 years, 50 patients died, and the all-cause mortality rate was 27.3% (21 patients) in the antihistamine group and 37.3% (29 patients) in the non-antihistamine group ( p = 0.0314). The cardiovascular mortality rate was 16.9% (13 patients) in the antihistamine group and 25.9% (20 patients) in the non-antihistamine group ( p = 0.0417). The results of this study suggest that all-cause and cardiovascular mortality improved with antihistamine use in patients receiving hemodialysis. However, the clinical efficacy of antihistamines needs to be confirmed in a prospective randomized study in the future. [ABSTRACT FROM AUTHOR]

The left atrium (LA) is afterload-sensitive, meaning that it responds to changes in left ventricular diastolic pressure, and left atrial volumetric remodeling has been reported. We prospectively examined the effects of LA enlargement and ST-T changes on cardiovascular outcome of chronic hemodialysis (HD) patients. Echocardiography was performed twice, a mean interval of 2.1 ± 0.4 years apart, and LA size, left ventricular mass index (LVMI), and other indices were evaluated. The prognostic value of ST-T changes and LA dilatation for cardiovascular events was investigated in a cohort of 112 HD patients. The LVDd, interventricular septum thickness, fractional shortening, and LVMI values were higher in the HD patients with ST-T changes and LA dilatation at the second echocardiography. Moreover, LV hypertrophy (LVH) and new cardiovascular events were more common in HD patients with both ST-T changes and LA dilatation ( p = 0.0127). Interdialysis weight gain, presence of ST-T changes and LA dilatation, and use of calcium channel blockers were significantly associated with LVH, and the odds ratios were 1.740, 2.870, and 0.304, respectively. Over a mean follow-up period of 2.1 ± 0.4 years, 27 patients experienced new cardiovascular event. A Cox proportional hazard analysis revealed that complication of coronary artery diseases, the presence of ST-T changes and LA dilatation, and serum albumin levels were significantly associated with incident cardiovascular events, and the hazard ratios were 3.898, 5.182, and 0.185 (1 g/dl per year increase), respectively. In a Kaplan-Meier analysis, incident cardiovascular events were significantly less common in HD patients without ST-T changes and LA dilatation than those with ( p < 0.0001), 50% event-free period was about 2 years in HD patients with ST-T changes and LA dilatation. In conclusion, ST-T changes and LA dilatation predict the cardiovascular outcome of chronic HD patients. Detecting ST-T changes on ECG and LA dilatation is useful for monitoring cardiovascular risk in chronic HD patients. [ABSTRACT FROM AUTHOR]

Suppression of left ventricular (LV) remodeling secondary to heart failure seems critical to improve the prognosis of hemodialysis (HD) patients. This is a retrospective study on the relationship of an antiallergic drug and antihistamines with LV hypertrophy. A total of 149 patients (88 males and 61 females) were entered in the study. Mean age was 66.7 years and mean duration of dialysis 14.4 years. Twenty-three patients received oral treatment with an antiallergic drug or second-generation antihistamines, 3 with the antiallergic drug and 20 with antihistamines. The multivariate analysis using LV mass index (LVMI) as the objective variable extracted the following independent factors: male sex, erythropoietin (EPO)/w, uric acid (UA), total cholesterol, antihistamines, antiallergic drug, and calcium channel blocker (CCB), with a standard regression coefficient of 0.187, 0.196, 0.212, −0.262, −0.215, −0.149 and −0.173, respectively. This study suggests a suppressive role of second-generation antihistamines on LV remodeling. Male sex, high-dose EPO/w, and elevated UA were considered as aggravating factors, and CCB as a suppressive factor. [ABSTRACT FROM AUTHOR]