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Sample records for chronic dialysis patients

  1. Oral Tori in Chronic Peritoneal Dialysis Patients.

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    Chia-Lin Hsu

    Full Text Available The pathogenesis of oral tori has long been debated and is thought to be the product of both genetic and environmental factors, including occlusal forces. Another proposed mechanism for oral tori is the combination of biomechanical forces, particularly in the oral cavity, combined with cortical bone loss and trabecular expansion, as one might see in the early stages of primary hyperparathyroidism. This study investigated the epidemiology of torus palatinus (TP and torus mandibularis (TM in peritoneal dialysis patients, and analyzed the influences of hyperparathyroidism on the formation of oral tori.In total, 134 peritoneal dialysis patients were recruited between July 1 and December 31, 2015 for dental examinations for this study. Patients were categorized into two subgroups based on the presence or absence of oral tori. Demographic, hematological, biochemical, and dialysis-related data were obtained for analysis.The prevalence of oral tori in our sample group was high at 42.5% (57 of 134, and most patients with oral tori were female (61.4%. The most common location of tori was TP (80.7%, followed by TP and TM (14.0%, then TM (5.3%. All 54 TP cases were at the midline, and most were <2 cm (59.3%, flat (53.7%, and located in the premolar region (40.7%. Of the 11 TM cases, all were bilateral and symmetric, mostly <2 cm (81.9%, lobular (45.4%, and located at premolar region (63.6%. Interestingly, patients with oral tori had slightly lower serum levels of intact parathyroid hormones than those without oral tori, but the difference was not statistically significant (317.3±292.0 versus 430.1±492.6 pg/mL, P = 0.126. In addition, patients with oral tori did not differ from patients without tori in inflammatory variables such as serum high sensitivity C-reactive protein levels (6.6±8.2 versus 10.3±20.2 mg/L, P = 0.147 or nutritional variables such as serum albumin levels (3.79±0.38 versus 3.77±0.45 g/dL, P = 0.790. Furthermore, there were no

  2. Determinants of survival among HIV-infected chronic dialysis patients.

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    Rodriguez, Rudolph A; Mendelson, Michael; O'Hare, Ann M; Hsu, Ling Chin; Schoenfeld, Patricia

    2003-05-01

    Over 100 HIV-infected patients have initiated chronic dialysis at San Francisco General Hospital (SFGH) since 1985. This study employed retrospective analysis to identify determinants of and trends in survival among HIV-infected patients who have initiated chronic dialysis at SFGH from January 1, 1985 to November 1, 2002 (n = 115). Cohort patient survival was compared with survival after an AIDS-opportunistic illness in all HIV-infected patients in San Francisco during the study period. Higher CD4 count (hazard ratio [HR], 0.86 per 50 cells/mm(3) increase; 95% confidence interval [CI], 0.80 to 0.93) and serum albumin (HR, 0.53 per 1 g/dl increase; CI, 0.36 to 0.78) at initiation of dialysis were strongly associated with lower mortality. Survival for those initiating dialysis during the era of highly active antiretroviral therapy (HAART) was 16.1 mo versus 9.4 mo for those initiating dialysis before this time, but this difference was not statistically significant. In adjusted analysis, only a non-statistically significant trend toward improved survival during the HAART era was noted (HR, 0.59; CI, 0.34 to 1.04). By comparison, survival for all HIV-infected patients after an AIDS-opportunistic illness in San Francisco increased from 16 mo in 1994 to 81 mo in 1996. The dramatic improvement in survival that has occurred since the mid-1990s for patients with HIV appears to be greatly attenuated in the sub-group undergoing dialysis. Although this may partly reflect confounding by race, injection drug use and HCV co-infection, future attempts to improve survival among HIV-infected dialysis patients should focus on barriers to the effective use of HAART in this group.

  3. Patient-Staff Interactions and Mental Health in Chronic Dialysis Patients

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    Swartz, Richard D.; Perry, Erica; Brown, Stephanie; Swartz, June; Vinokur, Amiram

    2008-01-01

    Chronic dialysis imposes ongoing stress on patients and staff and engenders recurring contact and long-term relationships. Thus, chronic dialysis units are opportune settings in which to investigate the impact of patients' relationships with staff on patient well-being. The authors designed the present study to examine the degree to which…

  4. Relationship of aluminum to neurocognitive dysfunction in chronic dialysis patients

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    Sprague, S.M.; Corwin, H.L.; Tanner, C.M.; Wilson, R.S.; Green, B.J.; Goetz, C.G.

    1988-10-01

    Aluminum has been proposed as the causative agent in dialysis encephalopathy syndrome. We prospectively assessed whether other, less severe, neuropsychologic abnormalities were also associated with aluminum. A total of 16 patients receiving chronic dialytic therapy were studied. The deferoxamine infusion test (DIT) was used to assess total body aluminum burden. Neurologic function was evaluated by quantitative measures of asterixis, myoclonus, motor strength, and sensation. Cognitive function was assessed by measures of dementia, memory, language, and depression. There were four patients with a positive DIT (greater than 125 micrograms/L increment in serum aluminum) that was associated with an increase in the number of neurologic abnormalities observed, as well as an increase in severity of myoclonus, asterixis, and lower extremity weakness. Patients with a positive DIT also showed significant impairment in memory; however, no differences were noted on tests of dementia, depression, or language. There was no significant correlation between sex, age, presence of diabetes, mode of dialysis, years of chronic renal failure, years of dialysis or years of aluminum ingestion and any neurologic or neurobehavioral measurement, serum aluminum level, or DIT. These changes may represent early aluminum-associated neurologic dysfunction.

  5. Lipid Profile in Chronic Renal Failure Patients on Dialysis

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    Nzere Nwamaka Chijioke

    2012-07-01

    Full Text Available ABSTRACTThe incidence of chronic renal failure (CRF is on the increase in Nigeria. This study on the effect of CRF on lipid profile is carried out in CRF patients on dialysis treatment. A total of 100 subjects (both male and female were used for the study. 50 of them were apparently healthy, while the remaining 50 were CRF patients on dialysis. The levels of triglyceride (TG, total cholesterol (TC, high density lipoprotein – cholesterol (HDL-C, low density lipoprotein- cholesterol (LDL-C and very low density lipoprotein –cholesterol (VLDL-L were estimated using enzymatic methods. Their cardiovascular risk indices (TC/HDL-C and LDL-C/HDL-C were also determined.The results indicated that all the parameters were significantly (p<0.05 altered in both sexes when compared with their counterparts in the control group. The cardiovascular risk indices, TC/HDL-C and LDL-C/HDL-C of the CRF patients were higher than those of the control group.In conclusion, the CRF patients on dialysis are at risk of developing cardiovascular disease.

  6. Serum Hepcidin Evaluation in Patients with Chronic Dialysis

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    V. Manolov

    2015-06-01

    Full Text Available The aim of our study was to quantify serum hepcidin levels in Bulgarian patients with chronic kidney disease (CKD. Expected high values of peptide hormones might provide a new therapeutic choice for anemia of chronic disease. We looked for correlation between serum hepcidin levels and some iron metabolism parameters in CKD patients. Results: The sandwich ELISA is highly specific for hepcidin-25. We found statistically significant differences in serum hepcidin levels in patients of the control group, with CKD stages II to IV and CKD stage V (on chronic dialysis: 12.7±8.7μg/L, 90.74±21.1μg/L, and 282.49±81.1μg/L, respectively. Significant correlation between serum hepcidin and transferrin saturation (r=0.340, P<0.05 was found in the group of patients with CKD stage V. Conclusion: The use of 2 monoclonal antibodies in a sandwich ELISA format provides a reliable, reproducible, and inexpensive method for measuring serum concentrations of the bioactive form of hepcidin in Bulgarian laboratory practice.

  7. Hemodialysis versus peritoneal dialysis: a case control study of survival in patients with chronic kidney disease stage 5

    DEFF Research Database (Denmark)

    Maier, Alexandra; Stocks, Franziska; Pommer, Wolfgang;

    2009-01-01

    It is still controversial whether the mode of dialysis or preexisting comorbidities may influence the prognosis of patients with chronic kidney disease stage 5. Therefore, we performed a prospective case control study to evaluate whether the mode of dialysis may influence outcome. We found 25 cases...... dialysis, predicted death in patients with chronic kidney disease. It is concluded that age and comorbidities but not mode of dialysis are important to predict survival in patients with chronic kidney disease stage 5....

  8. Upper Digestive Endoscopic Findings in Patients with Chronic Renal Insufficiency in Phase of Dialysis

    OpenAIRE

    Marcos Félix Osorio Pagola; David Rodríguez Zamora; Juan Luís de Pasos Carrazana; Libán Álvarez Cáceres; Orelvis Martínez Martínez; Anagalys Ortega Alvelay

    2009-01-01

    Background: Patients with chronic renal insufficiency in phase of dialysis present clinical manifestations that can include different symptoms. Morbidity due to gastric, esophageal and duodenal disturbances is significant and constitutes a considerable risk before, while and after a renal transplant. Objective: To identify the most frequent disturbances of the upper digestive tract in patients with chronic renal insufficiency who require dialysis. Methods: An observational, descriptive and r...

  9. Sensorineural Hearing Affection In Sickle Cell Disease Patients With Chronic Renal Failure Under Dialysis

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    Saeed Abdelwhab Saeed MD*, Magdy M El Sharkawy

    2002-09-01

    Full Text Available Objective: to study the problem of hearing loss in patients of chronic renal failure on regular haemodialysis and The factors which affect it. And to study the effect of sickle cell disease on hearing loss. we studied hearing loss in dialysis patients, sickle cell disease patients and patients of sickle cell disease with chronic renal failure under dialysis compared to normal control subjects. Design: !"",include sickle cell disease patients with chronic renal fa"# $%& ' ", i ,nclude ( # #"# $%&'", , ,( #&'", i 9nclude the normal *+&*+' All groups are subjected to full history, thorough clinical examination including neurological and ENT examination, investigations includes Hb, s. creatinine, s.albumen, s.calcium and calculation of kt/v for dialysis patients. Full audiological assessment, using #,-GSI audiometer was done for all groups with special concentration at frequency of - .Results: hearing loss was found in patients with chronic renal failure more than normal control. Patient with sickle cell disease have hearing disorders significantly higher than $/%- .% 0( # #cell disease have significantly. Marked degree of SNHL than those with SCD only. Hearing loss in patients with 12( # * 3 &4 !4! '#"#"patients with chronic renal failure with or without SCD correlate with duration of dialysis , presence of peripheral neuropathy, s. calcium level, efficiency of dialysis marked by kt/v. Conclusion and recommendation: hearing disorder is common in patients with chronic renal failure under regular haemodialysis and it increase with duration of dialysis it should be suspected if there is Peripheral neuropathy. It can be reduced with efficient dialysis, correction of anemia, adjustment of calcium level. Patients with SCD suffer also some degree of hearing loss especially at higher frequency and this degree of hearing loss

  10. Assessment and clinical aspects of health-related quality of life in dialysis patients and patients with chronic kidney disease

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    Molsted, Stig; Prescott, Lotte; Heaf, James;

    2007-01-01

    BACKGROUND/AIMS: It is relevant to investigate health-related quality of life (HRQOL) in dialysis and chronic kidney disease (CKD) patients in order to optimise treatment. The aim of this study was to investigate HRQOL in dialysis and CKD patients, to compare results from patients treated...... control parameters were measured and the patients completed the questionnaire Kidney Disease Quality Of Life. RESULTS: PD patients rated Dialysis Staff Encouragement and Patient Satisfaction better than HD patients (p... with hemodialysis (HD) and peritoneal dialysis (PD) and to investigate the prediction of dialysis quality control parameters (blood hemoglobin, plasma albumin, and Kt/V) and tobacco smoking in disease-specific HRQOL. METHODS: Seventy-one HD, 59 PD, and 63 CKD patients participated in the study. Dialysis quality...

  11. Chronic Kidney Disease-Mineral Bone Disorder in the Elderly Peritoneal Dialysis Patient

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    Heaf, James Goya

    2015-01-01

    PURPOSE: The purpose of this paper was to review the literature concerning the treatment of chronic kidney disease-mineral bone disorder (CKD-MBD) in the elderly peritoneal dialysis (PD) patient. ♦ RESULTS: Chronic kidney disease-mineral bone disorder is a major problem in the elderly PD patient......, with its associated increased fracture risk, vascular calcification, and accelerated mortality fracture risk. Peritoneal dialysis, however, bears a lower risk than hemodialysis (HD). The approach to CKD-MBD prophylaxis and treatment in the elderly PD patient is similar to other CKD patients, with some...

  12. Upstream Discussion Provided in the Ambulatory Setting to Assist Patients with Chronic Kidney Disease Considering Dialysis

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    Le, Tuan K; Chang, Mi; Nelson, Craig; Sortais, Julie Ann; Chand, Pushkar; Tallman, Karen

    2015-01-01

    The authors randomly assigned patients with Stage 4 or 5 chronic kidney disease who had not yet begun renal dialysis to 1 of 2 groups. The test group received an additional nephrology consult with an interdisciplinary team and reported help in forming a treatment plan, felt well understood, and had the opportunity to thoroughly discuss questions. They had a decrease in beginning dialysis, clinic visits, hospital admissions, days hospitalized, and emergency room visits.

  13. Impact of Pediatric Chronic Dialysis on Long-Term Patient Outcome: Single Center Study.

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    Levy Erez, Daniella; Krause, Irit; Dagan, Amit; Cleper, Roxana; Falush, Yafa; Davidovits, Miriam

    2016-01-01

    Objective. Owing to a shortage of kidney donors in Israel, children with end-stage renal disease (ESRD) may stay on maintenance dialysis for a considerable time, placing them at a significant risk. The aim of this study was to understand the causes of mortality. Study Design. Clinical data were collected retrospectively from the files of children on chronic dialysis (>3 months) during the years 1995-2013 at a single pediatric medical center. Results. 110 patients were enrolled in the study. Mean age was 10.7 ± 5.27 yrs. (range: 1 month-24 yrs). Forty-five children (42%) had dysplastic kidneys and 19 (17.5%) had focal segmental glomerulosclerosis. Twenty-five (22.7%) received peritoneal dialysis, 59 (53.6%) hemodialysis, and 6 (23.6%) both modalities sequentially. Median dialysis duration was 1.46 years (range: 0.25-17.54 years). Mean follow-up was 13.5 ± 5.84 yrs. Seventy-nine patients (71.8%) underwent successful transplantation, 10 (11.2%) had graft failure, and 8 (7.3%) continued dialysis without transplantation. Twelve patients (10.9%) died: 8 of dialysis-associated complications and 4 of their primary illness. The 5-year survival rate was 84%: 90% for patients older than 5 years and 61% for younger patients. Conclusions. Chronic dialysis is a suitable temporary option for children awaiting renal transplantation. Although overall long-term survival rate is high, very young children are at high risk for life-threatening dialysis-associated complications. PMID:27597898

  14. Association between family members of dialysis patients and chronic kidney disease: a multicenter study in China

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    Kong Xianglei

    2013-01-01

    Full Text Available Abstract Background Family members of patients with end stage renal disease were reported to have an increased prevalence of chronic kidney disease (CKD. However, studies differentiated genetic and non-genetic family members are limited. We sought to investigate the prevalence of CKD among fist-degree relatives and spouses of dialysis patients in China. Methods Seventeen dialysis facilities from 4 cities of China including 1062 first-degree relatives and 450 spouses of dialysis patients were enrolled. Sex- and age- matched controls were randomly selected from a representative sample of general population in Beijing. CKD was defined as decreased estimated glomerular (eGFR 2 or albuminuria. Results The prevalence of eGFR less than 60 mL/min/1.73 m2, albuminuria and the overall prevalence of CKD in dialysis spouses were compared with their counterpart controls, which was 3.8% vs. 7.8% (P 2, albuminuria and the overall prevalence of CKD in dialysis relatives were also compared with their counterpart controls, which was 1.5% vs. 2.4% (P = 0.12, 14.4% vs. 8.4% (P  Conclusions The association between being family members of dialysis patients and presence of CKD is different between first-degree relatives and spouses. The underlying mechanisms deserve further investigation.

  15. Subjective global assessment of nutritional status is strongly associated with mortality in chronic dialysis patients

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    de Mutsert, Renee; Grootendorst, Diana C.; Boeschoten, Elisabeth W.; Brandts, Hans; van Manen, Jeannette G.; Krediet, Raymond T.; Dekker, Friedo W.

    2009-01-01

    Background: The subjective global assessment of nutritional status (SGA) is used to assess the nutritional status of chronic dialysis patients, but longitudinal data in relation to mortality risk are lacking. Objective: Our objective was to study the long-term and time-dependent associations of the

  16. New clinical guidelines for selective direct injection therapy of the parathyroid glands in chronic dialysis patients.

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    Onoda, Noritaka; Fukagawa, Masafumi; Tominaga, Yoshihiro; Kitaoka, Masafumi; Akizawa, Tadao; Koiwa, Fumihiko; Kakuta, Takatoshi; Kurokawa, Kiyoshi

    2008-08-01

    In 2000, the Japanese Society for Parathyroid Intervention issued the 'Guidelines for percutaneous ethanol injection therapy of the parathyroid glands in chronic dialysis patients'. Since then, the concept of 'selective PEIT' has been well accepted and the number of patients treated by this method in Japan has increased. Recently, it has been reported that the effect of PEIT differs depending on the degree of nodular hyperplasia. Several new drugs have become available since 2000, and active vitamin D and its analogue have also been used for direct injection into the parathyroids. We present the new 'Guidelines for selective direct injection therapy of the parathyroid glands in chronic dialysis patients', a revised version of the 2000 Guidelines. We believe that these new guidelines are useful for selecting direct injection therapy in patients with advanced secondary hyperparathyroidism.

  17. Circadian variation of blood pressure in patients with chronic renal failure on continuous ambulatory peritoneal dialysis

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    Clausen, P; Feldt-Rasmussen, B; Ladefoged, Jens

    1995-01-01

    The circadian pattern of blood pressure variation was investigated in 10 patients with advanced chronic renal failure on continuous ambulatory peritoneal dialysis (CAPD) and in an age-matched group of controls without renal disease with similar office blood pressure level. Monitoring was done using....... In patients with chronic renal failure undergoing CAPD, an otherwise unnoticed 24-h hypertension and nocturnal blood pressure elevation can be discovered by use of 24-h blood pressure monitoring and this may indicate a need of earlier start of antihypertensive treatment in CAPD patients with borderline...

  18. Comparison of 5 IU and 10 IU tuberculin test results in patients on chronic dialysis

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    H Tayebi Khosroshahi

    2012-01-01

    Full Text Available Immunocompromised patients such as those with end-stage kidney failure under-going hemodialysis (HD are at increased risk of developing tuberculosis (TB. For this reason, routine TB screening of HD patients with tuberculin test has been recommended. The Center for Disease Control and Prevention (CDC has recommended that patients with chronic renal failure should undergo annual skin testing for TB with tuberculin [purified protein derivative (PPD], with an induration of ≥10 mm at 48 h depicting a positive reaction. The aim of this study was to compare the results of two different doses of PPD in dialysis patients. This descriptive and comparative multicenter study was performed on 255 patients on chronic dialysis in Tabriz, Iran. These patients did not have the PPD test done within the preceding one year. Patients were divided into two groups randomly and conventional or double-dose tuberculin test was performed using the Mantoux technique with 5 IU (group 1 and 10 IU (group 2 of PPD. Results were interpreted 48-72 h after injection. Patients were divided into those with less than 10 mm and those with ≥10 mm duration. Mean age was 44.6 ± 15 years (M/F = 1.5/1. The mean duration on dialysis was 39 ± 7 months. There was no significant difference regarding the age, gender, dura-tion on dialysis, causes of chronic kidney disease, erythrocyte sedimentation rate, C-reactive protein and serum albumin between the two groups. The mean induration was 4.6 mm and 7.7 mm in groups 1 and 2, respectively. There was induration ≥10 mm in 19.6% and 25.5% of group 1 and 2, respectively, which showed a significant difference (P <0.05. In conclusion, because of the high frequency of TB in dialysis patients, an annual tuberculin test may be recommended. Our study showed that the double-dose tuberculin test may be a better substitute to the conventional test in dialysis patients.

  19. Psycho-social Features of Chronic Dialysis Patients in Saudi Arabia: Experience of one Centre

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    AL-Homrany Mohammed; Bilal Ali

    2001-01-01

    The goals of chronic dialysis treatment for end-stage renal disease (ESRD) patients include restoration of the highest achievable state of personal physical health and preservation as well as restoration and development of the highest level of psychological and social functions. We conducted this study to evaluate factors influencing the process of adaptation such as religious faith, economic status and extended family-tribal system. It was hoped that studying these factors might provide furt...

  20. Understanding by older patients of dialysis and conservative management for chronic kidney failure

    OpenAIRE

    Tonkin-Crine, S; Okamoto, I; Leydon, G M; Murtagh, F. E.; Farrington, K; Caskey, F.; Rayner, H.; Roderick, P.

    2014-01-01

    Background: older adults with chronic kidney disease stage 5 may be offered a choice between dialysis and conservative management. Few studies have explored patients’ reasons for choosing conservative management and none have compared the views of those who have chosen different treatments across renal units. Study design: qualitative study with semistructured interviews. Settings & participants: patients 75 years or older recruited from 9 renal units. Units were chosen to reflect var...

  1. Upper Digestive Endoscopic Findings in Patients with Chronic Renal Insufficiency in Phase of Dialysis

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    Marcos Félix Osorio Pagola

    2009-12-01

    Full Text Available Background: Patients with chronic renal insufficiency in phase of dialysis present clinical manifestations that can include different symptoms. Morbidity due to gastric, esophageal and duodenal disturbances is significant and constitutes a considerable risk before, while and after a renal transplant. Objective: To identify the most frequent disturbances of the upper digestive tract in patients with chronic renal insufficiency who require dialysis. Methods: An observational, descriptive and retrospective study was carried out in this search. The universe was composed by all the patients with a diagnosis of chronic renal insufficiency in a dialysis phase, who had been included in the Hemodialysis Program at the University Hospital “Dr. Gustavo Aldereguía Lima” from Cienfuegos and who had undergone an upper digestive endoscopy from January to May, 2008. The patient’s health record was studied to get information for the variables under study. Results: the average age was 46,7 years and the most affected patients were males. The mean value for serum creatinine was 929,7 mMol/L, for serum urea 21,4 mMol/L and for hemoglobin 8,4 g/L. The most frequent cause of chronic nephropathy was High Blood Pressure in 25 patients (56,8 %, followed by Diabetes Mellitus in 9 patients (20,5 %. 52,3 % of the patients were asymptomatic, but the most frequent symptoms reported by the patients were flatulence (25 % and nausea (15,9 %. Endoscopy revealed normal results in most of the patients (40,9 %. Conclusions: Antral erythematous endoscopic gastritis was the most frequent endoscopic diagnosis followed by duodenal ulcer

  2. Outpatient red blood cell transfusion payments among patients on chronic dialysis

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    Gitlin Matthew

    2012-11-01

    Full Text Available Abstract Background Payments for red blood cell (RBC transfusions are separate from US Medicare bundled payments for dialysis-related services and medications. Our objective was to examine the economic burden for payers when chronic dialysis patients receive outpatient RBC transfusions. Methods Using Truven Health MarketScan® data (1/1/02-10/31/10 in this retrospective micro-costing economic analysis, we analyzed data from chronic dialysis patients who underwent at least 1 outpatient RBC transfusion who had at least 6 months of continuous enrollment prior to initial dialysis claim and at least 30 days post-transfusion follow-up. A conceptual model of transfusion-associated resource use based on current literature was employed to estimate outpatient RBC transfusion payments. Total payments per RBC transfusion episode included screening/monitoring (within 3 days, blood acquisition/administration (within 2 days, and associated complications (within 3 days for acute events; up to 45 days for chronic events. Results A total of 3283 patient transfusion episodes were included; 56.4% were men and 40.9% had Medicare supplemental insurance. Mean (standard deviation [SD] age was 60.9 (15.0 years, and mean Charlson comorbidity index was 4.3 (2.5. During a mean (SD follow-up of 495 (474 days, patients had a mean of 2.2 (3.8 outpatient RBC transfusion episodes. Mean/median (SD total payment per RBC transfusion episode was $854/$427 ($2,060 with 72.1% attributable to blood acquisition and administration payments. Complication payments ranged from mean (SD $213 ($168 for delayed hemolytic transfusion reaction to $19,466 ($15,424 for congestive heart failure. Conclusions Payments for outpatient RBC transfusion episodes were driven by blood acquisition and administration payments. While infrequent, transfusion complications increased payments substantially when they occurred.

  3. Prevalence, awareness, treatment, and control of hypertension in the non-dialysis chronic kidney disease patients

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    ZHENG Ying; CAI Guang-yan; CHEN Xiang-mei; FU Ping; CHEN Jiang-hua; DING Xiao-qiang; YU Xue-qing

    2013-01-01

    Background Data on the epidemiology of hypertension in Chinese non-dialysis chronic kidney disease (CKD) patients are limited.The aim of the present study was to investigate the prevalence,awareness,treatment,and control of hypertension in the non-dialysis CKD patients through a nationwide,multicenter study in China.Methods The survey was performed in 61 tertiary hospitals in 31 provinces,municipalities,and autonomous regions in China (except Hong Kong,Macao,and Taiwan).Trained physicians collected demographic and clinical data and measured blood pressure (BP) using a standardized protocol.Hypertension was defned as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg,and/or use of antihypertensive medications.BP <140/90 mmHg and <130/80 mmHg were used as the 2 thresholds of hypertension control.In multivariate logistic regression with adjustment for sex and age,we analyzed the association between CKD stages and uncontrolled hypertension in non-dialysis CKD patients.Results The analysis included 8927 non-dialysis CKD patients.The prevalence,awareness,and treatment of hypertension in non-dialysis CKD patients were 67.3%,85.8%,and 81.0%,respectively.Of hypertensive CKD patients,33.1% and 14.1% had controlled BP to <140/90 mmHg and <130/80 mmHg,respectively.With successive CKD stages,the prevalence of hypertension in non-dialysis CKD patients increased,but the control of hypertension decreased (P<0.001).When the threshold of BP <130/80 mmHg was considered,the risk of uncontrolled hypertension in CKD 2,3a,3b,4,and 5 stages increased 1.3,1.4,1.4,2.5,and 4.0 times compared with CKD 1 stage,respectively (P<0.05).Using the threshold of <140/90 mmHg,the risk of uncontrolled hypertension increased in advanced stages (P<0.05).Conclusions The prevalence of hypertension Chinese non-dialysis CKD patients was high,and the hypertension control was suboptimal.With successive CKD stages,the risk of uncontrolled hypertension increased.

  4. Effect of an Oral Adsorbent, AST-120, on Dialysis Initiation and Survival in Patients with Chronic Kidney Disease

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    Shingo Hatakeyama

    2012-01-01

    Full Text Available The oral adsorbent AST-120 has the potential to delay dialysis initiation and improve survival of patients on dialysis. We evaluated the effect of AST-120 on dialysis initiation and its potential to improve survival in patients with chronic kidney disease. The present retrospective pair-matched study included 560 patients, grouped according to whether or not they received AST-120 before dialysis (AST-120 and non-AST-120 groups. The cumulative dialysis initiation free rate and survival rate were compared by the Kaplan-Meier method. Multivariate analysis was used to determine the impact of AST-120 on dialysis initiation. Our results showed significant differences in the 12- and 24-month dialysis initiation free rate (P<0.001, although no significant difference was observed in the survival rate between the two groups. In conclusion, AST-120 delays dialysis initiation in chronic kidney disease (CKD patients but has no effect on survival. AST-120 is an effective therapy for delaying the progression of CKD.

  5. Effects of Diabetes Mellitus, Age, and Duration of Dialysis on Parathormone in Chronic Hemodialysis Patients

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    Nasri Hamid

    2008-01-01

    Full Text Available Secondary hyperparathyroidism (SHPTH can develop early in the course of chronic renal failure and becomes more prominent as kidney function declines. We studied the effect of diabetes, age, and dialysis on parathyroid function in 60 (21 women, 39 males; 44 non-diabetic, 16 diabetic hemodialysis (HD patients. Serum intact PTH (iPTH, calcium, phosphorus, alkaline phosphatase (ALP, and magnesium (Mg were measured. Adequacy of HD was evaluated by calculating the urea reduction rate (URR. There were significantly lower values of serum iPTH, ALP, and dialysis adequacy among diabetic than non-diabetes HD patients. In addition, there were an inverse correlation of age and serum iPTH (r= -0.27, p= 0.034 as well as age and serum phosphorus (r= -0.28, p= 0.031. There was also a positive correlation between serum iPTH with the duration (r= 0.001, p=0.42 and doses of dialysis treatment (r= 0.38, p= 0.002. We conclude that a significant negative correlation between age and serum phosphorus and lower parathyroid activity in diabetic HD patients, which implies more prevalence of bone disease in elderly diabetic HD patients. Further study of bone disease in this group of patients is required to evaluate its effect on outcome and different therapeutic interventions.

  6. Peritoneal Dialysis is Associated With A Better Survival in Cirrhotic Patients With Chronic Kidney Disease.

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    Chou, Che-Yi; Wang, Shu-Ming; Liang, Chih-Chia; Chang, Chiz-Tzung; Liu, Jiung-Hsiun; Wang, I-Kuan; Hsiao, Lien-Cheng; Muo, Chih-Hsin; Chung, Chi-Jung; Huang, Chiu-Ching

    2016-01-01

    Peritoneal dialysis (PD) can be an ideal treatment in cirrhotic patients with ascites and chronic kidney disease stage 5 (CKD 5D) who require dialysis. The survival of cirrhotic patients with CKD 5D on PD, however, is not clear. We compared the survival of cirrhotic patients with CKD 5D on PD and the survival of those on HD. Two datasets including a cohort study of China Medical University Hospital (CMUH) from 2004 to 2013 and the Longitudinal National Health Insurance Database for Catastrophic Illness Patients (LHID-CIP) of Taiwan from 1996 to 2011 were analyzed. The survival of cirrhotic patients on PD and the propensity score matched cirrhotic patients on HD were analyzed using Cox proportional hazards regression. In CMUH cohort of 85 PD and 340 HD patients, the all-cause mortality was lower in PD patients compared to it in HD patients (hazard ratio [HR]: 0.48, 95% confidence interval [CI]: 0.31-0.74, P model for end-stage liver disease (MELD) score, however, was not associated with all-cause mortality. In the LHID-CIP cohort of 285 PD and 1140 HD patients, the HR of all-cause mortality in PD patients was 0.61 (95% CI: 0.47 - 0.79, P < 0.01), as compared with HD patients. PD in cirrhotic patients who need dialysis is associated with lower all-cause mortality than HD is. This association is independent of patients' comorbidity, severity of liver cirrhosis, and serum albumin levels.

  7. Sleep disorders and its related risk factors in patients undergoing chronic peritoneal dialysis

    Institute of Scientific and Technical Information of China (English)

    Li Han; Li Xiaobei; Feng Sujuan; Zhang Guizhi; Wang Wei; Wang Shixiang

    2014-01-01

    Background The prevalence of sleep disorders has been shown to be high in patients with chronic dialysis patients and may contribute to impaired quality of life and higher mortality in this population.However,there are few data on the relationship of sleep disorders and their risk factors in chronic dialysis patients.The aim of this study was to evaluate the relationship of sleep disorders and their risk factors in chronic dialysis patients.Methods A total of 42 continuous ambulatory peritoneal dialysis (CAPD) patients were involved in this cross-sectional study.Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI).Restless legs syndrome (RLS) was diagnosed according to the criteria of the International Restless Legs Syndrome Study Group.And depression was assessed by Hamilton depression scale.General information and laboratory data were collected.Results The prevalence of sleep disorders was 47.6% in the CAPD patients.According to the PSQI,the 42 CAPD patients were divided into sleep disturbance group and non-sleep disorders group.There were no significant differences in age,gender,dialysis duration,hemoglobin,serum creatinine,urea nitrogen,β2-microglobulin,parathyroid hormone,calcium,and phosphorus between CAPD patients with sleep disorders and those without sleep disorders.But the level of serum albumin (AIb) in CAPD patients with sleep disorders was significantly lower than that in CAPD patients without sleep disorders (31.3±1.4 vs.34.3±3.7,t=3.603,P=0.001).And the prevalence of RLS and depression was significantly higher than that in CAPD patients without sleep disorders (RLS:11/22 vs.1/20,x2=10.395,P=0.001; depression:7/22 vs.1/20,x2=4.886,P=0.027).In CAPD patients with RLS,the prevalence of sleep disorders was significantly higher than that in CAPD patients without RLS (11/22 vs.11/30,x2=10.395,P=0.001).And in CAPD patients with depression,the prevalence of sleep disorders was significantly higher than that in CAPD patients without

  8. The importance of ultrasonographic measurement of peritoneal wall thickness in pediatric chronic peritoneal dialysis patients.

    Science.gov (United States)

    Yavaşcan, Önder; Aksu, Nejat; Alparslan, Caner; Sarıtaş, Serdar; Elmas, Cengiz Han; Eraslan, Ali Nihat; Duman, Soner; Mir, Sevgi

    2015-04-01

    Loss of peritoneal function due to peritoneal fibrosing syndrome (PFS) is a major factor leading to treatment failure in chronic peritoneal dialysis (PD) patients. Although the precise biologic mechanisms responsible for these changes have not been defined, the general assumption is that alterations in peritoneal function are related to structural changes in the peritoneal membrane. Studies of the peritoneal membrane by non-invasive ultrasonography (US) in chronic PD patients are limited. The aim of the present study is to assess the relationship between functional parameters of peritoneum and peritoneal thickness measured by US in children treated by chronic PD. We recruited two groups of patients: 23 subjects (13 females, 10 males) on chronic PD (patient group) and 26 (7 females, 19 males) on predialysis out-patient follow-up (creatinine clearance: 20-60 mL/min/1.73 m(2)) (control group). Age, sex, weight, height, body mass index (BMI), chronic PD duration, episodes of peritonitis and the results of peritoneal equilibration test (PET) were recorded. Hemoglobin (Hb), blood pressure (BP), left ventricular mass index (LVMI) and renal osteodystrophy (ROD) parameters were also obtained. The thickness of the parietal peritoneum was measured by trans-abdominal US in all children. Statistical analyses were performed by using Student's t and Pearson's correlation tests. Mean peritoneal thickness in chronic PD patients (1028.26 ± 157.26 μm) was significantly higher than control patients (786.52 ± 132.33). Mean peritoneal thickness was significantly correlated with mean body height (R(2) = 0.93, p thickness and Hb, BP, LVMI and ROD parameters. In conclusion, ultrasonographic measurement of peritoneal membrane thickness is a simple and non-invasive method in chronic PD children. This diagnostic tool likely enables to assess peritoneal structure and function in these patients.

  9. The importance of ultrasonographic measurement of peritoneal wall thickness in pediatric chronic peritoneal dialysis patients.

    Science.gov (United States)

    Yavaşcan, Önder; Aksu, Nejat; Alparslan, Caner; Sarıtaş, Serdar; Elmas, Cengiz Han; Eraslan, Ali Nihat; Duman, Soner; Mir, Sevgi

    2015-04-01

    Loss of peritoneal function due to peritoneal fibrosing syndrome (PFS) is a major factor leading to treatment failure in chronic peritoneal dialysis (PD) patients. Although the precise biologic mechanisms responsible for these changes have not been defined, the general assumption is that alterations in peritoneal function are related to structural changes in the peritoneal membrane. Studies of the peritoneal membrane by non-invasive ultrasonography (US) in chronic PD patients are limited. The aim of the present study is to assess the relationship between functional parameters of peritoneum and peritoneal thickness measured by US in children treated by chronic PD. We recruited two groups of patients: 23 subjects (13 females, 10 males) on chronic PD (patient group) and 26 (7 females, 19 males) on predialysis out-patient follow-up (creatinine clearance: 20-60 mL/min/1.73 m(2)) (control group). Age, sex, weight, height, body mass index (BMI), chronic PD duration, episodes of peritonitis and the results of peritoneal equilibration test (PET) were recorded. Hemoglobin (Hb), blood pressure (BP), left ventricular mass index (LVMI) and renal osteodystrophy (ROD) parameters were also obtained. The thickness of the parietal peritoneum was measured by trans-abdominal US in all children. Statistical analyses were performed by using Student's t and Pearson's correlation tests. Mean peritoneal thickness in chronic PD patients (1028.26 ± 157.26 μm) was significantly higher than control patients (786.52 ± 132.33). Mean peritoneal thickness was significantly correlated with mean body height (R(2) = 0.93, p measurement of peritoneal membrane thickness is a simple and non-invasive method in chronic PD children. This diagnostic tool likely enables to assess peritoneal structure and function in these patients. PMID:25594613

  10. Comparison between two physiotherapy protocols for patients with chronic kidney disease on dialysis.

    Science.gov (United States)

    Neto, José Roberto Sostena; Figueiredo E Castro, Letícia Magalhães; Santos de Oliveira, Fernanda; Silva, Andréia Maria; Maria Dos Reis, Luciana; Quirino, Ana Paula Assunção; Dragosavac, Desanka; Kosour, Carolina

    2016-05-01

    [Purpose] To compare the effects of two physiotherapy protocols for chronic kidney disease patients on dialysis. [Subjects and Methods] This is a prospective, randomized study, in chronic kidney disease patients 18 years of age or older on dialysis. Sessions for each group (were conducted three times per week for a total of 10 sessions), during hemodialysis. Respiratory muscle strength (maximal inspiratory and expiratory pressure), peak expiratory flow, and peripheral muscle strength were evaluated. The study group received motor and respiratory physiotherapy, and the control group received motor physiotherapy alone. [Results] We observed a significant increase in the maximal inspiratory pressure in the study group in the 5th and 10th sessions and in the maximal expiratory pressure in the 1st session, peak flow in the 1st and 10th sessions, and dynamometry in the 10th session. In the control group, there was a significant decrease in maximal inspiratory pressure in the 5th and 10th sessions, and in maximal expiratory pressure in the 10th session, peak flow in the 5th and 10th sessions, and dynamometry in the 5th session. [Conclusion] Implementation of motor physiotherapy combined with respiratory physiotherapy may have contributed to the improvement of the variables analyzed in the study group. PMID:27313390

  11. Quality of sleep in dialysis patients

    OpenAIRE

    Sabet, Rahele; Naghizadeh, Mohammad Mehdi; Azari, Sousan

    2012-01-01

    Background: Sleep quality is an important and determining factor in the quality of life in dialysis patients. Although many chronic dialysis patients complain of poor sleep, we know little about its related factors. Therefore, this study was designed to study sleep quality and its predictors among dialysis patients. Materials and Methods: This was a cross-sectional study carried out during August-December 2009 in Shariati Dialysis Center, Fasa University of Medical Sciences. Data were gathere...

  12. Prevalence of depressive and anxiety disorders in dialysis patients with chronic kidney disease

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    Andrzej Kokoszka

    2016-05-01

    A very high rate of prevalence of depressive disorders in dialysis patients was confirmed in the Polish population when a clinical structured interview was applied. It indicates that routine screening for depressive disorders in these patients is necessary.

  13. Thiazolidinediones and Risk of Long-Term Dialysis in Diabetic Patients with Advanced Chronic Kidney Disease: A Nationwide Cohort Study.

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    Yu-Hsin Chen

    Full Text Available Thiazolidinediones (TZDs reduce urinary albumin excretion and proteinuria in diabetic nephropathy. The effect of TZDs on hard renal outcome in diabetic patients with chronic kidney disease (CKD is unknown. We investigate the association of TZDs and risk of long-term dialysis or death in diabetic patients with advanced CKD. The nationwide population-based cohort study was conducted using Taiwan's National Health Insurance Research Database. From January 2000 to June 2009, 12350 diabetic patients with advanced CKD (serum creatinine levels greater than 6 mg/dL but not yet receiving renal replacement therapy were selected for the study. We used multivariable Cox regression models and a propensity score-based matching technique to estimate hazard ratios (HRs for development of long-term dialysis and the composite outcome of long-term dialysis or death for TZD users (n=1224 as compared to nonusers (n=11126. During a median follow-up of 6 months, 8270 (67.0% patients required long-term dialysis and 2593 (21.0% patients died before starting long-term dialysis. Using propensity score matched analysis, we found TZD users were associated with a lower risk for long-term dialysis (HR, 0.80; 95% confidence interval [CI], 0.74-0.86 and the composite outcome of long-term dialysis or death (HR, 0.85; 95% CI, 0.80-0.91. The results were consistent across most patient subgroups. Use of TZDs among diabetic patients with advanced CKD was associated with lower risk for progression to end-stage renal disease necessitating long-term dialysis or death. Further randomized controlled studies are required to validate this association.

  14. A comparison of sleep disturbances and sleep apnea in patients on hemodialysis and chronic peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Hamdan Al-Jahdali

    2011-01-01

    Full Text Available Studies have shown that sleep disorders are common among dialysis patients; however, few studies have compared the prevalence of different sleep disorders in patients on peritoneal dialysis (PD and hemodialysis (HD. We used questionnaires to assess the prevalence of common sleep disorders in dialysis patients. We compared the prevalence of sleep apnea (SA risk, restless legs syndrome (RLS, insomnia, and excessive daytime sleepiness (EDS, as well as sleep quality, in both groups. Of the 227 patients who were enrolled in the study, the total number of patients on HD was 188 (82%, while the total number of patients on PD was 39 (18%. There were no significant differences between the two groups regarding age, neck size, or duration on dialysis (all P >0.05. The estimated overall prevalence of SA was significantly higher in PD patients in comparison with HD patients (92% and 67%, respectively; P <0.05. The prevalence of insomnia was similar in both groups. The prevalence of RLS was significantly greater in PD than in HD patients (69% and 46%, respectively; P <0.05. In addition, EDS was significantly higher in PD than in HD patients (77% and 37%, respectively; P <0.05. Our study shows that sleep disorders are common in dialysis patients; however, SA, EDS, and RLS were more common in PD patients than in HD pa-tients. Poor sleep quality and insomnia were comparable in both groups.

  15. Psycho-social Features of Chronic Dialysis Patients in Saudi Arabia: Experience of one Centre.

    Science.gov (United States)

    Al-Homrany, M A; Bilal, A M

    2001-01-01

    The goals of chronic dialysis treatment for end-stage renal disease (ESRD) patients include restoration of the highest achievable state of personal physical health and preservation as well as restoration and development of the highest level of psychological and social functions. We conducted this study to evaluate factors influencing the process of adaptation such as religious faith, economic status and extended family-tribal system. It was hoped that studying these factors might provide further dimension to our understanding of the psychopathology of ESRD patients, and to help offer new ideas to improve the quality of their lives. A sample comprising 54 patients with ESRD was studied in Abha hemodialysis centre in Southern Saudi Arabia. The socio-demographic characteristics, clinical and laboratory data were collected. The psychiatric status of the patients was evaluated using a structured "The Comprehensive Psychiatric Rating Scale" (CPRS) clinical interview. The result indicated that the major co-morbidity (in 60% of these patients) was a depressive illness due to renal failure diagnosable according to DSM-IV criteria. Our study suggests the need for specific anti-depressant treatment in order to ameliorate many distressing symptoms, which may affect the quality of these patients' life. Concomitant social problems of poverty, absence of spouse and illiteracy, dictate a more prompt attitude in initiating support systems and attention to providing leisure activities.

  16. Psycho-social Features of Chronic Dialysis Patients in Saudi Arabia: Experience of one Centre

    Directory of Open Access Journals (Sweden)

    AL-Homrany Mohammed

    2001-01-01

    Full Text Available The goals of chronic dialysis treatment for end-stage renal disease (ESRD patients include restoration of the highest achievable state of personal physical health and preservation as well as restoration and development of the highest level of psychological and social functions. We conducted this study to evaluate factors influencing the process of adaptation such as religious faith, economic status and extended family-tribal system. It was hoped that studying these factors might provide further dimension to our understanding of the psychopathology of ESRD patients, and to help offer new ideas to improve the quality of their lives. A sample comprising 54 patients with ESRD was studied in Abha hemodialysis centre in Southern Saudi Arabia. The socio-demographic characteristics, clinical and laboratory data were collected. The psychiatric status of the patients was evaluated using a structured "The Comprehensive Psychiatric Rating Scale" (CPRS clinical interview. The result indicated that the major co-morbidity (in 60% of these patients was a depressive illness due to renal failure diagnosable according to DSM-IV criteria. Our study suggests the need for specific anti-depressant treatment in order to ameliorate many distressing symptoms, which may affect the quality of these patients′ life. Concomitant social problems of poverty, absence of spouse and illiteracy, dictate a more prompt attitude in initiating support systems and attention to providing leisure activities.

  17. Resistance training and testosterone levels in male patients with chronic kidney disease undergoing dialysis

    DEFF Research Database (Denmark)

    Molsted, Stig; Andersen, Jesper L.; Eidemak, Inge;

    2014-01-01

    BACKGROUND: We investigated serum testosterone and insulin-like growth factor 1 (IGF-1) levels' associations with muscle fibre size and resistance training in male dialysis patients. METHODS: Male patients were included in a 16-week control period followed by 16 weeks of resistance training thric...

  18. A cross-sectional study of dialysis practice-patterns in patients with chronic kidney disease on maintenance hemodialysis.

    Science.gov (United States)

    Kulkarni, Manjunath Jeevanna; Jamale, Tukaram; Hase, Niwrutti K; Jagdish, Pradeep Kiggal; Keskar, Vaibhav; Patil, Harsha; Shete, Abhijeet; Patil, Chetan

    2015-09-01

    We studied the dialysis practice-patterns with regard to various aspects of chronic kidney disease (CKD) stage 5D, like anemia, mineral bone disease, vaccination, hospitalization, hypertension and cost of therapy. Four hundred and sixty-four adult hemodialysis (HD) patients from various dialysis centers of Mumbai were included in the study. The mean age of the study patients was 47.2 years. Temporary dialysis catheters were the most common initial vascular access. Thirteen percent of prevalent HD patients were on temporary catheters; 33% of patients had history of failure of arterio-venous fistula. The most common cause of failure was access thrombosis. About 75% of the patients had hemoglobin quality of life than the general population. The therapy itself brings with it a unique set of problems, such as vascular access-related complications, which cause significant mortality and morbidity. This study was a study of the current HD practices. The primary goal of this cross-sectional observational study is to understand dialysis practices and obtain data that can be used to improve care in the future.

  19. A low bioimpedance phase angle predicts a higher mortality and lower nutritional status in chronic dialysis patients

    Science.gov (United States)

    Dumler Md, Francis

    2010-04-01

    Bioelectrical impedance analysis is an established technique for body composition analysis. The phase angle parameter, an index of body cell mass, tissue hydration, and membrane integrity, makes it suitable for assessing nutritional status and survivability. We evaluated the significance of a low phase angle value on nutritional status and mortality in 285 chronic dialysis patients during a longitudinal prospective observational study. Patients in the lower phase angle tertile had decreased body weight, body mass index, fat free mass, body cell mass, and lower serum albumin concentrations than those in the higher tertile (P<001). In addition, mortality rates were significantly lower (P=0.05) in the highest tertile patients. In conclusion, the phase angle is a useful method for identifying dialysis patients at high risk for malnutrition and increased mortality.

  20. Bone biomarkers help grading severity of coronary calcifications in non dialysis chronic kidney disease patients.

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    Marion Morena

    Full Text Available BACKGROUND: Osteoprotegerin (OPG and fibroblast growth factor-23 (FGF23 are recognized as strong risk factors of vascular calcifications in non dialysis chronic kidney disease (ND-CKD patients. The aim of this study was to investigate the relationships between FGF23, OPG, and coronary artery calcifications (CAC in this population and to attempt identification of the most powerful biomarker of CAC: FGF23? OPG? METHODOLOGY/PRINCIPAL FINDINGS: 195 ND-CKD patients (112 males/83 females, 70.8 [27.4-94.6] years were enrolled in this cross-sectional study. All underwent chest multidetector computed tomography for CAC scoring. Vascular risk markers including FGF23 and OPG were measured. Logistic regression analyses were used to study the potential relationships between CAC and these markers. The fully adjusted-univariate analysis clearly showed high OPG (≥10.71 pmol/L as the only variable significantly associated with moderate CAC ([100-400[ (OR = 2.73 [1.03;7.26]; p = 0.04. Such association failed to persist for CAC scoring higher than 400. Indeed, severe CAC was only associated with high phosphate fractional excretion (FEPO(4 (≥38.71% (OR = 5.47 [1.76;17.0]; p = 0.003 and high FGF23 (≥173.30 RU/mL (OR = 5.40 [1.91;15.3]; p = 0.002. In addition, the risk to present severe CAC when FGF23 level was high was not significantly different when OPG was normal or high. Conversely, the risk to present moderate CAC when OPG level was high was not significantly different when FGF23 was normal or high. CONCLUSIONS: Our results strongly suggest that OPG is associated to moderate CAC while FGF23 rather represents a biomarker of severe CAC in ND-CKD patients.

  1. Mineral and bone disorders, morbidity and mortality in end-stage renal failure patients on chronic dialysis

    Science.gov (United States)

    MOLDOVAN, DIANA; RUSU, CRINA; KACSO, INA MARIA; POTRA, ALINA; PATIU, IOAN MIHAI; GHERMAN-CAPRIOARA, MIRELA

    2016-01-01

    Background and aim In spite of numerous interventions, the control of mineral disturbances remains poor in end-stage renal failure (ESRF) patients. Chronic kidney disease - mineral and bone disorders (CKD-MBD) represent an important cause of mortality and morbidity. The aim of this study is to analyze the relationship between mineral and bone disorders (MBD) and their components impact on all-cause mortality and cardiovascular (CDV) mortality and morbidity in chronic dialysis patients. Methods This prospective study was carried out in a cohort of 92 randomly selected patients with ESRF treated with hemodialysis (HD) and peritoneal dialysis (PD). The data regarding demographic and clinical characteristics were recorded, including vascular disease (coronary, cerebral, peripheral). The follow-up lasted 40 months and the final evaluation included the number and causes of deaths, CDV events and disease. Serum Ca, P, ALP, iPTH, albumin, cholesterol, urea and creatinine levels were measured. The plain radiographic films of hands and pelvis evaluated all bone abnormalities suggestive of renal osteodystrophy (ROD) and peripheral vascular calcification (VC). Results All-cause annual mortality represented 9.25% in HD and 9.09% in PD patients. The CDV mortality represented almost 44% in HD patients and 66% in PD patients from all deaths. There was a high prevalence of CDV diseases and events. High and low serum P levels were associated with a worse survival rate. Hypercalcaemia was associated with high risk for CDV events in HD patients. In PD patients, the relationship between increased ALP levels and all-cause mortality was significant. Other mineral markers were not predictive of the outcome in the studied patients. In the HD patients the severity of VC was associated with all-cause and CDV mortality, and with CDV events. Male gender, hypercholesterolemia, decreased URR, albumin and creatinine were identified as risk factors for all-cause mortality. The diabetics had higher

  2. A Rare Case of Aeromonas Hydrophila Catheter Related Sepsis in a Patient with Chronic Kidney Disease Receiving Steroids and Dialysis: A Case Report and Review of Aeromonas Infections in Chronic Kidney Disease Patients

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    Muhammad Abdul Mabood Khalil

    2013-01-01

    Full Text Available Aeromonas hydrophila (AH is an aquatic bacterium. We present a case of fifty-five-year-old gentleman with chronic kidney disease (CKD due to crescentic IgA nephropathy who presented to us with fever. He was recently pulsed with methyl prednisolone followed by oral prednisolone and discharged on maintenance dialysis through a double lumen dialysis catheter. Blood culture from peripheral vein and double lumen dialysis catheter grew AH. We speculate low immunity due to steroids and uremia along with touch contamination of dialysis catheter by the patient or dialysis nurse could have led to this rare infection. Dialysis catheter related infection by AH is rare. We present our case here and take the opportunity to give a brief review of AH infections in CKD patients.

  3. Depression in dialysis patients.

    Science.gov (United States)

    King-Wing Ma, Terry; Kam-Tao Li, Philip

    2016-08-01

    Depression is the most common psychiatric illness in patients with end-stage renal disease (ESRD). The reported prevalence of depression in dialysis population varied from 22.8% (interview-based diagnosis) to 39.3% (self- or clinician-administered rating scales). Such differences were attributed to the overlapping symptoms of uraemia and depression. Systemic review and meta-analysis of observational studies showed that depression was a significant predictor of mortality in dialysis population. The optimal screening tool for depression in dialysis patients remains uncertain. The Beck Depression Inventory (BDI), Patient Health Questionnaire (PHQ) and Center for Epidemiologic Studies Depression Scale (CESD) have been validated for screening purposes. Patients who scored ≥14 using BDI should be referred to a psychiatrist for early evaluation. Structured Clinical Interview for DSM disorders (SCID) remains the gold standard for diagnosis. Non-pharmacological treatment options include cognitive behavioural therapy and exercise training programs. Although frequent haemodialysis may have beneficial effects on patients' physical and mental well-being, it cannot and should not be viewed as a treatment of depression. Selective serotonin reuptake inhibitors (SSRIs) are generally effective and safe in ESRD patients, but most studies were small, non-randomized and uncontrolled. The European Renal Best Practice (ERBP) guideline suggests a trial of SSRI for 8 to 12 weeks in dialysis patients who have moderate-major depression. The treatment effect should be re-evaluated after 12 weeks to avoid prolonging ineffective medication. This review will discuss the current understanding in the diagnosis and management of depression in dialysis patients. PMID:26860073

  4. Recovery of renal function in dialysis patients

    Directory of Open Access Journals (Sweden)

    Patlovany Matthew

    2003-10-01

    Full Text Available Abstract Background Although recovery of renal functions in dialysis dependent patients is estimated to be greater than 1%, there are no indicators that actually suggest such revival of renal function. Residual renal function in dialysis patients is unreliable and seldom followed. Therefore renal recovery (RR in dialysis dependent patients may remain unnoticed. We present a group of dialysis dependent patients who regained their renal functions. The aim of this project is to determine any indicators that may identify the recovery of renal functions in dialysis dependent patients. Methods All the discharges from the chronic dialysis facilities were identified. Among these discharges deaths, transplants, voluntary withdrawals and transfers either to another modality or another dialysis facility were excluded in order to isolate the patients with RR. The dialysis flow sheets and medical records of these patients were subsequently reviewed. Results Eight patients with a mean age of 53.8 ± 6.7 years (± SEM were found to have RR. Dialysis was initiated due to uremic symptoms in 6 patients and fluid overload in the remaining two. The patients remained dialysis dependent for 11.1 ± 4.2 months. All these patients had good urine output and 7 had symptoms related to dialysis. Their mean pre-initiation creatinine and BUN levels were 5.21 ± 0.6 mg/dl and 72.12 ± 11.12 mg/dl, respectively. Upon discontinuation, they remained dialysis free for 19.75 ± 5.97 months. The mean creatinine and BUN levels after cessation of dialysis were 2.85 ± 0.57 mg/dl and 29.62 ± 5.26 mg/dl, respectively, while the mean creatinine clearance calculated by 24-hour urine collection was 29.75 ± 4.78 ml/min. One patient died due to HIV complications. One patient resumed dialysis after nine months. Remaining continue to enjoy a dialysis free life. Conclusion RR must be considered in patients with good urine output and unresolved acute renal failure. Dialysis intolerance may be

  5. Development of a symptom assessment instrument for chronic hemodialysis patients: the Dialysis Symptom Index.

    Science.gov (United States)

    Weisbord, Steven D; Fried, Linda F; Arnold, Robert M; Rotondi, Armando J; Fine, Michael J; Levenson, David J; Switzer, Galen E

    2004-03-01

    Little is known about the prevalence, severity, or impact of symptoms in hemodialysis patients because of the lack of a validated symptom assessment instrument. We systematically developed an index to assess physical and emotional symptom burden in this patient population. We employed four steps in the generation of this index: a review of dialysis quality-of-life instruments, three focus groups, experts' content validity assessment, and test-retest reliability measurement. Seventy-five symptoms were identified. Of these, 46 appeared in > or = 4 of the instruments/focus groups and were considered for inclusion. Twelve were grouped into other symptom constructs and experts judged four of the remaining items not to be pertinent, leaving 30 items in the new index. Overall kappa statistic was 0.48+/-0.22. These steps allowed the systematic development of a 30-item symptom assessment index for hemodialysis patients. Additional reliability and validity testing is needed prior to its widespread use.

  6. Efficiency and safety of lamivudine therapy in patients with chronic HBV infection, dialysis or after kidney transplantation

    Institute of Scientific and Technical Information of China (English)

    Tadeusz Wojciech Lapinski; Robert Flisiak; Jerzy Jaroszewicz; Ma3gorzata Michalewicz; Oksana Kowalczuk

    2005-01-01

    AIM: To analyze the effectiveness and safety of lamivudine treatment in patients with chronic HBV infection undergoing hemodialysis or after kidney transplantation, and to study the frequency of tyrosine - methionine - aspartate - aspartate (YMDD) mutation occurrence after lamivudine treatment.METHODS: We analyzed 91 patients with chronic hepatitis B, among whom, 16 patients underwent hemodialysis, 7patients had kidney transplantation and 68 patients had normal function of kidney. The hemodialysis patients were treated by lamivudine 300 mg/wk. Patients after kidney transplantation and patients with normal function of kidney were treated with lamivudine 100 mg/d. Therapy lasted for 12 mo. HBV-DNA, HBsAg, HBeAg and anti-HBe, and antiHCV antibodies were assessed in sera of patients. The analysis was performed before and 6 mo after the end of lamivudine treatment. Before, during and after the lamivudine therapy,the number of erythrocytes, leukocytes, platelets and hemoglobin concentration, ALT and AST activity, as well as bilirubin, urea and creatinine concentrations were analyzed in sera from patients.RESULTS: After the 12-mo lamivudine treatment, elimination of HBV - DNA was observed in 56% patients undergoing hemodialysis and in 53% patients with normal kidney function. Only 1 from 7 (14%) kidney-transplanted patients eliminated HBV-DNA. Furthermore, HBeAg elimination was observed in 36% hemodialysis patients, in 51% patients with normal function of kidneys and in 43% kidneytransplanted patients. Among the patients undergoing dialysis, no YMDD mutation was found after 12 mo of therapy, while it was detected in 9 patients (13%) with normal function of kidney and in 2 kidney-transplanted patients (29%, P<0.006). We did not observe significant side effects of lamivudine treatment in studied patients.CONCLUSION: Effectiveness of lamivudine therapy in dialysis patients is comparable with that in patients withnormal function of kidney. Lamivudine treatment is well

  7. [Intra-dialysis parenteral nutrition in chronic renal patients: consensus SEN-SENPE].

    Science.gov (United States)

    García de Lorenzo, A; Arrieta, J; Ayúcar, A; Barril, G; Huarte, E

    2010-01-01

    Given the high prevalence of the hyponutrition state among haemodialysis patients and knowing that this implies an increase in the rates of infection, hospitalisation and hospital stay, which translates into an increase in global morbid-mortality, the Spanish Society of Nephrology (SEN) and the Spanish Society of Parenteral and Enteral Nutrition (SENPE) have reached a consensus on the indications, contraindications, and limitations of Intra-Dialysis Parenteral Nutrition (IDPN.) This consensus considers IDPN as a valid alternative to other types of nutritional support when these show their lack of efficacy. The bases are set regarding the timing of nutritional intervention with IDPN, its ideal composition, the time of administration, its controls, follow-up schedules, and the time at which the nutritional support has to be discontinued.

  8. Are Diuretics Underutilized in Dialysis Patients?

    Science.gov (United States)

    Trinh, Emilie; Bargman, Joanne M

    2016-09-01

    While oral diuretics are commonly used in patients with chronic kidney disease for the management of volume and blood pressure, they are often discontinued upon initiation of dialysis. We suggest that diuretics are considerably underutilized in peritoneal dialysis and haemodialysis patients despite numerous potential benefits and few side effects. Moreover, when diuretics are used, optimal doses are not always prescribed. In peritoneal dialysis, the use of diuretics can improve volume status and minimize the need for higher glucose-containing solutions. In patients on haemodialysis, diuretics can help lessen interdialytic weight gain, resulting in decreased ultrafiltration rates and fewer episodes of intradialytic hypotension. This paper will review the mechanism of action of diuretics in patients with renal insufficiency, quantify the risk of side effects and elaborate on the potential advantages of diuretic use in peritoneal dialysis and hemodialysis patients with residual kidney function.

  9. Progression of aortic calcification is associated with disorders of mineral metabolism and mortality in chronic dialysis patients.

    NARCIS (Netherlands)

    Noordzij, M.; Cranenburg, E.M.; Engelsman, L.F.; Hermans, M.M.; Boeschoten, E.W.; Brandenburg, V.M.; Bos, W.J.W.; Kooman, J.P.; Dekker, F.W.; Ketteler, M.; Schurgers, L.J.; Krediet, R.T.; Korevaar, J.C.

    2011-01-01

    Background. Previous studies have shown that simple imaging methods may be useful for detection of vascular calcifications in dialysis patients. Based on annual, plain chest X-rays during follow-up on dialysis, we studied the associations of mineral metabolism with the presence and progression of ao

  10. Progression of aortic calcification is associated with disorders of mineral metabolism and mortality in chronic dialysis patients

    NARCIS (Netherlands)

    M. Noordzij; E.M. Cranenburg; L.F. Engelsman; M.M. Hermans; E.W. Boeschoten; V.M. Brandenburg; W.J.W. Bos; J.P. Kooman; F.W. Dekker; M. Ketteler; L.J. Schurgers; R.T. Krediet; J.C. Korevaar

    2011-01-01

    Previous studies have shown that simple imaging methods may be useful for detection of vascular calcifications in dialysis patients. Based on annual, plain chest X-rays during follow-up on dialysis, we studied the associations of mineral metabolism with the presence and progression of aortic calcifi

  11. Intravenous iron supplementation for the treatment of the anemia of moderate to severe chronic renal failure patients not receiving dialysis.

    Science.gov (United States)

    Silverberg, D S; Iaina, A; Peer, G; Kaplan, E; Levi, B A; Frank, N; Steinbruch, S; Blum, M

    1996-02-01

    Iron deficiency may develop in hemodialysis patients, especially when erythropoietin is given. The role of iron deficiency in the anemia of predialysis chronic renal failure (CRF), however, is much less clear. We have intravenously (IV) administered iron as ferric saccharate in a total dose of 200 mg elemental iron monthly for 5 months to 33 CRF patients who remained anemic despite oral iron supplementation and who had no laboratory signs of iron overload. None was receiving erythropoietin therapy. In 22 of the patients there was an increase in the hematocrit values by the end of the study. These patients were considered responders to intravenous iron (IV Fe) therapy. In 11 patients the iron administration was not associated with improvement of the anemia (nonresponders). Before onset of the IV Fe therapy there were no differences between the responders and nonresponders with regard to degree of anemia, serum ferritin, iron saturation, renal function, or blood pressure. One additional patient was excluded from the study because of a mild reaction during an IV test dose before the study. No worsening of kidney function and no other side effects were noted. In four patients (three responders and one nonresponder) the control of blood pressure necessitated antihypertensive drug therapy adjustment. In conclusion, IV Fe supplementation in two thirds of anemic CRF patients not receiving dialysis resulted in a significant improvement of the anemia, thus avoiding the necessity of erythropoietin or blood administration. This could be achieved by increasing the plasma ferritin levels to 200 to 400 microns/L and/or increasing the iron saturation to 25% to 35%. Intravenous ferric saccharate appears to be a safe and effective method of administering iron for the correction of anemia in CRF patients not receiving dialysis.

  12. 25 (OH) Vitamin D in Patients with Chronic Kidney Disease and Dialysis Patients

    OpenAIRE

    Özkan ULUTAŞ; Taşkapan, Hülya

    2012-01-01

    In addition to its role on calcium homeostasis, vitamin D exhibits local (paracrine) effects on cell proliferation differentiation and immune function. Most cells in the body express Vitamin D receptors and 1α-hydroxylase, thereby permitting local production of 1,25 dihydroxycholecalciferol, which has therapeutic implications (paracrine effects). Studies have shown that chronic vitamin D deficiency may have serious adverse consequences such as increased risk of hypertension, multiple sclerosi...

  13. Protein-controlled versus restricted protein versus low protein diets in managing patients with non-dialysis chronic kidney disease: a single centre experience in Australia.

    Science.gov (United States)

    Chan, Maria

    2016-01-01

    Nutrition has been an important part of medical management in patients with chronic kidney disease for more than a century. Since the 1970s, due to technological advances in renal replacement therapy (RRT) such as dialysis and transplantation, the importance of nutrition intervention in non-dialysis stages has diminished. In addition, it appears that there is a lack of high-level evidence to support the use of diet therapy, in particular the use of low protein diets to slow down disease progression. However, nutrition abnormalities are known to emerge well before dialysis is required and are associated with poor outcomes post-commencing dialysis. To improve clinical outcomes it is prudent to incorporate practice research and quality audits into routine care, as part of the continuous clinical practice improvement process. This article summarises the experience of and current practices in a metropolitan tertiary teaching hospital in Sydney, Australia. PMID:27624699

  14. Long-term survival and predictors for mortality among dialysis patients in an endemic area for chronic liver disease: a national cohort study in Taiwan

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    Chien Chih-Chiang

    2012-06-01

    Full Text Available Abstract Background Patients with end-stage renal disease (ESRD are at a higher risk for chronic hepatitis, liver cirrhosis (LC and mortality than the general population. Optimal modalities of renal replacement therapy for ESRD patients with concomitant end-stage liver disease remain controversial. We investigated the long-term outcome for chronic liver disease among dialysis patients in an endemic area. Methods Using Taiwan’s National Health Insurance claim data (NHRI-NHIRD-99182, We performed a longitudinal cohort study to investigate the impact of comorbidities on mortality in dialysis patients. We followed up 11293 incident hemodialysis (HD and 761 peritoneal dialysis (PD patients from the start of dialysis until the date of death or the end of database period (December 31, 2008. A Cox proportional hazards model was used to identify the risk factors for all-cause mortality. Results Patients receiving PD tended to be younger and less likely to have comorbidities than those receiving HD. At the beginning of dialysis, a high prevalence rate (6.16 % of LC was found. Other than well-known risk factors, LC (hazard ratio [HR] 1.473, 95 % CI: 1.329-1.634 and dementia (HR 1.376, 95 % CI: 1.083-1.750 were also independent predictors of mortality. Hypertension and mortality were inversely associated. Dialysis modality and three individual comorbidities (diabetes mellitus, chronic lung disease, and dementia interacted significantly on mortality risk. Conclusions LC is an important predictor of mortality; however, the effect on mortality was not different between HD and PD patients.

  15. The FIND-CKD study-a randomized controlled trial of intravenous iron versus oral iron in non-dialysis chronic kidney disease patients : background and rationale

    NARCIS (Netherlands)

    Macdougall, Iain C.; Bock, Andreas; Carrera, Fernando; Eckardt, Kai-Uwe; Gaillard, Carlo; Van Wyck, David; Roubert, Bernard; Cushway, Timothy; Roger, Simon D.

    2014-01-01

    Background. Rigorous data are sparse concerning the optimal route of administration and dosing strategy for iron therapy with or without concomitant erythropoiesis-stimulating agent (ESA) therapy for the management of iron deficiency anaemia in patients with non-dialysis dependent chronic kidney dis

  16. Efficacy and tolerability of sevelamer carbonate in hyperphosphatemic patients who have chronic kidney disease and are not on dialysis

    DEFF Research Database (Denmark)

    Ketteler, M.; Rix, M.; Fan, S.;

    2008-01-01

    supplemented with native vitamin D (400 IU). The primary efficacy parameter was the change from baseline in serum phosphorous. Secondary measures included the percentage of serum phosphorus responders; changes in serum lipids, calcium-phosphorus product, and bicarbonate; and safety and tolerability. RESULTS....... There were statistically significant decreases in serum calcium-phosphorus product and total and low-density lipoprotein cholesterol at the end of treatment and a statistically significant increase in mean serum bicarbonate levels (from 16.6 to 18.2 mEq/L). Sevelamer carbonate was well tolerated. CONCLUSIONS......: Sevelamer carbonate is an effective and well-tolerated therapy for the control of phosphorous levels in hyperphosphatemic patients who have chronic kidney disease and are not on dialysis Udgivelsesdato: 2008/7...

  17. Resistance Training and Testosterone Levels in Male Patients with Chronic Kidney Disease Undergoing Dialysis

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    Stig Molsted

    2014-01-01

    Full Text Available Background. We investigated serum testosterone and insulin-like growth factor 1 (IGF-1 levels’ associations with muscle fibre size and resistance training in male dialysis patients. Methods. Male patients were included in a 16-week control period followed by 16 weeks of resistance training thrice weekly. Blood samples were obtained to analyse testosterone, luteinizing hormone (LH, IGF-1, and IGF-binding protein 3. Muscle fibres’ size was analysed in biopsies from m. vastus lateralis. Results. The patients’ testosterone levels were within the normal range at baseline (n=20 (19.5 (8.2–52.1 nmol/L versus 17.6 (16.1–18.0, resp. whereas LH levels were higher (13.0 (5.5–82.8 U/L versus 4.3 (3.3–4.6, P<0.001, resp.. IGF-1 and IGF-binding protein 3 levels were higher in the patients compared with reference values (203 (59–590 ng/mL versus 151 (128–276, P=0.014, and 5045 (3370–9370 ng/mL versus 3244 (3020–3983, P<0.001, resp.. All hormone levels and muscle fibre size (n=12 remained stable throughout the study. Age-adjusted IGF-1 was associated with type 1 and 2 fibre sizes (P<0.05. Conclusion. Patients’ total testosterone values were normal due to markedly increased LH values, which suggest a compensated primary insufficiency of the testosterone producing Leydig cell. Even though testosterone values were normal, resistance training was not associated with muscle hypertrophy. This trial is registered with ISRCTN72099857.

  18. Long-Term Effects of Low-Dose Spironolactone on Chronic Dialysis Patients: A Randomized Placebo-Controlled Study.

    Science.gov (United States)

    Lin, ChongTing; Zhang, Qing; Zhang, HuiFang; Lin, AiXia

    2016-02-01

    The purpose of this 2-year multicentric, randomized, placebo-controlled study was to evaluate the long-term effects and adverse effects of spironolactone on chronic dialysis patients. A total of 253 non-heart failure dialysis patients with end-stage renal disease were randomly assigned to 2-year treatment with spironolactone (25 mg once daily, n=125) or a matching placebo (n=128) as add-on therapy. The primary outcome was a composite of death from cardiocerebrovascular (CCV) events, aborted cardiac arrest, and sudden cardiac death, and the secondary outcome was death from all causes. Other CCV-related indexes such as left ventricular mass index, left ventricular ejection fraction, heart rate variability, vascular endothelial function, and blood pressure-lowering effect were analyzed for patients who completed the whole 2-year follow-up study. Sociodemographic, clinical, and relevant laboratory data were also collected. During the 2-year follow-up, the primary outcome occurred less frequently in the spironolactone group vs the control group (7.2% vs 18.0%; adjusted hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.26-0.78). Death from CCV events occurred in 4.0% of patients in the spironolactone group and in 11.7% of patients in the control group. Neither aborted cardiac arrest nor sudden cardiac death was significantly reduced by spironolactone treatment. The secondary outcome occurred less frequently in the spironolactone group vs the control group (9.6% vs 19.5%; adjusted HR, 0.52; 95% CI, 0.29-0.94). Other CCV-related indexes except for heart rate variability were significantly improved. This study demonstrates that use of low-dose spironolactone in non-heart failure dialysis patients can effectively reduce the risks of both CCV morbidity and mortality with few side effects. Moreover, the beneficial effect was mediated through improving the endothelial function or reducing left ventricular size independent of blood pressure changes, rather than mediation

  19. Lessons learned from peginesatide in the treatment of anemia associated with chronic kidney disease in patients on dialysis

    Directory of Open Access Journals (Sweden)

    Kaushik T

    2013-11-01

    Full Text Available Tarun Kaushik, Muhammad Magdi YaqoobBarts Health NHS Trust, William Harvey Research Unit, London, UKAbstract: Peginesatide is the newest erythropoietin-stimulating agent (ESA in the quest for the ideal treatment of anemia in chronic kidney disease (CKD patients. Reduced frequency of administration along with a possibly lower cost as a result of simpler manufacturing techniques compared with other available agents makes peginesatide a highly desirable product in the competitive ESA market. Peginesatide is noninferior to the other ESAs, and has a good safety profile in patients on hemodialysis. The higher rates of adverse cardiovascular events reported in CKD patients not on dialysis in the recent Phase III studies require further, better planned, studies. Peginesatide had to be withdrawn from the market in the US after some reports of hypersensitivity reactions to the drug. This is a setback, but the scientific advances gained as a result of this product development can be used to develop other, newer products.Keywords: anemia, hemodialysis, chronic kidney disease, peginesatide

  20. Prognostic Value of Reverse Dipper Blood Pressure Pattern in Chronic Kidney Disease Patients not Undergoing Dialysis: Prospective Cohort Study

    Science.gov (United States)

    Wang, Cheng; Ye, Zengchun; Li, Yan; Zhang, Jun; Zhang, Qunzi; Ma, Xinxin; Peng, Hui; Lou, Tanqi

    2016-01-01

    The “reverse dipping” blood pressure (BP) pattern has been studied among the general population and in individuals suffering from hypertension. However, the prognosis of this pattern in chronic kidney disease (CKD) patients is not known. We monitored BP throughout the day and followed health outcomes in 588 CKD patients admitted to our hospital. Time to all-cause mortality, cardiovascular mortality, renal events and cardiovascular events was recorded. Multivariate-adjusted Cox regression analyses were carried out to detect the prognostic value of a reverse dipping BP pattern. Prevalence of a “dipper”, “non-dipper” and “reverse dippers” was 34.69%, 43.54% and 18.03%, respectively. Patients with a reverse dipping pattern had a higher prevalence of total mortality, cardiovascular mortality, renal events and cardiovascular events than patients with a dipping pattern (P < 0.025). Multivariate-adjusted Cox regression analyses showed that reverse dippers (versus dippers) were associated with a higher risk of total mortality (hazard ratio [HR], 5.08; 95% confidence interval [CI], 1.79~14.47), cardiovascular mortality (4.17; 1.25~13.88), renal events (3.00; 1.59~5.65) and cardiovascular events (4.12; 1.78~9.51) even after adjustment by 24-h systolic BP. These data suggest that a reverse dipping BP pattern, independent of 24-h levels of systolic BP, has prognostic value in CKD patients not undergoing dialysis. PMID:27713498

  1. The elderly patient on dialysis: geriatric considerations.

    Science.gov (United States)

    Singh, Pooja; Germain, Michael J; Cohen, Lewis; Unruh, Mark

    2014-05-01

    The burgeoning population of older dialysis patients presents opportunities to provide personalized care. The older dialysis population has a high burden of chronic health conditions, decrements in quality of life and a high risk of death. In order to address these challenges, this review will recommend routinely establishing prognosis through the use of prediction instruments and communicating these findings to older patients. The challenges to prognosis in adults with end-stage renal disease (ESRD) include the subjective nature of clinical judgment, application of appropriate prognostic tools and communication of findings to patients and caregivers. There are three reasons why we believe these conversations occur infrequently with the dialysis population. First, there have previously been no clinically practical instruments to identify individuals undergoing maintenance hemodialysis (HD) who are at highest risk for death. Second, nephrologists have not been trained to have conversations about prognosis and end-of-life care. Third, other than hospitalizations and accrual of new diagnoses, there are no natural milestone guidelines in place for patients supported by dialysis. The prognosis can be used in shared decision-making to establish goals of care, limits on dialysis support or parameters for withdrawal from dialysis. As older adults with ESRD benefit from kidney transplantation, prognosis can also be used to determine who should be referred for evaluation by a kidney transplant team. The use of prognosis in older adults may determine approaches to optimize well-being and personalize care among older adults ranging from hospice to kidney transplantation. PMID:23787545

  2. Restless legs syndrome in patients on dialysis

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    Al-Jahdali Hamdan

    2009-01-01

    Full Text Available Restless legs syndrome (RLS is an extremely distressing problem experienced by patients on dialysis; the prevalence appears to be greater than in the general population, with a wide variation from 6.6% to 80%. The diagnosis of RLS is a clinical one, and its definition has been clarified and standardized by internationally recognized diagnostic criteria, published in 1995 by the International Restless Legs Syndrome Study Group (IRLSSG. This study was designed to find out the prevalence of RLS in Saudi patients with end-stage renal disease (ESRD on maintenance dialysis. This is a cross sectional study carried out between May and Sept 2007 at two centers, King Abdulaziz Medical City-King Fahad National Guard Hospital (KAMC-KFNGH, Riyadh and King Faisal Specialist Hospital and Research Centre (KFHRC, Jeddah, Saudi Arabia. Data were gathered on 227 Saudi patients on chronic maintenance hemodialysis or chronic peritoneal dialysis. The prevalence of RLS was measured using IRLSSG′s RLS Questionnaire (RLSQ. Potential risk factors for RLS including other sleep disorders, underlying cause of chronic renal failure, duration on dialysis, dialysis shift, biochemical tests and demographic data were also evaluated. The overall prevalence of RLS was 50.22% including 53.7% males and 46.3% females. Their mean age was 55.7 ± 17.2 years and mean duration on dialysis 40.4 ± 37.8 months. Significant predictors of RLS were history of diabetes mellitus (DM, coffee intake, afternoon dialysis, gender and type of dialysis (P= 0.03, 0.01, < 0.001, 0.05 and 0.009 respectively. Patients with RLS were found to be at increased risk of having insomnia and excessive daytime sleepiness (EDS (P= < 0.001 and 0.001, respectively. Our study suggests that RLS is a very common problem in dialysis population and was significantly associated with other sleep disorders, particularly insomnia, and EDS. Optimal care of dialysis patient should include particular attention to the diagnosis

  3. Anxiety disorders in dialysis patients

    Directory of Open Access Journals (Sweden)

    Novaković Milan

    2007-01-01

    Full Text Available Introduction. Anxiety, as a primary symptom, includes all conditions of indefinite fear and psychic disorders dominated by fear. All dialysis patients suffer from anxiety as an independent phenomenon, or as part of another disease. Material and Methods. This study included 753 patients on chronic hemodialysis in Bosnia and Herzegovina (B&H in the period 1999-2004. The patients were divided into two groups: the first group included 348 patients with Balkan Endemic Nephropathy (BEN, and the control group included 405 patients with other diagnoses causing renal insufficiency (N18. The study was designed as a comparative cross sectional study, and patients were tested using questionnaires assessing anxiety, depression and general mental health status. Statistical analysis was done using standard descriptive and analytical methods. Results. Socio-demographic data showed highly significant differences between BEN and N18 in relation to place of residence (urban/rural (c2 = 23.970 p<0.01; in the incidence of renal comorbidity (c2 = 23.970 p<0.01; familial renal comorbidity (c2 = 23.970 p<0.01; and migrations (c2 = 4.874 p<0.01. Beck Anxiety Inventory Scores were highly significantly different between the two groups p<0.001, in regard to the incidence and variables. Hamilton Depression Rating Scale demonstrated a group significance p<0.001, and variables pointed to somatization, general anxiety and depression. This was confirmed by mini-mental state examination pointing to generalmental weakness. Conclusion. Anxiety appeared in all tested dialysis patients. It may be independent, somatized as part of another mental disorder or reinforced by a cognitive damage. Structured anxiety and depression result in pre-suicidal risk. .

  4. Managing diabetes in dialysis patients.

    Science.gov (United States)

    O'Toole, Sam M; Fan, Stanley L; Yaqoob, M Magdi; Chowdhury, Tahseen A

    2012-03-01

    Burgeoning levels of diabetes are a major concern for dialysis services, as diabetes is now the most common cause of end-stage renal disease in most developed nations. With the rapid rise in diabetes prevalence in developing countries, the burden of end stage renal failure due to diabetes is also expected to rise in such countries. Diabetic patients on dialysis have a high burden of morbidity and mortality, particularly from cardiovascular disease, and a higher societal and economic cost compared to non-diabetic subjects on dialysis. Tight glycaemic and blood pressure control in diabetic patients has an important impact in reducing risk of progression to end stage renal disease. The evidence for improving glycaemic control in patients on dialysis having an impact on mortality or morbidity is sparse. Indeed, many factors make improving glycaemic control in patients on dialysis very challenging, including therapeutic difficulties with hypoglycaemic agents, monitoring difficulties, dialysis strategies that exacerbate hyperglycaemia or hypoglycaemia, and possibly a degree of therapeutic nihilism or inertia on the part of clinical diabetologists and nephrologists. Standard drug therapy for hyperglycaemia (eg, metformin) is clearly not possible in patients on dialysis. Thus, sulphonylureas and insulin have been the mainstay of treatment. Newer therapies for hyperglycaemia, such as gliptins and glucagon-like peptide-1 analogues have become available, but until recently, renal failure has precluded their use. Newer gliptins, however, are now licensed for use in 'severe renal failure', although they have yet to be trialled in dialysis patients. Diabetic patients on dialysis have special needs, as they have a much greater burden of complications (cardiac, retinal and foot). They may be best managed in a multidisciplinary diabetic-renal clinic setting, using the skills of diabetologists, nephrologists, clinical nurse specialists in nephrology and diabetes, along with

  5. Comparing risk of new onset diabetes mellitus in chronic kidney disease patients receiving peritoneal dialysis and hemodialysis using propensity score matching.

    Directory of Open Access Journals (Sweden)

    Che-Yi Chou

    Full Text Available Chronic kidney disease (CKD patients are at risk for developing new-onset diabetes mellitus (NODM even after hemodialysis (HD and peritoneal dialysis (PD treatment. It is not clear if the incidence for NODM is different in CKD patients receiving HD and PD. This study compared the risk of NODM in PD patients and HD patients.All HD and PD patients in Taiwan Renal Registry Database from 1997 to 2005 were included and all patients were followed to December 31, 2008. The risk of NODM was analyzed in PD patients and propensity score matched HD patients using logistic regression for early type NODM (6 months after dialysis.A total of 2548 PD patients and 10192 HD patients who had no diabetes on the initiation of dialysis were analyzed. The incidence for NODM was 3.7 per 100 patient/year for HD and 2.4 for PD patients. HD patients are more at risk for developing early type NODM (p<0.001 with an adjusted odds ratio of 1.41 [95% confidence interval (CI 1.12-1.78]. HD patients are more at risk for late type NODM (p<0.001 with an adjusted hazard ratio of 2.01 (95% CI: 1.77-2.29. Patient's age was negatively associated with risk of early type of NODM (p<0.001 but positively associated with risk of late type NODM (p<0.001.Chronic kidney disease patients receiving hemodialysis are more at risk for developing new-onset diabetes mellitus compared to those receiving peritoneal dialysis.

  6. Clinical Value of Natriuretic Peptides in Predicting Time to Dialysis in Stage 4 and 5 Chronic Kidney Disease Patients

    Science.gov (United States)

    Sundqvist, Sofia; Larson, Thomas; Cauliez, Bruno; Bauer, Fabrice; Dumont, Audrey; Le Roy, Frank; Hanoy, Mélanie; Fréguin-Bouilland, Caroline; Godin, Michel

    2016-01-01

    Background Anticipating the time to renal replacement therapy (RRT) in chronic kidney disease (CKD) patients is an important but challenging issue. Natriuretic peptides are biomarkers of ventricular dysfunction related to poor outcome in CKD. We comparatively investigated the value of B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) as prognostic markers for the risk of RRT in stage 4 and 5 CKD patients, and in foretelling all-cause mortality and major cardiovascular events within a 5-year follow-up period. Methods Baseline plasma BNP (Triage, Biosite) and NT-proBNP (Elecsys, Roche) were measured at inclusion. Forty-three patients were followed-up during 5 years. Kaplan-Meier analysis, with log-rank testing and hazard ratios (HR), were calculated to evaluate survival without RRT, cardiovascular events or mortality. The independent prognostic value of the biomarkers was estimated in separate Cox multivariate analysis, including estimated glomerular filtration rate (eGFR), creatininemia and comorbidities. Results During the first 12-month follow-up period, 16 patients started RRT. NT-proBNP concentration was higher in patients who reached endpoint (3221 ng/L vs 777 ng/L, p = 0.02). NT-proBNP concentration > 1345 ng/L proved significant predictive value on survival analysis for cardiovascular events (p = 0.04) and dialysis within 60 months follow-up (p = 0.008). BNP concentration > 140 ng/L was an independent predictor of RRT after 12 months follow-up (p<0.005), and of significant predictive value for initiation of dialysis within 60 months follow-up. Conclusions Our results indicate a prognostic value for BNP and NT-proBNP in predicting RRT in stage 4 and 5 CKD patients, regarding both short- and long-term periods. NT-proBNP also proved a value in predicting cardiovascular events. Natriuretic peptides could be useful predictive biomarkers for therapeutic guidance in CKD. PMID:27548064

  7. Research Progress in Chronic Inflammatory State of Peritoneal Dialysis Patients%腹膜透析患者慢性炎症状态研究进展

    Institute of Scientific and Technical Information of China (English)

    白鸽

    2013-01-01

    Peritoneal dialysis is one of the effective treatment of end-stage renal disease,which can substitute parts of renal function.Because not all of the functions of the kidney can be substituted by peritoneal dialysis,many factors in vivo still affect the patients for long-term survival.Chronic inflammation is highly prevalent in long-term peritoneal dialysis population.The causes of inflammation are usually complex and multifactorial,involving both dialysis-related and dialysis-unrelated factors.The elevated inflammatory factors have negative influence on the peritoneal structure and function,cardiovascular system,nutritional status,residual renal function,dialysis sufficiency and quality of life.How to reduce inflammatory state and improve the peritoneal dialysis patients' survival rate are the research hotspots.%腹膜透析(PD)是终末期肾脏疾病治疗的有效方法之一,可替代肾脏的部分功能.由于PD不能代替肾脏的全部功能,体内仍然存在许多影响患者长期生存的因素.长期接受PD的患者体内普遍存在慢性炎症状态,其原因是复杂的、多种因素共同参与的,主要包括透析相关性及非透析相关性因素.体内炎性因子的增高对腹膜结构与功能、心血管系统、营养状况、残肾功能、透析充分性以及生存质量都有不利影响.如何减轻炎症状态,提高PD患者生存率是目前研究的热点.

  8. Pro: Higher serum bicarbonate in dialysis patients is protective.

    Science.gov (United States)

    Misra, Madhukar

    2016-08-01

    Chronic metabolic acidosis is common in dialysis patients. Bicarbonate administration via the dialysate helps maintain the acid-base balance in these patients. Serum bicarbonate level in dialysis patients is determined by several factors that include dietary protein intake, nutritional status and dialysis prescription, etc. Additionally, a meaningful interpretation of serum bicarbonate in dialysis patients requires an understanding of complexities involving its measurement. Both very low as well very high levels of serum bicarbonate have been associated with adverse outcomes in observational studies. However, recent observational data, when adjusted for the confounding effects of nutritional status, do not associate higher predialysis serum bicarbonate with adverse consequences. At this time, there are no prospective studies available that have examined the association of serum bicarbonate with hard outcomes in dialysis patients. The ideal level of serum bicarbonate in dialysis patients is therefore unknown. This article examines the available data with regard to the benefits of higher predialysis serum bicarbonate. PMID:27411723

  9. Differences in survival on chronic dialysis treatment between ethnic groups in Denmark

    DEFF Research Database (Denmark)

    van den Beukel, Tessa O; Hommel, Kristine; Kamper, Anne-Lise;

    2016-01-01

    BACKGROUND: In Western countries, black and Asian dialysis patients experience better survival compared with white patients. The aim of this study is to compare the survival of native Danish dialysis patients with that of dialysis patients originating from other countries and to explore...... the association between the duration of residence in Denmark before the start of dialysis and the mortality on dialysis. METHODS: We performed a population-wide national cohort study of incident chronic dialysis patients in Denmark (≥18 years old) who started dialysis between 1995 and 2010. RESULTS: In total......, 8459 patients were native Danes, 344 originated from other Western countries, 79 from North Africa or West Asia, 173 from South or South-East Asia and 54 from sub-Saharan Africa. Native Danes were more likely to die on dialysis compared with the other groups (crude incidence rates for mortality: 234...

  10. HIVAN and medication use in chronic dialysis patients in the United States: analysis of the USRDS DMMS Wave 2 study

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    Agodoa Lawrence Y

    2003-07-01

    Full Text Available Abstract Background The use and possible effects of factors known to improve outcomes in patients with human immunodeficiency virus associated nephropathy (HIVAN, namely of angiotensin converting enzyme inhibitors (ACE and antiretroviral therapy, has not been reported for a national sample of dialysis patients. Methods We conducted a historical cohort study of the United States Renal Data System (USRDS Dialysis Morbidity and Mortality Study (DMMS Wave 2 to identify risk factors associated with increased mortality in these patients. Data were available for 3374 patients who started dialysis and were followed until March 2000. Cox Regression analysis was used to model adjusted hazard ratios (AHR with HIVAN as a cause of end stage renal disease (ESRD and its impact on mortality during the study period, adjusted for potential confounders. Results Of the 3374 patients who started dialysis, 36 (1.1% had ESRD as a result of HIVAN. Only 22 (61% of patients with HIVAN received antiretroviral agents, and only nine patients (25% received combination antiretroviral therapy, and only 14% received ACE inhibitors. Neither the use of multiple antiretroviral drugs (AHR, 0.62, 95% CI, 0.10, 3.86, p = 0.60, or ACE inhibitors were associated with a survival advantage. Patients with HIVAN had an increased risk of mortality (adjusted hazard ratio, 4.74, 95% Confidence Interval, 3.12, 7.32, p Conclusions Medications known to improve outcomes in HIV infected patients were underutilized in patients with HIVAN. Adjusted for other factors, a primary diagnosis of HIVAN was associated with increased mortality compared with other causes of ESRD.

  11. Baseline Predictors of Mortality among Predominantly Rural-Dwelling End-Stage Renal Disease Patients on Chronic Dialysis Therapies in Limpopo, South Africa.

    Directory of Open Access Journals (Sweden)

    Ramon A Tamayo Isla

    Full Text Available Dialysis therapy for end-stage renal disease (ESRD continues to be the readily available renal replacement option in developing countries. While the impact of rural/remote dwelling on mortality among dialysis patients in developed countries is known, it remains to be defined in sub-Saharan Africa.A single-center database of end-stage renal disease patients on chronic dialysis therapies treated between 2007 and 2014 at the Polokwane Kidney and Dialysis Centre (PKDC of the Pietersburg Provincial Hospital, Limpopo South Africa, was retrospectively reviewed. All-cause, cardiovascular, and infection-related mortalities were assessed and associated baseline predictors determined.Of the 340 patients reviewed, 52.1% were male, 92.9% were black Africans, 1.8% were positive for the human immunodeficiency virus (HIV, and 87.5% were rural dwellers. The average distance travelled to the dialysis centre was 112.3 ± 73.4 Km while 67.6% of patients lived in formal housing. Estimated glomerular filtration rate (eGFR at dialysis initiation was 7.1 ± 3.7 mls/min while hemodialysis (HD was the predominant modality offered (57.1%. Ninety-two (92 deaths were recorded over the duration of follow-up with the majority (34.8% of deaths arising from infection-related causes. Continuous ambulatory peritoneal dialysis (CAPD was a significant predictor of all-cause mortality (HR: 1.62, CI: 1.07-2.46 and infection-related mortality (HR: 2.27, CI: 1.13-4.60. On multivariable cox regression, CAPD remained a significant predictor of all-cause mortality (HR: 2.00, CI: 1.29-3.10 while the risk of death among CAPD patients was also significantly modified by diabetes mellitus (DM status (HR: 4.99, CI: 2.13-11.71.CAPD among predominantly rural dwelling patients in the Limpopo province of South Africa is associated with an increased risk of death from all-causes and infection-related causes.

  12. Determination of the bone-mineral content of the peripheral skeleton (ulna and calcaneus) in chronic renal failure patients on maintenance dialysis using 125 I-photon absorptiometry

    International Nuclear Information System (INIS)

    The bone-mineral content (BMC) of the peripheral skeleton was measured in 53 chronic renal-failure patients on maintenance dialysis using the 125 I photon absorptiometry according to Cameron. 39.6% of the patients were found to have a clearly pathological calcium content in calcaneus and ulna (33%). In total BMC assessments 43.4% of the patients examined showed strongly reduced BMC values at two measurement sites at least. Average bone-mineral content was below the value of the corresponding normal groups in all age groups of the dialysis patients. In addition, a significant correlation was verified to exist between the calcium contents of calcaneus and ulna. A significant correlation was found as well between reduced BMC values and dialysis duration. The correlation between the increased serum level of alkaline phosphatase and the reduced mineral content of the skeleton was significant as well. A minor but not significant correlation existed between the increase of the parathormone (PTH) level in the serum and the decrease of calcium content in calcaneus and ulna. A good correlation was found when contrasting the results of visual roentgenography and the BMC values established by photodensitometry: the median BMC value of patients with clear pathological X-ray findings was significantly below the one of patients without pathological X-ray findings. However, photon absorptiometry is superior to the subjective evaluation of X-ray pictures in the early diagnosis of bone diseases involving bone-mineral loss. (orig.)

  13. Ankle-brachial blood pressure index predicts cardiovascular events and mortality in Japanese patients with chronic kidney disease not on dialysis.

    Science.gov (United States)

    Yoshitomi, Ryota; Nakayama, Masaru; Ura, Yoriko; Kuma, Kazuyoshi; Nishimoto, Hitomi; Fukui, Akiko; Ikeda, Hirofumi; Tsuchihashi, Takuya; Tsuruya, Kazuhiko; Kitazono, Takanari

    2014-12-01

    The ankle-brachial blood pressure index (ABPI) has been recognized to have a predictive value for cardiovascular (CV) events and mortality in general or dialysis populations. However, the associations between ABPI and those outcomes have not been fully investigated in predialysis patients. The present study aimed to clarify the relationships between ABPI and both CV events and mortality in Japanese chronic kidney disease (CKD) patients not on dialysis. In this prospective observational study, we enrolled 320 patients with CKD stages 3-5 who were not on dialysis. At baseline, ABPI was examined and a low ABPI was defined as ABPI were risk factors for CV events. It was demonstrated that age, a history of cerebrovascular disease and low ABPI were determined as independent risk factors for CV mortality. In addition, age, body mass index and low ABPI were independently associated with all-cause mortality. In patients with CKD, low ABPI during the predialysis period is independently associated with poor survival and CV events, suggesting the usefulness of measuring ABPI for predicting CV events and patient survival in CKD. PMID:25056682

  14. Comparison between Calcitriol and Calcitriol Plus Low-Dose Cinacalcet for the Treatment of Moderate to Severe Secondary Hyperparathyroidism in Chronic Dialysis Patients

    Directory of Open Access Journals (Sweden)

    Chien-Te Lee

    2013-04-01

    Full Text Available Aim: Uremic hyperparathyroidism (UHPT has been shown to contribute to the development and progression of chronic kidney disease—mineral bone disorder. UHPT is frequently observed in chronic dialysis patients, and patients with UHPT are associated with increased risk of all-cause and cardiovascular mortality. Cinacalcet is a novel agent that increases sensitivity to the calcium-sensing receptor and is approved for control of UHPT. Nevertheless, cinacalcet is costly and information regarding efficacy of low-dose cinacalcet on UHPT is limited. Methods: We conducted a retrospective study to evaluate treatment with either low-dose calcitriol combined with low-dose cinacalcet (25 mg (d-Cinacalcet or calcitriol alone (VitD in dialysis patients with moderate to severe UHPT. A total of 81 dialysis patients were enrolled (40 subjects in d-Cinacalcet group and 41 subjects in VitD group. Demographic data including age, gender, duration on dialysis and biochemical data were reviewed and recorded. Results: At the end of the study, the intact parathyroid hormone (iPTH levels of the d-Cinacalcet group declined significantly (from 1166.0 ± 469.3 pg/mL to 679.8 ± 421.6 pg/mL, p < 0.0001, while there was no significant change in the VitD group. Significant decrease of serum calcium (Ca: 9.9 ± 0.6 mg/dL vs. 9.6 ± 0.8 mg/dL, p = 0.002, phosphorus (P: 5.9 ± 1.3 mg/dL vs. 4.9 ± 0.9 mg/dL, p < 0.0001 and calcium phosphate product (Ca × P: 58.7 ± 15.0 mg2/dL2 vs. 46.9 ± 8.9 mg2/dL2, p < 0.0001 were observed in the d-Cinacalcet group. In addition, the subjects in the d-Cinacalcet group had a greater proportion to achieve Kidney Disease Outcomes Quality Initiative (KDOQI-recommended biochemical targets than the subjects in the VitD group (Ca: 48% vs. 24%; P: 78% vs. 32%; Ca × P: 85% vs. 37%; iPTH: 15% vs. 0%. Conclusions: We conclude that combination therapy of low-dose cinacalcet and calcitriol is more effective than calcitriol alone as a treatment for

  15. Dialysis vintage, body composition, and survival in peritoneal dialysis patients.

    Science.gov (United States)

    Avram, Morrell M; Mittman, Neal; Fein, Paul A; Agahiu, Samuel; Hartman, William; Chattopadhyay, Neil; Matza, Betty

    2012-01-01

    The relationship between dialysis vintage (length of time on dialysis), body composition, and survival has been reported in hemodialysis patients. In the present study, we examined the association ofdialysis vintage with body composition and survival in peritoneal dialysis (PD) patients. At enrollment, body composition in 65 PD patients was determined by bioelectrical impedance analysis. Patients (mean age at enrollment: 54 years) were followed for up to 11 years maximum. At enrollment, the mean, median, and maximum dialysis vintages were 51, 34, and 261 months respectively. After adjusting for age, race, sex, and diabetes status, dialysis vintage was indirectly correlated (partial correlation coefficients) with body weight (r = -0.40, p = 0.001), body mass index (r = -0.40, p = 0.002), body surface area (r = -0.39, p = 0.002), body cell mass (r = -0.39, p = 0.002), total body fat weight (r = -0.30, p = 0.02), and fat percentage of body weight (r = -0.31, p = 0.018), and directly correlated with extracellular mass to body cell mass ratio (r = 0.27, p = 0.039). The observed cumulative survival was significantly higher (p = 0.007) in patients with a dialysis vintage at enrollment of 35 months or less, than in patients with dialysis vintage at enrollment of more than 35 months. In the multivariate Cox regression analysis, adjusting for age, race, sex, and diabetes, dialysis vintage at enrollment remained an independent predictor of mortality (relative risk: 1.010; p = 0.002). Increase in relative risk of death with increasing dialysis vintage may be partly explained by the association of vintage with unfavorable changes in body composition and the nutrition status of patients over time.

  16. China collaborative study on dialysis: a multi-centers cohort study on cardiovascular diseases in patients on maintenance dialysis

    Directory of Open Access Journals (Sweden)

    Hou Fanfan

    2012-08-01

    Full Text Available Abstract Background Cardiovascular disease (CVD is the main cause of death in patients on chronic dialysis. The question whether dialysis modality impacts cardiovascular risk remains to be addressed. China Collaborative Study on Dialysis, a multi-centers cohort study, was performed to evaluate cardiovascular morbidity during maintenance hemodialysis (HD and peritoneal dialysis (PD. Method The cohort consisted of chronic dialysis patients from the database of 9 of the largest dialysis facilities around China. The inclusion period was between January 1, 2005, and December 1, 2010. Cardiovascular morbidity was defined as the presence of clinically diagnosed ischemic heart disease, heart failure, peripheral vascular disease, and/or stroke. The patients who had cardiovascular morbidity before initiation of dialysis were excluded. Data collection was based on review of medical record. Result A total of 2,388 adult patients (1,775 on HD and 613 on PD were enrolled. Cardiovascular morbidity affected 57% patients and was comparable between HD and PD patients. However, clinically diagnosed ischemic heart disease and stroke was more prevalent in PD than HD patients. When the patients were stratified by age or dialysis vintage, the cardiovascular morbidity was significantly higher in PD than HD among those aged 50 years or older, or those receiving dialysis over 36 months. Multivariate analysis revealed that the risk factors for cardiovascular morbidity had different pattern in PD and HD patients. Hyperglycemia was the strongest risk factor for cardiovascular morbidity in PD, but not in HD patients. Hypertriglyceridemia and hypoalbuminemia were independently associated with CVD only in PD patients. Conclusions Cardiovascular morbidity during chronic dialysis was more prevalent in PD than HD patients among those with old age and long-term dialysis. Metabolic disturbance-related risk factors were independently associated with CVD only in PD patients

  17. [Study of the binding characteristics of chlorophenoxyisobutyric acid to serum proteins in chronically uremic patients : influence of dialysis and heparine (author's transl)].

    Science.gov (United States)

    Lacour, B; Di Giulio, S; Nicolaï, A; Drüeke, T; Debray, M; Boulu, R G

    1982-01-01

    The binding characteristics of chlorophenoxyisobutyric acid (CPIB) to serum proteins has been studied in 10 chronically uremic patients and 9 healthy subjects using the technique of equilibrium dialysis. Scatchard analysis of the results indicated a significant decrease in association constants for low as well as for high affinity sites. The number of binding sites however was not diminished thus suggesting the presence of competitive inhibitors. Such inhibitors were dializable, at least in part, as demonstrated by in vivo-hemodialysis and in vitro-dialysis experiments. The in vivo administration of 50 mg heparin intravenously led to a striking increase in the unbound fraction of serum CPIB whereas the addition of 10 IU/ml heparin in vitro induced no change of protein binding which is in favor of only an indirect effect of heparin. In conclusion, CPIB binding to serum proteins of chronically uremic patients as compared to normal volunteers was decreased leading to an increase of its unbound circulating fraction. The observed change of protein binding appeared to be due to the presence of competitive inhibitors in uremic serum. PMID:7088259

  18. 透析与非透析老年慢性肾脏病患者自由生活状态下的能量消耗%Energy expenditure of elderly dialysis and non-dialysis patients with chronic kidney disease under free-riving state

    Institute of Scientific and Technical Information of China (English)

    陈伟军; 张晓丽; 盛蔚文; 陆轶君; 冯欣慧; 叶志斌

    2011-01-01

    Objective To investigate the energy consumption of elderly dialysis and non-dialysis patients with chronic kidney disease under free-living state. Methods The dialysis group consisted of twenty randomly selected elderly dialysis patients (10 patients with peritoneal dialysis and 10 patients with hemodialysis), and the non-dialysis group involved twenty non-dialysis patients with chronic kidney disease. These two groups were comparable in age, height, body weight. Twenty-four total energy consumption as well as the energy consumption under different activities patterns (standing, sitting, lying and walking) were measured using MiniSun's IDEEA (Intelligent Device for Energy Expenditure and Activity) system. Results Daily energy consumption of the dialysis group was significantly higher than that of the non-dialysis group. However, there was no difference between the two groups in the proportion of energy expenditure at sitting, standing, walking, lying position. The amount of the energy expenditure of the dialysis group was mostly distributed in the 2000-2500 Kcal / d range, while the non-dialysis group in the 1500-2000 Kcal / d range (P0.05). The amount and the proportion of energy consumption in lying as well as standing position was higher in hemodialysis group than peritoneal dialysis group. Hemodialysis patients consumed less energy than peritoneal dialysis patients during walking activities (P0.05);透析组能量消耗多分布在2000-2500 kcal/d区间,非透析组能量消耗多分布在1 500-2000kcal/d区间内,两组有统计学差异.血透与腹透组的能量消耗相近(P>0.05),但血透患者卧、站状态下消耗等量所占的比例、所消耗能量的数值均高于腹透患者,而走状态下所消耗能量所占的比例、所消耗能量的数值低于腹透患者(P<0.05).结论 老年透析患者的能量消耗高于非透析患者.老年血透和腹透患者自由生活状态下的能茸消耗相近,但在不同活动状态下所消耗的能蛰有所不同.

  19. Sequence-Based Polymorphisms in the Mitochondrial D-Loop and Potential SNP Predictors for Chronic Dialysis

    OpenAIRE

    Jin-Bor Chen; Yi-Hsin Yang; Wen-Chin Lee; Chia-Wei Liou; Tsu-Kung Lin; Yueh-Hua Chung; Li-Yeh Chuang; Cheng-Hong Yang; Hsueh-Wei Chang

    2012-01-01

    BACKGROUND: The mitochondrial (mt) displacement loop (D-loop) is known to accumulate structural alterations and mutations. The aim of this study was to investigate the prevalence of single nucleotide polymorphisms (SNPs) within the D-loop among chronic dialysis patients and healthy controls. METHODOLOGY AND PRINCIPAL FINDINGS: We enrolled 193 chronic dialysis patients and 704 healthy controls. SNPs were identified by large scale D-loop sequencing and bioinformatic analysis. Chronic dialysis p...

  20. Evaluation of body composition and nitrogen content of renal patients on chronic dialysis as determined by total body neutron activation

    International Nuclear Information System (INIS)

    Total body protein (nitrogen), body cell mass (potassium), fat, and water were measured in 15 renal patients on maintenance hemodialysis (MHD). Total body nitrogen was measured by means of prompt γ neutron activation analysis; total body water was determined with tritium labeled water; total body potassium was measured by whole body counting. The extracellular water was determined by a technique utilizing the measurement of total body chloride and plasma chloride. When compared with corresponding values of a control group of the same age, sex, and height, the protein content, body cell mass, and total body fat of the MHD patients were within the normal range. The only significant change was an increase in the extracellular water/body cell mass ratio in the male MHD patients compared to the control. The lack of significant difference of the nitrogen values of the MHD patients compared to matched controls suggests that dialysis minimizes any residual effects of uremic toxicity or protein-calorie malnutrition. These findings further suggest that there is a need to reevaluate the traditional anthropometric and biochemical standards of nutritional status for MHD patients. It was concluded that it is particularly important to measure protein stores of MHD patients with low protein intake to ascertain nutritional status. Finally, in vivo measurement of total body nitrogen and potassium for determination of body composition provides a simple, direct, and accurate assessment of the nutritional status of MHD patients

  1. Diabetic patients treated with dialysis: complications and quality of life

    DEFF Research Database (Denmark)

    Sørensen, V R; Mathiesen, E R; Watt, T;

    2007-01-01

    population (47 +/- 19). The diabetic dialysis patients had similar levels of kidney-specific quality of life and mental health compared with the control groups. Reduced physical health was predicted by the presence of end-stage renal disease, diabetes and short time spent in education. Among the diabetic......AIMS/HYPOTHESIS: The aim of this study was to describe the prevalence of complications, health-related quality of life (HRQOL) and the influence of beliefs about control over health in diabetic dialysis patients. METHODS: Of 53 eligible diabetic patients on chronic dialysis during January 2004...... in our clinic, 38 (76%) completed a kidney-specific (Kidney Disease Quality of Life) and a generic (SF-36) questionnaire and were characterised in terms of cardiovascular diseases and diabetic complications. Matched groups of non-diabetic dialysis patients (n = 40) and diabetic patients with a long...

  2. Aliskiren prevents the toxic effects of peritoneal dialysis fluids during chronic dialysis in rats.

    Directory of Open Access Journals (Sweden)

    Juan Pérez-Martínez

    Full Text Available The benefits of long-term peritoneal dialysis (PD in patients with end-stage renal failure are short-lived due to structural and functional changes in the peritoneal membrane. In this report, we provide evidence for the in vitro and in vivo participation of the renin-angiotensin-aldosterone system (RAAS in the signaling pathway leading to peritoneal fibrosis during PD. Exposure to high-glucose PD fluids (PDFs increases damage and fibrosis markers in both isolated rat peritoneal mesothelial cells and in the peritoneum of rats after chronic dialysis. In both cases, the addition of the RAAS inhibitor aliskiren markedly improved damage and fibrosis markers, and prevented functional modifications in the peritoneal transport, as measured by the peritoneal equilibrium test. These data suggest that inhibition of the RAAS may be a novel way to improve the efficacy of PD by preventing inflammation and fibrosis following peritoneal exposure to high-glucose PDFs.

  3. [Destructive spondylarthropathy in dialysis patients].

    Science.gov (United States)

    Stein, G; Schneider, A; Marzoll, I; Sperschneider, H; Ritz, E

    1991-01-01

    Back pain and a cervicobrachial syndrome, as well as progressive sensory and motor deficits as far as symptoms of paraplegia, developed in two dialysis patients two and five years after the start of dialysis. One was a 60-year-old woman with pyelonephritis, the other a 55-year-old man with glomerulonephritis. There were typical radiological signs of destructive spondylarthropathy (narrowed intervertebral spaces and slippage of the vertebral bodies). The female patient required several operations (spondylothesis and orthothesis) and both patients received daily 10,000 IU vitamin D and 3-4 g calcium carbonate. In the woman the destructive process no longer progressed one year after onset of symptoms, but she still required many analgesics. She died three months later of circulatory failure. The man died four weeks after the onset of symptoms from purulent meningitis. At autopsy only renal fibrous ostitis was still demonstrable. Amyloidosis resulting from an increase in beta 2-microglobulin level were excluded by both histological and immunohistochemical examinations. PMID:1985800

  4. Con: Higher serum bicarbonate in dialysis patients is protective.

    Science.gov (United States)

    Chauveau, Philippe; Rigothier, Claire; Combe, Christian

    2016-08-01

    Metabolic acidosis is often observed in advanced chronic kidney disease, with deleterious consequences on the nutritional status, bone and mineral status, inflammation and mortality. Through clearance of the daily acid load and a net gain in alkaline buffers, dialysis therapy is aimed at correcting metabolic acidosis. A normal bicarbonate serum concentration is the recommended target in dialysis patients. However, several studies have shown that a mild degree of metabolic acidosis in patients treated with dialysis is associated with better nutritional status, higher protein intake and improved survival. Conversely, a high bicarbonate serum concentration is associated with poor nutritional status and lower survival. It is likely that mild acidosis results from a dietary acid load linked to animal protein intake. In contrast, a high bicarbonate concentration in patients treated with dialysis could result mainly from an insufficient dietary acid load, i.e. low protein intake. Therefore, a high pre-dialysis serum bicarbonate concentration should prompt nephrologists to carry out nutritional investigations to detect insufficient dietary protein intake. In any case, a high bicarbonate concentration should be neither a goal of dialysis therapy nor an index of adequate dialysis, whereas mild acidosis could be considered as an indicator of appropriate protein intake. PMID:27411724

  5. A randomized, double-blind, placebo-controlled trial of calcium acetate on serum phosphorus concentrations in patients with advanced non-dialysis-dependent chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Ho Chiang-Hong

    2011-02-01

    Full Text Available Abstract Background Hyperphosphatemia in patients with chronic kidney disease (CKD contributes to secondary hyperparathyroidism, soft tissue calcification, and increased mortality risk. This trial was conducted to examine the efficacy and safety of calcium acetate in controlling serum phosphorus in pre-dialysis patients with CKD. Methods In this randomized, double-blind, placebo-controlled trial, 110 nondialyzed patients from 34 sites with estimated GFR 2 and serum phosphorus > 4.5 mg/dL were randomized to calcium acetate or placebo for 12 weeks. The dose of study drugs was titrated to achieve target serum phosphorus of 2.7-4.5 mg/dL. Serum phosphorus, calcium, iPTH, bicarbonate and serum albumin were measured at baseline and every 2 weeks for the 12 week study period. The primary efficacy endpoint was serum phosphorus at 12 weeks. Secondary endpoints were to measure serum calcium and intact parathyroid hormone (iPTH levels. Results At 12 weeks, serum phosphorus concentration was significantly lower in the calcium acetate group compared to the placebo group (4.4 ± 1.2 mg/dL vs. 5.1 ± 1.4 mg/dL; p = 0.04. The albumin-adjusted serum calcium concentration was significantly higher (9.5 ± 0.8 vs. 8.8 ± 0.8; p p Conclusions In CKD patients not yet on dialysis, calcium acetate was effective in reducing serum phosphorus and iPTH over a 12 week period. Trial Registration www.clinicaltrials.gov NCT00211978.

  6. Temporal perspective and other psychological factors making it difficult to adapt to requirements of treatment in chronic dialysis patients

    Directory of Open Access Journals (Sweden)

    Zawadzka, Barbara

    2014-10-01

    Full Text Available Aim. The study analyzed the relationship between temporal perspective, selected personal resources, and unhealthy behavior, manifesting in problems with adherence to fluid intake restrictions, in chronic hemodialyzis patients. The authors tried to answer the question whether there is temporal perspective and other psychological factors increasing the risk of non-adaptive behaviors. Methods. Sixty-one patients, aged 23–81 years (M = 59; SD = 13,9 on chronic hemodialysis at the Department of Nephrology University Hospital were qualified to the study. The study group consisted of 30 patients with poorer fluid regimen adherence and 31 controls, who maintained fluid regimen. The patients were qualified on the bases of the average interdialysis weight gains measured nine times during three weeks. The following research tools were used: P. Zimbardo and J. Boyd ZTPI test; P.T. Costa and R.R. McCrae NEO-FFI Inventory; J. Strelau Temperament Inventory, R. Schwarzer GSES; M. F. Scheier; C. S. Carver and M. W. Bridges LOT-R; M. Watson and S. Greer CECS; BJ. Felton, TA. Revenson, GA. Hinrichsen AIS. Results. Difficulties in adapting to the fluid intake restrictions are significantly associated with temporal orientation towards negative aspects of the present and the past. Non-adaptive health behaviors are typical for patients with temperamental lack of balance between agitation and inhibition processes and are characterized by high agreeableness and low conscientiousness. The association between excessive anger control and the risk of non-adherence medical recommendations. Conclusions. Time perception and other personality factors form mechanisms regulating health behaviors in chronically treatment patients.

  7. Cognitive Dysfunction in Chronic Renal Disease: Impact of Dialysis Modality

    Directory of Open Access Journals (Sweden)

    Recep AK

    2015-12-01

    Full Text Available OBJECTIVE: Cognitive dysfunction (CD is common among patients with chronic kidney disease (CKD and contributes to morbidity and mortality. We aimed to explore the factors involved in the development of CD in patients with CKD and to compare cognitive function between hemodialysis (HD and peritoneal dialysis (PD patients. MATERIAL and METHODS: We studied 122 patients with different stages of CKD, and divided them into two groups: Predialysis Group: included 60 CKD patients, (28 stage III and 34 stage IV; Dialysis Group: included 60 patients on dialysis therapy, (30 on HD and 30 on PD. Psychometric tests were done all patients. The results were compared with 41 healthy subjects. RESULTS: We found that the CD rate was higher in patients with CKD (24.6% than controls (0%, p<0.001. The Mini Mental Test score was found to be correlated with age (r=-0.428, hemoglobin (r=0.336, CRP (r=-0.311, and albumin (r=0.336; the Calculation Test score was found to be correlated with LDL cholesterol (r=-0.336; the Praxis Test Score was found to be correlated with duration of CKD (r=-0.204, HDL (r=0.188; and the Visual Memory Test score was found to be correlated with parathormone levels (r=-0.270. We found the CD rate to be higher in patients on HD (50% than on PD (23.3%, p=0.032. CONCLUSION: Our findings suggest that anemia, malnutrition and inflammation play an important role in the development of CD in our patients, and cognitive functions are better preserved in the PD group than the HD group.

  8. Reduced glomerular filtration rate, inflammation and HDL cholesterol as main determinants of superoxide production in non-dialysis chronic kidney disease patients.

    Science.gov (United States)

    Morena, Marion; Patrier, Laure; Jaussent, Isabelle; Bargnoux, Anne-Sophie; Dupuy, Anne-Marie; Badiou, Stéphanie; Leray-Moragues, Hélène; Klouche, Kada; Canaud, Bernard; Cristol, Jean-Paul

    2011-06-01

    Enhanced oxidative stress partly resulting from an over-production of superoxide anion (O(2)(•-)) represents a novel and particular risk factor in chronic kidney disease (CKD) patients. This study was therefore designed to evaluate O(2)(•-) determinants in this population. O(2)(•-) production was evaluated using chemiluminescence method in 136 CKD patients (79M/57F, median age: 69.5 [27.4-94.6]). Renal function (evaluated by the glomerular filtration rate using modification of diet in renal disease (MDRD)), inflammation, lipids, nutritional and bone mineral as well as clinical parameters were evaluated. Potential relationships between O(2)(•-) and these clinico-biological parameters were investigated to identify main determinants of such a pathological process. Enhanced O(2)(•-) production has been observed at the pre-dialysis phase: stages 4 and 5 of CKD (p = 0.0065). In multivariate analysis, low eGFR (MDRD <30 mL/min/1.73 m(2); p = 0.046), high fibrinogen (≥3.7 g/L; p = 0.044) and abnormal HDL cholesterol (<1.42 mmol/L and ≥ 1.75 mmol/L; p = 0.042) were the main determinants of O(2)(•-) production in CKD patients.

  9. Hematological profile of chronic kidney disease (CKD patients in Iran, in pre-dialysis stages and after initiation of hemodialysis

    Directory of Open Access Journals (Sweden)

    Afshar Reza

    2010-01-01

    Full Text Available Anemia is a common sequealae of chronic kidney disease (CKD, associated with significant morbidity. A cross-sectional study was conducted on 100 CKD patients (54 hemodia-lyzed, 46 pre-dialyzed. Data including, complete blood count, BUN, creatinine, creatinine clea-rance, underlying diseases and hemodialysis duration were collected by a questionnaire. The most frequent morphologic features were normochromic-normocytic (80%, hypochromic-microcytic (15% and macrocytic (5%. The frequency of anemia in hemodialyzed and pre-dialyzed patients (with mean Hgb level of 10.27 and 11.11 g/dL were 85% and 75%. Hemoglobin concentration was positively correlated to calculated creatinine clearance (P < 0.001. The severity of anemia among hemodialyzed patients was mild (Hgb > 10 g/dL in 5%, moderate in 70% and severe (Hgb < 7 g/dL in 25%, while in pre-dialyzed was mild in 45% and moderate in 55%. There was no correlation between the anemia and CKD causes or hemodialysis duration. In conclusion, data shows that anemia in our patients with CKD is a predominant manifestation, with high frequency but of moderate degree. The most likely cause is inadequate erythropoietin production.

  10. Mineral Metabolic Abnormalities and Mortality in Dialysis Patients

    Directory of Open Access Journals (Sweden)

    Masanori Abe

    2013-03-01

    Full Text Available The survival rate of dialysis patients, as determined by risk factors such as hypertension, nutritional status, and chronic inflammation, is lower than that of the general population. In addition, disorders of bone mineral metabolism are independently related to mortality and morbidity associated with cardiovascular disease and fracture in dialysis patients. Hyperphosphatemia is an important risk factor of, not only secondary hyperparathyroidism, but also cardiovascular disease. On the other hand, the risk of death reportedly increases with an increase in adjusted serum calcium level, while calcium levels below the recommended target are not associated with a worsened outcome. Thus, the significance of target levels of serum calcium in dialysis patients is debatable. The consensus on determining optimal parathyroid function in dialysis patients, however, is yet to be established. Therefore, the contribution of phosphorus and calcium levels to prognosis is perhaps more significant. Elevated fibroblast growth factor 23 levels have also been shown to be associated with cardiovascular events and death. In this review, we examine the associations between mineral metabolic abnormalities including serum phosphorus, calcium, and parathyroid hormone and mortality in dialysis patients.

  11. 42 CFR 414.316 - Payment for physician services to patients in training for self-dialysis and home dialysis.

    Science.gov (United States)

    2010-10-01

    ... training for self-dialysis and home dialysis. 414.316 Section 414.316 Public Health CENTERS FOR MEDICARE... Payment for physician services to patients in training for self-dialysis and home dialysis. (a) For each... for self-dialysis and home dialysis. (b) CMS determines the amount on the basis of program...

  12. Difficult peritonitis cases in children undergoing chronic peritoneal dialysis: relapsing, repeat, recurrent and zoonotic episodes.

    Science.gov (United States)

    Bakkaloglu, Sevcan A; Warady, Bradley A

    2015-09-01

    Despite technological improvements in dialysis connectology and dialysis technique, peritonitis remains the most common and most significant complication of peritoneal dialysis (PD) in children. Most children undergoing chronic PD experience none or only one peritonitis episode, while others have multiple episodes or episodes secondary to unusual organisms. Knowledge of potential risk factors and likely patient outcome is imperative if treatment is to be optimized. In this review we will, in turn, describe episodes of peritonitis that are characterized as either relapsing, recurrent, repeat or zoonosis-related to highlight the clinical issues that are commonly encountered by clinicians treating these infections.

  13. Effectiveness of Home Visits to Pediatric Peritoneal Dialysis Patients

    OpenAIRE

    Ellis, Eileen N.; Blaszak, Christine; Wright, Sherida; Van Lierop, Andrea

    2012-01-01

    Home visits by trained personnel to patients undergoing home dialysis are required, but little is reported about the effectiveness of such home visits. We retrospectively reviewed home visits to 22 pediatric patients undergoing continuous cycling peritoneal dialysis (PD) at home. A trained dialysis nurse completed each home visit. An average of 1.5 pertinent dialysis findings and 1 pertinent medication finding was noted for each home visit to these patients. The interdisciplinary dialysis tea...

  14. Prophylactic dialysis in non-dialysis-dependent patients with renal failure after CABG

    Directory of Open Access Journals (Sweden)

    Roghayyeh Borji

    2014-03-01

    Conclusion: According the results of this study, prophylactic dialysis, before conduct-ing CABG, does not have any significant effect on mortality and other complications. The only exception is lung complications in non-dialysis-dependent patients with renal failure.

  15. Efficacy,safety and tolerance of continuous erythropoietin receptor activator intravenous administration on anemia correction in dialysis patients with chronic renal anemia

    Institute of Scientific and Technical Information of China (English)

    钱家麒

    2013-01-01

    Objective To evaluate the efficacy,safety and toler-ance of continuous erythropoietin receptor activator(CE-RA) once every 2 weeks intravenous injection on anemia correction in dialysis patients compared to Epoetin-β(EPO-β) administration. Methods An open label,

  16. [Anemia treatment in peritoneal dialysis patients].

    Science.gov (United States)

    Janković, Nikola; Janković, Mateja

    2009-09-01

    Anemia is highly prevalent among chronic kidney disease (CKD) patients and patients receiving renal replacement therapy. In this paper we will outline the prevention and treatment of anemia in patients treated with peritoneal dialysis (PD). PD patients are less anemic and more sensitive to erythropoesis-stimulating agent (ESA) than their hemodialysis (HD) counterparts and, in general, dosages required for achieving similar hemoglobin levels to those achieved in HD patients are remarkably less. Before starting with ESA treatment we have to evaluate the degree of anemia and excluded other causes which are not connected with CKD and method of treatment. Patient's compliance is crucial for a successful therapy and it can be improved by decreasing frequency of administration of ESA. Since ESAare expensive, "cost-effectivnes" studies represent an important factor in choosing a distinct drug. Subcutaneous administration provides better long-term utilization of ESA in comparison to intravenous administration and is therefore preferred in PD patients. Intraperitoneal administration is not recommended due to poor bioavailability. In some patients we can observe the reduced response to ESA therapy. The definition of reduced response is generally regarded as a failure to achieve target hemoglobin concentration of >11 g/dL. Identification of underlying cause is not always easy but every attempt should be made to investigate every patient with resistance to therapy because some causes are easily corrected. Since 2005 particular ESA drugs have been approved by Croatian Institute for Health Insurance and registered for use in Croatia. For PD patients the ESAcan be prescribed by general practitioner. The list of available drugs is available in the official government newspaper Nardone novine No.27, March 2nd, 2009. PMID:20232548

  17. [Ethical problems in dialysis in elderly patients].

    Science.gov (United States)

    Alloatti, S; Gabrielli, D; Molino, A; Venturella, E; Mattioni, A

    2003-01-01

    The incidence and prevalence of elderly patients are progressively increasing in most dialysis facilities with consequent medical assistance difficulties and the need to find a suitable care unit. Particularly in this age group, the clinical assessment is often difficult and the selection criteria vary widely, not only from country to country, but also from one dialysis unit to another unit in the same area. The authors discuss some of the more complex arguments for and against dialysis in elderly patients. For some of the more difficult cases, Kantian deontology and its three ethical principles of beneficence, non-maleficence and autonomy can facilitate the decision-making process regarding the acceptance or refusal of the therapy. The central role of the patients themselves, the involvement of the family, the discussion of the individual case within the dialysis team, and the good performance of the pre-dialysis program are particularly important. In certain cases it is possible to actually discontinue the treatment, or not initiate it, by using different arguments in competent or incompetent patients. In conclusion, the difficult choice of whether to treat or turn down an elderly patient must depend exclusively on the medical clinical assessment of each case, whereas economical considerations can incorrectly influence that choice. PMID:12647283

  18. CT coronary angiography is feasible for the assessment of coronary artery disease in chronic dialysis patients, despite high average calcium scores.

    Directory of Open Access Journals (Sweden)

    Mihály K de Bie

    Full Text Available PURPOSE: Significant obstructive coronary artery disease (CAD is common in asymptomatic dialysis patients. Identifying these high risk patients is warranted and may improve the prognosis of this vulnerable patient group. Routine catheterization of incident dialysis patients has been proposed, but is considered too invasive. CT-angiography may therefore be more appropriate. However, extensive coronary calcification, often present in this patient group, might hamper adequate lumen evaluation. The objective of this study was to assess the feasibility of CT-angiography in this patient group. METHODS: For this analysis all patients currently participating in the ICD2 trial (ISRCTN20479861, with no history of PCI or CABG were included. The major epicardial vessels were evaluated on a segment basis (segment 1-3, 5-8, 11 and 13 by a team consisting of an interventional and an imaging specialist. Segments were scored as not significant, significant and not interpretable. RESULTS: A total of 70 dialysis patients, with a mean age of 66±8 yrs and predominantly male (70% were included. The median calcium score was 623 [79, 1619]. Over 90% of the analyzed segments were considered interpretable. The incidence of significant CAD on CT was 43% and was associated with cardiovascular events during follow-up. The incidence of cardiovascular events after 2-years follow-up: 36% vs. 0% in patients with no significant CAD (p<0.01. CONCLUSION: Despite the high calcium scores CT-angiography is feasible for the evaluation of the extent of CAD in dialysis patients. Moreover the presence of significant CAD on CT was associated with events during follow-up.

  19. Salmon calcitonin in prevention of osteoporosis in maintenance dialysis patients

    Institute of Scientific and Technical Information of China (English)

    WANG Shi-xiang; LI Han

    2008-01-01

    Background Renal osteodystrophy is one of the commonest complications of chronic renal failure. It may have a severe impact on the quality of life of patients on maintenance dialysis therapy. Besides post-menopausal women and elderly people, the dialysis patients are another high risk group. But at present, there is no research on how to prevent osteoporosis in maintenance dialysis patients. This study was conducted to observe the bone density of maintenance dialysis patients and to evaluate the clinical outcomes and safety of different administration dosage of salmon calcitonin to prevent osteoporosis in maintenance dialysis patients.Methods One hundred and forty-eight patients on maintenance dialysis were involved in the 12-month, randomized, controlled trial. Fifty patients (experiment Ⅰ group) received subcutaneous injection of salmon calcitonin (50 U) three times a week for 12 months. Fifty patients (experiment Ⅱ group) received subcutaneous injection of salmon calcitonin (100 U) three times a week for 12 months. At the same time, both of them received oral calcium carbonate 1500 mg tid and rocaltrol 0.25 μg qn for 12 months. The control group only received oral calcium carbonate 1500 mg tid and rocaltrol 0.25 μg qn for 12 months. The levels of bone mass density (BMD) of the lumbar spine and femoral neck, serum intact parathyroid hormone (iPTH), osteocatcin (OC), calcium, phosphorus, alkaline phosphatase (ALP) were assessed at baseline and then again after 3, 6 and 12 months of treatment.Results The values of BMD at the lumbar spine and femoral neck before the treatment were not significantly different from those 3, 6, and 12 months after the treatment in trial groups I and II (all P >0.05) and there were no significant differences in the BMD values at different time points between trial groups I and I1. In the control group, the BMD values at the lumbar spine and femoral neck 3, 6, and 12 months after the beginning of trial were significantly lower than

  20. Pulmonary hypertenstion ad leading factor in patients undergoing dialysis

    International Nuclear Information System (INIS)

    Objective: To determine the frequency and leading factors of pulmonary hypertension among chronic hemodialysis patients. Study Design: Case series. Place and Duration of Study: Hemodialysis Unit, Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi, from September 2011 to March 2012. Methodology: Patients of either gender aged between 16 to 60 years of age undergoing hemodialysis for at least 3 months not having pre-existing valvular heart disease, chronic lung disease or connective tissue disorder were included. Pulmonary hypertension was prospectively estimated by Doppler echocardiogram on patients undergoing dialysis. Pulmonary artery pressure was calculated on the post-dialysis day and leading factors were compared between patients with and without pulmonary hypertension. Results: A total of 178 patients were included in study with male to female ratio120/58 (2.06:1). The mean age was 33.84 +- 11.9 years. The mean duration of hemodialysis was 23.85 +- 22.48 months. Pulmonary hypertension was found in 76 (42.7%) patients. Out of the studied factors, low serum albumin ( 3.4 mg/dl, p = 0.01) was found to be statistically significant in patients with pulmonary hypertension. Conclusion: Pulmonary hypertension was frequently present in dialysis population (42.7%). This subset of patients had significantly lower albumin levels in serum. More research is needed in its pathogenesis to arrest its course. (author)

  1. Switching patients with non-dialysis chronic kidney disease from oral iron to intravenous ferric carboxymaltose: effects on erythropoiesis-stimulating agent requirements, costs, hemoglobin and iron status.

    Directory of Open Access Journals (Sweden)

    Jorge Eduardo Toblli

    Full Text Available Patients with non-dialysis-dependent chronic kidney disease (ND-CKD often receive an erythropoiesis-stimulating agent (ESA and oral iron treatment. This study evaluated whether a switch from oral iron to intravenous ferric carboxymaltose can reduce ESA requirements and improve iron status and hemoglobin in patients with ND-CKD.This prospective, single arm and single-center study included adult patients with ND-CKD (creatinine clearance ≤40 mL/min, hemoglobin 11-12 g/dL and iron deficiency (ferritin 20%. Outcome measures were ESA dose requirements during the observation period after initial ferric carboxymaltose treatment (primary endpoint; number of hospitalizations and transfusions, renal function before and after ferric carboxymaltose administration, number of adverse reactions (secondary endpoints. Hemoglobin, mean corpuscular volume, ferritin and transferrin saturation were measured monthly from baseline until end of study. Creatinine clearance, proteinuria, C-reactive protein, aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase bimonthly from baseline until end of study.Thirty patients were enrolled (age 70.1±11.4 years; mean±SD. Mean ESA consumption was significantly reduced by 83.2±10.9% (from 41,839±3,668 IU/patient to 6,879±4,271 IU/patient; p<0.01. Hemoglobin increased by 0.7±0.3 g/dL, ferritin by 196.0±38.7 μg/L and transferrin saturation by 5.3±2.9% (month 6 vs. baseline; all p<0.01. No ferric carboxymaltose-related adverse events were reported and no patient withdrew or required transfusions during the study.Among patients with ND-CKD and stable normal or borderline hemoglobin, switching from oral iron to intravenous ferric carboxymaltose was associated with significant improvements in hematological and iron parameters and a significant reduction in ESA dose requirements in this single-center pilot study.ClinicalTrials.gov NCT02232906.

  2. Switching Patients with Non-Dialysis Chronic Kidney Disease from Oral Iron to Intravenous Ferric Carboxymaltose: Effects on Erythropoiesis-Stimulating Agent Requirements, Costs, Hemoglobin and Iron Status

    Science.gov (United States)

    Toblli, Jorge Eduardo; Di Gennaro, Federico

    2015-01-01

    Background Patients with non-dialysis-dependent chronic kidney disease (ND-CKD) often receive an erythropoiesis-stimulating agent (ESA) and oral iron treatment. This study evaluated whether a switch from oral iron to intravenous ferric carboxymaltose can reduce ESA requirements and improve iron status and hemoglobin in patients with ND-CKD. Methods This prospective, single arm and single-center study included adult patients with ND-CKD (creatinine clearance ≤40 mL/min), hemoglobin 11–12 g/dL and iron deficiency (ferritin 20%). Outcome measures were ESA dose requirements during the observation period after initial ferric carboxymaltose treatment (primary endpoint); number of hospitalizations and transfusions, renal function before and after ferric carboxymaltose administration, number of adverse reactions (secondary endpoints). Hemoglobin, mean corpuscular volume, ferritin and transferrin saturation were measured monthly from baseline until end of study. Creatinine clearance, proteinuria, C-reactive protein, aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase bimonthly from baseline until end of study. Results Thirty patients were enrolled (age 70.1±11.4 years; mean±SD). Mean ESA consumption was significantly reduced by 83.2±10.9% (from 41,839±3,668 IU/patient to 6,879±4,271 IU/patient; p<0.01). Hemoglobin increased by 0.7±0.3 g/dL, ferritin by 196.0±38.7 μg/L and transferrin saturation by 5.3±2.9% (month 6 vs. baseline; all p<0.01). No ferric carboxymaltose-related adverse events were reported and no patient withdrew or required transfusions during the study. Conclusion Among patients with ND-CKD and stable normal or borderline hemoglobin, switching from oral iron to intravenous ferric carboxymaltose was associated with significant improvements in hematological and iron parameters and a significant reduction in ESA dose requirements in this single-center pilot study. Trial Registration ClinicalTrials.gov NCT02232906 PMID

  3. Phosphate binding therapy in dialysis patients: focus on lanthanum carbonate

    Directory of Open Access Journals (Sweden)

    Ismail A Mohammed

    2008-11-01

    Full Text Available Ismail A Mohammed, Alastair J HutchisonManchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Oxford Road, Manchester, UKAbstract: Hyperphosphatemia is an inevitable consequence of end stage chronic kidney disease and is present in the majority of dialysis patients. Recent observational data has associated hyperphosphatemia with increased cardiovascular mortality among dialysis patients. Dietary restriction of phosphate and current dialysis prescription practices are not enough to maintain serum phosphate levels within the recommended range so that the majority of dialysis patients require oral phosphate binders. Unfortunately, conventional phosphate binders are not reliably effective and are associated with a range of limitations and side effects. Aluminium-containing agents are highly efficient but no longer widely used because of well established and proven toxicity. Calcium based salts are inexpensive, effective and most widely used but there is now concern about their association with hypercalcemia and vascular calcification. Sevelamer hydrochloride is associated with fewer adverse effects, but a large pill burden and high cost are limiting factors to its wider use. In addition, the efficacy of sevelamer as a monotherapy in lowering phosphate to target levels in severe hyperphosphatemia remains debatable. Lanthanum carbonate is a promising new non-aluminium, calcium-free phosphate binder. Preclinical and clinical studies have demonstrated a good safety profile, and it appears well tolerated and effective in reducing phosphate levels in dialysis patients. Its identified adverse events are apparently mild to moderate in severity and mostly GI related. It appears to be effective as a monotherapy, with a reduced pill burden, but like sevelamer, it is significantly more expensive than calcium-based binders. Data on its safety profile over 6 years of treatment are now available.Keywords: hyperphosphatemia, lanthanum

  4. Depression in hemodialysis patients: the role of dialysis shift

    Directory of Open Access Journals (Sweden)

    Flavio Teles

    2014-03-01

    Full Text Available OBJECTIVE: Depression is the most important neuropsychiatric complication in chronic kidney disease because it reduces quality of life and increases mortality. Evidence demonstrating the association between dialysis shift and depression is lacking; thus, obtaining such evidence was the main objective of this study. METHOD: This cross-sectional study included patients attending a hemodialysis program. Depression was diagnosed using Beck's Depression Inventory. Excessive daytime sleepiness was evaluated using the Epworth Sleepiness Scale. RESULTS: A total of 96 patients were enrolled (55 males, age 48±14 years. Depression and excessive daytime sleepiness were observed in 42.7% and 49% of the patients, respectively. When comparing variables among the three dialysis shifts, there were no differences in age, dialysis vintage, employment status, excessive daytime sleepiness, hemoglobin, phosphorus levels, or albumin levels. Patients in the morning shift were more likely to live in rural areas (p<0.0001, although patients in rural areas did not have a higher prevalence of depression (p= 0.30. Patients with depression were more likely to be dialyzed during the morning shift (p= 0.008. Independent risk factors for depression were age (p<0.03, lower levels of hemoglobin (p<0.01 and phosphorus (p<0.01, and dialysis during the morning shift (p= 0.0009. The hospitalization risk of depressive patients was 4.5 times higher than that of nondepressive patients (p<0.008. CONCLUSION: These data suggest that depression is associated with dialysis shift, higher levels of phosphorus, and lower levels of hemoglobin. The results highlight the need for randomized trials to determine whether this association occurs by chance or whether circadian rhythm disorders may play a role.

  5. Efficacy of bolus intravenous iron treatment in peritoneal dialysis patients

    Directory of Open Access Journals (Sweden)

    Jovanović Nataša

    2005-01-01

    Full Text Available Introduction. Normocytic, normochromic anemia is one of the first signs of chronic renal failure and it is common in patients on chronic dialysis treatment. It causes decrease in oxygen supply to tissues, increases cardiac minute volume, causes left ventricular hyperthrophy, cardiac insufficiency, disorders related to cognitive functions and immune response, and increases morbidity and mortality rates. The leading cause of anemia in patients on chronic peritoneal dialysis (PD is iron depletion and most patients on PD need oral or parenteral iron supplementation. The aim of this study was to evaluate our first experience with bolus intravenous ferrogluconate therapy in patients on chronic peritoneal dialysis at the Nephrology Clinic of the Clinical Center of Serbia (CCS. Material and Methods. We examined 11 patients, 7 males and 4 females, mean-age 49 years (range 31 to 68 years on chronic PD. All patients received blood transfusions, oral or intramuscular iron supplementation before 465 to 665 mg ferrogluconate therapy was given in 500 ml. saline intravenous infusion; 5 of them were on erythropoietin therapy and 2 of them started with EPO therapy after the ferrogluconate therapy. Results. The blood count improved during the first 3 months after application of bolus intravenous iron therapy (ferrogluconate; erythropoietin dose was not increased during the follow-up. Some patients suffered from side effects during infusion and 6 patients received the complete treatment. Discussion. Blood count improves in a number of patients affected by end-stage renal disease during the first months on continuous ambulatory peritoneal dialysis (CAPD treatment. But a large number of patients on chronic CAPD treatment are iron-depleted and they require oral or parenteral substitution. Side effects and complications of intravenous iron therapy were not severe and only one patient suffered from allergic manifestations. Ferremia and blood count improved in patients

  6. Self-Management Awareness in Patients on Maintenance Dialysis

    OpenAIRE

    Shintani, Keiko; Meguro, Yuko; Kondo, Hiroko

    2009-01-01

    The present study characterizes selfmanagement awareness in patients on maintenance dialysis. We conducted interviews with 9 patients on maintenance dialysis which were then analyzed by comparative content analysis. This was done in order to gather information to support future self-management. Seven categories emerged as a result of this analysis. Patients on maintenance dialysis were aware of a continuation and the need for dialysis treatment, perceived that they were handling self-manageme...

  7. Influence of Diet Balanced with Essential Amino Acids / Keto Acid Analogs and High-Nutrient Blend on the Progression of Renal Failure in Patients in the Pre-Dialysis Stage of Chronic Kidney Disease Caused by Systemic Autoimmune Diseases

    OpenAIRE

    I I Aleksandrova; Mikhailov, A. A.; Lyudmila Y. Milovanova; Yury S. Milovanov

    2013-01-01

    The aim of the study was to evaluate the effect of a low protein diet (LPD) balanced with essential amino acids (EAA) / keto acid analogs (KAA) and protein “SUPRO-XT 219D” in the composition of the high-energy nutrient blend (HENB) for slow down of renal failure in patients in the pre-dialysis stage of chronic kidney disease (CKD) induced by systemic autoimmune diseases (SAD).Material and Methods: In this study, 46 patients (35 with systemic lupus erythematosus and 15 with various forms of sy...

  8. Fat free mass index as parameter for nutritional status in non-dialysis chronic kidney disease patients stage 3, 4 and 5

    OpenAIRE

    Meilani Kumala; Widjaja Lukito; Soemilah Sastroamidjojo; Wiguno Prodjosudjadi

    2008-01-01

    The aim of this study is to obtain body composition parameters for early detection of PEM in non dialysis CKD (ND-CKD) patients. The study was carried out using the cross sectional design. The subjects of the study consist of 45 ND-CKD patients and 45 healthy subjects matched for age, gender, height and body mass index (BMI). The nutritional status of patients and healthy subjects were classified based on BMI (WHO, 1995) into low, normal and high nutritional status groups. Fat free mass (FFM)...

  9. Chronic Kidney Disease: Evolution of Healthcare Costs and Resource Consumption from Predialysis to Dialysis in Piedmont Region, Italy

    Directory of Open Access Journals (Sweden)

    Daniela Paola Roggeri

    2014-01-01

    Full Text Available This study aims at assessing the evolution in healthcare costs for chronic kidney disease (CKD patients through the analysis of administrative databases of Piedmont region, Italy. This is a retrospective, observational study, for which patients undergoing at least one dialysis for CKD in the period of June 1, 2010–May 31, 2011 were selected. Two subpopulations were evaluated: patients incident-to-dialysis observed for the 12 months preceding dialysis entrance (PreD and “established” dialysis patients (at least 120 dialyses/year observed for 12 months (EstD. Overall, 1,059 PreD and 2,018 EstD patients were selected. The average yearly cost per PreD patient accounted for 11,123€ ± 15,095€ (75% hospitalizations, 17% drugs, and 8% diagnostic/therapeutic procedures. The average yearly cost per EstD patient accounted for 53,764€ ± 14,685€ (59% dialysis, 21% diagnostic/therapeutic procedures, 13% hospitalizations, and 6.7% drugs. Among EstD population, hemodialysis patients cost 56,049€ ± 13,473€ per year, whereas peritoneal dialysis patients cost 34,978€ ± 10,847€ per year. The significant difference in expenditure between predialysis and dialysis suggests that prevention, early diagnosis, and the consequent possible delay of dialysis entrance could lead to important savings for healthcare services, as well as a better global health status for patients.

  10. Correlation between dialysis solution type and cardiovascular morbidity rate in patients undergoing continuous ambulatory peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Stanković-Popović Verica

    2008-01-01

    Full Text Available Background/Aim. Peritoneal dialysis (PD patients have an increased risk for cardiovascular diseases. The aim of the study was to evaluate the cardiovascular changes in patients undergoing chronic PD and the eventual existing differences depending on biocompatibility of dialysis solutions. Methods. After 3±2 years of starting PD, 21 PD patients on the treatment with bioincompatible dialysis solutions (conventional glucose- based solutions: PDP-1, average age 47.43±12.87 years, and 21 PD patients on the treatment with biocompatible dialysis solutions (neutral solutions with lower level of glucose degradation products, lower concentration of Ca2+ and neutral pH: PDP-2, average age 68.62±13.98 years, participated in the longitudinal study. The average number of episodes of peritonitis was similare in both groups: 1 episode per 36 months of the treatment. The control group included 21 patients with preterminal phase of chronic renal failure (Glomerular Filtration Rate: 22.19±10.73 ml/min, average age 65.29± 13.74 years. All the patients underwent transthoracal echocardiography (in order to detect: eject fraction (EF, left ventricular hypertrophy (LVH, and valvular calcification (VC and B-mode ultrasonography of common carotid artery (CCA: IMT, lumen narrowing, and plaque detection. Results. The values of EF were: in PDP-1 group 62.05±5.65%, in PDP-2 group 53.43±7.47%, and in the control group 56.71±8.12% (Bonferroni test, p = 0.001. The recorded LVH was: in PDP-1 group in 47.6% of the patients; in PDP-2 group in 61.9% of the patients; and in control the group in 52.4% (χ2 test; p = 0.639. The detected VC was: in PDP-1 in 52.4% of the patients, in PDP-2 group in 42.9% of the patients, and in the control group in 23.8% of the patients (χ2 test; p = 0.776. The IMT was: in PDP-1 group 1.26±0.54 mm, in PDP-2 group 1.23±0.32, and in the control group 1.25±0.27 mm (Bonferroni test; p = 0.981. An average lumen narrowing was: in PDP-1 group 13

  11. Depressive Symptomatology in Children and Adolescents with Chronic Renal Insufficiency Undergoing Chronic Dialysis

    Directory of Open Access Journals (Sweden)

    Edith G. Hernandez

    2011-01-01

    Full Text Available This paper presents a descriptive study, using the Birleson Scale to determine the frequency of depressive symptomatology in children and adolescents with chronic renal insufficiency (CRI undergoing hemodialysis (HD and chronic peritoneal dialysis (CPD. There were 67 patients (40 female and 27 male with a mean age of 14.76±2.71 years, duration of illness ≥3 months, 43 (64.18% patients with CPD and 24 (35.82% undergoing HD. The frequency of high occurrence, low occurrence, and absence of depressive symptomatology was 10.45% (=7, 43.28% (=29, and 46.27% (=31, respectively; all of the seven (100% patients with high occurrence of depressive symptomatology were female (=0.04, and none of these (0% had a friend to confide in (=0.03. Depressive symptomatology in patients with CPD was associated with a lower weekly / compared to those without depressive symptomatology (2.15±0.68 versus 2.52±0.65; =0.01. There was no association with patient age, caregiver, time and dialysis type, anemia, bone disease, nutritional or financial status, origin, schooling, or employment.

  12. Self-evaluation in dialysis patients

    OpenAIRE

    Bargiel-Matusiewicz, K; Sobota, A; Wilczynska, A.

    2010-01-01

    Objective The aim of this study is to present the results of a self-reported evaluation of the psychoemotional status by dialysis patients. The level of self-esteem influences the emotions felt, both positive and negative, which in turn may determine the adherence to treatment instructions, and which certainly is reflected in the somatic condition. Material and methods The study was a randomized controlled trial using a sample of 102 fully informed and consenting patients with end-stage renal...

  13. Potential Role of Vegetarianism on Nutritional and Cardiovascular Status in Taiwanese Dialysis Patients: A Case-Control Study

    OpenAIRE

    Ou, Shih-Hsiang; Chen, Mei-Yin; Huang, Chien-Wei; Chen, Nai-Ching; Wu, Chien-Hsing; Hsu, Chih-Yang; Chou, Kang-Ju; Lee, Po-Tsang; Fang, Hua-Chang; Chen, Chien-Liang

    2016-01-01

    Background & Objectives Cardiovascular disease remains the most common cause of death for patients on chronic dialysis. End stage renal disease patients undergoing dialysis imposed to reduce phosphorus intake, which likely contributes to development of vegetarian diet behaviors. Vegetarian diets are often lower in protein content, in contradiction to the recommendation that a high protein diet is followed by patients undergoing dialysis. The purpose of the study was to investigate the effects...

  14. [Technological advances and micro-inflammation in dialysis patients].

    Science.gov (United States)

    Ferro, Giuseppe; Ravaglia, Fiammetta; Ferrari, Elisa; Romoli, Elena; Michelassi, Stefano; Caiani, David; Pizzarelli, Francesco

    2015-01-01

    As currently performed, on line hemodiafiltration reduces, but does not normalize, the micro-inflammation of uremic patients. Recent technological advances make it possible to further reduce the inflammation connected to the dialysis treatment. 
Short bacterial DNA fragments are pro-inflammatory and can be detected in the dialysis fluids. However, their determination is not currently within normal controls of the quality of the dialysate. The scenario may change once the analysis of these fragments yields reliable, inexpensive, quick and easy to evaluate the results. At variance with standard bicarbonate dialysate, Citrate dialysate induces far less inflammation both for the well-known anti-inflammatory effect of such buffer and also because it is completely acetate free, e.g. a definitely pro-inflammatory buffer. However, the extensive use of citrate dialysate in chronic dialysis is prevented because of concerns about its potential calcium lowering effect. In our view, high convective exchange on line hemodiafiltration performed with dialysate, whose sterility and a-pirogenicity is guaranteed by increasingly sophisticated controls and with citrate buffer whose safety is certified, can serve as the gold standard of dialysis treatments in future.

  15. Recovery of Chronic Dialysis Hypotension After Kidney Transplantation: A Case Report

    Directory of Open Access Journals (Sweden)

    Mustafa YAPRAK

    2014-01-01

    Full Text Available Chronic dialysis hypotension is described as low systolic blood pressure (<100 mmHg during interdialytic period. The presence of low predialysis systolic blood pressure, typically <110 mmHg, is signifi cantly associated with increased mortality. Kidney transplantation is the preferred model of renal replacement therapy in the treatment of end-stage renal disease (ESRD as it improves quality of life and survival. In this article, a long-term hemodialysis (HD patient with chronic hypotension improved after kidney transplantation is presented. A 39-year-old male patient received a deceased donor kidney transplant. The patient was on HD for 23 years. The patient had suffered from chronic persistent hypotension for the last 8 years. Blood pressure was 70/50 mmHg before dialysis and 60/40 mmHg after dialysis. In the post-transplant period, blood pressure was maintained above 110/70 mmHg by intermittent infusion of dopamine. Hypotension was improved after 24 days and dopamine was discontinued. Various etiologies may cause chronic hypotension in patients receiving long-term HD treatment. Kidney transplantation may improve survival and quality of life by correcting hypotension in these patients. Therefore kidney transplantation should not be avoided as renal replacement therapy in ESRD patients with hypotension.

  16. Cardiovascular risk factors in hemodialysis and peritoneal dialysis patients

    Directory of Open Access Journals (Sweden)

    Helal Imed

    2010-01-01

    Full Text Available Cardiovascular diseases are a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD. The aim of our investigation was the evaluation of an extensive cardiovascular profile in hemodialysis (HD and peritoneal dialysis (PD patients. We studied 74 patients with ESRD (38 males, 36 females, maintained either on chronic HD (n= 50 or chronic PD (n= 24 and age and sex matched 20 healthy subjects as controls. The lipid profile, homo-cysteine (Hcy and C reactive protein (CRP were measured. When compared to a healthy popu-lation, HD patients displayed a marked atherogenic profile, as attested by increased levels of total cholesterol (TC, triglycerides (TG, low-density lipoprotein-cholesterol (LDL-C, apolipoprotein A (Apo A, CRP, Hcy and lower concentrations of high-density lipoprotein-cholesterol (HDL-C, Apo B, albumin (ALB. A significant difference was noted concerning the rates of Apo B, HDL-C, TC, ALB and Hcy. Same biological disorders that those found at HD patients were noted in these PD patients. One also noted lower concentration in Apo A. there were a significant diffe-rence with the reference group concerning the rates of albumin, Apo A, HDL-Cl and Hcy. When compared to PD patients, HD patients had significantly decreased concentration of LDL-C. The peculiar metabolic changes observed in the present study confirm the marked tendency of patients with impaired renal function for developing cardiovascular diseases, irrespectively of the type of dialysis. We suggest including uremia-related risk factors in the panel for evaluation of cardio-vascular risk in dialysis patients.

  17. The Danish Registry on Regular Dialysis and Transplantation:completeness and validity of incident patient registration

    DEFF Research Database (Denmark)

    Hommel, Kristine; Rasmussen, Søren; Madsen, Mette;

    2010-01-01

    BACKGROUND: The Danish National Registry on Regular Dialysis and Transplantation (NRDT) provides systematic information on the epidemiology and treatment of end-stage chronic kidney disease in Denmark. It is therefore of major importance that the registry is valid and complete. The aim...... of the present study was to evaluate the registration of incident patients on chronic renal replacement therapy (RRT). METHODS: Incident patients on chronic RRT in the period 2001-2004 were identified in NRDT and in the National Patient Registry, which contains information on hospital admissions and treatments....... In the National Patient Registry, identification of patients was as follows: patients receiving the procedure of dialysis during a minimum of 90 days and for a minimum of 12 times or the procedure of renal transplantation. Only patients with at least 2 years of dialysis-free interval before and never being...

  18. Pre-dialysis clinic attendance improves quality of life among hemodialysis patients

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    Lam Miu

    2002-04-01

    Full Text Available Abstract Background Although previous research has demonstrated that referral to pre-dialysis clinics is associated with favourable objective outcomes, the benefit of a pre-dialysis clinic from the perspective of patient-perceived subjective outcomes, such as quality of life (QOL, is less well defined. Methods A retrospective incident cohort study was conducted to determine if pre-dialysis clinic attendance was a predictor of better QOL scores measured within the first six months of hemodialysis (HD initiation. Inclusion criteria were HD initiation from January 1 1998 to January 1 2000, diagnosis of chronic renal failure, and completion of the QOL questionnaire within six months of HD initiation. Patients receiving HD for less than four weeks were excluded. An incident cohort of 120 dialysis patients was identified, including 74 patients who attended at least one pre-dialysis clinic and 46 patients who did not. QOL was measured using the SF 36-Item Health Survey. Independent variables included age, sex, diabetes, pre-dialysis clinic attendance and length of attendance, history of ischemic heart disease, stroke, peripheral vascular disease, heart failure, malignancy, and chronic lung disease, residual creatinine clearance at dialysis initiation, and kt/v, albumin and hemoglobin at the time of QOL assessment. Bivariate and multivariate linear regression analyses were used to identify predictors of QOL scores. Results Multivariate analysis suggested that pre-dialysis clinic attendance was an independent predictor of higher QOL scores in four of eight health domains (physical function, p Conclusions We conclude that pre-dialysis clinic attendance favourably influences patient-perceived quality of life within six months of dialysis initiation.

  19. Factors Associated with Unplanned Dialysis Starts in Patients followed by Nephrologists: A Retropective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Pierre Antoine Brown

    Full Text Available The number of patients starting dialysis is increasing world wide. Unplanned dialysis starts (patients urgently starting dialysis in hospital is associated with increased costs and high morbidity and mortality. Risk factors for starting dialysis urgently in hospital have not been well studied. The primary objective of this study was to identify risk factors for unplanned dialysis starts in patients followed in a multidisciplinary chronic kidney disease (CKD clinic. We performed a retrospective cohort study of 649 advanced CKD patients followed in a multidisciplinary CKD clinic at a tertiary care hospital from January 01, 2010 to April 30, 2013. Patients were classified as unplanned start (in hospital or elective start. Multivariable logistic regression was used to identify variables associated with unplanned dialysis initiation. 184 patients (28.4% initiated dialysis, of which 76 patients (41.3% initiated dialysis in an unplanned fashion and 108 (58.7% starting electively. Unplanned start patients were more likely to have diabetes (68.4% versus 51.9%; p = 0.04, CAD (42.1% versus 24.1%; p = 0.02, congestive heart failure (36.8% versus 17.6%; p = 0.01, and were less likely to receive modality education (64.5% vs 89.8%; p < 0.01 or be assessed by a surgeon for access creation (40.8% vesrus 78.7% p < 0.01. On multivariable analysis, higher body mass index (OR 1.07, 95% CI 1.02, 1.13, and a history of congestive heart failure (OR 2.41, 95% CI 1.09, 5.41 were independently associated with an unplanned start. Unplanned dialysis initiation is common among advanced CKD patients, even if they are followed in a multidisciplinary chronic kidney disease clinic. Timely education and access creation in patients at risk may lead to lower costs and less morbidity and mortality.

  20. Dialysis

    Science.gov (United States)

    ... kidney transplant, you will need a treatment called dialysis. There are two main types of dialysis. Both types filter your blood to rid your ... clinic for treatments several times a week. Peritoneal dialysis uses the lining of your abdomen, called the ...

  1. Asymptomatic Effluent Protozoa Colonization in Peritoneal Dialysis Patients.

    Science.gov (United States)

    Simões-Silva, Liliana; Correia, Inês; Barbosa, Joana; Santos-Araujo, Carla; Sousa, Maria João; Pestana, Manuel; Soares-Silva, Isabel; Sampaio-Maia, Benedita

    Currently, chronic kidney disease (CKD) is a global health problem. Considering the impaired immunity of CKD patients, the relevance of infection in peritoneal dialysis (PD), and the increased prevalence of parasites in CKD patients, protozoa colonization was evaluated in PD effluent from CKD patients undergoing PD. Overnight PD effluent was obtained from 49 asymptomatic stable PD patients. Protozoa analysis was performed microscopically by searching cysts and trophozoites in direct wet mount of PD effluent and after staining smears. Protozoa were found in PD effluent of 10.2% of evaluated PD patients, namely Blastocystis hominis, in 2 patients, and Entamoeba sp., Giardia sp., and Endolimax nana in the other 3 patients, respectively. None of these patients presented clinical signs or symptoms of peritonitis at the time of protozoa screening. Our results demonstrate that PD effluent may be susceptible to asymptomatic protozoa colonization. The clinical impact of this finding should be further investigated. PMID:27659930

  2. Asymptomatic Effluent Protozoa Colonization in Peritoneal Dialysis Patients.

    Science.gov (United States)

    Simões-Silva, Liliana; Correia, Inês; Barbosa, Joana; Santos-Araujo, Carla; Sousa, Maria João; Pestana, Manuel; Soares-Silva, Isabel; Sampaio-Maia, Benedita

    Currently, chronic kidney disease (CKD) is a global health problem. Considering the impaired immunity of CKD patients, the relevance of infection in peritoneal dialysis (PD), and the increased prevalence of parasites in CKD patients, protozoa colonization was evaluated in PD effluent from CKD patients undergoing PD. Overnight PD effluent was obtained from 49 asymptomatic stable PD patients. Protozoa analysis was performed microscopically by searching cysts and trophozoites in direct wet mount of PD effluent and after staining smears. Protozoa were found in PD effluent of 10.2% of evaluated PD patients, namely Blastocystis hominis, in 2 patients, and Entamoeba sp., Giardia sp., and Endolimax nana in the other 3 patients, respectively. None of these patients presented clinical signs or symptoms of peritonitis at the time of protozoa screening. Our results demonstrate that PD effluent may be susceptible to asymptomatic protozoa colonization. The clinical impact of this finding should be further investigated.

  3. Patient-Centered Dialysis Care: Depression, Pain, and Quality of Life.

    Science.gov (United States)

    Weisbord, Steven D

    2016-01-01

    Remarkable advancements have been made in the provision of chronic dialysis therapy since its inception decades ago. A series of studies inform current dialysis dosing recommendations, while advancements in strategies to treat mineral and bone disease, acid-base and electrolyte disturbances, and anemia have facilitated the management of these well-recognized complications of ESRD. The collective result has been a model of chronic dialysis care focused principally on the achievement of metabolic and dialysis-related targets. In fact, guidelines such as the Kidney Disease Outcomes Quality Initiative put forth by the National Kidney Foundation recommend metrics that characterize successful dialysis care, including the attainment of specific solute clearance targets; maintenance of hemoglobin, calcium, phosphorous, and parathyroid hormone levels within target ranges; and the preferred use of primary arteriovenous fistulae for vascular access. This focus on serologic and dialysis-specific outcomes has helped renal providers manage the biochemical effects related to the loss of kidney function and has reduced ESRD-related morbidity and mortality. Yet, absent from this model of care is an emphasis on the treatment of bothersome symptoms and the impact of such treatment on quality of life (QOL). Among the many symptoms that affect patients on chronic dialysis, depression and pain are particularly common, strongly associated with decrements in QOL, and potentially treatable. This review discusses key research findings and unanswered questions pertaining to the prevalence, significance, and treatment of depression and pain and the effect of such treatment on QOL in patients dependent on chronic dialysis, with the broad goal of incorporating symptom management strategies into a paradigm of patient-centered dialysis care.

  4. Dialysis Facility and Patient Characteristics Associated with Utilization of Home Dialysis

    OpenAIRE

    Walker, David R.; Inglese, Gary W.; Sloand, James A.; Just, Paul M.

    2010-01-01

    Background and objectives: Nonmedical factors influencing utilization of home dialysis at the facility level are poorly quantified. Home dialysis is comparably effective and safe but less expensive to society and Medicare than in-center hemodialysis. Elimination of modifiable practice variation unrelated to medical factors could contribute to improvements in patient outcomes and use of scarce resources.

  5. Hypomagnesemia Is Associated with Increased Mortality among Peritoneal Dialysis Patients

    Science.gov (United States)

    Dai, Zhiwei; Zhu, Beixia; Fei, Jinping; Xue, Congping; Wu, Dan

    2016-01-01

    Objective Hypomagnesemia has been associated with an increase in mortality among the general population as well as patients with chronic kidney disease or those on hemodialysis. However, this association has not been thoroughly studied in patients undergoing peritoneal dialysis. The aim of this study was to evaluate the association between serum magnesium concentrations and all-cause and cardiovascular mortalities in peritoneal dialysis patients. Methods This single-center retrospective study included 253 incident peritoneal dialysis patients enrolled between July 1, 2005 and December 31, 2014 and followed to June 30, 2015. Patient’s demographic characteristics as well as clinical and laboratory measurements were collected. Results Of 253 patients evaluated, 36 patients (14.2%) suffered from hypomagnesemia. During a median follow-up of 29 months (range: 4–120 months), 60 patients (23.7%) died, and 35 (58.3%) of these deaths were attributed to cardiovascular causes. Low serum magnesium was positively associated with peritoneal dialysis duration (r = 0.303, p < 0.001) as well as serum concentrations of albumin (r = 0.220, p < 0.001), triglycerides (r = 0.160, p = 0.011), potassium (r = 0.156, p = 0.013), calcium(r = 0.299, p < 0.001)and phosphate (r = 0.191, p = 0.002). Patients in the hypomagnesemia group had a lower survival rate than those in the normal magnesium groups (p < 0.001). In a multivariate Cox proportional hazards regression analysis, serum magnesium was an independent negative predictor of all-cause mortality (hazard ratio [HR] = 0.075, p = 0.011) and cardiovascular mortality (HR = 0.003, p < 0.001), especially in female patients. However, in univariate and multivariate Cox analysis, △Mg(difference between 1-year magnesium and baseline magnesium) was not an independent predictor of all-cause mortality and cardiovascular mortality. Conclusion Hypomagnesemia was common among peritoneal dialysis patients and was independently associated with all

  6. Impact of vitamin D on chronic kidney diseases in non-dialysis patients: a meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Lijuan Xu

    Full Text Available BACKGROUND AND OBJECTIVES: Recent studies have supported a role for both newer and more established vitamin D compounds in improving proteinuria, although systematic evaluation is lacking. Furthermore, concerns remain regarding the influence of vitamin D on the progression of renal function. We analyzed the efficacy and safety of vitamin D in non-dialysis patients and compared the use of newer versus established vitamin D compounds by performing a meta-analysis of randomized controlled trials. DESIGN: A literature search of PubMed (1975 to September, 2012, EMBASE.com (1966 to September, 2012 and Ovid EBM Reviews (through September, 2012 was conducted. RESULTS: Eighteen studies were eligible for final inclusion; of these, six explored the effects of vitamin D on proteinuria, twelve studied the effects of supplementation on renal function, and fifteen discussed the incidence of hypercalcemia. Compared to the placebo or no interference, both the newer and established vitamin D sterols reduced proteinuria to a similar extent (RR, 2.00; 95% CI, 1.42 to 2.81. No decrease in the glomerular filter rate was observed (SMD, -0.10; 95%CI, -0.24 to 0.03, and the risk for dialysis initiation was 1.48 (95% CI, 0.54 to 4.03 with vitamin D treatment. Additionally, there was an increased risk of hypercalcemia for patients treated with either newer or established vitamin D compounds as compared with the controls (RR, 4.78; 95% CI, 2.20 to 10.37. The head-to-head studies showed no differences in the effects of either newer or established compounds on proteinuria or the risk of hypercalcemia. No serious adverse events were associated with the administration of vitamin D. CONCLUSIONS: Vitamin D therapy appears to decrease proteinuria and have no negative influence on renal function in non-dialysis patients. But the occurrence of hypercalcemia should be evaluated when vitamin D is provided. No superiority for newer versus established vitamin D analogue is found.

  7. Late diagnosis of chronic renal failure and the quality of life during dialysis treatment.

    Science.gov (United States)

    Sesso, R; Yoshihiro, M M; Ajzen, H

    1996-10-01

    We evaluated the quality of life of 101 hemodialysis patients who had a late or = 6 months, N = 54) diagnosis of chronic renal failure. At the time of the survey patients had been stable on dialysis for at least 3 months and for less than 24 months; median duration of dialysis was 9.1 months. Quality of life was measured by the kidney disease questionnaire (including the intensity and duration of physical symptoms, fatigue, depression, relationship with others and frustration), the health and life satisfaction indices, functional status (Karnofsky scale), and the time trade-off method. Scores for the several indicators of quality of life were closely similar for the late and early diagnosis groups. Health satisfaction compared to one year prior to dialysis was slightly better for the early diagnosis group. For both groups, functional status was a little worse during the first year of dialysis than one year before its start. In the late diagnosis group, elderly patients and diabetics had more impairment in several dimensions assessed. In addition, in this group greater income was significantly correlated with better physical performance (r = 0.52, P < 0.001) and with health satisfaction (r = 0.36, P = 0.027). These findings suggest that after a median duration of 9 months on a dialysis program, patients with a late and early diagnosis of chronic renal failure have a similar performance in terms of quality of life parameters. Age, diabetes and income are associated with the quality of life of patients with a late diagnosis. PMID:9181098

  8. Factors Affecting Hemodialysis Patients' Satisfaction with Their Dialysis Therapy

    Directory of Open Access Journals (Sweden)

    M. Al Eissa

    2010-01-01

    Full Text Available Aim. To assess the degree of satisfaction among hemodialysis patients and the factors influencing this satisfaction. Methods. Patients were recruited from 3 Saudi dialysis centers. Demographic data was collected. Using 1 to 10 Likert scale, the patients were asked to rate the overall satisfaction with, and the overall impact of, their dialysis therapy on their lives and to rate the effect of the dialysis therapy on 15 qualities of life domains. Results. 322 patients were recruited (72.6% of the total eligible patients. The mean age was 51.7 years (±15.4; 58% have been on dialysis for >3 years. The mean Charlson Comorbidity Index was 3.2 (±2, and Kt/V was 1.3 (±0.44. The mean satisfaction score was (7.41 ± 2.75 and the mean score of the impact of the dialysis on the patients' lives was 5.32 ± 2.55. Male patients reported worse effect of dialysis on family life, social life, energy, and appetite. Longer period since the commencement of dialysis was associated with adverse effect on finances and energy. Lower level of education was associated with worse dialysis effect on stress, overall health, sexual life, hobbies, and exercise ability. Conclusion. The level of satisfaction is affected by gender, duration on dialysis, educational level, and standard of care given.

  9. Vitamin K Status of Canadian Peritoneal Dialysis Patients

    Science.gov (United States)

    Vitamin K –dependent proteins have been implicated in the regulation of vascular calcification, a condition that is prevalent among peritoneal dialysis patients. Vitamin K status in this patient population is unknown. In a cross-sectional study of 22 peritoneal dialysis patients selected from a Can...

  10. Erythropoietin production in renal cell carcinoma and renal cysts in autosomal dominant polycystic kidney disease in a chronic dialysis patient with polycythemia: A case report

    OpenAIRE

    Ito, Keiichi; Asano, Takako; TOMINAGA, SUSUMU; Yoshii, Hidehiko; SAWAZAKI, HARUTAKE; ASANO, TOMOHIKO

    2014-01-01

    In patients undergoing chronic hemodialysis (HD), erythropoietin (EPO) production from the kidney generally decreases and renal anemia develops. Patients without anemia, but with high serum EPO (sEPO) levels are rare among HD patients. The current study presents the case of a 67-year-old female HD patient with autosomal dominant polycystic kidney disease (ADPKD) and renal cell carcinoma (RCC), manifesting polycythemia with elevated sEPO levels. A radical nephrectomy was performed, which dimin...

  11. Hepatitis C Virus Core Antigen Test in Monitoring of Dialysis Patients

    Directory of Open Access Journals (Sweden)

    Gioacchino Li Cavoli

    2012-01-01

    Full Text Available Hepatitis C virus infection is a persistent worldwide public health concern. The prevalence of HCV infection is much higher in patients on chronic haemodialysis (HD than in the general population. HCV infection can detrimentally affect patients throughout the spectrum of chronic kidney disease. Despite the control of blood products, hepatitis C virus transmission is still being observed among patients undergoing dialysis. Detection systems for serum HCV antibodies are insensitive in the acute phase because of the long serological window. Direct detection of HCV depends on PCR test but this test is not suitable for routine screening. Recent studies have highlighted the importance of HCV core antigen detection as an alternative to PCR. Few studies exist about the efficacy of HCV core antigen test in dialysis population. We studied the utility of HCV core antigen test in routine monitoring of virological status of dialysis patients. We screened 92 patients on long-term dialysis both by PCR HCV-RNA and HCV core antigen test. The sensitivity of HCVcAg test was 90%, the specificity 100%, the positive predictive power 100%, the negative predictive power 97%, and the accuracy 97%. We think serological detection of HCV core antigen may be an alternative to NAT techniques for routine monitoring of patients on chronic dialysis.

  12. Dialysis and renal transplantation in HIV-infected patients

    DEFF Research Database (Denmark)

    Trullas, Joan Carles; Mocroft, Amanda; Cofan, Federico;

    2010-01-01

    To determine prevalence and characteristics of end-stage renal diseases (ESRD) [dialysis and renal transplantation (RT)] among European HIV-infected patients.......To determine prevalence and characteristics of end-stage renal diseases (ESRD) [dialysis and renal transplantation (RT)] among European HIV-infected patients....

  13. Resistant Yersinia Enterocolitica Peritonitis in a Peritoneal Dialysis Patient

    Directory of Open Access Journals (Sweden)

    Mehmet ÖZDEN

    2012-09-01

    Full Text Available Peritonitis is an important problem of peritoneal dialysis patients. Although Gram (+ bacteria are more frequent, Gram (- bacteria can rarely be the cause of peritonitis. Yersinia enterocolitica is a Gram (- enteric bacteria that especially causes gastrointestinal infections via contaminated food intake in immunosuppressive situations such as haemochromatosis, desferroxamine therapy or chronic hepatitis. We report a 51-year-old man who had been undergoing SAPD because of chronic renal failure for 2 years. We evaluated his peritoneal fl uid because of symptoms of peritonitis. His peritoneal cellular composition was consistent with peritonitis and after the microbiological culture of the fl uid we determined Yersinia enterocolitica as the pathogenic agent. The peritonitis persisted despite the administration of long term combined antibiotherapy and we removed the peritoneal catheter. In conclusion, Yersinia enterocolitica peritonitis is resistant to conventional antibiotic therapy and an indication for catheter removal.

  14. Assessment of subjective and hemodynamic tolerance of different high- and low-flux dialysis membranes in patients undergoing chronic intermittent hemodialysis: a randomized controlled trial.

    Science.gov (United States)

    Bianchi, Giorgia; Salvadé, Vanja; Lucchini, Barbara; Schätti-Stählin, Sibylle; Salvadé, Igor; Burnier, Michel; Gabutti, Luca

    2014-10-01

    Clinical experience and experimental data suggest that intradialytic hemodynamic profiles could be influenced by the characteristics of the dialysis membranes. Even within the worldwide used polysulfone family, intolerance to specific membranes was occasionally evoked. The aim of this study was to compare hemodynamically some of the commonly used polysulfone dialyzers in Switzerland. We performed an open-label, randomized, cross-over trial, including 25 hemodialysis patients. Four polysulfone dialyzers, A (Revaclear high-flux, Gambro, Stockholm, Sweden), B (Helixone high-flux, Fresenius), C (Xevonta high-flux, BBraun, Melsungen, Germany), and D (Helixone low-flux, Fresenius, Bad Homburg vor der Höhe, Germany), were compared. The hemodynamic profile was assessed and patients were asked to provide tolerance feedback. The mean score (±SD) subjectively assigned to dialysis quality on a 1-10 scale was A 8.4 ± 1.3, B 8.6 ± 1.3, C 8.5 ± 1.6, D 8.5 ± 1.5. Kt/V was A 1.58 ± 0.30, B 1.67 ± 0.33, C 1.62 ± 0.32, D 1.45 ± 0.31. The low- compared with the high-flux membranes, correlated to higher systolic (128.1 ± 13.1 vs. 125.6 ± 12.1 mmHg, P 20 mmHg) were 70 with A, 87 with B, 73 with C, and 75 with D (P < 0.01 B vs. A, 0.05 B vs. C and 0.07 B vs. D). The low-flux membrane correlated to higher blood pressure levels compared with the high-flux ones. The Helixone high-flux membrane ensured the best efficiency. Unfortunately, the very same dialyzer correlated to a higher incidence of hypotensive episodes.

  15. Bladder perforation in a peritoneal dialysis patient.

    Science.gov (United States)

    Ounissi, M; Sfaxi, M; Fayala, H; Abderrahim, E; Ben Abdallah, T; Chebil, M; Ben Maiz, H; Kheder, A

    2012-05-01

    The dysfunction of the catheter in peritoneal dialysis (PD) is a frequent complication. However, perforation of organs are rare, particularly that of the urinary bladder. This requires an early diagnosis and prompt treatment of patients. We report here the case of a 38-year-old woman having end-stage renal disease due to autosomal-dominant polycystic kidney disease treated by PD since November 2000. Three years later, she was treated for Staphylococcal peritonitis. Four months later, she presented with a severe urge to urinate at the time of the fluid exchanges. The biochemical analysis of the fluid from the bladder showed that it was dialysis fluid. Injection of contrast through the catheter demonstrated the presence of a fistula between the bladder and the peritoneal cavity. She underwent cystoscopic closure of the fistulous tract and the PD catheter was removed. Subsequently, the patient was treated by hemodialysis. One month later, a second catheter was implanted surgically after confirming the closure of the fistula. Ten days later, she presented with pain at the catheter site and along the tunnel, which was found to be swollen along its track. The injection of contrast produced swelling of the subcutaneous tunnel but without extravasation of the dye. PD was withdrawn and the patient was put back on hemodialysis. Bladder fistula is a rare complication in PD and diagnosis should be suspected when patient complains of an urge to pass urine during the exchanges, which can be confirmed by contrast study showing presence of dye in the bladder. PD may be possible after the closure of the fistula, but recurrence may occur. PMID:22569443

  16. Bladder perforation in a peritoneal dialysis patient

    Directory of Open Access Journals (Sweden)

    M Ounissi

    2012-01-01

    Full Text Available The dysfunction of the catheter in peritoneal dialysis (PD is a frequent compli-cation. However, perforation of organs are rare, particularly that of the urinary bladder. This re-quires an early diagnosis and prompt treatment of patients. We report here the case of a 38-year-old woman having end-stage renal disease due to autosomal-dominant polycystic kidney disease treated by PD since November 2000. Three years later, she was treated for Staphylococcal peritonitis. Four months later, she presented with a severe urge to urinate at the time of the fluid exchanges. The biochemical analysis of the fluid from the bladder showed that it was dialysis fluid. Injection of contrast through the catheter demonstrated the presence of a fistula between the bladder and the peritoneal cavity. She underwent cystoscopic closure of the fistulous tract and the PD catheter was removed. Subsequently, the patient was treated by hemodialysis. One month later, a second catheter was implanted surgically after confirming the closure of the fistula. Ten days later, she presented with pain at the catheter site and along the tunnel, which was found to be swollen along its track. The injection of contrast produced swelling of the subcutaneous tunnel but without extravasation of the dye. PD was withdrawn and the patient was put back on hemodialysis. Bladder fistula is a rare complication in PD and diagnosis should be suspected when patient complains of an urge to pass urine during the exchanges, which can be confirmed by contrast study showing presence of dye in the bladder. PD may be possible after the closure of the fistula, but recurrence may occur.

  17. Sequence-based polymorphisms in the mitochondrial D-loop and potential SNP predictors for chronic dialysis.

    Directory of Open Access Journals (Sweden)

    Jin-Bor Chen

    Full Text Available BACKGROUND: The mitochondrial (mt displacement loop (D-loop is known to accumulate structural alterations and mutations. The aim of this study was to investigate the prevalence of single nucleotide polymorphisms (SNPs within the D-loop among chronic dialysis patients and healthy controls. METHODOLOGY AND PRINCIPAL FINDINGS: We enrolled 193 chronic dialysis patients and 704 healthy controls. SNPs were identified by large scale D-loop sequencing and bioinformatic analysis. Chronic dialysis patients had lower body mass index, blood thiols, and cholesterol levels than controls. A total of 77 SNPs matched with the positions in reference of the Revised Cambridge Reference Sequence (CRS were found in the study population. Chronic dialysis patients had a significantly higher incidence of 9 SNPs compared to controls. These include SNP5 (16108Y, SNP17 (16172Y, SNP21 (16223Y, SNP34 (16274R, SNP35 (16278Y, SNP55 (16463R, SNP56 (16519Y, SNP64 (185R, and SNP65 (189R in D-loop of CRS. Among these SNPs with genotypes, SNP55-G, SNP56-C, and SNP64-A were 4.78, 1.47, and 5.15 times more frequent in dialysis patients compared to controls (P<0.05, respectively. When adjusting the covariates of demographics and comorbidities, SNP64-A was 5.13 times more frequent in dialysis patients compared to controls (P<0.01. Furthermore, SNP64-A was found to be 35.80, 3.48, 4.69, 5,55, and 4.67 times higher in female patients and in patients without diabetes, coronary artery disease, smoking, and hypertension in an independent significance manner (P<0.05, respectively. In patients older than 50 years or with hypertension, SNP34-A and SNP17-C were found to be 7.97 and 3.71 times more frequent (P<0.05 compared to patients younger than 50 years or those without hypertension, respectively. CONCLUSIONS AND SIGNIFICANCE: The results of large-scale sequencing suggest that specific SNPs in the mtDNA D-loop are significantly associated with chronic dialysis. These SNPs can be considered

  18. An assessment of survival among Korean elderly patients initiating dialysis: a national population-based study.

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    Shina Lee

    Full Text Available BACKGROUND: Although the proportion of the elderly patients with incident end-stage renal disease (ESRD patients has been increasing in Korea, there has been a lack of information on outcomes of dialysis treatment. This study aimed to assess the survival rate and to elucidate predictors for all-cause mortality among elderly Korean patients initiating dialysis. METHODS: We analyzed 11,301 patients (6,138 men aged 65 years or older who had initiated dialysis from 2005 to 2008 and had followed up (median, 37.8 months; range, 3-84 months. Baseline demographics, comorbidities and mortality data were obtained using the database from the Health Insurance Review & Assessment Service. RESULTS: The unadjusted 5-year survival rate was 37.6% for all elderly dialysis patients, and the rate decreased with increasing age categories; 45.9% (65∼69, 37.5% (70∼74, 28.4% (75∼79, 24.1% (80∼84, and 13.7% (≥85 years. The multivariate Cox proportional hazard model revealed that age, sex, dialysis modality, the type of insurance, and comorbidities such as diabetes mellitus, myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, dementia, chronic pulmonary disease, hemiparesis, liver disease, and any malignancy were independent predictors for mortality. In addition, survival rate was significantly higher in patients on hemodialysis compared to patients on peritoneal dialysis during the whole follow-up period in the intention-to-treat analysis. CONCLUSIONS: Survival rate was significantly associated with age, sex, and various comorbidities in Korean elderly patients initiating dialysis. The results of our study can help to provide relevant guidance on the individualization strategy in elderly ESRD patients requiring dialysis.

  19. Peripheral Vascular Disease–Related Procedures in Dialysis Patients: Predictors and Prognosis

    OpenAIRE

    Plantinga, Laura C; Fink, Nancy E.; Coresh, Josef; Stephen M Sozio; Parekh, Rulan S.; Melamed, Michal L.; Powe, Neil R.; Jaar, Bernard G.

    2009-01-01

    Background and objectives: Peripheral vascular disease (PVD) is prevalent among dialysis patients, and many dialysis patients undergo PVD-related procedures. We aimed to examine the risk factors for and prognosis after such procedures in the dialysis setting.

  20. Residual renal function and nutritional status in patients on continuous ambulatory peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Jovanović Nataša

    2005-01-01

    Full Text Available Introduction During the last years, an increasing number of patients with end-stage renal failure caused by various underlying diseases, all over the world, is treated by renal replacement therapy. Nutritional status Malnutrition is often found in patients affected by renal failure; it is caused by reduced intake of nutritional substances due to anorexia and dietary restrictions hormonal and metabolic disorders, comorbid conditions and loss of proteins, amino-acids, and vitamins during the dialysis procedure itself. Nutritional status significantly affects the outcome of patients on chronic dialysis treatment. Recent epiodemiological trials have proved that survival on chronic continuous ambulatory peritoneal dialysis program depends more on residual renal function (RRF than on peritoneal clearances of urea and creatinine. Material and methods The aim of the study was to analyze the influence of RRF on common biochemical and anthropometric markers of nutrition in 32 patients with end-stage renal failure with various underlying diseases during the first 6 months on continuous ambulatory peritoneal dialysis (CAPD. The mean residual creatinine clearance was 8,3 ml/min and the mean RRF was 16,24 week in our patients at the beginning of the chronic peritoneal dialysis treatment. Results and conclusion During the follow-up, the RRF slightly decreased, while the nutritional status of patients significantly improved. Gender and age, as well as the leading disease and peritonitis didn't influence the RRF during the first 6 months of CAPD treatment. We found several positive correlations between RRF and laboratory and anthropometric markers of nutrition during the follow-up, proving the positive influence of RRF on nutritional status of patients on chronic peritoneal dialysis.

  1. Measures of blood pressure and cognition in dialysis patients

    Science.gov (United States)

    There are few reports on the relationship of blood pressure with cognitive function in maintenance dialysis patients. The Cognition and Dialysis Study is an ongoing investigation of cognitive function and its risk factors in six Boston area hemodialysis units. In this analysis, we evaluated the rela...

  2. Kidney Dialysis Patients Discover New Hope through ABE Program.

    Science.gov (United States)

    Amonette, Linda; And Others

    A program was developed to provide adult basic education (ABE) to kidney patients while they are receiving dialysis treatment. The program, which relies on an individualized learning approach, involved the coordinated efforts of the following parties: West Virginia Dialysis Facilities, Inc.; the Charleston Renal Group; and the Kanawha County Adult…

  3. Quality of life in dialysis patients from the United Arab Emirates

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    Abdelbasit M Ayoub

    2013-01-01

    Full Text Available Background: The quality of life (QOL has emerged as an important parameter for evaluating the quality of health-care for patients with renal failure. The literature suggests that many factors impact QOL. The QOL of dialysis patients in the United Arab Emirates (UAE has not been studied before. This research examined the QOL of patients in the UAE on dialysis using two QOL tools. Materials and Methods: A descriptive comparative survey design was used to study 161 dialysis patients. The participants completed the 36-Item Short Form Health Survey (SF-36 and the QOL index dialysis version tool. Comparative analyses of the results for both tools were done using descriptive statistics. Multiple linear regression analysis determines the effect of the variables on the QOL scores. Results: The questionnaires return rate was 93%. The overall QOL for dialysis patients was rated low when self-assessed using the SF-36 (58.9 compared to QOL index (77.2. The multiple regression analysis revealed that having a chronic illness had the strongest impact on the total scores of both tools. The comparison between the statistically significant variables for both samples revealed contradictory results from the two tools used. This meant that the two tools measured QOL differently. Conclusion: The two QOL tools scores impacted very differently on most socio-demographic variables on the two samples. More studies are required to explore the concept of QOL in the Arab dialysis population.

  4. [Patients in pre-dialysis: decision taking and free choice of treatment].

    Science.gov (United States)

    Sarrias Lorenz, X; Bardón Otero, E; Vila Paz, M L

    2008-01-01

    treatment. Because of the impossibility of establishing universal rules of proportionality, it is necessary to make a personal judgment of conscience in each specific case. Recommendations for initiation or not of dialysis: Taking shared decisions between the patient (or relatives and/or advisors) and the physician. These shared decisions will be documented with signing of the proposed informed consent or rejection of the treatment. The medical team should always be sure that the patients has fully understood the consequences of the decision taken. Explanation of the modalities should include: - Types of dialysis treatment available. - Not to initiate dialysis and continue with conservative treatment until death. This situation may cause many problems if we do not have the help of the palliative care service. - Try dialysis for a limited time. - Stop dialysis and receive medical care until death. - Evaluate the prognosis of renal disease and concomitant diseases, life expectancy and family support. Resolution of conflicts: Conflicts may occur: - Between nephrologist and patient/family. - Between members of the nephrological team. - Between nephrologist and other physicians. When conflicts persist and the need for initiation of dialysis is urgent, it is necessary to initiate treatment and continue it until the resolution of these conflicts, making a record of this decision. In such cases, the Hospital Ethics Care Committee can help with appropriate advice to solve the discrepancies. Decisions taken in advance may be useful in this type of patients. Patients with advanced chronic kidney disease with criteria for Noninclusion or withdrawal of dialysis. - Severe or irreversible dementia. - conditions of permanent unconsciousness. - advanced tumors with metastasis. - terminal disease of another nontransplantable organ. - severe physical and/or mental disabilities. (Strength of Recommendation C)

  5. [Concerning: aging, the beginning of dialysis, the beginning of dependence: repercussions on the psychopathology of the very old dialysis patient].

    Science.gov (United States)

    Antoine, V; Edy, T; Souid, M; Barthélémy, F; Saint-Jean, O

    2004-01-01

    The incidence of psychopathology, particularly depression, is high in dialysed elderly patients whereas their perceived level of health in the mental domain is similar to that of a non-dialysed and, even younger, population. Although the losses associated with advancing years, chronic disease and then entry into dialysis renders the psyche of elderly people frail, they do not strictly add in negative terms: their psychological reserve or resignation helps very elderly people to tolerate dialysis and its constraints. However, maintaining functional autonomy (ability to provide for one's fundamental needs and preserve leisure activities) while remaining independent to take decisions (particularly in controlling ways of receiving assistance) and preserving close relationships emerge as major determinant factors of the quality of life of very elderly dialysed patients. Added to the dependency due to dialysis, losses in these domains very often represent a turning point by changing the patient's identity, predisposing to the development of relationship problems, leading the patient to question his self-esteem or even resulting in psychological dependency, which itself adversely affects the quality of life. These mechanisms of psychopathology may not hide the possibility of an underlying dementia. PMID:15185555

  6. Comparison of oral Lactobacillus and Streptococcus mutans between diabetic dialysis patients with non-diabetic dialysis patients and healthy people

    Science.gov (United States)

    Rezazadeh, Fahimeh; Bazargani, Abdollah; Roozbeh-Shahroodi, Jamshid; Pooladi, Ali; Arasteh, Peyman; Zamani, Khosro

    2016-01-01

    Introduction: Diabetes is associated with higher rates of caries, on the other hand some studies have shown that renal failure can be protective against dental caries. Objectives: In this study we compared oral Lactobacillus and Streptococcus mutans between diabetic dialysis and non-diabetic dialysis patients and the normal population. Patients and Methods: During November 2014 to January 2014, 85 people that referred to our medical care center entered the study. The sample included 30 diabetic dialysis, 28 non-diabetic dialysis patients and 27 healthy people. Oral saliva samples were obtained from their tongue and oral floor for microbiological examination. Patients’ data were compared before and after dialysis. Results: The amount of Lactobacillus and S. mutans did not show a significant difference between the three groups (P=0.092 and P=0.966 for S. mutans and lactobacillus, respectively). A positive and meaningful correlation was seen between fasting blood sugar (FBS) levels and the amount of S. mutans in the diabetic dialysis group (P=0.023; r=0.413). A meaningful and positive correlation was also seen between the amount of blood urea nitrogen (BUN) after dialysis and the amount of oral S. mutans in the non-diabetic dialysis group (P=0.03; r=0.403). Conclusion: Despite the differences in the prevalence of caries that have been reported between renal failure patients and diabetic patients, we did not find any significant difference between diabetic dialysis, non-diabetic dialysis patients and the healthy population, regarding their amount of oral cariogenic bacteria.

  7. Determinants of survival in patients receiving dialysis in Libya.

    Science.gov (United States)

    Alashek, Wiam A; McIntyre, Christopher W; Taal, Maarten W

    2013-04-01

    Maintenance dialysis is associated with reduced survival when compared with the general population. In Libya, information about outcomes on dialysis is scarce. This study, therefore, aimed to provide the first comprehensive analysis of survival in Libyan dialysis patients. This prospective multicenter study included all patients in Libya who had been receiving dialysis for >90 days in June 2009. Sociodemographic and clinical data were collected upon enrollment and survival status after 1 year was determined. Two thousand two hundred seventy-three patients in 38 dialysis centers were followed up for 1 year. The majority were receiving hemodialysis (98.8%). Sixty-seven patients were censored due to renal transplantation, and 46 patients were lost to follow-up. Thus, 2159 patients were followed up for 1 year. Four hundred fifty-eight deaths occurred, (crude annual mortality rate of 21.2%). Of these, 31% were due to ischemic heart disease, 16% cerebrovascular accidents, and 16% due to infection. Annual mortality rate was 0% to 70% in different dialysis centers. Best survival was in age group 25 to 34 years. Binary logistic regression analysis identified age at onset of dialysis, physical dependency, diabetes, and predialysis urea as independent determinants of increased mortality. Patients receiving dialysis in Libya have a crude 1-year mortality rate similar to most developed countries, but the mean age of the dialysis population is much lower, and this outcome is thus relatively poor. As in most countries, cardiovascular disease and infection were the most common causes of death. Variation in mortality rates between different centers suggests that survival could be improved by promoting standardization of best practice.

  8. Psychosocial effects on caregivers for children on chronic peritoneal dialysis.

    Science.gov (United States)

    Tsai, T-C; Liu, S-I; Tsai, J-D; Chou, L-H

    2006-12-01

    The study was designed to explore the psychosocial effects on caretakers of children in Taiwan on chronic peritoneal dialysis (CPD). This is a case-control study, performed with subjects drawn from eight medical centers. The study group consisted of caretakers of 32 children with renal failure being treated with CPD. For comparison, a control group of caretakers of 64 healthy children as well as the regional Taiwanese studies were used. Two instruments were used to explore the presence of probable depression and quality of life (QOL) of the caretakers: the Taiwanese Depression Questionnaire, and the World Health Organization QOL BRIEF-Taiwan Version. In the study group, only 25% of caregivers had full-time jobs, and 66% of families had an annual income of less than US dollar 15,000. Of the 32 families in the study group, 16% had only a single parent. The prevalence of probable depression was significantly more common in the study group compared with control and referent group (28% vs 5% and 9.44%; P = 0.001). QOL scores in four domains were also significantly lower in the study group. In conclusion, even with the advances of peritoneal dialysis techniques, caring for children on CPD in Taiwan has significant adverse psychosocial effects on the primary caregivers. Attention should be paid to the psycho-social status of the caregivers. PMID:16985519

  9. Peritoneal Fluid Transport rather than Peritoneal Solute Transport Associates with Dialysis Vintage and Age of Peritoneal Dialysis Patients

    OpenAIRE

    Jacek Waniewski; Stefan Antosiewicz; Daniel Baczynski; Jan Poleszczuk; Mauro Pietribiasi; Bengt Lindholm; Zofia Wankowicz

    2016-01-01

    During peritoneal dialysis (PD), the peritoneal membrane undergoes ageing processes that affect its function. Here we analyzed associations of patient age and dialysis vintage with parameters of peritoneal transport of fluid and solutes, directly measured and estimated based on the pore model, for individual patients. Thirty-three patients (15 females; age 60 (21–87) years; median time on PD 19 (3–100) months) underwent sequential peritoneal equilibration test. Dialysis vintage and patient ag...

  10. Cardiovascular and noncardiovascular mortality among patients starting dialysis

    DEFF Research Database (Denmark)

    de Jager, Dinanda J; Grootendorst, Diana C; Jager, Kitty J;

    2009-01-01

    CONTEXT: Cardiovascular mortality is considered the main cause of death in patients receiving dialysis and is 10 to 20 times higher in such patients than in the general population. OBJECTIVE: To evaluate if high overall mortality in patients starting dialysis is a consequence of increased...... cardiovascular mortality risk only or whether noncardiovascular mortality is equally increased. DESIGN, SETTING, AND PATIENTS: Using data from between January 1, 1994, and January 1, 2007, age-stratified mortality in a European cohort of adults starting dialysis and receiving follow-up for a mean of 1.8 (SD, 1.......1) years (European Renal Association-European Dialysis and Transplant Association [ERA-EDTA] Registry [N = 123,407]) was compared with the European general population (Eurostat). MAIN OUTCOME MEASURES: Cause of death was recorded by ERA-EDTA codes in patients and matching International Statistical...

  11. Multicystic transformation of the kidneys in dialysis patients

    DEFF Research Database (Denmark)

    Frifelt, J J; Larsen, C; Elle, Birgitte;

    1989-01-01

    In a dialysis population patients who had been treated merely with haemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD) were examined with ultrasound. The occurrence of multicystic transformation of the kidney was 4/15 in HD patients and 8/25 in CAPD patients with no significant...... difference between the two groups. There was a significant association between the occurrence of multicystic transformation and the patient age while there was no significant association to the duration of dialysis or the duration of the uraemic state. No tumour or any other complication to cystic...... transformation was found. In 582 persons without renal disease examined as controls we found 44 with cystic change. This material does not support the recommendation of regular ultrasound examination of our dialysis patients. However, until these results can be confirmed by prospective studies we must recommend...

  12. Patients in assisted automated peritoneal dialysis develop strategies for self-care

    DEFF Research Database (Denmark)

    Holch, Kirsten

    2008-01-01

      Background Since 2000, a model for Assisted Automated Peritoneal Dialysis (aAPD) for patients in their own home needing chronic dialysis treatment has been developed at Aarhus University Hospital, Skejby, Denmark. The patient group consists of physically or mentally frail elderly who cannot...... show that patients in their own home strengthen their self-care capacity in the period between three and six months after starting aAPD treatment. Examples of this are initiatives concerning promotion of appetite, sleep, dressing, social contact and prevention of infection and fall. Conclusion Elderly...... people develop their own strategies for adapting aAPD to the way they have met their needs in their own home. The patients experience the treatment as part of the every day life and show increasing creativity to find solutions to satisfy their needs. Technical assistance concerning dialysis makes...

  13. NEUROPSYCHOLOGICAL CHARACTERIZATION OF ADULT PATIENTS UNDER DIALYSIS IN A SPECIALIZED INSTITUTIONIN MEDELLIN, COLOMBIA

    OpenAIRE

    ANA DUARTE; LUZ GÓMEZ; DANIEL AGUIRRE; DAVID PINEDA

    2006-01-01

    Introduction: Patients with chronic renal failure (CRF) have cognitive impairments and intellectual deficiencies comparedwith normal people. Objective: To analyze the neuropsychological characteristics in adult patients (18 to 65 years old),belonging to a dialysis program in the Instituto del Riñón [Kidney Institute] of Medellín-Colombia. Subjects andMethods: A non-randomized sample of 59 patients, aged between 23 to 64 years old, a neuropsychological tests batterywas applied to patients, whi...

  14. Sequential rupture of triceps and quadriceps tendons in a dialysis patient using hormone supplements.

    Science.gov (United States)

    Soo, I; Christiansen, J; Marion, D; Courtney, M; Luyckx, V A

    2011-02-01

    Spontaneous rupture of tendons is rare, and typically occurs in large weight bearing tendons such as the quadriceps, Achilles and patellar tendon, in the context of various chronic diseases including end-stage renal disease. In general, tendon rupture in dialysis patients is associated with hyperparathyroidism, long duration of dialysis, steroid and quinolone use. We present a case of a young man on chronic dialysis who presented with sequential rupture of triceps and quadriceps tendons requiring surgical repair, several months after initiating use of multiple hormone supplements including human growth hormone and androgens. The supplements were obtained over the internet with the aim of improving his kidney function. Although this patient did have hyperparathyroidism, it is likely his PTH elevation was exacerbated by use of human growth hormone, and tendon rupture risk increased by concurrent use of an androgen supplement. This case highlights the fact that dialysis patients do utilize alternative remedies and that there may be unexpected, dialysis-specific complications associated with their use.

  15. Peritonitis in peritoneal dialysis patients after renal transplantation

    NARCIS (Netherlands)

    Bakir, N; Surachno, S; Sluiter, WJ; Struijk, DG

    1998-01-01

    Background. The occurrence of peritonitis in peritoneal dialysis patients after renal transplantation during immunosuppression might increase morbidity and mortality. Hence the timing of catheter removal is still controversial. The associated risk factors of this complication have not been analyzed.

  16. Arterial Stiffening and Clinical Outcomes in Dialysis Patients

    OpenAIRE

    Kato, Akihiko

    2015-01-01

    Cardiovascular disease (CVD) is an important cause of morbidity and mortality in dialysis patients. Brachial-ankle pulse wave velocity (baPWV) is more efficient to handily assess arteriosclerosis than aortic PWV. The cardio-ankle vascular index (CAVI) is also a novel blood pressure-independent arterial stiffness parameter. In dialysis patients, both baPWV and CAVI are increased compared to general subjects. Several studies have demonstrated that increased baPWV is associated with carotid athe...

  17. Evaluating Infection Prevention Strategies in Out-Patient Dialysis Units Using Agent-Based Modeling

    Science.gov (United States)

    Wares, Joanna R.; Lawson, Barry; Shemin, Douglas; D’Agata, Erika M. C.

    2016-01-01

    Patients receiving chronic hemodialysis (CHD) are among the most vulnerable to infections caused by multidrug-resistant organisms (MDRO), which are associated with high rates of morbidity and mortality. Current guidelines to reduce transmission of MDRO in the out-patient dialysis unit are targeted at patients considered to be high-risk for transmitting these organisms: those with infected skin wounds not contained by a dressing, or those with fecal incontinence or uncontrolled diarrhea. Here, we hypothesize that targeting patients receiving antimicrobial treatment would more effectively reduce transmission and acquisition of MDRO. We also hypothesize that environmental contamination plays a role in the dissemination of MDRO in the dialysis unit. To address our hypotheses, we built an agent-based model to simulate different treatment strategies in a dialysis unit. Our results suggest that reducing antimicrobial treatment, either by reducing the number of patients receiving treatment or by reducing the duration of the treatment, markedly reduces overall colonization rates and also the levels of environmental contamination in the dialysis unit. Our results also suggest that improving the environmental decontamination efficacy between patient dialysis treatments is an effective method for reducing colonization and contamination rates. These findings have important implications for the development and implementation of future infection prevention strategies. PMID:27195984

  18. Obstetric outcomes in women with end-stage renal disease on chronic dialysis: a review

    Science.gov (United States)

    Yang, L Y; Thia, E W H; Tan, L K

    2010-01-01

    Pregnancies in women on chronic dialysis for end-stage renal disease are high risk, but outcomes appear to have improved with increasing experience and advances in dialysis care. This paper reviews the existing data on outcomes in such pregnancies to enable evidence-based preconception counselling and anticipation of antenatal complications.

  19. Erythropoietin production in renal cell carcinoma and renal cysts in autosomal dominant polycystic kidney disease in a chronic dialysis patient with polycythemia: A case report.

    Science.gov (United States)

    Ito, Keiichi; Asano, Takako; Tominaga, Susumu; Yoshii, Hidehiko; Sawazaki, Harutake; Asano, Tomohiko

    2014-11-01

    In patients undergoing chronic hemodialysis (HD), erythropoietin (EPO) production from the kidney generally decreases and renal anemia develops. Patients without anemia, but with high serum EPO (sEPO) levels are rare among HD patients. The current study presents the case of a 67-year-old female HD patient with autosomal dominant polycystic kidney disease (ADPKD) and renal cell carcinoma (RCC), manifesting polycythemia with elevated sEPO levels. A radical nephrectomy was performed, which diminished the polycythemia, but the sEPO levels remained high. To determine the origin of the EPO production, immunohistochemistry was performed to detect EPO in the RCC and the renal cysts of the surgically resected kidney. In addition, the sEPO and EPO levels in a renal cyst were determined by enzyme immunoassay. EPO expression was demonstrated in RCC and cyst epithelial cells using immunohistochemistry, revealing extremely high EPO levels in the cyst fluid. Due to the remission of polycythemia following the nephrectomy, EPO production from the resected kidney appeared to have been the cause of the polycythemia. Positive EPO staining of the renal cysts in the resected polycystic kidney and sustained sEPO elevation following nephrectomy led to the hypothesis of EPO production in the renal cysts of the contralateral polycystic kidney. Although the postoperative EPO level was higher than the normal range, the hematocrit (Hct) level gradually decreased and recombinant human EPO was required again three months following the nephrectomy. Eight months after the nephrectomy, the Hct level was 30.2% with the use of rHuEPO. In conclusion, EPO production from RCC and renal cysts in ADPKD appeared to cause polycythemia in the HD patient. PMID:25295086

  20. Complete response of a metastatic gastroesophageal adenocarcinoma on irinotecan-based chemotherapy in a dialysis patient

    Directory of Open Access Journals (Sweden)

    J Verwimp

    2010-05-01

    Full Text Available J Verwimp1, F Geurs1, S Ponette2, J Ponette2, J Martens3, K Bulté21Department of Medical Oncology, 2Department of Gastroenterology, 3Department of Nephrology, Regionaal Ziekenhuis Sint-Maria, Ziekenhuislaan, Halle, BelgiumAbstract: We present the first case report of a complete response of metastatic gastroesophageal cancer in a chronic hemodialysis patient with irinotecan-based chemotherapy. An elderly dialysis patient presented with diffuse liver metastases by a gastroesophageal adenocarcinoma. He received combination chemotherapy with 5 fluorouracil and irinotecan. After six months of chemotherapy, liver scans show complete remission. The principles, practice, and experience of chemotherapy with irinotecan during dialysis are discussed.Keywords: gastroesophageal cancer, irinotecan, chemotherapy, dialysis

  1. Prevalence and correlates of functional dependence among maintenance dialysis patients.

    Science.gov (United States)

    Kavanagh, Niall T; Schiller, Brigitte; Saxena, Anjali B; Thomas, I-Chun; Kurella Tamura, Manjula

    2015-10-01

    Functional dependence is an important determinant of longevity and quality of life. The purpose of the current study was to determine the prevalence and correlates of functional dependence among patients with end-stage renal disease (ESRD) receiving maintenance dialysis. We enrolled 148 participants with ESRD from five clinics. Functional status, as measured by basic and instrumental activities of daily living (ADL, IADL), was ascertained by validated questionnaires. Functional dependence was defined as needing assistance in at least one of seven IADLs or at least one of four ADLs. Demographic characteristics, chronic health conditions, anthropometric measurements, and laboratories were assessed by a combination of self-report and chart review. Cognitive function was assessed with a neurocognitive battery, and depressive symptoms were assessed by questionnaire. Mean age of the sample was 56.2 ± 14.6 years. Eighty-seven participants (58.8%) demonstrated dependence in ADLs or IADLs, 70 (47.2%) exhibited IADL dependence alone, and 17 (11.5%) exhibited combined IADL and ADL dependence. In a multivariable-adjusted model, stroke, cognitive impairment, and higher systolic blood pressure were independent correlates of functional dependence. We found no significant association between demographic characteristics, chronic health conditions, depressive symptoms or laboratory measurements, and functional dependence. Impairment in executive function was more strongly associated with functional dependence than memory impairment. Functional dependence is common among ESRD patients and independently associated with stroke, systolic blood pressure, and executive function impairment. PMID:25731070

  2. Intermittent Oral Versus Intravenous Alfacalcidol in Dialysis Patients

    Directory of Open Access Journals (Sweden)

    Mitwalli Ahmed

    2000-01-01

    Full Text Available Patients with end-stage renal failure (ESRF on maintenance dialysis, commonly develop secondary hyperparathyroidism and renal osteodystrophy (ROD. Alfacalcidol, taken orally or administered intravenously, is known to reverse these complications. In this study, 19 ESRF patients, who were on dialysis (13 on hemodialysis and six on peritoneal dialysis for longer than six months and having serum parathormone levels at least four times normal and serum calcium less than 2.1 mmol/L, were randomly allocated to treatment with oral or intravenous (i.v. alfacalcidol for a period of 12 months. There were six patients on hemodialysis (HD and three on peritoneal dialysis (PD in the oral treatment group while in the i.v. group there were seven patients on HD and three on PD. Clinical and serial biochemical assessments showed no statistically significant difference between the orally- and i.v.-treated patients in terms of suppressing secondary hyperparathyroidism and osteodystrophy. However, patients with features of mild ROD on bone histology, had more satisfactory changes in biochemistry when compared to others. Our results further support the use of intermittent oral alfacalcidol in ESRF patients because of its cost effectiveness, ease of administration and convenience, especially for peritoneal dialysis patients.

  3. Patients in assisted automated peritoneal dialysis develop strategies for selfcare

    DEFF Research Database (Denmark)

    Holch, Kirsten

      Patients in Assisted Automated Peritoneal Dialysis develop strategies for self-care Background: Since 2000 a model for Assisted Automated Peritoneal Dialysis (AAPD) in the patients own home has been developed at Aarhus University Hospital, Skejby. The patient group consists of physically...... Henderson's areas of need and Dorothea Orem's self - care theory combined with problems and symptoms in End Stage Renal Disease (ESRD) patients. Results The results showed that patients in their own home improve their self-care capacity in the period between three and six months after starting AAPD...

  4. Assessment and Management of Hypertension in Patients on Dialysis

    Science.gov (United States)

    Flynn, Joseph; Pogue, Velvie; Rahman, Mahboob; Reisin, Efrain; Weir, Matthew R.

    2014-01-01

    Hypertension is common, difficult to diagnose, and poorly controlled among patients with ESRD. However, controversy surrounds the diagnosis and treatment of hypertension. Here, we describe the diagnosis, epidemiology, and management of hypertension in dialysis patients, and examine the data sparking debate over appropriate methods for diagnosing and treating hypertension. Furthermore, we consider the issues uniquely related to hypertension in pediatric dialysis patients. Future clinical trials designed to clarify the controversial results discussed here should lead to the implementation of diagnostic and therapeutic techniques that improve long-term cardiovascular outcomes in patients with ESRD. PMID:24700870

  5. Gastrointestinal symptoms in patients undergoing peritoneal dialysis: Multivariate analysis of correlated factors

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    AIM: To investigate gastrointestinal (GI) symptoms in peritoneal dialysis (PD) patients and to explore related factors contributing to GI symptoms. METHODS: One hundred and twelve patients undergoing PD participated in the study. The gastrointestinal symptom rating scale was used for measuring GI symptoms. Information on age, height, weight, body mass index, disease leading to chronic renal failure, history of corticosteroid therapy, presence of predialytic GI symptoms, daily dosage of pills, and duration, ...

  6. Fatigue in patients receiving maintenance dialysis: a review of definitions, measures, and contributing factors.

    Science.gov (United States)

    Jhamb, Manisha; Weisbord, Steven D; Steel, Jennifer L; Unruh, Mark

    2008-08-01

    Fatigue is a debilitating symptom or side effect experienced by many patients on long-term dialysis therapy. Fatigue has a considerable effect on patient health-related quality of life and is viewed as being more important than survival by some patients. Renal providers face many challenges when attempting to reduce fatigue in dialysis patients. The lack of a reliable, valid, and sensitive fatigue scale complicates the accurate identification of this symptom. Symptoms of daytime sleepiness and depression overlap with fatigue, making it difficult to target specific therapies. Moreover, many chronic health conditions common in the long-term dialysis population may lead to the development of fatigue and contribute to the day-to-day and diurnal variation in fatigue in patients. Key to improving the assessment and treatment of fatigue is improving our understanding of potential mediators, as well as potential therapies. Cytokines have emerged as an important mediator of fatigue and have been studied extensively in patients with cancer-related fatigue. In addition, although erythropoietin-stimulating agents have been shown to mitigate fatigue, the recent controversy regarding erythropoietin-stimulating agent dosing in patients with chronic kidney disease suggests that erythropoietin-stimulating agent therapy may not serve as the sole therapy to improve fatigue in this population. In conclusion, fatigue is an important and often underrecognized symptom in the dialysis population. Possible interventions for minimizing fatigue in patients on long-term dialysis therapy should aim at improving health care provider awareness, developing improved methods of measurement, understanding the pathogenesis better, and managing known contributing factors.

  7. Gastrointestinal Non-Infectious Complications in Patients on Peritoneal Dialysis

    Directory of Open Access Journals (Sweden)

    Kostović Milica

    2016-06-01

    Full Text Available Gastrointestinal complications are common among patients on peritoneal dialysis. Risk factors for the development of gastrointestinal complications in this patient population include: toxic effects of uremic toxins, frequent use of nonsteroidal anti-inflammatory drugs, Helicobacter pylori infection, angiodysplasia, increased intra-abdominal pressure, use of bioincompatible solution for peritoneal dialysis, increased glucose in solutions for peritoneal dialysis, secondary hyperparathyroidism (hypercalcemia, a disorder of lipid metabolism (hypertriglyceridemia, and the duration of peritoneal dialysis treatment. The most important non-infectious gastrointestinal complications in patients on peritoneal dialysis are: gastrointestinal bleeding, herniation and leaking of the dialysate from the abdomen (increased intra-abdominal pressure, impaired lung function (intra-abdominal hypertension, acute pancreatitis, and encapsulating sclerosis of the peritoneum. Intra-abdominal hypertension is defined as IAP ≥ 12 mmHg. Pouring the peritoneal dialysis solution leads to increased intra-abdominal pressure, which results in the development of hernias, pleuro-peritoneal dialysate leakage (hydrothorax, and restrictive pulmonary dysfunction. Risk factors for the development of acute pancreatitis in this patient population include: uraemia, secondary hyperparathyroidism with hypercalcemia, hypertriglyceridemia, features of the peritoneal dialysis solution (osmolarity, acidity, glucose, chemical irritation, and calcium in the solution for peritoneal dialysis lead to “local hypercalcemia”, toxic substances from the dialysate, the bags and tubing, and peritonitis and treatment of peritonitis with antibiotics and anticoagulants. Encapsulating sclerosis of the peritoneum is rare and is the most serious complication of long-term peritoneal dialysis. It is characterized by thickening of the peritoneum, including cancer, and signs and symptoms of obstructive ileus

  8. Relative survival of peritoneal dialysis and haemodialysis patients

    DEFF Research Database (Denmark)

    Heaf, James G; Wehberg, Sonja

    2014-01-01

    INTRODUCTION: Epidemiological studies consistently show an initial survival advantage for PD patients compared to HD. It has recently been suggested that this is due to the fact that many HD patients are referred late, and start dialysis on an acute, in-patient basis. The present study was perfor...

  9. Upper Digestive Endoscopic Findings in Patients with Chronic Renal Insufficiency in Phase of Dialysis Hallazgos mediante endoscopia digestiva superior en el paciente con insuficiencia renal crónica en fase de diálisis

    Directory of Open Access Journals (Sweden)

    Orelvis Martínez Martínez

    2009-12-01

    Full Text Available Background: Patients with chronic renal insufficiency in phase of dialysis present clinical manifestations that can include different symptoms. Morbidity due to gastric, esophageal and duodenal disturbances is significant and constitutes a considerable risk before, while and after a renal transplant. Objective: To identify the most frequent disturbances of the upper digestive tract in patients with chronic renal insufficiency who require dialysis. Methods: An observational, descriptive and retrospective study was carried out in this search. The universe was composed by all the patients with a diagnosis of chronic renal insufficiency in a dialysis phase, who had been included in the Hemodialysis Program at the University Hospital “Dr. Gustavo Aldereguía Lima” from Cienfuegos and who had undergone an upper digestive endoscopy from January to May, 2008. The patient’s health record was studied to get information for the variables under study. Results: the average age was 46,7 years and the most affected patients were males. The mean value for serum creatinine was 929,7 mMol/L, for serum urea 21,4 mMol/L and for hemoglobin 8,4 g/L. The most frequent cause of chronic nephropathy was High Blood Pressure in 25 patients (56,8 %, followed by Diabetes Mellitus in 9 patients (20,5 %. 52,3 % of the patients were asymptomatic, but the most frequent symptoms reported by the patients were flatulence (25 % and nausea (15,9 %. Endoscopy revealed normal results in most of the patients (40,9 %. Conclusions: Antral erythematous endoscopic gastritis was the most frequent endoscopic diagnosis followed by duodenal ulcer Fundamento: Los pacientes con insuficiencia renal crónica en fase de diálisis presentan manifestaciones clínicas que pueden incluir diferentes sistemas. La morbilidad por alteraciones de esófago y estómago, así como duodenal es

  10. Fate of patients during the first year of dialysis

    Directory of Open Access Journals (Sweden)

    Selma Siham El Khayat

    2013-01-01

    Full Text Available Care in dialysis is often associated with significant morbidity and mortality during the first year. Knowledge of its magnitude and causes could improve the prognosis of these patients. The aim of this study was to evaluate the survival and morbidity during the first year of dialysis for patients who initiated their dialysis between January 1, 2009 and December 31, 2009 and to study their possible correlation with baseline status at the beginning of treatment. A multi-center retrospective study was conducted in 11 dialysis centers. Clinical data at the beginning of dialysis and during the following year were collected. Mortality and morbidity risk factors were assessed by comparing different groups. Statistical analysis was performed with SPSS version 11. This study involved 134 patients, 79 men and 55 women, of whom 132 were on hemodialysis and two patients were on peritoneal dialysis. The mean age at initiation of treatment was 54.37 ± 18.09 years. Initial causes of nephropathy were dominated by diabetes (44.02% and hypertension (11.19%. Among these patients, 39.55% had never received prior nephrological follow-up and 64.92% had started renal replacement therapy on an emergency basis. The initial clinical state was dominated by the presence of hypertension (50.74%, diabetes (44.02%, coronary insufficiency (13.43% and heart failure (7.46%. Only 26.86% of the incident patients showed no comorbidity. During the first year of follow-up, 37.31% of the patients experienced at least one episode of comorbidity. Hospitalization was necessary in about half of these cases (17.91% of all patients. The overall mortality rate was 14.17%. One patient received a kidney transplant. The mortality rate in the first year of dialysis was lower in our study than in other series. Regular nephrological follow-up of these patients before they reach end-stage could have a significant influence on survival in dialysis.

  11. Late initiation of dialysis in diabetic Egyptian patients

    Directory of Open Access Journals (Sweden)

    Salwa Ibrahim

    2015-01-01

    Conclusion In Conclusion , our study showed that there is delayed referral for nephrology care and delayed initiation of dialysis when patients presented through the emergency department. Of particular interest was the fact that diabetic patients were most often subjected to this practice.

  12. Bone alkaline phosphatase and mortality in dialysis patients

    NARCIS (Netherlands)

    C. Drechsler; M. Verduijn; S. Pilz; R.T. Krediet; F.W. Dekker; C. Wanner; M. Ketteler; E.W. Boeschoten; V. Brandenburg

    2011-01-01

    Serum alkaline phosphatase (AP) is associated with vascular calcification and mortality in hemodialysis patients, but AP derives from various tissues of origin. The aim of this study was to assess the effect of bone-specific AP (BAP) on morbidity and mortality in dialysis patients. From a prospectiv

  13. Dialysis Disequilibrium Syndrome-Induced Cerebral Edema in a Patient with Uremia Following Hemodialysis: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Min; Kim, Heung Cheol [Dept. of Radiology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon (Korea, Republic of)

    2012-03-15

    Dialysis disequilibrium syndrome is a metabolic complication that can be caused by rapid removal of plasma urea during hemodialysis. Dialysis disequilibrium syndrome can lead to osmotic demyelinating syndrome. This case report describes one case of encephalopathy accompanied by dialysis disequilibrium syndrome with imaging findings acquired immediately after hemodialysis in a 55-year-old woman with chronic renal failure. The patient was observed to present repetitive seizures and sudden deterioration of consciousness immediately after hemodialysis. Shortly after the onset of symptoms, the patient underwent a CT scan. The imaging findings of the CT scan reveal symmetrical diffuse white matter edema of bilateral cerebral hemispheres that extends to the pons along the internal capsule. A follow-up MRI taken two years later shows that reversible changes without damage have occurred in the lesions. The patient can thus be seen to present symptoms characteristically associated with dialysis disequilibrium syndrome, while brain imaging reveals dif-fuse reversible brain edema.

  14. Potential Role of Vegetarianism on Nutritional and Cardiovascular Status in Taiwanese Dialysis Patients: A Case-Control Study.

    Directory of Open Access Journals (Sweden)

    Shih-Hsiang Ou

    Full Text Available Cardiovascular disease remains the most common cause of death for patients on chronic dialysis. End stage renal disease patients undergoing dialysis imposed to reduce phosphorus intake, which likely contributes to development of vegetarian diet behaviors. Vegetarian diets are often lower in protein content, in contradiction to the recommendation that a high protein diet is followed by patients undergoing dialysis. The purpose of the study was to investigate the effects of a vegetarian diet on the nutritional and cardiovascular status of dialysis patients.A study of 21 vegetarian dialysis patients and 42 age- and sex-matched non-vegetarian dialysis patients selected as controls was conducted in the Kaohsiung Veterans General Hospital. Brachial-ankle pulse wave velocity and biochemistry data including total homocysteine levels, serum lipid profiles, high-sensitivity C-reactive protein, vitamin D levels, albumin, and normalized protein catabolic rate were measured.Compared with the non-vegetarian control group, vegetarian subjects had lower body weight, body mass index, serum phosphate, blood urea nitrogen, serum creatinine, vitamin D, uric acid, albumin, and normalized protein catabolic rate (p < 0.05. The vegetarian group showed higher brachial-ankle pulse wave velocity than the non-vegetarian group (1926.95 ± 456.45 and 1684.82 ± 309.55 cm/sec, respectively, p < 0.05. After adjustment for age, albumin, pre-dialysis systolic blood pressure, and duration of dialysis, vegetarian diet remained an independent risk factor for brachial-ankle pulse wave velocity.The present study revealed that patients on dialysis who follow vegetarian diets may experience subclinical protein malnutrition and vitamin D deficiency that could offset the beneficial cardiovascular effects of vegetarianism.

  15. Arterial Stiffening and Clinical Outcomes in Dialysis Patients.

    Science.gov (United States)

    Kato, Akihiko

    2015-09-01

    Cardiovascular disease (CVD) is an important cause of morbidity and mortality in dialysis patients. Brachial-ankle pulse wave velocity (baPWV) is more efficient to handily assess arteriosclerosis than aortic PWV. The cardio-ankle vascular index (CAVI) is also a novel blood pressure-independent arterial stiffness parameter. In dialysis patients, both baPWV and CAVI are increased compared to general subjects. Several studies have demonstrated that increased baPWV is associated with carotid atherosclerosis and diastolic left ventricular dysfunction in hemodialysis (HD) patients. In addition, higher baPWV is related to all-cause and cardiovascular (CV) mortality. CAVI is similarly associated with CVD. However, baPWV is superior to CAVI as a predictor of CV outcomes in HD patients. Besides these outcomes, a close relationship exists between sarcopenia, abdominal visceral obesity and arterial stiffening. Reduction of thigh muscle mass is inversely correlated with baPWV and CAVI in males. Abdominal fatness is also associated with increased arterial stiffness in females. These observations provide further evidence of higher risk of CV events in HD patients with sarcopenic obesity. In addition, arterial stiffness is associated with cerebral small vessel disease and decreased cognitive function in the elderly. However, it is unknown whether arterial stiffness may be useful as an early indicator of cognitive decline in dialysis patients. Because dialysis patients are at risk of developing dementia, more studies are needed to elucidate the causal link between arterial stiffness and cognitive impairment. PMID:26587457

  16. Elevated levels of procoagulant plasma microvesicles in dialysis patients.

    Directory of Open Access Journals (Sweden)

    James O Burton

    Full Text Available Cardiovascular (CV death remains the largest cause of mortality in dialysis patients, unexplained by traditional risk factors. Endothelial microvesicles (EMVs are elevated in patients with traditional CV risk factors and acute coronary syndromes while platelet MVs (PMVs are associated with atherosclerotic disease states. This study compared relative concentrations of circulating MVs from endothelial cells and platelets in two groups of dialysis patients and matched controls and investigated their relative thromboembolic risk. MVs were isolated from the blood of 20 haemodialysis (HD, 17 peritoneal dialysis (PD patients and 20 matched controls. Relative concentrations of EMVs (CD144(+ ve and PMVs (CD42b(+ ve were measured by Western blotting and total MV concentrations were measured using nanoparticle-tracking analysis. The ability to support thrombin generation was measured by reconstituting the MVs in normal plasma, using the Continuous Automated Thrombogram assay triggered with 1µM tissue factor. The total concentration of MVs as well as the measured sub-types was higher in both patient groups compared to controls (p0.3. Dialysis patients have higher levels of circulating procoagulant MVs than healthy controls. This may represent a novel and potentially modifiable mediator or predictor of occlusive cardiovascular events in these patients.

  17. Elevated levels of procoagulant plasma microvesicles in dialysis patients.

    Science.gov (United States)

    Burton, James O; Hamali, Hassan A; Singh, Ruchir; Abbasian, Nima; Parsons, Ruth; Patel, Amit K; Goodall, Alison H; Brunskill, Nigel J

    2013-01-01

    Cardiovascular (CV) death remains the largest cause of mortality in dialysis patients, unexplained by traditional risk factors. Endothelial microvesicles (EMVs) are elevated in patients with traditional CV risk factors and acute coronary syndromes while platelet MVs (PMVs) are associated with atherosclerotic disease states. This study compared relative concentrations of circulating MVs from endothelial cells and platelets in two groups of dialysis patients and matched controls and investigated their relative thromboembolic risk. MVs were isolated from the blood of 20 haemodialysis (HD), 17 peritoneal dialysis (PD) patients and 20 matched controls. Relative concentrations of EMVs (CD144(+ ve)) and PMVs (CD42b(+ ve)) were measured by Western blotting and total MV concentrations were measured using nanoparticle-tracking analysis. The ability to support thrombin generation was measured by reconstituting the MVs in normal plasma, using the Continuous Automated Thrombogram assay triggered with 1µM tissue factor. The total concentration of MVs as well as the measured sub-types was higher in both patient groups compared to controls (p0.3). Dialysis patients have higher levels of circulating procoagulant MVs than healthy controls. This may represent a novel and potentially modifiable mediator or predictor of occlusive cardiovascular events in these patients. PMID:23936542

  18. Bioimpedance Spectroscopy for the Detection of Fluid Overload in Chinese Peritoneal Dialysis Patients

    OpenAIRE

    Kwan, Bonnie Ching-Ha; Szeto, Cheuk-Chun; Chow, Kai-Ming; Law, Man-Ching; Cheng, Mei Shan; Leung, Chi-Bon; Pang, Wing-Fai; Kwong, Vickie Wai-Ki; Li, Philip Kam-tao

    2014-01-01

    ♦ Background: Fluid overload probably contributes to the cardiovascular risk of peritoneal dialysis (PD) patients. We studied the relationship between over-hydration as determined by bioimpedance spectroscopy and dialysis adequacy, nutritional status, and arterial stiffness in Chinese PD patients.

  19. Effects of oral enalapril and verapamil on dialysis adequacy and solute clearance in chronic ambulatory peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Shahnaz Atabak

    2013-01-01

    Full Text Available Peritoneal dialysis offers several advantages such as better clearance of intermediate/large molecules and better preservation of renal residual function when compared with hemodialysis. However, dialysis adequacy is one of the subjects of concern of this modality. There are some drugs that are capable of influencing solute transport in the peritoneum, such as acetyle co-enzyme inhibitors (ACE-I medications and calcium channel blockers. Captopril and Verapamil are often mentioned, but their use has shown varying conclusions and initial studies were performed with the intra-peritoneal administration of these drugs and there are only a few studies on the effect of the oral administration of these drugs. This study was undertaken with the aim to evaluate the effects of oral administration of Verapamil and Enalapril among continuous ambulatory peritoneal dialysis (CAPD patients. The results of this study showed that Verapamil and Enalapril do not have any effects on glucose, creatinine, sodium, potassium and urea clearance (during the 4-h peritoneal equilibration test (PET test. However, it was shown that Enalapril significantly increased the peritoneal urea Kt/V and caused a meaningful decrease in the diastolic and mean blood pressures. Therefore, we feel that Enalapril may be administered as an anti-hypertensive medication of choice in CAPD patients, which can also result in better dialysis adequacy. However, further studies with larger sample sizes are needed in the future.

  20. Association between ambient carbon monoxide and secondary hyperparathyroidism in nondiabetic patients undergoing peritoneal dialysis

    OpenAIRE

    Weng CH; Hu CC; Yen TH; Huang WH

    2015-01-01

    Cheng-Hao Weng,1,2 Ching-Chih Hu,3 Tzung-Hai Yen,1,2 Wen-Hung Huang1,2 1Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou, 2College of Medicine, Chang Gung University, Taoyuan, 3Liver Research Unit, Department of Hepatogastroenterology, Chang Gung Memorial Hospital, Keelung, Taiwan Background: Secondary hyperparathyroidism (SHPT) is a major disorder in patients with chronic renal disease with or without dialysis. Air pollution has been confirmed...

  1. Delivered dialysis dose is suboptimal in hospitalized patients.

    Science.gov (United States)

    Obialo, C I; Hernandez, B; Carter, D

    1998-01-01

    Underdialyzed patients have high hospitalization and mortality rates. It is unclear if such patients receive adequate dialysis during hospitalization. In this cross-sectional study, we evaluated single treatment delivered dialysis dose during hospitalization and compared this to the dosage received at the free-standing outpatient clinics in the same patients. Eighty-four patients (54% male) aged 23-63 years (means +/- SD 55.5 +/- 14.6) who have been on dialysis for at least 3 months were evaluated. Hypertension and diabetes were the most common diagnoses, while thrombosed graft or fistula accounted for 40% of admissions. The mean dialysis treatment time (Td) was 30 min longer in the outpatient (OP) setting than the hospital (H): 3.6 +/- 0.3 vs. 3.1 +/- 0.2 h (p < 0.0001). Attained blood flow (QB) was 15% greater in the OP than H: 394 +/- 40 vs. 331 +/- 54 ml/min (p < 0.0001). The Kt/V was analyzed in 49 of 84 patients; the OP Kt/V was 20% greater than the H Kt/V: 1.38 +/- 0.2 vs. 1.11 +/- 0.1 (p < 0.0001). A further breakdown of H Kt/V according to access and membrane types showed that patients with functional grafts/fistula had a higher Kt/V than those with temporary accesses 1.14 +/- 0.1 vs. 1.07 +/- 0.1 (p = 0.01). We conclude that hospitalized patients receive suboptimal dialysis dose, this could have a negative impact on survival if hospitalization is recurrent and prolonged. Kinetic modeling should be routinely performed in such patients and Td should be increased in patients with temporary accesses. PMID:9845829

  2. Prevalence of metabolic syndrome in pre-dialysis chronic renal failure patients%慢性肾功能不全非透析患者代谢综合征的发生率

    Institute of Scientific and Technical Information of China (English)

    林沁; 项协隆; 庄永泽; 李俊霞

    2011-01-01

    目的 观察慢性肾功能不全(CRF)非透析患者中代谢综合征(MS)的发生率及其特点.方法 收集2009-01-2010-01在我院肾内科住院的CRF非透析患者298例(非透析CRF组,男111例,女187例,年龄30~62岁),分为糖尿病肾病(n=30)与非糖尿病肾病组(n=268);同时在我院征募年龄、性别匹配的肾功能正常的健康体检者300人作为对照组.每例患者均进行腰围、血压、空腹血糖、血脂、血肝功能、肾功能、电解质24 h尿白蛋白及眼底检查等,采用国际糖尿病联盟的定义诊断MS.比较各组患者MS的发生率.结果 非透析CRF组MS发生率明显高于对照组(21.8%比11.3%).与对照组相比,非透析CRF组MS患者血压升高发生率(93.0%比35.0%)、血尿酸升高发生率(87.6%比20.7%)及高三酰甘油发生率(40.6%比25.7%)均明显增高(均P<0.01).与非糖尿病肾病组的MS患者比较,糖尿病肾病组的MS患者腰围超标发生率(66.7%比25.4%)及空腹血糖升高发生率(100%比16.0%)均明显升高(均P<0.01).结论 慢性肾功能不全非透析患者MS及高尿酸发生率明显增高.%Objective To investigate the prevalence and the characteristics of Metabolic Syndrome (MS) in pre-dial-ysis chronic renal failure (CRF) patients. Methods From January 2009 to January 2010, 298 cases of pre-dialysis CRF inpatients (pre-dialysis CRF group, 111 male and 187 female, aged from 30 to 62 years) in our nephrology department were divided into diabetic nephropathy (n = 30) and non-diabetic nephropathy subgroup (n = 268). And 300 cases of age-and sex-matched persons accepted heath examination with normal renal function served as the control group. Waist circumference, blood pressure, fasting blood glucose, lipid profile, renal function, electrolytes, 24-hour urinary protein and fundus examination were tested for each subject. MS was defined by International Diabetes Federation criteria. The prevalence of MS was compared between

  3. Predicting mortality in patients with diabetes starting dialysis.

    Directory of Open Access Journals (Sweden)

    Merel van Diepen

    Full Text Available BACKGROUND: While some prediction models have been developed for diabetic populations, prediction rules for mortality in diabetic dialysis patients are still lacking. Therefore, the objective of this study was to identify predictors for 1-year mortality in diabetic dialysis patients and use these results to develop a prediction model. METHODS: Data were used from the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD, a multicenter, prospective cohort study in which incident patients with end stage renal disease (ESRD were monitored until transplantation or death. For the present analysis, patients with DM at baseline were included. A prediction algorithm for 1-year all-cause mortality was developed through multivariate logistic regression. Candidate predictors were selected based on literature and clinical expertise. The final model was constructed through backward selection. The model's predictive performance, measured by calibration and discrimination, was assessed and internally validated through bootstrapping. RESULTS: A total of 394 patients were available for statistical analysis; 82 (21% patients died within one year after baseline (3 months after starting dialysis therapy. The final prediction model contained seven predictors; age, smoking, history of macrovascular complications, duration of diabetes mellitus, Karnofsky scale, serum albumin and hemoglobin level. Predictive performance was good, as shown by the c-statistic of 0.810. Internal validation showed a slightly lower, but still adequate performance. Sensitivity analyses showed stability of results. CONCLUSIONS: A prediction model containing seven predictors has been identified in order to predict 1-year mortality for diabetic incident dialysis patients. Predictive performance of the model was good. Before implementing the model in clinical practice, for example for counseling patients regarding their prognosis, external validation is necessary.

  4. Epidemiologic trends in chronic renal replacement therapy over forty years: A Swiss dialysis experience

    Directory of Open Access Journals (Sweden)

    Lehmann Petra

    2012-07-01

    Full Text Available Abstract Background Long term longitudinal data are scarce on epidemiological characteristics and patient outcomes in patients on maintenance dialysis, especially in Switzerland. We examined changes in epidemiology of patients undergoing renal replacement therapy by either hemodialysis or peritoneal dialysis over four decades. Methods Single center retrospective study including all patients which initiated dialysis treatment for ESRD between 1970 and 2008. Analyses were performed for subgroups according to dialysis vintage, based on stratification into quartiles of date of first treatment. A multivariate model predicting death and survival time, using time-dependent Cox regression, was developed. Results 964 patients were investigated. Incident mean age progressively increased from 48 ± 14 to 64 ± 15 years from 1st to 4th quartile (p  Discussion We document an increase of a predominantly elderly incident and prevalent dialysis population, with progressively shortened survival after initiation of renal replacement over four decades, and, nevertheless, a prolonged lifespan. Analysis of the data is limited by lack of information on comorbidity in the study population. Conclusions Survival in patients on renal replacement therapy seems to be affected not only by medical and technical advances in dialysis therapy, but may mostly reflect progressively lower mortality of individuals with cardiovascular and metabolic complications, as well as a policy of accepting older and polymorbid patients for dialysis in more recent times. This is relevant to make demographic predictions in face of the ESRD epidemic nephrologists and policy makers are facing in industrialized countries.

  5. Transperitoneal transport in diabetic and non-diabetic patients on peritoneal dialysis

    DEFF Research Database (Denmark)

    Graff, J; Fugleberg, Steen; Nielsen, S L;

    1999-01-01

    To investigate differences in the transport characteristics of the peritoneal membrane between diabetic and non-diabetic patients on chronic peritoneal dialysis, a study was conducted in 21 non-diabetic and 18 diabetic patients. Transperitoneal transport of small solutes was evaluated in terms...... of the mass transfer area coefficients (urea, creatinine and glucose), ultra-filtration sieving coefficients (urea and creatinine) and by peritoneal equilibration test results. The capacity of the peritoneal membrane to transport macromolecules was evaluated by albumin mass transfer rates and clearances......-labelled human albumin. Despite a significantly increased transcapillary escape rate of albumin in the diabetic patients, no differences in peritoneal membrane characteristics could be demonstrated between diabetic and non-diabetic patients on peritoneal dialysis....

  6. Cardiovascular morbidity and mortality risk factors in peritoneal dialysis patients

    Directory of Open Access Journals (Sweden)

    Jovanović Dijana B.

    2008-01-01

    Full Text Available Cardiovascular (CVS morbidity and mortality in the endstage renal disease (ESRD patients on peritoneal dialysis therapy is 10-30 folds higher than in general population. The prevalence of well known traditional risk factors such as age, sex, race, arterial hypertension, hyperlipidaemia, diabetes, smoking, physical inactivity is higher in the uraemic patients. Besides these, there are specific, nontraditional risk factors for dialysis patients. Mild inflammation present in peritoneal dialysis (PD patients which can be confirmed by specific inflammatory markers is the cause of CVS morbidity and mortality in these patients. Hypoalbuminaemia, hyperhomocysteinaemia and a higher level of leptin are important predictors of vascular complications as well as CVS events in the PD patients. Plasma norepinephrine, an indicator of sympathetic activity, is high in the ESRD patients and higher in the PD patients than in the patients on haemodialysis (HD. Therefore, norepinephrine may be a stronger risk factor in the PD patients. The same applies to asymmetric dimethylargine (ADMA, an endogenous inhibitor of nitric oxide synthase, which is an important risk factor of CVS morbidity and mortality 15 % higher in the PD than the HD patients. Hyperphosphataemia, secondary hyperparathyroidism and high calcium x phosphate product have been associated with the progression of the coronary artery calcification and valvular calcifications and predict all-cause CVS mortality in the PD patients. Residual renal function (RRF declines with time on dialysis but is slower in the PD than the HD patients. RRF decline is associated with the rise of proinflammatory cytokines and the onset of hypervolaemia and hypertension which increase the risk of CVS diseases, mortality in general and CVS mortality. In conclusion, it is very important to establish all CVS risk factors in the PD patients to prevent CVS diseases and CVS mortality in this population.

  7. Risk factor and cost accounting analysis for dialysis patients in Taiwan.

    Science.gov (United States)

    Su, Bin-Guang; Tsai, Kai-Li; Yeh, Shu-Hsing; Ho, Yi-Yi; Liu, Shin-Yi; Rivers, Patrick A

    2010-05-01

    According to the 2004 US Renal Data System's annual report, the incidence rate of chronic renal failure in Taiwan increased from 120 to 352 per million populations between 1990 and 2003. This incidence rate is the highest in the world. The prevalence rate, which ranks number two in the world (Japan ranks number one), also increased from 384 to 1630 per million populations. Based on 2005 Taiwan national statistics, there were 52,958 end-stage renal disease (ESRD) patients receiving routine dialysis treatment. This number, which comprised less than 0.2% of the total population and consumed $2.6 billion New Taiwan dollars, was more than 6.12% of the total annual spending of national health insurance during 2005. Dialysis expenditures for patients with ESRD rank the highest among all major injuries (traumas) and diseases. This article identifies and discusses the risk factors associated with consumption of medical resources during dialysis. Instead of using reimbursement data to estimate cost, as seen in previous studies, this study uses cost data within organizations and focuses on evaluating and predicting the resource consumption pattern for dialysis patients with different risk factors. Multiple regression analysis was used to identify 23 risk factors for routine dialysis patients. Of these risk factors, six were associated with the increase of dialysis cost: age (i.e. 75 years old and older), liver function disorder, hypertension, bile-duct disorder, cancer and high blood lipids. Patients with liver function disorder incurred much higher costs for injection medication and supplies. Hypertensive patients incurred higher costs for injection medication, supplies and oral medication. Patients with bile-duct disorder incurred a significant difference in check-up costs (i.e. costs were higher for those aged 75 years and older than those who were younger than 30 years of age). Cancer patients also incurred significant differences in cost of medical supplies. Patients

  8. Capnocytophaga cynodegmi peritonitis in a peritoneal dialysis patient

    DEFF Research Database (Denmark)

    Pers, Charlotte; Tvedegaard, Erling; Christensen, Jens Jørgen;

    2007-01-01

    The first reported case of peritonitis caused by Capnocytophaga cynodegmi is presented. The patient was treated with peritoneal dialysis and had contact with a cat. C. cynodegmi is part of the normal oral flora of dogs and cats but is very rarely isolated in clinical specimens from humans....

  9. INVESTIGATION OF SERUM MICROCYSTIN CONCENTRATIONS AMONG DIALYSIS PATIENTS, BRAZIL, 1996

    Science.gov (United States)

    Investigation of Serum Microcystin Concentrations Among Dialysis Patients, Brazil, 1996Elizabeth D. Hilborn 1, Wayne W. Carmichael 2, Sandra M.F.O. Azevedo 31- USEPA/ORD/NHEERL, Research Triangle Park, NC2- Wright State University, Dayton, OH3- Federal Univers...

  10. Solute clearance measurement in the assessment of dialysis adequacy among African continuous ambulatory peritoneal dialysis patients

    Directory of Open Access Journals (Sweden)

    Aliyu Abdu

    2015-01-01

    Full Text Available Solute clearance measurement is an objective means of quantifying the dose of peritoneal dialysis (PD. Despite continued debate on the interpretation and precise prognostic value of small solute clearance in PD patients, guidelines based on solute clearance values are common in clinical practice. There is limited information on the solute clearance indices and PD adequacy parameters among this predominantly low socioeconomic status PD population. We investigated the solute clearance among continuous ambulatory peritoneal dialysis (CAPD patients at the Charlotte Maxeke Johannesburg Academic Hospital and its relationship with other parameters of PD adequacy. Seventy patients on CAPD were studied in this cross-sectional study. Solute clearance was assessed using urea clearance (Kt/V. Linear regression analysis was used to determine factors associated with solute clearance, while analysis of variance was used to test the influence of weekly Kt/V on blood pressure (BP, hemoglobin (Hb and other biochemical parameters. The mean age of the study population was 37.9 ± 12.4 years, 43% were females and 86% were black Africans. The mean duration on CAPD was 19.7 ± 20.8 months. Mean systolic and diastolic BP were 144 ± 28 and 92 ± 17 mm Hg, respectively. The mean Hb was 11.1 ± 2.2 g/dL and the mean weekly Kt/V was 1.7 ± 0.3. Factors like systolic BP, Hb level, serum levels of cholesterol, calcium, phosphate, parathyroid hormone and albumin were not significantly associated with the weekly Kt/V. We conclude that the dose of PD received by the majority of our patients in terms of the weekly Kt/V is within the recommended values and that this finding is significant considering the low socioeconomic background of our patients. There is no significant association between Kt/V and other indices of dialysis adequacy.

  11. An analysis of caregiver burden of patients with hemodialysis and peritoneal dialysis.

    Science.gov (United States)

    Cantekin, Işın; Kavurmacı, Mehtap; Tan, Mehtap

    2016-01-01

    Since caregivers have roles and responsibilities in all phases from the diagnosis of the disease to discharge and homecare, their care burdens increase. The problems experienced by caregivers, whose care burden increase and accordingly whose life quality is deteriorated, complicate the treatment-receiving patient's adaptation to the disease. This study was performed to determine the burden to primary caregivers of patients undergoing dialysis. This descriptive study was conducted with the family caregivers of 114 patients from Erzurum Ataturk University's Medical Faculty Nephrology Department: 54 were relatives of patients receiving hemodialysis and 60 were relatives of patients receiving peritoneal dialysis during August to December 2014. The percentage of the patients with low levels of caregiver burden is 13% in the hemodialysis group, while it is 35% in the peritoneal dialysis group. These findings are statistically significant. To conclude, chronic diseases affect not only patients, but also their relatives who care for them. Nursing care needs to include both patients and their relatives and support them. It is hoped that this study will guide nursing care in this direction.

  12. Peritoneal Fluid Transport rather than Peritoneal Solute Transport Associates with Dialysis Vintage and Age of Peritoneal Dialysis Patients.

    Science.gov (United States)

    Waniewski, Jacek; Antosiewicz, Stefan; Baczynski, Daniel; Poleszczuk, Jan; Pietribiasi, Mauro; Lindholm, Bengt; Wankowicz, Zofia

    2016-01-01

    During peritoneal dialysis (PD), the peritoneal membrane undergoes ageing processes that affect its function. Here we analyzed associations of patient age and dialysis vintage with parameters of peritoneal transport of fluid and solutes, directly measured and estimated based on the pore model, for individual patients. Thirty-three patients (15 females; age 60 (21-87) years; median time on PD 19 (3-100) months) underwent sequential peritoneal equilibration test. Dialysis vintage and patient age did not correlate. Estimation of parameters of the two-pore model of peritoneal transport was performed. The estimated fluid transport parameters, including hydraulic permeability (LpS), fraction of ultrasmall pores (α u), osmotic conductance for glucose (OCG), and peritoneal absorption, were generally independent of solute transport parameters (diffusive mass transport parameters). Fluid transport parameters correlated whereas transport parameters for small solutes and proteins did not correlate with dialysis vintage and patient age. Although LpS and OCG were lower for older patients and those with long dialysis vintage, αu was higher. Thus, fluid transport parameters--rather than solute transport parameters--are linked to dialysis vintage and patient age and should therefore be included when monitoring processes linked to ageing of the peritoneal membrane. PMID:26989432

  13. Peritoneal Fluid Transport rather than Peritoneal Solute Transport Associates with Dialysis Vintage and Age of Peritoneal Dialysis Patients

    Directory of Open Access Journals (Sweden)

    Jacek Waniewski

    2016-01-01

    Full Text Available During peritoneal dialysis (PD, the peritoneal membrane undergoes ageing processes that affect its function. Here we analyzed associations of patient age and dialysis vintage with parameters of peritoneal transport of fluid and solutes, directly measured and estimated based on the pore model, for individual patients. Thirty-three patients (15 females; age 60 (21–87 years; median time on PD 19 (3–100 months underwent sequential peritoneal equilibration test. Dialysis vintage and patient age did not correlate. Estimation of parameters of the two-pore model of peritoneal transport was performed. The estimated fluid transport parameters, including hydraulic permeability (LpS, fraction of ultrasmall pores (αu, osmotic conductance for glucose (OCG, and peritoneal absorption, were generally independent of solute transport parameters (diffusive mass transport parameters. Fluid transport parameters correlated whereas transport parameters for small solutes and proteins did not correlate with dialysis vintage and patient age. Although LpS and OCG were lower for older patients and those with long dialysis vintage, αu was higher. Thus, fluid transport parameters—rather than solute transport parameters—are linked to dialysis vintage and patient age and should therefore be included when monitoring processes linked to ageing of the peritoneal membrane.

  14. Peritoneal Fluid Transport rather than Peritoneal Solute Transport Associates with Dialysis Vintage and Age of Peritoneal Dialysis Patients.

    Science.gov (United States)

    Waniewski, Jacek; Antosiewicz, Stefan; Baczynski, Daniel; Poleszczuk, Jan; Pietribiasi, Mauro; Lindholm, Bengt; Wankowicz, Zofia

    2016-01-01

    During peritoneal dialysis (PD), the peritoneal membrane undergoes ageing processes that affect its function. Here we analyzed associations of patient age and dialysis vintage with parameters of peritoneal transport of fluid and solutes, directly measured and estimated based on the pore model, for individual patients. Thirty-three patients (15 females; age 60 (21-87) years; median time on PD 19 (3-100) months) underwent sequential peritoneal equilibration test. Dialysis vintage and patient age did not correlate. Estimation of parameters of the two-pore model of peritoneal transport was performed. The estimated fluid transport parameters, including hydraulic permeability (LpS), fraction of ultrasmall pores (α u), osmotic conductance for glucose (OCG), and peritoneal absorption, were generally independent of solute transport parameters (diffusive mass transport parameters). Fluid transport parameters correlated whereas transport parameters for small solutes and proteins did not correlate with dialysis vintage and patient age. Although LpS and OCG were lower for older patients and those with long dialysis vintage, αu was higher. Thus, fluid transport parameters--rather than solute transport parameters--are linked to dialysis vintage and patient age and should therefore be included when monitoring processes linked to ageing of the peritoneal membrane.

  15. Sleep disorders in patients with end-stage renal disease undergoing dialysis: comparison between hemodialysis, continuous ambulatory peritoneal dialysis and automated peritoneal dialysis.

    Science.gov (United States)

    Losso, Ricardo L M; Minhoto, Gisele R; Riella, Miguel C

    2015-02-01

    Sleep disorders for patients on dialysis are significant causes of a poorer quality of life and increased morbidity and mortality. No study has evaluated patients undergoing automated peritoneal dialysis (APD) to assess their sleep disorders compared to hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). A total of 166 clinically stable patients who had been on dialysis for at least 3 months were randomly selected for the study and divided into HD, CAPD or APD. Socio-demographic, clinical and laboratory parameters and self-administered questionnaires were collected for the investigation of insomnia, restless legs syndrome (RLS), bruxism, rapid eye movement sleep behavior disorder, excessive daytime sleepiness (EDS), obstructive sleep apnea syndrome (OSAS), sleepwalking, sleep hygiene, depression and anxiety. Insomnia was detected in more than 80 % of patients on the three modalities. OSAS was lower for patients on HD (36 %) than on CAPD (65 %) (p < 0.01) or APD (60 %) (p < 0.04). Patients on APD were more likely to have RLS compared to those on HD or CAPD (p < 0.04) (50 vs. 23 vs. 33 %). No differences among the modalities were found in bruxism, EDS, sleepwalking, sleep hygiene, depression or anxiety. ESRD patients undergoing any one of the three dialysis modalities studied had a high prevalence of sleep disorders. Patients on HD had a lower proportion of OSAS than those on CAPD and APD, which is most likely attributed to their lower body mass indices. The possible causes of higher RLS rates in APD patients have not been established.

  16. Changes of serum leptin levels and the influential factors in peritoneal dialysis patients

    Institute of Scientific and Technical Information of China (English)

    晏焕青

    2014-01-01

    Objective To investigate the changes of serum leptin levels and the influential factors in maintenance peritoneal dialysis patients.Methods Seventy-six peritoneal dialysis patients were chosen at the time before,and 3months,6 months,12 months,18 months and 24months after they began the peritoneal dialysis therapy,to examine body mass index(BMI),

  17. Historical Study (1986-2014): Improvements in nutritional status of dialysis patients

    DEFF Research Database (Denmark)

    Koefoed, Mette; Kromann, Charles Boy; Hvidtfeldt, Danni;

    2016-01-01

    OBJECTIVE: Malnutrition is common in dialysis patients and is associated with adverse clinical outcomes. Despite an increased focus on improved nutrition in dialysis patients, it is claimed that the prevalence of malnutrition in this group of patients has not changed during the last decades. Direct...... historical comparisons of the nutritional status of dialysis patients have never been published. To directly compare the nutritional status of past and current dialysis patients, we implemented the methodology of a study from 1986 on a population of dialysis patients in 2014. DESIGN: Historical study...... comparing results of two cross-sectional studies performed in 1986 and 2014. SETTING: We compared the nutritional status of hemodialysis (HD) and peritoneal dialysis (PD) patients attending the dialysis center at Roskilde Hospital, Denmark, in February to June 2014, with that of HD and PD patients treated...

  18. Sleep disorders in patients with end-stage renal disease undergoing dialysis: comparison between hemodialysis, continuous ambulatory peritoneal dialysis and automated peritoneal dialysis.

    Science.gov (United States)

    Losso, Ricardo L M; Minhoto, Gisele R; Riella, Miguel C

    2015-02-01

    Sleep disorders for patients on dialysis are significant causes of a poorer quality of life and increased morbidity and mortality. No study has evaluated patients undergoing automated peritoneal dialysis (APD) to assess their sleep disorders compared to hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). A total of 166 clinically stable patients who had been on dialysis for at least 3 months were randomly selected for the study and divided into HD, CAPD or APD. Socio-demographic, clinical and laboratory parameters and self-administered questionnaires were collected for the investigation of insomnia, restless legs syndrome (RLS), bruxism, rapid eye movement sleep behavior disorder, excessive daytime sleepiness (EDS), obstructive sleep apnea syndrome (OSAS), sleepwalking, sleep hygiene, depression and anxiety. Insomnia was detected in more than 80 % of patients on the three modalities. OSAS was lower for patients on HD (36 %) than on CAPD (65 %) (p sleepwalking, sleep hygiene, depression or anxiety. ESRD patients undergoing any one of the three dialysis modalities studied had a high prevalence of sleep disorders. Patients on HD had a lower proportion of OSAS than those on CAPD and APD, which is most likely attributed to their lower body mass indices. The possible causes of higher RLS rates in APD patients have not been established. PMID:25358390

  19. Segmental and whole body electrical impedance measurements in dialysis patients

    OpenAIRE

    Nescolarde Selva, Lexa

    2006-01-01

    The main objective of this thesis is to contribute to the prevention and control of the cardiovascular risk, hydration state and nutritional state in dialysis patients using non-invasive electrical impedance measurements. The thesis is structured in three parts with the following objectives: 1) to establish electrical impedance reference data for healthy Cuban population, 2)to improve the diagnostic based on impedance methods in Cuban hemodialysis (HD)patients and 3) to develop the impedance ...

  20. Dialysis - hemodialysis

    Science.gov (United States)

    Artificial kidneys - hemodialysis; Dialysis; Renal replacement therapy - hemodialysis; End-stage renal disease - hemodialysis; Kidney failure - hemodialysis; Renal failure - hemodialysis; Chronic kidney ...

  1. 慢性肾衰竭非透析患者心脏功能和甲状腺功能的关系%Relationship between cardiovascular disorders and thyroid function in non-dialysis patients with chronic renal failure

    Institute of Scientific and Technical Information of China (English)

    黄智敏; 孙彬; 沈冬云; 毛慧娟; 刘佳; 张波; 张承宁; 邢昌赢

    2013-01-01

    目的:回顾性分析慢性肾衰竭非透析患者心脏功能及甲状腺功能的变化,并探讨其中的关系。方法:采用横断面研究的方法,取慢性肾衰竭患者70例以MDRD法及胱抑素C(cystatin C,cyc C)法评估肾小球滤过率(glomerular filtration rate,eGFR),根据eGFR分成2组,≥30 mL·min-1·(1.73 m2)-1为A组,<30 mL·min-1·(1.73 m2)-1为B组,收集患者临床资料和生化指标与甲状腺功能,心脏超声检查测量心脏腔径及心功能参数。分析各组之间的心脏结构及功能与甲状腺激素之间的关系。结果:B组促甲状腺激素(thyroid stimulating hormone,TSH)、左心室重量指数较A组升高;多元线性回归提示eGFR与左心室重量指数呈负相关(β=-0.32,P<0.01);在左室肥厚研究对象中多元线性回归提示游离三碘甲状腺原氨酸(free triiodothyronine,FT3)与左心室重量指数呈负相关(β=-2.83,P<0.01);与MDRD法相比,利用cyc C评估肾功能预测心脏结构异常有优势,但在甲状腺功能异常者利用eGFR(MDRD)评估更有优势。结论:慢性肾衰竭随着肾功能减退,左心室重量指数及TSH升高。在慢性肾衰竭左室肥厚患者中,随着FT3的减低,左心室重量指数升高。%Objective:To investigate the changes of cardiovascular disorder and thyroid function, to explore the relationship in non-dialysis patients with chronic renal failure (CRF). Methods: A total of 70 cases in patients with CRF were enrolled in the retrospective study. The patients were divided into group A and group B by estimated glomerular filtration rate (MDRD) (eGFR) ≥30, <30 mL·min-1·(1.73 m2)-1. Clinical data, biochemical indicators and thyroid function were collected. Cardiac ultrasound measurement of cardiac lumen diameter parameters and function were assessed by echocardiography. The associations between the changes of cardiac structure and function with thyroid function were analyzed in different

  2. Liver dialysis in acute-on-chronic liver failure: current and future perspectives.

    Science.gov (United States)

    Maiwall, Rakhi; Maras, Jaswinder Singh; Nayak, Suman Lata; Sarin, Shiv Kumar

    2014-09-01

    Patients with acute-on-chronic liver failure (ACLF) are known to have a very high mortality rate as the majority of these patients succumb to multiorgan failure. Liver transplant remains the only option for these patients; however, there are problems with its availability, cost and also the complications and side effects associated with immunosuppression. Unlike advanced decompensated liver disease, there is a potential for hepatic regeneration and recovery in patients with ACLF. A liver support system, cell or non-cell based, logically is likely to provide temporary functional support until the donor liver becomes available or the failing liver survives the onslaught of the acute insult and spontaneously regenerates. Understanding the pathogenesis of liver failure and regeneration is essential to define the needs for a support system. Removal of hepatotoxic metabolites and inhibitors of hepatic regeneration by liver dialysis, a non-cell-based hepatic support, could help to provide a suitable microenvironment and support the failing liver. The current systems, i.e., MARS and Prometheus, have failed to show survival benefits in patients with ACLF based on which newer devices with improved functionality are currently under development. However, larger randomized trials are needed to prove whether these devices can enable restoration of the complex dysregulated immune system and impact organ failure and mortality in these patients. PMID:26201332

  3. Hemoperitoneum in a peritoneal dialysis patient from a retroperitoneal source.

    Science.gov (United States)

    Balsera, Cristina; Guest, Steven

    2013-01-01

    Hemoperitoneum in peritoneal dialysis patients is a known but infrequent complication. Hemoperitoneum is more frequent in women because of its association with a variety of gynecologic presentations such as reflux menstruation, ovulation, endometrial tissue implants within the peritoneal cavity (endometriosis), and bleeding follicular cysts. Other intraperitoneal causes of hemoperitoneum include minor catheter or abdominal trauma, vascular anomalies, or hepatic or splenic cysts. Less frequently encountered is a presentation of hemoperitoneum from a retroperitoneal source. These presentations result either from peritoneal inflammation and subsequent peritoneal bleeding or retroperitoneal cavity pathology rupturing into the peritoneal cavity. Here, we present the case of a peritoneal dialysis patient presenting with hemoperitoneum several days after undergoing cardiac catheterization. The catheterization was complicated by a large retroperitoneal hematoma. Details of the case are reported, and other retroperitoneal causes of hemoperitoneum are reviewed.

  4. Association between ambient carbon monoxide and secondary hyperparathyroidism in nondiabetic patients undergoing peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Weng CH

    2015-09-01

    Full Text Available Cheng-Hao Weng,1,2 Ching-Chih Hu,3 Tzung-Hai Yen,1,2 Wen-Hung Huang1,2 1Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou, 2College of Medicine, Chang Gung University, Taoyuan, 3Liver Research Unit, Department of Hepatogastroenterology, Chang Gung Memorial Hospital, Keelung, Taiwan Background: Secondary hyperparathyroidism (SHPT is a major disorder in patients with chronic renal disease with or without dialysis. Air pollution has been confirmed as being associated with increased incidence of human morbidity and mortality. To our knowledge, investigating air pollution as a dialysis-unrelated factor for SHPT in patients undergoing dialysis is limited. We developed this study to assess the effect of air pollution and other important risk factors on SHPT in patients undergoing peritoneal dialysis (PD. Materials and methods: We recruited a total of 141 patients who did not have diabetes mellitus, were nonsmokers, and were undergoing PD in this cross-sectional study. We analyzed the difference in air quality based on the patients’ living areas. We estimated demographic, hematological, nutritional, inflammatory, biochemical, air pollutant, and dialysis-related data based on this cross-sectional study. Subgroup analysis of the relationship between air pollutants and the clinical variables and having or not having hyperparathyroidism (HPT (intact parathyroid hormone level ≥180 pg/dL was also performed. Results: A total of 141 patients undergoing PD (30 men and 111 women were enrolled in the study. Sixty-eight patients had SHPT. In a binary logistic regression, high environmental CO exposure (odds ratio [OR] 3.22, 95% confidence interval [CI] 1.42–7.28; P=0.005, serum phosphate levels (OR 1.66, 95% CI 1.17–2.37; P=0.005, hypoalbuminemia (OR 3.76, 95% CI 1.29–10.94; P=0.015, and use of calcitriol (OR 8.25, 95% CI 3.43–19.85; P<0.001 were positively associated with SHPT. Conclusion: The findings of

  5. Potential Role of Vegetarianism on Nutritional and Cardiovascular Status in Taiwanese Dialysis Patients: A Case-Control Study

    Science.gov (United States)

    Chen, Mei-Yin; Huang, Chien-Wei; Chen, Nai-Ching; Wu, Chien-Hsing; Hsu, Chih-Yang; Chou, Kang-Ju; Lee, Po-Tsang; Fang, Hua-Chang; Chen, Chien-Liang

    2016-01-01

    Background & Objectives Cardiovascular disease remains the most common cause of death for patients on chronic dialysis. End stage renal disease patients undergoing dialysis imposed to reduce phosphorus intake, which likely contributes to development of vegetarian diet behaviors. Vegetarian diets are often lower in protein content, in contradiction to the recommendation that a high protein diet is followed by patients undergoing dialysis. The purpose of the study was to investigate the effects of a vegetarian diet on the nutritional and cardiovascular status of dialysis patients. Design, Setting, Participants, Measurements A study of 21 vegetarian dialysis patients and 42 age- and sex-matched non-vegetarian dialysis patients selected as controls was conducted in the Kaohsiung Veterans General Hospital. Brachial-ankle pulse wave velocity and biochemistry data including total homocysteine levels, serum lipid profiles, high-sensitivity C-reactive protein, vitamin D levels, albumin, and normalized protein catabolic rate were measured. Results Compared with the non-vegetarian control group, vegetarian subjects had lower body weight, body mass index, serum phosphate, blood urea nitrogen, serum creatinine, vitamin D, uric acid, albumin, and normalized protein catabolic rate (p vegetarian group showed higher brachial-ankle pulse wave velocity than the non-vegetarian group (1926.95 ± 456.45 and 1684.82 ± 309.55 cm/sec, respectively, p vegetarian diet remained an independent risk factor for brachial-ankle pulse wave velocity. Conclusions The present study revealed that patients on dialysis who follow vegetarian diets may experience subclinical protein malnutrition and vitamin D deficiency that could offset the beneficial cardiovascular effects of vegetarianism. PMID:27295214

  6. Extracorporeal albumin dialysis with the molecular adsorbent recirculating system in acute-on-chronic liver failure

    DEFF Research Database (Denmark)

    Bañares, Rafael; Nevens, Frederik; Larsen, Fin Stolze;

    2013-01-01

    Acute-on-chronic liver failure (ACLF) is a frequent cause of death in cirrhosis. Albumin dialysis with the molecular adsorbent recirculating system (MARS) decreases retained substances and improves hemodynamics and hepatic encephalopathy (HE). However, its survival impact is unknown. In all, 189...

  7. Correlational studies on insulin resistance and leptin gene polymorphisms in peritoneal dialysis patients

    Directory of Open Access Journals (Sweden)

    Liou Cao

    2015-09-01

    Full Text Available Objective(s:The aim of the study was to investigate the relationship between insulin resistance (IR and leptin (LEP gene polymorphisms in peritoneal dialysis (PD patients. Materials and Methods: From July 1, 2011 to August 1, 2011, patients who received chronic PD were chosen and divided into three groups (DM, high HOMR-IR, and low HOMR-IR. Two PCR products of LEP were sequenced and aligned and the distribution of polymorphisms was analyzed using χ2 analysis. In addition, serum leptin level, PD conditions, and biochemical parameters according to different genotype of G-2548A and A19G were statistically analyzed (P-value

  8. Peritoneal membrane characteristics in patients on peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Jamal Al-wakeel

    2011-01-01

    Full Text Available Peritoneal dialysis (PD is a well-established modality for treatment of patients with end-stage renal disease, giving excellent patient and technique survival rates. In Saudi Arabia, data collected by the Saudi Center for Organ Transplantation showed that in 2008, patients on PD accounted for a mere 4.8% of total patients on renal replacement therapy, including hemodialysis and renal transplantation. This study was conducted to identify the characteristics of membrane per-meability in the Saudi population and to assess the role of various factors affecting solute transport across the peritoneal membrane. We followed up a total of 52 patients on Continuous Ambulatory Peritoneal Dialysis (CAPD as well as Automated Peritoneal Dialysis (APD, being treated in the PD unit of the King Khalid University Hospital, Riyadh. There were 30 female and 22 male patients; 14 patients were using CAPD while 38 patients were on APD. The mean age of the patients was 50.5 years, with a range of 14-86 years. The average body mass index (BMI was 27.1 kg/m 2 and the mean body surface area (BSA of the study patients was 1.71 m 2 . A standardized PET test was performed on all patients, 4-6 weeks after initiation of regular PD. The Kt/V and creatinine clearance measured 6-8 weeks after initiation of dialysis were 1.96 and 56.59 L/week, respectively. Residual renal function was assessed on the basis of daily urine output, using 24-hour urine collection. The mean serum urea con-centration was 16.91 mmol/L and mean serum creatinine was 702 μmol/L. According to the Peritoneal Equiliberation Test (PET, 8% of the subjects belonged to the high trans-porter category, 44% patients belonged to the high-average transport group, 46% to the low-average category and 2% came in the low transporter category. Our study suggests that the patient characteristics and demographic para-meters seen in the Saudi population are comparable to those seen in other studies from the Middle East and

  9. North American experience with Low protein diet for Non-dialysis-dependent chronic kidney disease.

    Science.gov (United States)

    Kalantar-Zadeh, Kamyar; Moore, Linda W; Tortorici, Amanda R; Chou, Jason A; St-Jules, David E; Aoun, Arianna; Rojas-Bautista, Vanessa; Tschida, Annelle K; Rhee, Connie M; Shah, Anuja A; Crowley, Susan; Vassalotti, Joseph A; Kovesdy, Csaba P

    2016-01-01

    Whereas in many parts of the world a low protein diet (LPD, 0.6-0.8 g/kg/day) is routinely prescribed for the management of patients with non-dialysis-dependent chronic kidney disease (CKD), this practice is infrequent in North America. The historical underpinnings related to LPD in the USA including the non-conclusive results of the Modification of Diet in Renal Disease Study may have played a role. Overall trends to initiate dialysis earlier in the course of CKD in the US allowed less time for LPD prescription. The usual dietary intake in the US includes high dietary protein content, which is in sharp contradistinction to that of a LPD. The fear of engendering or worsening protein-energy wasting may be an important handicap as suggested by a pilot survey of US nephrologists; nevertheless, there is also potential interest and enthusiasm in gaining further insight regarding LPD's utility in both research and in practice. Racial/ethnic disparities in the US and patients' adherence are additional challenges. Adherence should be monitored by well-trained dietitians by means of both dietary assessment techniques and 24-h urine collections to estimate dietary protein intake using urinary urea nitrogen (UUN). While keto-analogues are not currently available in the USA, there are other oral nutritional supplements for the provision of high-biologic-value proteins along with dietary energy intake of 30-35 Cal/kg/day available. Different treatment strategies related to dietary intake may help circumvent the protein- energy wasting apprehension and offer novel conservative approaches for CKD management in North America. PMID:27435088

  10. Lanthanum carbonate versus placebo for management of hyperphosphatemia in patients undergoing peritoneal dialysis: a subgroup analysis of a phase 2 randomized controlled study of dialysis patients

    Directory of Open Access Journals (Sweden)

    Hutchison Alastair J

    2013-02-01

    Full Text Available Abstract Background This short-term study assessed the efficacy and safety of lanthanum carbonate in the treatment of hyperphosphatemia in dialysis patients; here, we report a prespecified subgroup analysis of patients undergoing peritoneal dialysis. Methods Men and women (n = 39 who had received continuous ambulatory peritoneal dialysis for chronic kidney disease for 6 months or more were enrolled in eight renal medicine departments in the United Kingdom. A 2-week washout period was followed by a 4-week dose-titration phase during which patients received lanthanum carbonate titrated up to 2250 mg/day. This was followed by a 4-week, randomized, placebo-controlled, parallel-group phase during which patients continued to receive either lanthanum carbonate at the titrated dose, or a matched dose of placebo. The main outcome measure was control of serum phosphate levels (1.3-1.8 mmol/l at the end of the parallel-group phase. Results Serum phosphate was controlled in 3/39 (8% patients at the beginning of the dose-titration phase (after washout and in 18/31 (58% patients treated with lanthanum carbonate at its end. After the parallel-group phase, 60% of lanthanum carbonate-treated patients and 10% of those receiving placebo had controlled serum phosphate. There was no difference in mean (95% confidence interval serum phosphate levels between groups at randomization: lanthanum carbonate, 1.57 (1.34-1.81 mmol/l; placebo, 1.58 (1.40-1.76 mmol/l (p = 0.96. However, a difference was seen at the end of the parallel-group phase: lanthanum carbonate, 1.56 (1.33-1.79 mmol/l; placebo, 2.25 (1.81-2.68 mmol/l (p = 0.0015. There were no clinically important changes in nutritional parameters and no serious treatment-related adverse events were recorded. Conclusions At doses up to 2250 mg/day, lanthanum carbonate is well tolerated and controls hyperphosphatemia effectively. Treatment with higher doses of lanthanum carbonate may allow patients undergoing

  11. Dispute of Beginning Dialysis Timing Choice and Traditional Chinese Medicine Advantage in Patients with Chronic Renal Failure%慢性肾衰竭开始透析时机选择的争议和中医优势探讨

    Institute of Scientific and Technical Information of China (English)

    陈英兰; 毕礼明

    2012-01-01

    笔者根据目前多个国家或地区如中国(包括台湾)、英国、欧洲、美国、日本等对慢性肾衰竭开始透析治疗时机建议上的差异,分析当前过早或过迟透析的不利之处,同时结合中医治疗慢性肾衰竭的优势,并评估其在治疗中的地位.结果认为中医治疗慢性肾衰竭可以延缓其进入透析的时间,但仍需要高级别的临床研究证据.%In this review,according to the existing guidelines from several countries such as China,England, Europe, America,Japan and so on,which evaluated the timing of dialysis treatment,we analyzed the disadvantages of starting with relatively higher or lower renal function and evaluated the status of traditional Chinese medicine to cure chronic renal failure for its advantages. There were some disputes on early versus late initiation of dialysis. It was concluded that initiation of dialysis should not depend on a predefined magnitude of renal function, but it should be tailored to the individual patient. Traditional Chinese medicine may benefit on quality of life for patients and slowing the time to initiate dialysis. However,this therapy need more high-grade evidences of clinical studies.

  12. Calciphylaxis in chronic, non-dialysis-dependent renal disease

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    Paschke Ralf

    2003-09-01

    Full Text Available Abstract Background Calciphylaxis cutis is characterized by media calcification of arteries and, most prominently, of cutaneous and subcutaneous arterioles occurring in renal insufficiency patients. Case Report A 53-year-old woman with chronic cardiac and renal failure complained of painful crural, non-varicosis ulcers. She was hospitalized in an immobilized condition due to both the crural ulcerations and the existing heart-failure state (NYHA III-IV having pleural and pericardial effusions, atrial fibrillation and weight loss of 30 kg over the past year. Despite normalization of calcium-phosphorus balance and improvement of renal function, the clinical course of crural ulcerations deteriorated during the following 3 months. After failure of surgical debridements, multiple courses of sterile-maggot therapy were introduced at a late stage to stabilize the wounds. The patient died of recurrent wound infections and sepsis paralleled by exacerbations of renal malfunction. Conclusions The role of renal disease in vascular complications is discussed. Sterile-maggot debridement may constitute a therapy for the ulcerated calciphylaxis at an earlier stage, i.e. when first ulcerations appear.

  13. Profile of peginesatide and its potential for the treatment of anemia in adults with chronic kidney disease who are on dialysis

    Directory of Open Access Journals (Sweden)

    Mikhail A

    2012-05-01

    Full Text Available Ashraf MikhailRenal Unit, Morriston Hospital, Swansea University, Wales, UKAbstract: Peginesatide is a synthetic, dimeric peptide that is covalently linked to polyethylene glycol (PEG. The amino acid sequence of peginesatide is unrelated to that of erythropoietin (EPO and is not immunologically cross-reactive with EPO. Peginesatide binds to and activates the human EPO receptor, stimulating the proliferation and differentiation of human red cell precursors in vitro in a manner similar to other EPO-stimulating agents (ESAs. In Phase II and III studies in dialysis and predialysis patients, peginesatide administered once monthly was as effective as epoetin alfa given thrice weekly (dialysis patients or darbepoetin given once weekly (nondialysis patients, in correcting anemia of chronic kidney disease as well as maintaining hemoglobin within the desired target range. In the dialysis population, the reported side-effect profile of peginesatide was comparable to that known with other marketed ESAs. In the nondialysis studies, compared with those treated with darbepoetin, patients treated with peginesatide experienced a higher adverse-effect profile. Peginesatide is likely to be licensed for treatment of renal anemia in dialysis patients and not in nondialysis patients. Despite this limitation, peginesatide is likely to prove valuable in treating dialysis patients because of its infrequent mode of administration, thereby allowing for a reduced number of injections, with associated better compliance, reduced cold storage requirement, and improved stock accountability. PEGylated therapeutic proteins can elicit immunological response to the PEG moiety of the therapeutic complex. Only long-term experience and post-marketing surveillance will address whether this immunological response will have any impact on the clinical efficacy or safety of peginesatide in clinical practice.Keywords: peginesatide, dialysis, chronic kidney disease

  14. Dialysis Exercise Team: The Way to Sustain Exercise Programs in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Alessandro Capitanini

    2014-07-01

    Full Text Available Patients affected by end-stage renal disease (ESRD show quite lower physical activity and exercise capacity when compared to healthy individuals. In addition, a sedentary lifestyle is favoured by lack of a specific counseling on exercise implementation in the nephrology care setting. Increasing physical activity level should represent a goal for every dialysis patient care management. Three crucial elements of clinical care may contribute to sustain a hemodialysis exercise program: a involvement of exercise professionals, b real commitment of nephrologists and dialysis professionals, c individual patient adaptation of the exercise program. Dialysis staff have a crucial role to encourage and assist patients during intra-dialysis exercise, but other professionals should be included in the ideal “exercise team” for dialysis patients. Evaluation of general condition, comorbidities (especially cardiovascular, nutritional status and physical exercise capacity are mandatory to propose an exercise program, in either extra-dialysis or intra-dialysis setting. To this aim, nephrologist should lead a team of specialists and professionals including cardiologist, physiotherapist, exercise physiologist, renal dietician and nurse. In this scenario, dialysis nurses play a pivotal role since they guarantee a constant and direct approach. Unfortunately dialysis staff may often lack of information and formation about exercise management while they take care patients during the dialysis session. Building an effective exercise team, promoting the culture of exercise and increasing physical activity levels lead to a more complete and modern clinical care management of ESRD patients.

  15. Dialysis exercise team: the way to sustain exercise programs in hemodialysis patients.

    Science.gov (United States)

    Capitanini, Alessandro; Lange, Sara; D'Alessandro, Claudia; Salotti, Emilio; Tavolaro, Alba; Baronti, Maria E; Giannese, Domenico; Cupisti, Adamasco

    2014-01-01

    Patients affected by end-stage renal disease (ESRD) show quite lower physical activity and exercise capacity when compared to healthy individuals. In addition, a sedentary lifestyle is favoured by lack of a specific counseling on exercise implementation in the nephrology care setting. Increasing physical activity level should represent a goal for every dialysis patient care management. Three crucial elements of clinical care may contribute to sustain a hemodialysis exercise program: a) involvement of exercise professionals, b) real commitment of nephrologists and dialysis professionals, c) individual patient adaptation of the exercise program. Dialysis staff have a crucial role to encourage and assist patients during intra-dialysis exercise, but other professionals should be included in the ideal "exercise team" for dialysis patients. Evaluation of general condition, comorbidities (especially cardiovascular), nutritional status and physical exercise capacity are mandatory to propose an exercise program, in either extra-dialysis or intra-dialysis setting. To this aim, nephrologist should lead a team of specialists and professionals including cardiologist, physiotherapist, exercise physiologist, renal dietician and nurse. In this scenario, dialysis nurses play a pivotal role since they guarantee a constant and direct approach. Unfortunately dialysis staff may often lack of information and formation about exercise management while they take care patients during the dialysis session. Building an effective exercise team, promoting the culture of exercise and increasing physical activity levels lead to a more complete and modern clinical care management of ESRD patients.

  16. [Assisted peritoneal dialysis: home-based renal replacement therapy for the elderly patient].

    Science.gov (United States)

    Wiesholzer, Martin

    2013-06-01

    The number of elderly patients with end stage renal disease is constantly increasing. Conventional hämodiaylsis as the mainstay of renal replacement therapy is often poorly tolerated by frail eldery patients with multiple comorbidities. Although many of these patients would prefer a home based dialysis treatment, the number of elderly patients using peritoneal dialysis (PD) is still low. Impaired physical and cognitive function often generates insurmountable barriers for self care peritoneal dialysis. Assisted peritoneal dialysis can overcome many of these barriers and give elderly patients the ability of a renal replacement therapy in their own homes respecting their needs. PMID:23797681

  17. Calciphylaxis in peritoneal dialysis patients: a single center cohort study

    Science.gov (United States)

    Zhang, Yanchen; Corapi, Kristin M; Luongo, Maria; Thadhani, Ravi; Nigwekar, Sagar U

    2016-01-01

    Background Calciphylaxis is a rare but devastating condition in end-stage renal disease (ESRD) patients. Most research in the field of calciphylaxis is focused on hemodialysis (HD) patients; however, data on calciphylaxis incidence, risk factors, and mortality in peritoneal dialysis (PD) patients are limited. Methods In this cohort study, we examined data from adult patients who initiated PD for ESRD management at our institute’s PD unit from January 2001 to December 2015. Associations with the development of calciphylaxis were examined for clinical, laboratory, and medication exposures. Incidence of calciphylaxis and mortality in PD patients who developed calciphylaxis were analyzed. Treatments administered to treat calciphylaxis in PD patients were summarized. Results In this cohort of 63 patients, 7 patients developed calciphylaxis (incidence rate: 9.0 per 1,000 patient-years). Median age of PD patients who developed calciphylaxis was 50 years, 57% were white, 71% females, and 71% were previously on HD. Female sex, obesity, HD as a prior dialysis modality, recurrent hypotension, elevated time-averaged serum phosphorous levels, reduced time-averaged serum albumin levels, and warfarin therapy were associated with increased calciphylaxis risk in univariate logistic regression analyses. Intravenous sodium thiosulfate was administered in 57% of PD patients who developed calciphylaxis. One-year mortality in PD patients who developed calciphylaxis was 71% despite multimodal treatment including sodium thiosulfate, hyperbaric oxygen, cinacalcet, and wound debridement. Conclusion Calciphylaxis is a rare but frequently fatal condition in PD patients. Our study provides critical early insights into calciphylaxis incidence, risk factors, and prognosis in PD patients. Sample size and characteristics of patients included in our study limit generalizability to overall PD population and warrant examination in larger independent studies. PMID:27698566

  18. Measuring residual renal function in dialysis patients: can we dispense with 24-hour urine collections?

    Science.gov (United States)

    Davenport, Andrew

    2016-05-01

    Residual renal function is associated with improved survival and quality of life for dialysis patients. Whereas residual renal function is monitored in peritoneal dialysis patients, many hemodialysis centers simply concentrate on achieving dialyzer urea clearance targets. Accurately quantifying residual renal function from urine collections is arduous. Thus, there is a clinical need to develop alternative methods of assessing residual renal function based on serum testing, especially for patients receiving less than thrice weekly dialysis.

  19. Assessment of periodontal health status in patients undergoing renal dialysis: A descriptive, cross-sectional study

    Directory of Open Access Journals (Sweden)

    Anuradha Bhatsange

    2012-01-01

    Full Text Available Objective: An inter-relationship between periodontal disease and systemic health has been suspected for centuries, but evidence to explain the connection has only been elucidated in the past few decades. Among the systemic diseases, end stage renal disease has been shown to affect not only the general health of the patient but also oral and periodontal health. This study was undertaken to gain an insight into whether duration of dialysis therapy influences the oral and periodontal health of these patients and also to see if these parameters reflect their biochemical values. Materials and Methods: The study was conducted on 75 patients undergoing dialysis and a control group of 25 subjects. The study group was divided into three subgroups depending upon the duration of dialysis. Oral hygiene and periodontal disease status were measured by Simplified Oral Hygiene Index by Greene and Vermillion and Periodontal Disease Index by Ram-fjord. Biochemical parameters measured were blood urea nitrogen and salivary urea levels. Comparison of these parameters was made between the study and control groups through analysis of variance (ANOVA and student′s t-test. Results: Prevalence of periodontal disease was evident in the dialysis group. Oral hygiene status was poor in comparison with the control group. Clinical and biochemical parameters showed statistically significant difference between the groups rather than within the groups. Conclusion: Oral and periodontal health appeared to be compromised. Their deteriorating general health is anticipated to cause negligence towards oral health care. This population needs comprehensive oral and periodontal care right from the diagnosis of chronic renal failure. There exists a need for communication between nephrologists and oral health care professionals. Longitudinal studies warranted in this regard.

  20. RISK OF DEMENTIA IN PERITONEAL DIALYSIS PATIENTS COMPARED WITH HEMODIALYSIS PATIENTS

    Science.gov (United States)

    Wolfgram, Dawn F.; Szabo, Aniko; Murray, Anne M.; Whittle, Jeff

    2016-01-01

    Background Compared with similarly aged controls, patients with end-stage renal disease (ESRD) have a higher prevalence of cognitive impairment and more rapid cognitive decline, which is not explained by traditional risk factors alone. Since previous small studies suggest an association of cognitive impairment with dialysis modality, we compared incident dementia among patients initiating hemodialysis (HD) versus peritoneal dialysis (PD) in a large national cohort. Methods This is a retrospective cohort study of incident dialysis patients in the United States from 2006 to 2008 with no diagnosis of dementia prior to beginning dialysis. We evaluated the effect of initial dialysis modality on incidence of dementia, diagnosed by Medicare claims data, adjusted for baseline demographic and clinical data from USRDS registry. Results Our analysis included 121,623 patients, of whom 8,663 initiated dialysis on PD. The mean age of our cohort was 69.2 years. Patients who initiated on PD had a lower cumulative incidence of dementia than those who initiated HD (1.0% versus 2.7%, 2.5% versus 5.3%, and 3.9% versus 7.3% at 1, 2, and 3 years, respectively). The risk of dementia for patients who started on PD was lower compared with those who started on HD, with a hazard ratio (HR) = 0.46 [0.41, 0.53], in an unadjusted model and HR 0.74 [0.64, 0.86] in a matched model. Conclusions Dialysis modality is associated with incident dementia in a cohort of older ESRD patients. This finding warrants further investigation of the effect of dialysis modality on cognitive function and evaluation for possible mechanisms. PMID:25742686

  1. Peritoneal dialysis for chronic cardiorenal syndrome:Lessons learned from ultrafiltration trials

    Institute of Scientific and Technical Information of China (English)

    Amir; Kazory

    2015-01-01

    The current models of cardiorenal syndrome(CRS) are mainly based on a cardiocentric approach; they assume that worsening renal function is an adverse consequence of the decline in cardiac function rather than a separate and independent pathologic phenomenon. If this assumption were true,then mechanical extraction of fluid(i.e.,ultrafiltration therapy) would be expected to portend positive impact on renal hemodynamics and function through improvement in cardio-circulatory physiology and reduction in neurohormonal activation. However,currently available ultrafiltration trials,whether in acute heart failure(AHF) or in CRS,have so far failed to show any improvement in renal function; they have reported no impact or even observed adverse renal outcomes in this setting. Moreover,the presence or absence of renal dysfunction seems to affect the overall safety and efficacy of ultrafiltration therapy in AHF. This manuscript briefly reviews cardiorenal physiology in AHF and concludes that therapeutic options for CRS should not only target cardio-circulatory status of the patients,but they need to also have the ability of addressing the adverse homeostatic consequences of the associated decline in renal function. Peritoneal dialysis(PD) can be such an option for the chronic cases of CRS as it has been shown to provide efficient intracorporeal ultrafiltration and sodium extraction in volume overloaded patients while concurrently correcting the metabolic consequences of diminished renal function. Currently available trials on PD in heart failure have shown the safety and efficacy of this therapeutic modality for patients with chronic CRS and suggest that it could represent a pathophysiologically and conceptually relevant option in this setting.

  2. Reconsidering the Lack of Urea Toxicity in Dialysis Patients.

    Science.gov (United States)

    Massy, Ziad A; Pietrement, Christine; Touré, Fatouma

    2016-09-01

    Urea is an old uremic toxin which has been used for many years as a global biomarker of CKD severity and dialysis adequacy. Old studies were not in favor of its role as a causal factor in the pathogenesis of complications associated with the uremic state. However, recent experimental and clinical evidence is compatible with both direct and indirect toxicity of urea, particularly via the deleterious actions of urea-derived carbamylated molecules. Further studies are clearly needed to explore the potential relevance of urea-related CKD complications for patient management, in particular the place of new therapeutic strategies to prevent urea toxicity.

  3. Cost-effectiveness of kidney transplantation compared with chronic dialysis in end-stage renal disease

    Directory of Open Access Journals (Sweden)

    Diego Rosselli

    2015-01-01

    Full Text Available To estimate the costs and effectiveness measured in quality-adjusted life years (QALY of kidney transplantation compared with dialysis in adults suffering from end-stage renal disease from the perspective of the Colombian healthcare system, we designed a Markov model with monthly cycles over a five-year time horizon and eight transitional states, including death as an absorbing state. Transition probabilities were obtained from international registries, costs from different local sources [case studies, official tariffs (ISS 2001 + 35% for procedures and SISMED for medications]. Data were validated by an expert panel and we performed univariate, multivariate and probabilistic sensitivity analyses. Effectiveness indicators were months of life gained, months of dialysis averted and deaths prevented. The annual discount rate was 3% and the cost-utility threshold (willingness to pay was three times gross domestic product (GDP = USD 20,000 per QALY. The costs were adopted in US dollars (USD using the 2012 average exchange rate (1 USD = COP$ 1798. The discounted average total cost for five years was USD 76,718 for transplantation and USD 76,891 for dialysis, with utilities 2.98 and 2.10 QALY, respectively. Additionally, renal transplantation represented 6.9 months gained, 35 months in dialysis averted per patient and one death averted for each of the five patients transplanted in five years. We conclude that renal transplantation improves the overall survival rates and quality of life and is a cost-saving alternative compared with dialysis.

  4. Evaluation of insulin and C-peptide in diabetic patients undergoing renal dialysis

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    P. T. Annamala

    2016-10-01

    Conclusions: There are alterations in the levels of insulin, c-peptide and the glycemic status in diabetic patients during dialysis. This significant reduction may affect glucose metabolism in diabetic patients on dialysis. Hence, glycemic status should be continuously monitored in these patients. [Int J Res Med Sci 2016; 4(10.000: 4579-4582

  5. What is the optimal level of vitamin D in non-dialysis chronic kidney disease population?

    Science.gov (United States)

    Molina, Pablo; Górriz, José L; Molina, Mariola D; Beltrán, Sandra; Vizcaíno, Belén; Escudero, Verónica; Kanter, Julia; Ávila, Ana I; Bover, Jordi; Fernández, Elvira; Nieto, Javier; Cigarrán, Secundino; Gruss, Enrique; Fernández-Juárez, Gema; Martínez-Castelao, Alberto; Navarro-González, Juan F; Romero, Ramón; Pallardó, Luis M

    2016-01-01

    AIM To evaluate thresholds for serum 25(OH)D concentrations in relation to death, kidney progression and hospitalization in non-dialysis chronic kidney disease (CKD) population. METHODS Four hundred and seventy non-dialysis 3-5 stage CKD patients participating in OSERCE-2 study, a prospective, multicenter, cohort study, were prospectively evaluated and categorized into 3 groups according to 25(OH)D levels at enrollment (less than 20 ng/mL, between 20 and 29 ng/mL, and at or above 30 ng/mL), considering 25(OH)D between 20 and 29 ng/mL as reference group. Association between 25(OH)D levels and death (primary outcome), and time to first hospitalization and renal progression (secondary outcomes) over a 3-year follow-up, were assessed by Kaplan-Meier survival curves and Cox-proportional hazard models. To identify 25(OH)D levels at highest risk for outcomes, receiver operating characteristic (ROC) curves were performed. RESULTS Over 29 ± 12 mo of follow-up, 46 (10%) patients dead, 156 (33%) showed kidney progression, and 126 (27%) were hospitalized. After multivariate adjustment, 25(OH)D < 20 ng/mL was an independent predictor of all-cause mortality (HR = 2.33; 95%CI: 1.10-4.91; P = 0.027) and kidney progression (HR = 2.46; 95%CI: 1.63-3.71; P < 0.001), whereas the group with 25(OH)D at or above 30 ng/mL did not have a different hazard for outcomes from the reference group. Hospitalization outcomes were predicted by 25(OH) levels (HR = 0.98; 95%CI: 0.96-1.00; P = 0.027) in the unadjusted Cox proportional hazards model, but not after multivariate adjusting. ROC curves identified 25(OH)D levels at highest risk for death, kidney progression, and hospitalization, at 17.4 ng/mL [area under the curve (AUC) = 0.60; 95%CI: 0.52-0.69; P = 0.027], 18.6 ng/mL (AUC = 0.65; 95%CI: 0.60-0.71; P < 0.001), and 19.0 ng/mL (AUC = 0.56; 95%CI: 0.50-0.62; P = 0.048), respectively. CONCLUSION 25(OH)D < 20 ng/mL was an independent predictor of death and progression in patients with stage 3

  6. NEUROPSYCHOLOGICAL CHARACTERIZATION OF ADULT PATIENTS UNDER DIALYSIS IN A SPECIALIZED INSTITUTIONIN MEDELLIN, COLOMBIA

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    ANA DUARTE

    2006-10-01

    Full Text Available Introduction: Patients with chronic renal failure (CRF have cognitive impairments and intellectual deficiencies comparedwith normal people. Objective: To analyze the neuropsychological characteristics in adult patients (18 to 65 years old,belonging to a dialysis program in the Instituto del Riñón [Kidney Institute] of Medellín-Colombia. Subjects andMethods: A non-randomized sample of 59 patients, aged between 23 to 64 years old, a neuropsychological tests batterywas applied to patients, which assessed attention, memory, language, visual abilities, motor skills, executive functionand intellectual level. Comparisons with means from general population were done, and analysis comparing gender,age, school grades, socio economic stratum, and some clinical characteristics (type of dialysis, time from the startingdialysis, number of hospitalizations, Kt/v level, hematocrit, depression, and number of hospitalizations. Results:Patients had significant low performance in almost all neuropsychological functions, compared with general population.Comparisons between age, education and socioeconomic strata groups showed differences on executive function,visual-motor, visual perception, attention, and intelligence tasks. None difference was found between the clinicalgroups. Conclusions: Patients with CRF had disseminated cognitive impairment compared to general population.

  7. Exploring the opinion of hemodialysis patients about their dialysis unit.

    Science.gov (United States)

    Donia, Ahmed Farouk; Elhadedy, Mohamed Ahmed; El-Maghrabi, Hanzada Mohamed; Abbas, Mohamed Hamed; Foda, Mohamed Ashraf

    2015-01-01

    Hemodialysis (HD) patients are subjected to a number of physical and mental stresses. Physicians might be unaware of some of these problems. We assessed our patients' opinion about the service provided at the dialysis unit. Our unit has 89 patients on HD. A questionnaire exploring our patients' opinion relative to the service provided was prepared. The patients were asked to fill-in the questionnaire in a confidential manner. Questionnaires were then collected and examined while unaware of patient identities. Sixty-nine patients (77.5%) responded to the questionnaire. Eight patients (11.6%) revealed their names on the questionnaire. According to the questionnaire, the patients were asked to assess the service of each service by choosing one of the following grades: "excellent," "mediocre" or "bad." For the whole group of contributing patients, there were 563 "excellent," 85 "mediocre" and five "bad" choices in addition to 37 blank "no comment" choices. Food service had the least percentage (68%) of evaluation as "excellent," while doctor' performance got the highest excellent evaluation (85.5%). Thirty-five patients (50.7%) added further comment(s). An audit meeting was conducted to discuss these results. Exploring the opinion of patients on HD might uncover some areas of dissatisfaction and help in improving the provided service. We recommend widespread usage of questionnaires to assess patient satisfaction as well as to assess other health-care aspects. PMID:25579719

  8. Are non-cardiac surgeries safe for dialysis patients? - A population-based retrospective cohort study.

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    Yih-Giun Cherng

    Full Text Available BACKGROUND: End-stage renal disease represents a risk complex that complicates surgical results. The surgical outcomes of dialysis patients have been studied in specific fields, but the global features of postoperative adverse outcomes in dialysis patients receiving non-cardiac surgeries have not been examined. METHODS: Taiwan's National Health Insurance Research Database was used to study 8,937 patients under regular dialysis with 8,937 propensity-score matched-pair controls receiving non-cardiac surgery between 2004 and 2007. We investigated the influence of hemodialysis and peritoneal dialysis, effects of hypertension and diabetes, and impact of additional comorbidities on postoperative adverse outcomes. RESULTS: Postoperative mortality in dialysis patients was higher than in controls (odds ratio [OR] 3.33, 95% confidence interval [CI] 2.56 to 4.33 when receiving non-cardiac surgeries. Complications such as acute myocardial infarction, pneumonia, bleeding, and septicemia were significantly increased. Postoperative mortality was significantly increased among peritoneal dialysis patients (OR 2.71, 95% CI 1.70 to 4.31 and hemodialysis patients (OR 3.42, 95% CI 2.62 to 4.47 than in controls. Dialysis patients with both hypertension and diabetes had the highest risk of postoperative complications; these risks increased with number of preoperative medical conditions. Patients under dialysis also showed significantly increased length of hospitalization, more ICU stays and higher medical expenditures. CONCLUSION: Surgical patients under dialysis encountered significantly higher postoperative complications and mortality than controls when receiving non-cardiac surgeries. Different dialysis techniques, pre-existing hypertension/diabetes, and various comorbidities had complication-specific impacts on surgical adverse outcomes. These findings can help surgical teams provide better risk assessment and postoperative care for dialysis patients.

  9. Preventive effect of continuous quality improvement on the malnutrition,inflammation,peritoneal dialysis adequacy and cardiovascular events in elderly peritoneal dialysis patients

    Institute of Scientific and Technical Information of China (English)

    赵班

    2013-01-01

    Objective To investigate the preventive effect of continuous quality improvement (CQI) on malnutrition,inflammation,peritoneal dialysis adequacy and cardiovascular events in elderly patients undergoing peritoneal dialysis.Methods A single-center prospective self-controlled study was performed.32 stable elderly patients to undergo continuous ambulatory peritoneal dialysis (CAPD) were included.The continuous quality improvement program was conducted by using the 4-step problem-solving

  10. Spectrum of abdominal pathologies detected with CT in long term dialysis patients

    Energy Technology Data Exchange (ETDEWEB)

    Ulu, Esra Meltem Kayahan [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak cad. No.: 45, Bahcelievler/Ankara (Turkey)], E-mail: emkayahanulu@yahoo.com; Tarhan, N. Cagla [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak cad. No.: 45, Bahcelievler/Ankara (Turkey); Hocaoglu, Elif [Bakirkoy Dr Sadi Konuk Training and Research Hospital, Department of Radiology, Zuhurat Baba mah, Bakirkoy/Istanbul (Turkey); Akman, Beril [Department of Nephrology, Fevzi Cakmak cad. No.: 45, Bahcelievler/Ankara (Turkey); Basaran, Ceyla; Donmez, Fuldem Yildirim; Niron, Emin Alp [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak cad. No.: 45, Bahcelievler/Ankara (Turkey)

    2009-11-15

    As a consequence of the expanded use of long term hemodialysis and continuous ambulatory peritoneal dialysis (CAPD) treatments and extended life spans, complications of end-stage renal disease and dialysis treatments are being encountered with increasing frequency in these patients. Computed tomography can accurately depict many of the potential complications of end-stage renal disease on dialysis. This article presents the abdominal CT findings of 429 end-stage renal disease patients who are on either hemodialysis or continuous ambulatory peritoneal dialysis treatment.

  11. Exploring the opinion of hemodialysis patients about their dialysis unit

    Directory of Open Access Journals (Sweden)

    Ahmed Farouk Donia

    2015-01-01

    Full Text Available Hemodialysis (HD patients are subjected to a number of physical and mental stresses. Physicians might be unaware of some of these problems. We assessed our patients′ opinion about the service provided at the dialysis unit. Our unit has 89 patients on HD. A questionnaire exploring our patients′ opinion relative to the service provided was prepared. The patients were asked to fill-in the questionnaire in a confidential manner. Questionnaires were then collected and examined while unaware of patient identities. Sixty-nine patients (77.5% responded to the questionnaire. Eight patients (11.6% revealed their names on the questionnaire. According to the questionnaire, the patients were asked to assess the service of each service by choosing one of the following grades: "excellent," "mediocre" or "bad." For the whole group of contributing patients, there were 563 "excellent," 85 "mediocre" and five "bad" choices in addition to 37 blank "no comment" choices. Food service had the least percentage (68% of evaluation as "excellent," while doctor′ performance got the highest excellent evaluation (85.5%. Thirty-five patients (50.7% added further comment(s. An audit meeting was conducted to discuss these results. Exploring the opinion of patients on HD might uncover some areas of dissatisfaction and help in improving the provided service. We recommend widespread usage of questionnaires to assess patient satisfaction as well as to assess other health-care aspects.

  12. Associations of anemia persistency with medical expenditures in Medicare ESRD patients on dialysis

    Directory of Open Access Journals (Sweden)

    Jiannong Liu

    2009-04-01

    Full Text Available Jiannong Liu1, Haifeng Guo1, David Gilbertson1, Robert Foley1,2, Allan Collins1,21Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA; 2Department of Medicine, University of Minnesota, Minneapolis, MN, USAAbstract: Most end-stage renal disease (ESRD patients begin renal replacement therapy with hemoglobin levels below the recommended US National Kidney Foundation Dialysis Outcomes Quality Initiative Guidelines lower level of 110 g/L. Although most patients eventually reach this target, the time required varies substantially. This study aimed to determine whether length of time with below-target hemoglobin levels after dialysis initiation is associated with medical costs, and if so, whether intermediate factors underlie the associations. US patients initiating dialysis in 2002 were studied using the Centers for Medicare and Medicaid Services ESRD database. Anemia persistence (time in months with hemoglobin below 110 g/L was determined in a six-month entry period, and outcomes were assessed in the subsequent six-month follow-up period. The structural equation modeling technique was used to evaluate associations between persistent anemia and medical costs and to determine intermediate factors for these associations. The study included 28,985 patients. Mean per-patient-per-month medical cost was $6267 (standard deviation $5713 in the six-month follow-up period. Each additional month with hemoglobin below 110 g/L was associated with an 8.9% increment in medical cost. The increased cost was associated with increased erythropoietin use and blood transfusions, and increased rates of hospitalization and vascular access procedures in the follow-up period. Keywords: anemia persistency, end-stage renal disease, medical costs, structural equation modeling

  13. Care of the Patient with Renal Disease: Peritoneal Dialysis and Transplants, Nursing 321A.

    Science.gov (United States)

    Hulburd, Kimberly

    A description is provided of a course, "Care of the Patient with Renal Disease," offered at the community college level to prepare licensed registered nurses to care for patients with renal disease, including instruction in performing the treatments of peritoneal dialysis and continuous ambulatory peritoneal dialysis (CAPD). The first sections of…

  14. The relationship between changes of blood pressure during dialysis and mortality in maintenance hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    蔡宏

    2014-01-01

    Objective To determine the relationship between changes of blood pressure(BP)during dialysis and mortality in maintenance hemodialysis(MHD)patients.Methods A total of 364 cases of MHD patients were collected prospectively and the relationship between changes of blood pressure during dialysis and mortality was as-

  15. Changes in parathyroid hormone, body mass index and the association with mortality in dialysis patients

    NARCIS (Netherlands)

    C. Drechsler; D.C. Grootendorst; E.W. Boeschoten; R.T. Krediet; C. Wanner; F.W. Dekker

    2011-01-01

    Obesity is associated with secondary hyperparathyroidism in the general population. It is unknown whether body mass index (BMI) affects parathyroid hormone (PTH) level and its association with mortality in dialysis patients. From a prospective cohort study of incident dialysis patients in the Nether

  16. [Renal osteodystrophy (3); its treatment in dialysis patients].

    Science.gov (United States)

    Ghitu, S; Oprisiu, R; Benamar, L; Said, S; Tataru Albu, A; Arsenescu, I; el Esper, N; Morinière, P; Fournier, A

    2000-01-01

    The prevalence and the clinical gravity of the various histopathological varieties of renal osteodystrophy in dialysis patients depends on the severity of both the aluminium intoxication and that of hyperparathyroidism. The prevalence of bone pains, fractures and hypercalcemias are the highest in adynamic bone diseases (ABD) with severe aluminium intoxication, then in osteitis fibrosa and mixed osteopathy, in the ABD with moderate aluminium intoxication and rare in the mild lesion in spite of similar moderate aluminium intoxication. In the absence of aluminium intoxication, hypercalcemia and hyperphosphatemia prevalence is higher only when intact PTH is more that 4 times the upper limit of normal. When PTH is between 1 and 2 folds the ULN this prevalence is null and bone mineral density is the highest. 2. The low turnover aluminic bone diseases (osteomalacic or adynamic) will be cured by long term deferoxamine treatment. The hazards of such treatment justify the performance of a bone biopsy to ensure the diagnosis. Their prevention relies on adequate treatment of tapwater and definitive exclusion of long term administration of aluminum phosphate binders. 3. Non aluminic osteomalacia will be treated according to the same guidelines given for the uremic patients before dialysis. 4. Non aluminic adynamic bone disease will be cured by means aiming at stimulating PTH secretion as discontinuing 1 alpha hydroxylated vitamin D derivatives, and, if there is no hyperphosphatemia by discontinuation of calcium supplement. In case of hyperphosphatemia in dialysis patients CaCO3 doses have to be nevertheless increased after the dialysate calcium concentration (DCa) has been decreased in order to induce a negative perdialytic calcium balance for PTH secretion stimulation. In the near future substitution of CaCO3 by non calcemic non aluminic phosphate binders will suffice. 5. Osteitis fibrosa due to hyperparathyroidism will be treated first by securing an optimal vitamin D

  17. Serum phosphorus reduction in dialysis patients treated with cinacalcet for secondary hyperparathyroidism results mainly from parathyroid hormone reduction

    DEFF Research Database (Denmark)

    Zitt, Emanuel; Fouque, Denis; Jacobson, Stefan H;

    2013-01-01

    The calcimimetic cinacalcet lowers parathyroid hormone (PTH), calcium (Ca) and phosphorus (P) in dialysis patients with secondary hyperparathyroidism (SHPT). We explored serum P changes in dialysis patients treated with cinacalcet, while controlling for vitamin D sterol and phosphate binder (PB...

  18. Single port laparoscopic and open surgical accesses of chronic peritoneal dialysis in children: A single center experience over 12 years

    Science.gov (United States)

    Bıçakcı, Ünal; Genç, Gürkan; Tander, Burak; Günaydın, Mithat; Demirel, Dilek; Özkaya, Ozan; Rızalar, Rıza; Arıtürk, Ender; Bernay, Ferit

    2016-01-01

    INTRODUCTION: The aim of this study was to evaluate patients with end stage renal failure (ESRD) who underwent chronic peritoneal dialysis (CPD). The clinical outcomes of laparoscopic and open placements of catheters were compared. MATERIALS AND METHODS: We reviewed 49 (18 male and 31 female) children with CPD according to age, sex, cause of ESRD, catheter insertion method, kt/V rate, complications, presence of peritonitis, catheter survival rate between January 2002 and February 2014. RESULTS: Thirty-three patients were with open placement and 16 patients were with laparoscopic placement. The rate of the peritonitis is significantly less in patients with laparoscopic access than open access (n = 4 vs n = 25) (P V which indicates the effectiveness of peritoneal dialysis was mean 2.26 ± 0.08. No difference was found between laparoscopic and open methods according to kt/V. CONCLUSION: Laparoscopic placement of CPD results in lower peritonitis rate. Catheter survival rate was excellent in both groups. Single port laparoscopic access for CPD catheter insertion is an effective and safe method. PMID:27073310

  19. Organ Donation Campaigns: Perspective of Dialysis Patient's Family Members.

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    Makmor Tumin

    2014-07-01

    Full Text Available Solving the dilemma of the organ shortage in Malaysia requires educating Malaysians about organ donation and transplantation. This paper aims at exploring the average Malaysian households ' preferred channels of campaigns and the preferred campaigners in a family setting, targeting at the dialysis family members.We analyzed the responses of 350 respondents regarding organ donation campaigns. The respondents are 2 family members of 175 dialysis patients from 3 different institutions. The information on respondents' willingness to donate and preferred method and channel of organ donation campaign were collected through questionnaire.Malaysian families have a good tendency to welcome campaigns in both the public and private (their homes spheres. We also found that campaigns facilitated by the electronic media (Television and Radio and executed by experienced doctors are expected to optimize the outcomes of organ donation, in general. Chi-square tests show that there are no significant differences in welcoming campaigns among ethnics. However, ethnics preferences over the campaign methods and campaigners are significantly different (P <0.05.Ethnic differences imply that necessary modifications on the campaign channels and campaigners should also be taken under consideration. By identifying the preferred channel and campaigners, this study hopes to shed some light on the ways to overcome the problem of organ shortage in Malaysia.

  20. The interview with a patient on dialysis: feeling, emotions and fears.

    Science.gov (United States)

    Brunori, Francesco; Dozio, Beatrice; Colzani, Sara; Pozzi, Marco; Pisano, Lucia; Galassi, Andrea; Santorelli, Gennaro; Auricchio, Sara; Busnelli, Luisa; Di Carlo, Angela; Viganò, Monica; Calabrese, Valentina; Mariani, Laura; Mossa, Monica; Longoni, Stefania; Scanziani, Renzo

    2016-01-01

    This study has been performed in the Nephrology and Dialysis Unit, in Desio Hospital, Italy. The aim of this study is to evaluate, starting from research questions, which information is given to patient in the pre-dialysis colloquia for his/her chosen dialysis methods. Moreover, the study evaluated feelings, emotions and fears since the announcement of the necessity of dialysis treatment. The objective of the study was reached through the interview with patients on dialysis. The fact-finding survey was based on the tools of social research, as the semi-structured interview. Instead of using the questionnaire, even though it make it easier to collect larger set of data, the Authors decided to interview patients in person, since the interview allows direct patient contact and to build a relationship of trust with the interviewer, in order to allow patient explain better his/her feeling.

  1. Morphological changes of the peritoneum in peritoneal dialysis patients

    Institute of Scientific and Technical Information of China (English)

    方炜; 钱家麒; 余志远; 陈诗书

    2004-01-01

    Background Long-term peritoneal dialysis (PD) requires that the peritoneal membrane remain effective for dialysis. Research directed toward human peritoneal morphology and structure is limited. The present study was performed to investigate morphological changes of the human peritoneal membrane during PD and to elucidate the possible mechanisms of its functional deterioration. Methods A total of 32 peritoneal biopsies were performed in normal subjects (n=10), uremic nondialysis patients (n=12) at the time of catheter insertion, and PD patients (n=10) at the time of catheter removal or reinsertion or at the time of renal transplantation. Peritoneal morphology was examined by light microscopy, scanning electron microscopy, and transmission electron microscopy. Results The peritoneal membrane in normal subjects consisted of a monolayer of mesothelial cells on a basement membrane and a layer of connective tissue containing cells, blood vessels, and lymphatic vessels. Mesothelial cells were polygonal, often elongated, and had numerous microvilli on their luminal surface. There were lots of oval or roundish pinocytotic vesicles in the cytoplasm of the mesothelial cells. The peritoneal morphology of uremic nondialysis patients was similar to that of normal subjects. However, significant abnormalities of the peritoneal membrane were observed in PD patients, and the changes were found to be progressive. Microvilli were the first site of damage which involved microvilli shortening, a gradual reduction in their number, and, eventually, the total disappearance of microvilli. Mesothelial cells then detached from the basement membrane, disappearing completely in some cases. In the end, the peritoneal membrane consisted only of submesothelial connective tissue without any cells.Conclusions PD can modify peritoneal morphology and structure. The morphological change is progressive and may be one of the important causes of peritoneal failure. Peritoneal biopsies can provide lots of

  2. Uma avaliação da satisfação de pacientes em hemodiálise crônica com o tratamento em serviços de diálise no Brasil Assessment of the satisfaction of patients in chronic hemodialysis with the treatment at dialysis services in Brazil

    Directory of Open Access Journals (Sweden)

    Gisele Macedo da Silva

    2011-01-01

    Full Text Available O objetivo deste artigo foi avaliar a satisfação dos pacientes em tratamento hemodialítico crônico com o cuidado recebido nos serviços de diálise. Trata-se de estudo transversal desenvolvido a partir de amostra nacionalmente representativa de pacientes portadores de doença renal crônica terminal (N = 3.036 em tratamento em serviços de diálise e centros transplantadores do Brasil. Os pacientes em hemodiálise (HD responderam a um questionário de satisfação específico para essa modalidade, cujas questões envolveram satisfação com equipe, ambiente e cuidado prestado, e impacto da diálise nas atividades diárias. Para obter um escore de satisfação desses pacientes, foram utilizados modelos de Teoria de Resposta ao Item na análise dos 22 itens do questionário. A regressão linear foi utilizada para avaliar a associação entre fatores socioeconômicos, demográficos, clínicos e estruturais dos serviços de diálise e os escores de satisfação. Dos pacientes entrevistados, 1.621 estavam em HD no momento da entrevista. Todos responderam ao questionário de satisfação. A maioria era do sexo masculino, cor da pele não-branca, escolaridade This study aimed to evaluate the satisfaction of patients on chronic hemodialysis with the service provided in dialysis units. This cross-sectional study was developed in a nationally representative sample of patients with terminal renal disease (N = 3,036 treated at dialysis units and transplant centers in Brazil. Patients in hemodialysis (HD answered a satisfaction questionnaire designed for this modality, whose issues comprised satisfaction with staff, environment and health care management, and impact of dialysis in daily activities. The item response theory was applied in the analysis of the 22 questions of the satisfaction questionnaire to obtain a score of satisfaction. Linear regression was used to evaluate the association between socio-economic, demographic, clinical and structural

  3. Factors influencing skin autofluorescence of patients with peritoneal dialysis.

    Science.gov (United States)

    Mácsai, Emília; Benke, A; Cseh, A; Vásárhelyi, B

    2012-06-01

    Skin autofluorescence (SAF) measurement is a simple, noninvasive method to assess tissue advanced glycation end products (AGE). In patients with end-stage renal disease and in those on hemodialysis AGE production is increased. Less is known about those treated with peritoneal dialysis (PD). In this study we tested if SAF is influenced by clinical and treatment characteristics in PD patients.This cross-sectional study included 198 PD patients (of those, 128 were on traditional glucose-based solutions and 70 patients were partially switched to icodextrin-based PD). SAF measurements were done with a specific AGE Reader device. The impact of patients' age, gender, current diabetes, duration of PD, cumulative glucose exposure, body mass index, smoking habits and use of icodextrin on SAF values were tested with multiple regression analysis.Our analysis revealed that patients' age, current diabetes and icodextrin use significantly increase patients' SAF values (p = 0.015, 0.012, 0.005, respectively). AGE exposure of PD patients with diabetes and on icodextrin solution is increased. Further investigation is required whether this finding is due to the icodextrin itself or for a still unspecified clinical characteristic of PD population treated with icodextrin.

  4. Factors influencing skin autofluorescence of patients with peritoneal dialysis.

    Science.gov (United States)

    Mácsai, Emília; Benke, A; Cseh, A; Vásárhelyi, B

    2012-06-01

    Skin autofluorescence (SAF) measurement is a simple, noninvasive method to assess tissue advanced glycation end products (AGE). In patients with end-stage renal disease and in those on hemodialysis AGE production is increased. Less is known about those treated with peritoneal dialysis (PD). In this study we tested if SAF is influenced by clinical and treatment characteristics in PD patients.This cross-sectional study included 198 PD patients (of those, 128 were on traditional glucose-based solutions and 70 patients were partially switched to icodextrin-based PD). SAF measurements were done with a specific AGE Reader device. The impact of patients' age, gender, current diabetes, duration of PD, cumulative glucose exposure, body mass index, smoking habits and use of icodextrin on SAF values were tested with multiple regression analysis.Our analysis revealed that patients' age, current diabetes and icodextrin use significantly increase patients' SAF values (p = 0.015, 0.012, 0.005, respectively). AGE exposure of PD patients with diabetes and on icodextrin solution is increased. Further investigation is required whether this finding is due to the icodextrin itself or for a still unspecified clinical characteristic of PD population treated with icodextrin. PMID:22849846

  5. Extended dosing of darbepoetin alfa in peritoneal dialysis patients

    Directory of Open Access Journals (Sweden)

    Bridges Ian

    2011-03-01

    Full Text Available Abstract Background Anemia is common among peritoneal dialysis (PD patients, and most patients require erythropoiesis-stimulating agents (ESA to maintain their hemoglobin concentrations within current guideline recommendations. Darbepoetin alfa is an ESA with a 3-fold longer half-life and greater in vivo biological activity than recombinant human erythropoietin, allowing less frequent dosing that may simplify anemia management in these patients, providing benefits to patients, care givers and health care providers. Clinical studies have confirmed the efficacy and safety of darbepoetin alfa administered at extended dosing intervals. However, there are limited data on the management of anemia with ESAs in PD patients in routine clinical practice. The aim of this multicenter observational study in European and Australian dialysis patients was to evaluate darbepoetin alfa administered once every 2 weeks (Q2W in routine clinical practice for 12 months. Methods PD patients ≥18 years old and converting to treatment with darbepoetin alfa Q2W were eligible for enrollment regardless of previous or current ESA use. Patients enrolled in the study were treated according to local usual clinical practice. Data were collected up to 6 months prior to and 12 months after conversion to darbepoetin alfa Q2W. The primary endpoint was hemoglobin concentration 12 months after conversion to darbepoetin alfa Q2W. Results Of the 741 eligible PD patients (mean age, 61 years; male, 57%, 640 (86% completed the study. Mean hemoglobin concentration (g/dL was 11.69 (95% CI, 11.53-11.86 6 months before the conversion, 12.25 (95% CI, 12.13-12.38 at conversion, and 11.88 (95% CI, 11.74-12.02 12 months after conversion to darbepoetin alfa Q2W. The weekly equivalent ESA dose (μg/wk was a geometric mean of 25.24 (95% CI, 23.46-27.15 6 months before conversion, 20.90 (95% CI, 19.13-22.83 immediately before conversion, 18.89 (95% CI, 18.13-19.68 at conversion and 19.04 (95% CI, 17

  6. Intraperitoneal Hemorrhage in a Peritoneal Dialysis Patient Using Dabigatran: A Case Report

    Directory of Open Access Journals (Sweden)

    Egemen Cebeci

    2016-06-01

    Full Text Available Dabigatran is used for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. It is still unclear whether the use of dabigatran leads to more bleeding compared with warfarin. In this paper, we present a case of intraperitoneal hemorrhage in a 54-years-old male peritoneal dialysis patient using dabigatran for paroxysmal atrial fibrillation because international normalized ratio level could not be kept at target levels during follow-up. The use of dabigatran in atrial fibrillation has become widespread in recent years. Despite the low risk of intracranial hemorrhage, clinicians should be careful in patients with chronic kidney disease because coagulation monitoring is not possible.

  7. Effect of cinacalcet on cardiovascular disease in patients undergoing dialysis

    DEFF Research Database (Denmark)

    Chertow, Glenn M; Block, Geoffrey A; Correa-Rotter, Ricardo;

    2012-01-01

    Disorders of mineral metabolism, including secondary hyperparathyroidism, are thought to contribute to extraskeletal (including vascular) calcification among patients with chronic kidney disease. It has been hypothesized that treatment with the calcimimetic agent cinacalcet might reduce the risk ...

  8. 42 CFR 414.310 - Determination of reasonable charges for physician services furnished to renal dialysis patients.

    Science.gov (United States)

    2010-10-01

    ... services furnished to renal dialysis patients. 414.310 Section 414.310 Public Health CENTERS FOR MEDICARE... Determination of reasonable charges for physician services furnished to renal dialysis patients. (a) Principle. Physician services furnished to renal dialysis patients are subject to payment if the services are...

  9. Heart rhythm complexity impairment in patients undergoing peritoneal dialysis

    Science.gov (United States)

    Lin, Yen-Hung; Lin, Chen; Ho, Yi-Heng; Wu, Vin-Cent; Lo, Men-Tzung; Hung, Kuan-Yu; Liu, Li-Yu Daisy; Lin, Lian-Yu; Huang, Jenq-Wen; Peng, Chung-Kang

    2016-06-01

    Cardiovascular disease is one of the leading causes of death in patients with advanced renal disease. The objective of this study was to investigate impairments in heart rhythm complexity in patients with end-stage renal disease. We prospectively analyzed 65 patients undergoing peritoneal dialysis (PD) without prior cardiovascular disease and 72 individuals with normal renal function as the control group. Heart rhythm analysis including complexity analysis by including detrended fractal analysis (DFA) and multiscale entropy (MSE) were performed. In linear analysis, the PD patients had a significantly lower standard deviation of normal RR intervals (SDRR) and percentage of absolute differences in normal RR intervals greater than 20 ms (pNN20). Of the nonlinear analysis indicators, scale 5, area under the MSE curve for scale 1 to 5 (area 1–5) and 6 to 20 (area 6–20) were significantly lower than those in the control group. In DFA anaylsis, both DFA α1 and DFA α2 were comparable in both groups. In receiver operating characteristic curve analysis, scale 5 had the greatest discriminatory power for two groups. In both net reclassification improvement model and integrated discrimination improvement models, MSE parameters significantly improved the discriminatory power of SDRR, pNN20, and pNN50. In conclusion, PD patients had worse cardiac complexity parameters. MSE parameters are useful to discriminate PD patients from patients with normal renal function.

  10. The effect of different dialysis modalities on pruritus in patients with uremia

    Institute of Scientific and Technical Information of China (English)

    金东华

    2013-01-01

    Objective To study the effects of different dialysis modalities on pruritus in patients with uremia.Methods There were 19 hemodialysis (HD) patients,17 hemodialysis combined with hemodiafiltration (HD+HDF) patients and 20 peritoneal dialysis (PD) patients enrolled in for study.All patients were suffering from skin pruritus.Plasmaβ2-microglobulin (β2-MG) and intact parathyroid hormone (iPTH) were measured by using radio immunoassay before and 4 weeks,8 weeks after the initia-

  11. Reliability, validity and discriminatory ability of Spitzer's QL-index in dialysis patients.

    Science.gov (United States)

    Lim, T O; Morad, Z

    1998-12-01

    Quality of life outcome (QOL) on dialysis is important. We determined the measurement properties of Spitzer's QL-index, a QOL measure, in our patients on chronic haemodialysis. The QL-index measures 5 dimensions of QOL (activity, daily activities, general health, social support and psychological outlook). 59 haemodialysis (HD) patients from 2 centres were rated by 5 raters. Inter-rater agreement for the total score was good with a mean intra-class correlation coefficient 0.66 (range 0.47-0.81). That for dimension scores however was poor (weighted kappa range 0.07-1). Systematic differences between raters were also observed. Intra-rater agreement was generally better than inter-rater agreement. Significant gradients in scores were observed by age, serum albumin, comorbid disorders, previous hospitalisation, capacity for self care HD and rehabilitation status thus providing evidence for construct validity. The distribution of total scores was skewed indicating poor discriminatory ability. Nevertheless, QL-index has acceptable measurement properties for application in dialysis patients. PMID:10971983

  12. The effect of outpatient dialysis global budget cap on healthcare utilization by end-stage renal disease patients.

    Science.gov (United States)

    Chang, Ray-E; Hsieh, Chi-Jeng; Myrtle, Robert C

    2011-07-01

    Controlling the cost of chronic diseases remains one of the vexing problems of developed and developing nations alike. Taiwan, faced with rapidly escalating healthcare costs associated with End Stage Renal Disease (ESRD) services utilization, imposed an outpatient dialysis global budget (ODBG) on outpatient dialysis care. This study, using a before and after study design with a comparison group, assessed the impact of this policy innovation on outpatient, inpatient and emergency room utilization. Using a difference in difference (DID) strategy and the generalized estimating equation (GEE) approach, this study found providers responded to these changes through cost reduction and revenue enhancement strategies. This study extends our understanding of provider responses to changes in reimbursement policies that target one segment of the continuum of care required by chronic disease patients.

  13. Health-related quality of life in patients on hemodialysis and peritoneal dialysis.

    Science.gov (United States)

    Okpechi, Ikechi G; Nthite, Tebogo; Swanepoel, Charles R

    2013-05-01

    Chronic kidney disease (CKD) is a worldwide public health problem, and its treatment imposes a considerable burden on patients and their families. Limitations in everyday activity may worsen the situation and affect the health-related quality of life (HRQOL) of patients with CKD. There are no studies on the HRQOL of dialysis patients in South Africa. We assessed the HRQOL of patients undergoing hemodialysis (HD) and continuous ambulatory peritoneal dialysis (PD) attending the Groote Schuur Hospital renal unit by using the Kidney Disease Quality of Life-Short Form version 1.3 questionnaire. Baseline demographic and clinical details of the participants were recorded. Analysis was performed (unpaired t test and univariate analysis) to compare the HRQOL between HD and PD patients and to identify factors influencing HRQOL. The HRQOL was low but not significantly different between HD and PD patients. In PD patients, the use of erythropoiesis-stimulating agents (ESA) significantly contributed to the emotional well-being (r 2 = 0.267; P = 0.01) and alleviation of pain (r 2 = 0.073; P = 0.049); in HD patients also, ESA use was associated with emotional well-being (r 2 = 0.258; P <0.0001) as well as improvement in energy/fatigue (r 2 = 0.390; P <0.0001). Systolic and diastolic blood pressures significantly influenced cognitive function in PD patients (P <0.05). Parathyroid hormone level significantly influenced the physical functioning and energy/fatigue domains in HD patients (P <0.0001). Serum ferritin (r 2 = 0.441; P = 0.002) and level of hemoglobin concentration (r 2 = 0.180; P = 0.006) were significantly associated with the domain role emotional in PD and HD patients, respectively. Although HRQOL is low in dialysis patients in Cape Town, the factors that have been identified to be associated with these scores (such as anemia and hyperparathyroidism) if aggressively managed and corrected may assist in improving patients' HRQOL.

  14. First year survival of patients on maintenance dialysis treatment in Poland.

    Science.gov (United States)

    Brodowska-Kania, Dorota; Rymarz, Aleksandra; Gibin Ski, Krzysztof; Kiełczewska, Julia; Smoszna, Jerzy; Saracyn, Marek; Szamotulska, Katarzyna; Niemczyk, Stanisław

    2015-11-01

    Retrospective analysis of demographic and clinical data of all patients starting dialysis over two years in our Department (n = 105) has been conducted. Factors such as type of dialysis treatment, reason of end-stage renal disease, Body Mass Index (BMI), laboratory tests results, number and cause of death during first year of dialysis were taken under consideration. Five patients have been excluded from the analysis of mortality (four received renal transplantation, one changed dialysis center). Twenty tree deaths have been noted during first year of dialysis treatment. Nine of them occurred during the first three months of therapy. The leading cause of death was cardio-vascular events (n = 14, 60.9%), the second was malignancy (8, 34,8%), one patient died due to catheter associated infection. Malignancy as a cause of end-stage renal disease, lack of outpatient nephrology care, acute mode of beginning renal replacement therapy and lack of erythropoiesis stimulating agents therapy were associated with higher risk of all-cause mortality during first year of dialysis. Being under the outpatient nephrology care, etiology of ESRD other than malignancy and erythropoiesis stimulating agents therapy were independently associated with better survival during this period of time. Other independent variables did not reach statistical significance. To conclude, in order to improve one year survival of dialysis patients, outpatient nephrology care with adequate amount of visits and associated dialysis therapy should be employed. PMID:26663941

  15. 老年慢性肾脏病早期结肠透析患者临床护理路径应用效果分析%Analysis the Application Effect of Clinical Nursing Path of Colon Dialysis in Elderly Patients With Chronic Kidney Dysfunction

    Institute of Scientific and Technical Information of China (English)

    胡珺

    2015-01-01

    Objective Analysis the application effect of clinical nursing path of colon dialysis in elderly patients with chronic kidney dysfunction.Methods Selected 74 patients with chronic renal failure in our hospital from September 2013 to December 2014, and divided into observation group and control group. The Control group was using warm water dialysis, and the observation group was using dialysate .The control group took the clinical routine nursing, the observation group used the clinical nursing path.Compare the change of appetite, sleepand mood. Results After dialysis, in observation group, thw loss of appetite, insomnia, depressed were significantly lower than the control group, the difference was statistical y significant(P<0.05). Conclusion With dialysate, the effective clinical nursing path can significantly improve the patient's appetite, sleep and mood.%目的:分析护理路径在老年慢性肾脏病早期结肠透析患者中的临床效果。方法选择2013年9月~2014年12月于我院行结肠透析的老年早期慢性肾脏病患者共74例分为观察组、对照组,对照组采用温水透析,观察组采用透析液进行透析。对照组采取临床常规护理,观察组采用临床护理路径进行护理。观察治疗后食欲、睡眠、情绪的变化。结果观察组透析后发生食欲不振、失眠、情绪低落的患者低于对照组,差异有统计学意义(P<0.05)。结论在透析液的作用下,有效的临床护理路径可改善患者食欲、睡眠及情绪。

  16. Health-related quality of life in different stages of chronic kidney disease and at initiation of dialysis treatment

    Directory of Open Access Journals (Sweden)

    Pagels Agneta A

    2012-06-01

    Full Text Available Abstract Objectives To evaluate health-related quality of life (HRQoL in patients in different stages of chronic kidney disease (CKD up to initiation of dialysis treatment and to explore possible correlating and influencing factors. Methods Cross-sectional design with 535 patients in CKD stages 2–5 and 55 controls assessed for HRQoL through SF-36 together with biomarkers. Results All HRQoL dimensions deteriorated significantly with CKD stages with the lowest scores in CKD 5. The largest differences between the patient groups were seen in ‘physical functioning’, ‘role physical’, ‘general health’ and in physical summary scores (PCS. The smallest disparities were seen in mental health and pain. Patients in CKD stages 2–3 showed significantly decreased HRQoL compared to matched controls, with differences of large magnitude - effect size (ES ≥ .80 - in ‘general health’ and PCS. Patients in CDK 4 demonstrated deteriorated scores with a large magnitude in ‘physical function’, ‘general health’ and PCS compared to the patients in CKD 2–3. Patients in CKD 5 demonstrated deteriorated scores with a medium sized magnitude (ES 0.5 – 0.79 in ‘role emotional’ and mental summary scores compared to the patients in CKD 4. Glomerular filtration rate Conclusions Having CKD implies impaired HRQoL, also in earlier stages of the disease. At the time for dialysis initiation HRQoL is substantially deteriorated. Co-existing conditions, such as inflammation and cardiovascular disease seem to be powerful predictors of impaired HRQoL in patients with CKD. Within routine renal care, strategies to improve function and well-being considering the management of co-existing conditions like inflammation and CVD need to be developed.

  17. Health-related quality of life in patients on hemodialysis and peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Ikechi G Okpechi

    2013-01-01

    Full Text Available Chronic kidney disease (CKD is a worldwide public health problem, and its treatment imposes a considerable burden on patients and their families. Limitations in everyday activity may worsen the situation and affect the health-related quality of life (HRQOL of patients with CKD. There are no studies on the HRQOL of dialysis patients in South Africa. We assessed the HRQOL of patients undergoing hemodialysis (HD and continuous ambulatory peritoneal dialysis (PD attending the Groote Schuur Hospital renal unit by using the Kidney Disease Quality of Life-Short Form version 1.3 questionnaire. Baseline demographic and clinical details of the participants were recorded. Analysis was performed (unpaired t test and univariate analysis to compare the HRQOL between HD and PD patients and to identify factors influencing HRQOL. The HRQOL was low but not significantly different between HD and PD patients. In PD patients, the use of erythropoiesis-stimulating agents (ESA significantly contributed to the emotional well-being (r 2 = 0.267; P = 0.01 and alleviation of pain (r 2 = 0.073; P = 0.049; in HD patients also, ESA use was associated with emotional well-being (r 2 = 0.258; P <0.0001 as well as improve-ment in energy/fatigue (r 2 = 0.390; P <0.0001. Systolic and diastolic blood pressures signifi-cantly influenced cognitive function in PD patients (P <0.05. Parathyroid hormone level signi-ficantly influenced the physical functioning and energy/fatigue domains in HD patients (P <0.0001. Serum ferritin (r 2 = 0.441; P = 0.002 and level of hemoglobin concentration (r 2 = 0.180; P = 0.006 were significantly associated with the domain role emotional in PD and HD patients, respectively. Although HRQOL is low in dialysis patients in Cape Town, the factors that have been identified to be associated with these scores (such as anemia and hyperparathyroidism if aggressively managed and corrected may assist in improving patients′ HRQOL.

  18. Antibody response following Hepatitis B vaccination in peritoneal dialysis patients: does normalized urea clearance matter?

    OpenAIRE

    Erkan Dervisoglu; Melih Simsek; Ahmet Yilmaz

    2011-01-01

    OBJECTIVES: Data on the factors that contribute to the antibody response to hepatitis B virus vaccination in peritoneal dialysis patients are scarce. The current study was conducted on a group of peritoneal dialysis patients to learn how the response to hepatitis B virus vaccination varies according to the patient's clearance of urea normalized to total body water (Kt/V). METHODS: A convenience sample of 33 peritoneal dialysis patients (13 women and 20 men, with a mean age of 49¡12 years) was...

  19. Course of Encephalopathy in a Cirrhotic Dialysis Patient Treated Sequentially with Peritoneal and Hemodialysis

    Directory of Open Access Journals (Sweden)

    Suleyman Koz

    2015-01-01

    Full Text Available End-stage kidney disease and advanced cirrhosis are sometimes seen concomitantly. There is no consensus on dialysis modality in terms of determining the optimal way of treating these patients. It has been suggested that peritoneal dialysis is a better choice for these patients, but efficacy of hemodialysis in stable cirrhotic patients has not been evaluated sufficiently. We report a case with advanced cirrhosis and end-stage kidney disease who was faced with hepatic encephalopathy episodes up on starting renal replacement therapy. The case is also interesting in that it reveals effects of hemodialysis and peritoneal dialysis on hepatic encephalopathy episodes and quality of life of the patient.

  20. Estimating the concentration of urea and creatinine in the human serum of normal and dialysis patients through Raman spectroscopy.

    Science.gov (United States)

    de Almeida, Maurício Liberal; Saatkamp, Cassiano Junior; Fernandes, Adriana Barrinha; Pinheiro, Antonio Luiz Barbosa; Silveira, Landulfo

    2016-09-01

    Urea and creatinine are commonly used as biomarkers of renal function. Abnormal concentrations of these biomarkers are indicative of pathological processes such as renal failure. This study aimed to develop a model based on Raman spectroscopy to estimate the concentration values of urea and creatinine in human serum. Blood sera from 55 clinically normal subjects and 47 patients with chronic kidney disease undergoing dialysis were collected, and concentrations of urea and creatinine were determined by spectrophotometric methods. A Raman spectrum was obtained with a high-resolution dispersive Raman spectrometer (830 nm). A spectral model was developed based on partial least squares (PLS), where the concentrations of urea and creatinine were correlated with the Raman features. Principal components analysis (PCA) was used to discriminate dialysis patients from normal subjects. The PLS model showed r = 0.97 and r = 0.93 for urea and creatinine, respectively. The root mean square errors of cross-validation (RMSECV) for the model were 17.6 and 1.94 mg/dL, respectively. PCA showed high discrimination between dialysis and normality (95 % accuracy). The Raman technique was able to determine the concentrations with low error and to discriminate dialysis from normal subjects, consistent with a rapid and low-cost test. PMID:27393683

  1. Health-related quality of life and all-cause mortality in patients with diabetes on dialysis

    Directory of Open Access Journals (Sweden)

    Østhus Tone Britt

    2012-08-01

    Full Text Available Abstract Background This study tests the hypotheses that health-related quality of life (HRQOL in prevalent dialysis patients with diabetes is lower than in dialysis patients without diabetes, and is at least as poor as diabetic patients with another severe complication, i.e. foot ulcers. This study also explores the mortality risk associated with diabetes in dialysis patients. Methods HRQOL was assessed using the Short Form-36 Health Survey (SF-36, in a cross-sectional study of 301 prevalent dialysis patients (26% with diabetes, and compared with diabetic patients not on dialysis (n = 221, diabetic patients with foot ulcers (n = 127, and a sample of the general population (n = 5903. Mortality risk was assessed using a Kaplan-Meier plot and Cox proportional hazards analysis. Results Self-assessed vitality, general and mental health, and physical function were significantly lower in dialysis patients with diabetes than in those without. Vitality (p = 0.011 and general health (p Conclusions Physical aspects of HRQOL were perceived very low in dialysis patients with diabetes, and lower than in other dialysis patients and diabetic patients without dialysis. Mental aspects predicted mortality in dialysis patients with diabetes. Increased awareness and measures to assist physical function impairment may be particularly important in diabetes patients on dialysis.

  2. 42 CFR 414.335 - Payment for EPO furnished to a home dialysis patient for use in the home.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Payment for EPO furnished to a home dialysis... for EPO furnished to a home dialysis patient for use in the home. Link to an amendment published at 75 FR 49202, Aug. 12, 2010. (a) Payment for EPO used at home by a home dialysis patient is made only...

  3. Output of peritoneal cells during peritoneal dialysis.

    Science.gov (United States)

    Fakhri, O; Al-Mondhiry, H; Rifaat, U N; Khalil, M A; Al-Rawi, A M

    1978-01-01

    Peritoneal dialysis provides a good source for the collection of macrophages. Six patients with chronic renal failure undergoing peritoneal dialysis for the first time were studied, and maximum cell egress, mostly macrophages, occurred at 24-48 hours and diminished after 48 hours. PMID:670419

  4. Osteoarthropathy in dialysis amyloidosis

    International Nuclear Information System (INIS)

    Many long-term (>60 months) hemodialysis patients develop a severe osteoarticular disease, called 'dialysis arthropathy', which is characterized by the deposition in bone and synovia of a new type of amyloid made mainly of β2-microglobulin. In the present study, 31 patients (17 males, 14 females; age 54.1±13 years) undergoing chronic hemodialysis arthropathy by means of clinics and of radiological investigations (conventional radiography and computed tomography). Sixteen patients (51.6%) had radiographic evidence of dialysis arthropathy: geodes (shoulders, 12 cases; wrists, 11; hips, 2; knees, 2) and/or destructive arthropathies (cervical spine, 13 cases; dorsolumbar spine, 2; hands, 2; hips, 1). Within 24 months, these lesions were found to progress slowly in the majoriry of cases. In the diagnostic process, CT should be employed in the study of spine, shoulders and hips when the lesions have not been sufficiently demonstrated by conventional radiography in the presence of evident clinical signs. Patients with dialysis arthropathy had undergone dialysis for longer periods than those without it (p<0.005) and showed a significantly higher incidence of both carpal tunnel syndrome (p<0.0005) and shoulder pain (p<0.005). Our findings confirm the high incidence and clinical importance of dialysis arthropathy in long-term hemodialysis patients end the value of diagnostic imaging in screening such patients for those lesions

  5. Morbidity and Mortality in ESRD patients on dialysis

    International Nuclear Information System (INIS)

    End-stage renal disease (ESRD), due to its high morbidity and mortalityas well as social and financial implications, is a major public healthproblem. Outcome depends not only on different modalities of treatment likehemodialysis and peritoneal dialysis, but also on existing co-morbidities,age, duration on dialysis, supportive therapies and infection controlstrategies. Thus, a detailed study becomes necessary to improve health caredelivery, provide medical care and to establish a geographical reference. Thepresent study was undertaken to characterize the ESRD patient by theirdemographic and co-morbid conditions and relate this to the morbidity andmortality trends. The medical records of 110 ESRD patients seen over afive-year period (June 1995 to December 1999) in two tertiary-care hospitalsin Riyadh, Saudi Arabia were studied retrospectively. There were 79 (64.5%)males and 31 (35.5%) females; their age ranged from 17 to 92 years (mean age53.8 +- 17.8 years). Diabetes was the commonest cause of ESRD seen in 26(26.6%) followed by nephrosclerosis, unknown etiology, lupus nephritis,pyelonepritis and primary, glomerulonephritis. Diabetes mellitus was the mostprevalent co-morbidity seen during the study period and occurred in 65patients (59%) followed by heart disease in 36 (32.7%), liver disease in 30(27.3%), cerebrovascular accidents in 13 (11.8%) and neoplasm in 11 (10%).Seven (6.3%) patients only were smokers. Hemodialysis was the most frequenttreatment choice as renal replacement therapy. Among the causes ofhospitalization, cardiovascular conditions were the leading single cause(19.1%), followed by access related reasons and infections (11.5% each). Theoverall hospitalization rate was 11.2 days/year. The overall mortality ratewas 8.07 deaths/year. The leading cause of death was cardiovascular in 15(51.7%) followed by unknown/sudden death in eight (27.5%). Other causes ofdeath included fluid overload, gastrointestinal hemorrhage, septicemia, liverdisease and pulmonary

  6. Left Ventricular Diastolic Dysfunction in Dialysis Patients Assessed by Novel Speckle Tracking Strain Rate Analysis: Prevalence and Determinants

    Directory of Open Access Journals (Sweden)

    Mihály K. de Bie

    2012-01-01

    Full Text Available Background. Diastolic dysfunction is common among dialysis patients and is associated with increased morbidity and mortality. Novel echocardiographic speckle tracking strain analysis permits accurate assessment of left ventricular diastolic function, independent of loading conditions and taking all myocardial segments into account. The aim of the study was to evaluate the prevalence of diastolic dysfunction in chronic dialysis patients using this novel technique, and to identify its determinants among clinical and echocardiographic variables. Methods. Patients currently enrolled in the ICD2 study protocol were included for this analysis. Next to conventional echo measurements diastolic function was also assessed by global diastolic strain rate during isovolumic relaxation (SRIVR. Results. A total of 77 patients were included (age 67±8 years, 74% male. When defined as E/SRIVR ≥236, the prevalence of diastolic dysfunction was higher compared to more conventional measurements (48% versus 39%. Left ventricular mass (OR 1.02, 95% CI 1.00–1.04, P=0.014 and pulse wave velocity (OR 1.34, 95% CI 1.07–1.68, P=0.01 were independent determinants of diastolic dysfunction. Conclusion. Diastolic dysfunction is highly prevalent among dialysis patients and might be underestimated using conventional measurements. Left ventricular mass and pulse wave velocity were the only determinants of diastolic dysfunction in these patients.

  7. Prolactinoma in a Diabetic Dialysis Patient with Erectile Dysfunction: A Difficult Differential Diagnosis

    OpenAIRE

    Piccoli, Giorgina B.; Bermont, Francesca; Magnano, Andrea; Soragna, Giorgio; Terzolo, Massimo

    2006-01-01

    Dialysis patients often suffer from erectile dysfunction. The prevalence of this symptom in the context of dialysis is as high as 90%. Diabetes, diffuse vascular disease and pharmacological therapy are attendant causes of this condition, severely impairing the quality of life. Due to the high frequency of erectile dysfunction in uremic patients, minimalist diagnostic approaches are often used. Nevertheless, a careful differential diagnosis is also warranted in well dialyzed patients to identi...

  8. Quality of Life in Patients Undergoing Hemodialysis or Peritoneal Dialysis Treatment

    OpenAIRE

    Theofilou, Paraskevi

    2011-01-01

    Background “Does the type of dialysis treatment make a difference to the quality of life (QoL) and mental health of renal patients in Athens?” The study investigated the differences in 84 in-center hemodialysis (HD) and 60 continuous ambulatory peritoneal dialysis (CAPD/PD) patients. Methods Patient-reported assessments included: WHOQOL-BREF inventory of World Health Organization, General Health Questionnaire (GHQ-28) of Goldberg, State-Trait Anxiety Inventory, Center for Epidemiologic Studie...

  9. Quality of life, mental health and health beliefs: comparison between haemodialysis and peritoneal dialysis patients

    OpenAIRE

    Theofilou P

    2010-01-01

    Aim: The comparative study between in-centre haemodialysis (HD) and continuous ambulatory peritoneal dialysis (PD) patients regarding self-reported quality of life (QoL) as well as some psychological dimensions that may affect and may be affected by the patient’s state of health, like health locus of control beliefs, depression and anxiety. Material and Method: The sample consists of 144 patients in-centre haemodialysis or continuous ambulatory peritoneal dialysis (CAPD). Patient-reported ass...

  10. Cost and effectiveness assessment of cardiac rehabilitation for dialysis patients following coronary bypass

    OpenAIRE

    Huang, Yijian; Zhang, Rebecca; Culler, Steven; Kutner, Nancy

    2008-01-01

    Dialysis patients have a high risk of cardiovascular disease. In the general population, cardiac rehabilitation is recommended as a standard component of care and is covered by Medicare for patients who have undergone coronary artery bypass grafting (CABG). Previous investigation demonstrated survival benefit of cardiac rehabilitation in dialysis patients. This study investigated its impact on Medicare expenditure and its cost effectiveness. A cohort of 4,324 end-stage renal disease (ESRD) pa...

  11. Nutrición parenteral intradiálisis en el enfermo renal crónico: Consenso SEN-SENPE Intra-dialysis parenteral nutrition in chronic renal patients: Consensus SEN-SENPE

    Directory of Open Access Journals (Sweden)

    A. García de Lorenzo

    2010-06-01

    Full Text Available Ante la alta prevalencia de la situación de malnutrición en pacientes en hemodiálisis y conociendo que ello implica un aumento de la tasa de infecciones, hospitalización y estancia lo que se traduce en un incremento de la morbimortalidad global, la Sociedad Española de Nefrología (SEN y la Sociedad Española de Nutrición Parenteral y Enteral (SENPE realizan un consenso sobre las indicaciones, contraindicaciones y límites de la Nutrición Parenteral Intra Diálisis (NPID. En este consenso se considera a la NPID como una alternativa válida a otros tipos de soporte nutricional cuando estos demuestran su ineficacia. Se sientan las bases del momento de intervención nutricional con NPID, su composición ideal, el tiempo de administración, los controles, las pautas de seguimiento y el momento en que este soporte nutricional debe de ser discontinuado.Given the high prevalence of the hyponutrition state among haemodialysis patients and knowing that this implies an increase in the rates of infection, hospitalisation and hospital stay, which translates into an increase in global morbid-mortality, the Spanish Society of Nephrology (SEN and the Spanish Society of Parenteral and Enteral Nutrition (SENPE have reached a consensus on the indications, contraindications, and limitations of Intra-Dialysis Parenteral Nutrition (IDPN. This consensus considers IDPN as a valid alternative to other types of nutritional support when these show their lack of efficacy. The bases are set regarding the timing of nutritional intervention with IDPN, its ideal composition, the time of administration, its controls, follow-up schedules, and the time at which the nutritional support has to be discontinued.

  12. Fatal dialysis disequilibrium syndrome: A tale of two patients

    Directory of Open Access Journals (Sweden)

    Shaikh Nissar

    2010-01-01

    Full Text Available Dialysis disequilibrium syndrome (DDS is a central nervous system disorder, which occurs during hemodialysis (HD or within 24 h following the first HD. DDS commonly occurs in patients suffering from end-stage renal failure undergoing HD for the first time. In a critically ill patient suffering from severe sepsis or septic shock, the combined effects of post-HD brain edema and changes in the brain due to septic encephalopathy, may become amplified leading to DDS. Here we report 2 cases with acute renal failure (ARF, undergoing HD for more than a week and being ventilated and who developed DDS. DDS might have contributed to the sudden deterioration and death in these septic patients. The first case was a 31-year-old male, involved in a motor vehicle accident and had a severe abdominal injury. Underwent laparotomy and hemostasis was achieved. On day 4, the patient developed hemorrhagic shock associated with ARF, which prompted daily HD. On day 8, he went into septic shock. On day 16, 1 h after his daily HD, he became unresponsive and his pupils became dilated and fixed and he expired 2 days later. The second case was a young male who suffered severe abdominal and chest injury after a fall from a height. He developed ARF on day 3 and required HD. On day 9, he had septic shock. Three days later, during his daily HD, he became unconscious and his pupils were not reacting to light and the patient died on day 12. Conclusion: In patients with severe sepsis/septic shock, DDS may occur even after repeated sessions of HD. The acute care physicians, intensivists, and nephrologists should be aware of the risks of DDS.

  13. Open heart surgery in dialysis-dependent patients with end stage renal failure

    Directory of Open Access Journals (Sweden)

    Orkut Güçlü

    2013-09-01

    Full Text Available Objective: Patients with chronic renal insufficiency remaina risky subgroup in open heart surgery becauseof various reasons. The incidence of cardiovascular diseasein hemodialysis dependent renal failure is found tobe higher when compared with the normal population.Chronic dialysis is still a very important independent riskfactor for mortality and morbidity despite of many studies.In this study, we retrospectively evaluated the outcome ofpatients with chronic renal failure who had undergone toopen cardiac surgery.Methods: The medical charts of 36 patients on maintenancedialysis who underwent cardiovascular surgerywere retrospectively analyzed. Peroperative findings ofthese patients were analyzed from patients’ hospital records.Results: Twenty-seven men (75% and nine women(25% totally 36 patients were included to study. Themean age was 58.3±8.5 (range, 44-76 years. 12 patientsunderwent coronary artery bypass surgery, 10 hadconcomitant coronary artery bypass surgery and valvereplacements, five had valve replacements, three hadconcomitant coronary artery bypass surgery and left ventriculectomy,four had valve replacement with other valverepair, two had aortic surgery due to ascending aortic aneurysms.The mean cross clamp time was 78.1±31.3 minand the mean perfusion time was 158.8±92.2 min. Themean intensive care unit stay was 60±41 hours, and themean hospital stay was 12±5 days. Hospital mortality ratewas %38.8.Conclusions: Cardiac and renal functions are closely associatedwith each other. Cardiac surgery operations canbe applied to patients with end-stage renal failure underacceptable risks. Appropriate preoperative preparationwith good postoperative patient follow-up is necessary tohave acceptable levels of morbidity and mortality rates. JClin Exp Invest 2013; 4 (3: 335-338Key words: Cardiac surgery, chronic renal failure, mortality

  14. Plasma p-cresol lowering effect of sevelamer in peritoneal dialysis patients: evidence from a Cross-Sectional Observational Study.

    Directory of Open Access Journals (Sweden)

    Bruna Guida

    Full Text Available p-Cresol is a by-product of the metabolism of aromatic aminoacid operated by resident intestinal bacteria. In patients with chronic kidney disease, the accumulation of p-cresol and of its metabolite p-cresyl-sulphate causes endothelial dysfunction and ultimately increases the cardiovascular risk of these patients. Therapeutic strategies to reduce plasma p-cresol levels are highly demanded but not available yet. Because it has been reported that the phosphate binder sevelamer sequesters p-cresol in vitro we hypothesized that it could do so also in peritoneal dialysis patients. To explore this hypothesis we measured total cresol plasma concentrations in 57 patients with end-stage renal disease on peritoneal dialysis, 29 receiving sevelamer for the treatment of hyperphosphatemia and 28 patients not assuming this drug. Among the patients not assuming sevelamer, 16 were treated with lanthanum whereas the remaining 12 received no drug because they were not hyperphosphatemic. Patients receiving sevelamer had plasma p-cresol and serum high sensitivity C-reactive protein concentrations significantly lower than those receiving lanthanum or no drug. Conversely, no difference was observed among the different groups either in residual glomerular filtration rate, total weekly dialysis dose, total clearance, urine volume, protein catabolic rate, serum albumin or serum phosphate levels. Multiple linear regression analysis showed that none of these variables predicted plasma p-cresol concentrations that, instead, negatively correlated with the use of sevelamer. These results suggest that sevelamer could be an effective strategy to lower p-cresol circulating levels in peritoneal dialysis patients in which it could also favorably affect cardiovascular risk because of its anti-inflammatory effect.

  15. The "phosphorus pyramid": a visual tool for dietary phosphate management in dialysis and CKD patients.

    Science.gov (United States)

    D'Alessandro, Claudia; Piccoli, Giorgina B; Cupisti, Adamasco

    2015-01-20

    Phosphorus retention plays a pivotal role in the onset of mineral and bone disorders (MBD) in chronic kidney disease (CKD). Phosphorus retention commonly occurs as a result of net intestinal absorption exceeding renal excretion or dialysis removal. The dietary phosphorus load is crucial since the early stages of CKD, throughout the whole course of the disease, up to dialysis-dependent end-stage renal disease.Agreement exits regarding the need for dietary phosphate control, but it is quite challenging in the real-life setting. Effective strategies to control dietary phosphorus intake include restricting phosphorus-rich foods, preferring phosphorus sourced from plant origin, boiling as the preferred cooking procedure and avoiding foods with phosphorus-containing additives. Nutritional education is crucial in this regard.Based on the existing literature, we developed the "phosphorus pyramid", namely a novel, visual, user-friendly tool for the nutritional education of patients and health-care professionals. The pyramid consists of six levels in which foods are arranged on the basis of their phosphorus content, phosphorus to protein ratio and phosphorus bioavailability. Each has a colored edge (from green to red) that corresponds to recommended intake frequency, ranging from "unrestricted" to "avoid as much as possible".The aim of the phosphorus pyramid is to support dietary counseling in order to reduce the phosphorus load, a crucial aspect of integrated CKD-MBD management.

  16. Design of a multimedia PC-based telemedicine network for the monitoring of renal dialysis patients

    Science.gov (United States)

    Tohme, Walid G.; Winchester, James F.; Dai, Hailei L.; Khanafer, Nassib; Meissner, Marion C.; Collmann, Jeff R.; Schulman, Kevin A.; Johnson, Ayah E.; Freedman, Matthew T.; Mun, Seong K.

    1997-05-01

    This paper investigates the design and implementation of a multimedia telemedicine application being undertaken by the Imaging Science and Information Systems Center of the Department of Radiology and the Division of Nephrology of the Department of Medicine at the Georgetown University Medical Center (GUMC). The Renal Dialysis Patient Monitoring network links GUMC, a remote outpatient dialysis clinic, and a nephrologist's home. The primary functions of the network are to provide telemedicine services to renal dialysis patients, to create, manage, transfer and use electronic health data, and to provide decision support and information services for physicians, nurses and health care workers. The technical parameters for designing and implementing such a network are discussed.

  17. Pulmonary Hypertension in Dialysis Patients: A Cross-Sectional Italian Study

    Directory of Open Access Journals (Sweden)

    Fabio Fabbian

    2011-01-01

    Full Text Available Introduction. Pulmonary hypertension (PHT is an independent predictor of mortality. The aim of this study was to relate pulmonary arterial pressure (PAP to the cardiovascular status of dialysis patients. Methods. 27 peritoneal dialysis (PD and 29 haemodialysis (HD patients ( years, 37 males, dialysis vintage was months had PAP measured by echocardiography. Clinical and laboratory data of the patients were recorded. Results. PHT ( mmHg was detected in 22 patients (39%; PAP  mmHg and was diagnosed in 18.5% of PD patients and 58.6% of HD patients (. The group of subjects with PH had higher dialysis vintage ( versus months, , interdialytic weight gain ( versus  Kg, , lower diastolic blood pressure ( versus  mmHg, and ejection fraction ( versus %, than the patients with normal PAP. PAP was correlated positively with diastolic left ventricular volume (, and negatively with ejection fraction (, . PHT was independently associated with dialysis vintage (OR 1.022, 95% CI 1.002–1.041, and diastolic blood pressure (OR 0.861, 95% CI 0.766–0.967, . Conclusions. PHT is frequent in dialysis patients, it appears to be a late complication of HD treatment, mainly related to cardiac performance and cardiovascular disease history.

  18. Restless Legs Syndrome in Patients With Chronic Kidney Disease.

    Science.gov (United States)

    Novak, Marta; Winkelman, John W; Unruh, Mark

    2015-07-01

    Symptoms of restless legs syndrome (RLS) are common in patients with chronic kidney disease (CKD) on dialysis; symptoms of RLS are estimated to affect up to 25% of patients on dialysis when the international RLS diagnostic criteria are applied. RLS is a neurologic disorder with a circadian rhythmicity characterized by an overwhelming urge to move the legs during rest, which can be relieved temporarily by movement. RLS has been associated with an increase in sleep disturbance, higher cardiovascular morbidity, decreased quality of life, and an increased risk of death in patients with CKD. Although the exact pathophysiology of RLS is unknown, it is thought to involve an imbalance in iron metabolism and dopamine neurotransmission in the brain. The symptoms of moderate to severe RLS can be treated with several pharmacologic agents; however, data specific to patients on dialysis with RLS are lacking. The purpose of this article is to examine the relationship between, and complications of, RLS and CKD both in dialysis and nondialysis patients, and discuss the treatment options for patients on dialysis with RLS.

  19. Choosing to live with home dialysis-patients' experiences and potential for telemedicine support: a qualitative study

    Directory of Open Access Journals (Sweden)

    Rygh Ellen

    2012-03-01

    Full Text Available Abstract Background This study examines the patients' need for information and guidance in the selection of dialysis modality, and in establishing and practicing home dialysis. The study focuses on patients' experiences living with home dialysis, how they master the treatment, and their views on how to optimize communication with health services and the potential of telemedicine. Methods We used an inductive research strategy and conducted semi-structured interviews with eleven patients established in home dialysis. Our focus was the patients' experiences with home dialysis, and our theoretical reference was patients' empowerment through telemedicine solutions. Three informants had home haemodialysis (HHD; eight had peritoneal dialysis (PD, of which three had automated peritoneal dialysis (APD; and five had continuous ambulatory peritoneal dialysis (CAPD. The material comprises all PD-patients in the catchment area capable of being interviewed, and all known HHD-users in Norway at that time. Results All of the interviewees were satisfied with their choice of home dialysis, and many experienced a normalization of daily life, less dominated by disease. They exhibited considerable self-management skills and did not perceive themselves as ill, but still required very close contact with the hospital staff for communication and follow-up. When choosing a dialysis modality, other patients' experiences were often more influential than advice from specialists. Information concerning the possibility of having HHD, including knowledge of how to access it, was not easily available. Especially those with dialysis machines, both APD and HHD, saw a potential for telemedicine solutions. Conclusions As home dialysis may contribute to a normalization of life less dominated by disease, the treatment should be organized so that the potential for home dialysis can be fully exploited. Pre-dialysis information should be unbiased and include access to other patients

  20. Single port laparoscopic and open surgical accesses of chronic peritoneal dialysis in children: A single center experience over 12 years

    Directory of Open Access Journals (Sweden)

    Ünal Biçakci

    2016-01-01

    Full Text Available Introduction: The aim of this study was to evaluate patients with end stage renal failure (ESRD who underwent chronic peritoneal dialysis (CPD. The clinical outcomes of laparoscopic and open placements of catheters were compared. Materials and Methods: We reviewed 49 (18 male and 31 female children with CPD according to age, sex, cause of ESRD, catheter insertion method, kt/V rate, complications, presence of peritonitis, catheter survival rate between January 2002 and February 2014. Results: Thirty-three patients were with open placement and 16 patients were with laparoscopic placement. The rate of the peritonitis is significantly less in patients with laparoscopic access than open access (n = 4 v sn = 25 (P<0.01. Patients with peritonitis were younger than those who had no attack of peritonitis (10.95 ± 0.8 years vs 13.4 ± 0.85 years. According to the development of complications, significant difference has not been found between the open (n = 9 and laparoscopic (n = 3 approaches except the peritonitis. Catheter survival rate for the first year was 95%, and for five years was 87.5%. There was no difference between open and laparoscopic group according to catheter survival rate. The mean kt/V which indicates the effectiveness of peritoneal dialysis was mean 2.26 ± 0.08. No difference was found between laparoscopic and open methods according to kt/V. Conclusion: Laparoscopic placement of CPD results in lower peritonitis rate. Catheter survival rate was excellent in both groups. Single port laparoscopic access for CPD catheter insertion is an effective and safe method.

  1. Peritonitis due to Brevibacterium otitidis in a patient undergoing continuous ambulatory peritoneal dialysis.

    OpenAIRE

    Wauters, Georges; Van Bosterhaut, B; Avesani, V; Cuvelier, R.; Charlier, Jacqueline; Janssens, Michèle; Delmée, Michel

    2000-01-01

    Brevibacterium otitidis is a coryneform rod and, as far as is known, is isolated only from infected ears. We report the first known case of peritonitis caused by B. otitidis in a patient undergoing continuous ambulatory peritoneal dialysis.

  2. Diabetes Influences Peritoneal Morphology in Uremic Patients at the Initiation of Peritoneal Dialysis

    OpenAIRE

    Mizumasa, Tohru; Hirakata, Hideki; Kuroki, Yusuke; Katafuchi, Ritsuko; Yotsueda, Hideki; Mitsuiki, Koji; Nakashima, Yutaka; Tsuruya, Kazuhiko

    2013-01-01

    ♦ Background: The peritoneum begins to undergo morphologic changes before the start of peritoneal dialysis (PD), particularly in diabetic patients. The present study was conducted to investigate the effects of diabetes on the peritoneum.

  3. A fatal encephalopathy in chronic haemodialysis patients.

    Science.gov (United States)

    Burks, J S; Alfrey, A C; Huddlestone, J; Norenberg, M D; Lewin, E

    1976-04-10

    A distinct neurological syndrome in twelve chronic haemodialysis patients is described. This syndrome is currently the leading cause of death in one Denver dialysis unit. The hallmarks of this syndrome are progressive speech difficulties, mental changes, and a markedly abnormal electroencephalogram which may be present months before the clinical signs appear. Additional clinical features including seizures, myoclonus, asterixis, apraxia, focal neurological signs, and psychiatric symptoms may also be observed. Neuropathological changes are slight and non-specific. The aetiology of this syndrome is unknown but the clinical and pathological features suggest a toxic/metabolic disorder. To date, this disorder has been refractory to several therapeutic measures.

  4. A retrospective review of the two-step tuberculin skin test in dialysis patients

    OpenAIRE

    Foster, Rukhsana; Ferguson, Thomas W.; Rigatto, Claudio; Lerner, Blake; Tangri, Navdeep; Komenda, Paul

    2016-01-01

    Background Reactivation of latent Mycobacterium tuberculosis infection (LTBI) is a health concern for patients on dialysis or receiving a kidney transplant, as these patients are often immunosuppressed. The most frequently used test for LTBI screening in this population is the tuberculin skin test (TST). The diagnostic accuracy (sensitivity and specificity) of the TST in a contemporary North American or Western European dialysis population is unknown. Objectives Our objective was to determine...

  5. Peritonitis and catheter exit-site infection in patients on peritoneal dialysis at home

    OpenAIRE

    Ana Cristina Freire Abud; Luciana Kusumota; Manoel Antônio dos Santos; Flávia Fernanda Luchetti Rodrigues; Marta Maria Coelho Damasceno; Maria Lúcia Zanetti

    2015-01-01

    Objective: to analyze the complications related to peritonitis and catheter exit-site infections, in patients on peritoneal dialysis at home. Method: quantitative and cross-sectional study, carried out with 90 patients on peritoneal dialysis at home, in a municipality in the Northeast region of Brazil. For data collection, it was used two structured scripts and consultation on medical records. Descriptive analysis and comparison tests among independent groups were used, considering p

  6. Dietary Restrictions in Dialysis Patients: Is There Anything Left to Eat?

    OpenAIRE

    Kalantar-Zadeh, Kamyar; Brown, Amanda; Chen, Joline L. T.; Kamgar, Mohammad; Lau, Wei-Ling; Moradi, Hamid; Rhee, Connie M.; Streja, Elani; Kovesdy, Csaba P.

    2015-01-01

    A significant number of dietary restrictions are imposed traditionally and uniformly on maintenance dialysis patients, whereas there is very little data to support their benefits. Recent studies indicate that dietary restrictions of phosphorus may lead to worse survival and poorer nutritional status. Restricting dietary potassium may deprive dialysis patients of heart-healthy diets and lead to intake of more atherogenic diets. There is little data about the survival benefits of dietary sodium...

  7. [Prevalence of HIV infection in dialysis patients: results of a national multicenter study].

    Science.gov (United States)

    Poignet, J L; Desassis, J F; Chanton, N; Litchinko, M B; Zins, B; Kolko, A; Patte, R; Sobel, A

    1999-01-01

    In order to determine the prevalence of HIV infection in french patients with end-stage renal disease (ESRD) on maintenance dialysis therapy, questionnaire forms were mailed out in february 1997 to the heads of the 260 dialysis facilities. We documented number of patients on maintenance dialysis therapy (hemo and peritoneal dialysis) and for HIV infected dialysis patients: age, gender, cause and duration of ESRD, known duration of HIV infection, risk factors for HIV infection, HBV and/or HCV infection, presence of clinical acquired immunodeficiency syndrome (AIDS), total CD4 count and treatment with antiretroviral agents. Questionnaire forms were returned from 98% of the dialysis facilities. As of february 1997 some 22,707 patients with ESRD were treated by renal replacement therapy, 19,947 by hemodialysis (HD) and 2760 by peritoneal dialysis (PD). 82 patients with ESRD and HIV infection were reported corresponding to 0.36% prevalence rate of all patients undergoing dialysis at the time specified. The 82 study subjects with ESRD and HIV infection received hemodialysis (79 patients) or peritoneal dialysis (3 patients) in 42 facilities. Forty seven patients were treated in Paris and suburbs and 9 in our own center. All 82 patients comprised 63% men and 47% women which included patients coming from Africa (37%), Caribbean and Oceania (28%), Europe (35%) of a mean age of 41.8 years. Modes of transmission were homobisexuals 15%, heterosexuals 31%, intravenous drug abusers 17%, blood transfusion 17% and unknown 20%. The mean duration of HIV infection was 96 months (range 12-168 months) and the mean duration of ESRD was 58 months (range 1-235 months). HIV associated nephropathy was established in 31%. AIDS was diagnosed in 25 patients. Seventy one percent of the patients were receiving an antiretroviral drug (tritherapy in 25% of cases). In conclusion HIV prevalence rate among French dialysis patients is low and focused in Paris and oversea. Sexual transmission is the

  8. Dialysis modality choice in diabetic patients with end-stage kidney disease

    DEFF Research Database (Denmark)

    Couchoud, Cecile; Bolignano, Davide; Nistor, Ionut;

    2015-01-01

    BACKGROUND: Diabetes is the leading cause of end-stage kidney disease (ESKD). Because of conflicting results in observational studies, it is still subject to debate whether in diabetic patients the dialysis modality selected as first treatment (haemodialysis or peritoneal dialysis) may have a major...... on diabetes, end-stage kidney disease and dialysis modality. Selection of relevant studies, data extraction and analysis were performed by two independent reviewers. RESULTS: Twenty-five observational studies (23 on incident and 2 on prevalent cohorts) were included in this review. Mortality was the only main...... outcome addressed in large cohorts. When considering patient survival, results were inconsistent and varied across study designs, follow-up period and subgroups. We therefore found no evidence-based arguments in favour or against a particular dialysis modality as first choice treatment in patients...

  9. Hookworm Anemia in a Peritoneal Dialysis Patient in China.

    Science.gov (United States)

    Wu, Fuquan; Xu, Ying; Xia, Min; Ying, Guanghui; Shou, Zhangfei

    2016-06-01

    Hookworm infections as well as other intestinal nematodiases are endemic in China. In this case, a 70-year-old male showed symptoms of chest tightness, shortness of breath, and both lower extremities edema. The diagnostic result was chronic renal insufficiency, chronic kidney disease (5th stage), and renal anemia at first. Then, he received treatment with traditional drugs. However, this treatment did not help to alleviate the symptoms of the patient significantly. The results of gastroendoscopy showed hookworms in the duodenum, also confirmed by pathology examination. Anemia was markedly ameliorated after eliminating the parasites. The results mentioned above suggested that ancylostomiasis was the leading causes of anemia in this patient, and the etiology of anemia in uremic patients should be systematically considered. Especially when anemia could not be cured by regular treatments, rare diseases should be investigated. PMID:27417086

  10. [Assisted peritoneal dialysis].

    Science.gov (United States)

    Klarić, Dragan; Prkačin, Ingrid

    2014-04-01

    According to the National Registry of Renal Replacement Therapy (RRT), the incidence of chronic kidney disease (end-stage renal disease) and the need of RRT have declined in the last decade renal. One of the reasons for this tendency certainly is transplantation as the best choice. However, transplant procedure has limitations in elderly patients due to the number of comorbidities. This study was designed as retrospective analysis of outcomes in patients treated with peritoneal dialysis for a period of eleven years. Patients were divided into those who had been assisted or unassisted. Out of 100 patients treated with peritoneal dialysis (PD), 77 completed the treatment, including 26 assisted and 51 unassisted patients. Peritonitis was recorded in 20 assisted and 26 unassisted patients. Peritonitis was more common in unassisted patients, who were more frequently lost from PD. Assisted PD could be a good and safe choice of RRT in this special group of patients.

  11. Dialysis or conservative care for frail older patients: ethics of shared decision-making.

    Science.gov (United States)

    Muthalagappan, Seetha; Johansson, Lina; Kong, Wing May; Brown, Edwina A

    2013-11-01

    Increasing numbers of frail elderly with end-stage renal disease (ESRD) and multiple comorbidities are undertaking dialysis treatment. This has been accompanied by increasing dialysis withdrawal, thus warranting investigation into why this is occurring and whether a different approach to choosing treatment should be implemented. Despite being a potentially life-saving treatment, the physical and psychosocial burdens associated with dialysis in the frail elderly usually outweigh the benefits of correcting uraemia. Conservative management is less invasive and avoids the adverse effects associated with dialysis, but unfortunately it is often not properly considered until patients withdraw from dialysis. Shared decision-making has been proposed to allow patients active participation in healthcare decisions. Through this approach, patients will focus on their personal values to receive appropriate treatment, and perhaps opt for conservative management. This may help address the issue of dialysis withdrawal. Moreover, shared decision-making attempts to resolve the conflict between autonomy and other ethical principles, including physician paternalism. Here, we explore the ethical background behind shared decision-making, and whether it is genuinely in the patient's best interests or whether it is a cynical solution to encourage more patients to consider conservative care, thus saving limited resources.

  12. [99mTc-MAA peritoneal scintigraphy in pleuroperitoneal comunication in peritoneal dialysis patients].

    Science.gov (United States)

    Hernández Martínez, A C; Marín Ferrer, M D; Coronado Poggio, M; Escabias Del Pozo, C; Coya Viña, J; Martín Curto, L

    2010-01-01

    Peritoneal dialysis is a fully-contrasted alternative for the treatment of end-stage renal disease although it is not exempt of complications. Peritonitis and exit-site infections are among the most frequent complications found. Pleural effusion secondary to pleuroperitoneal communication (PPC) is a serious and uncommon complication in these patients. We present the case of a 50-year old man diagnosed of end-stage renal disease undergoing treatment with peritoneal dialysis who presented progressive dyspnea and right pleural effusion. The peritoneal scintigraphy with (99m)Tc-MAA makes it possible to confirm communication of intraperitoneal dialysis fluid to the pleural cavity. PMID:20117860

  13. 蔗糖铁注射液治疗慢性肾衰竭透析患者贫血的效果分析%Effectiveness analysis of iron sucrose injection in the treatment of anemia patients with chronic renal failure receiving dialysis

    Institute of Scientific and Technical Information of China (English)

    张玉环; 李艳; 郑璇

    2013-01-01

    目的 探讨蔗糖铁注射液治疗慢性肾衰竭透析患者贫血的效果.方法 将本科室2011年3月~2012年3月收治的64例慢性肾衰竭透析患者随机分为对照组和观察组,并分别口服速力菲片和静脉滴注蔗糖铁注射液.分析治疗效果,治疗前、治疗后3个月的贫血相关指标(红细胞比积HCT、血清铁蛋白FS、血红蛋白Hb、红细胞RBC和网织红细胞数RC)和治疗期间的不良反应情况.结果 治疗3个月后,观察组的总有效率高于对照组(81.25% vs.56.25%,P<0.05);除RC外,观察组治疗后的其余贫血指标均优于对照组,除HCT(P <0.05),其余均为P<0.01;两组的不良反应率差异无统计学意义(P>0.05).结论 蔗糖铁注射液治疗慢性肾衰竭透析患者贫血的效果较好,不仅可提高治疗有效率,且患者的耐受好.%Objective To explore the effectiveness of iron sucrose injection in the treatment of anemia patients with chronic renal failure receiving dialysis.Methods 64 anemia patients with chronic kidney disease receiving dialysis of our hospital from March 2011 to March 2012 were randomly divided into Control group (ferrous succinate tablets) and Observation group (iron sucrose injection).The following indices were compared between two groups,such as treatment effect,anemia related indicators (HCT,FS,Hb,RBC and RC) before and 3 months after treatment as well as the adverse reactions.Results Three months later,the total effective rate of Observation group was higher than that of Control group (81.25% vs.56.25%,P < 0.05).Despite of RC,the remaining anemia related indicators of Observation group were superior to those of control group.There were no statistical differences on the adverse reaction rate of two groups (P > 0.05).Conclusion The effectiveness of iron sucrose injection in the treatment of anemia with chronic renal failure receiving dialysis is better.iron sucrose injection;chronic renal failure;anemia;clinical effect

  14. A comparison of the quality of life of the patients undergoing hemodialysis versus peritoneal dialysis and its correlation to the quality of dialysis.

    Science.gov (United States)

    Atapour, Abdolamir; Nasr, Salar; Boroujeni, Amir Momeni; Taheri, Diana; Dolatkhah, Shahaboddin

    2016-03-01

    Over the years, there has been a steady increase in the number of patients requiring dialysis. However, no consensus exists between choosing either hemodialysis (HD) or peritoneal dialysis (PD) as the preferred method of dialysis for patients. In this study, we have compared the quality of life of the patients undergoing either HD or PD. This cross-sectional study was performed in the dialysis center of the Noor and Saint Ali Asghar University Hospital in Isfahan, Iran in 2012. Forty-six patients who underwent PD (28 males and 18 females) and 46 similar patients undergoing HD (26 males and 20 females) were compared. A standardized Persian version of the short form-36 (SF-36) tool was used to assess the quality of life and to assess the quality of dialysis weekly Kt/V in patients undergoing PD and single random Kt/V sampling in HD patients were assessed. Patients undergoing PD reported higher scores in physical functioning. The lowest scores in both groups were reported in mental health section. In physical functioning section, physical role functioning section and overall score of the SF-36 tool, PD patients reported significantly higher scores compared to the HD patients (P qualities of the dialysis in the two patient groups. Aspects of quality of life such as physical functioning, physical role functioning, bodily pain, general health perceptions, and overall score were significantly different between the two groups. If these results are substantiated by subsequent longitudinal studies, then the choice of dialysis could be better guided in patients by the quality of life issues.

  15. A comparison of the quality of life of the patients undergoing hemodialysis versus peritoneal dialysis and its correlation to the quality of dialysis

    Directory of Open Access Journals (Sweden)

    Abdolamir Atapour

    2016-01-01

    Full Text Available Over the years, there has been a steady increase in the number of patients requiring dialysis. However, no consensus exists between choosing either hemodialysis (HD or peritoneal dialysis (PD as the preferred method of dialysis for patients. In this study, we have compared the quality of life of the patients undergoing either HD or PD. This cross-sectional study was performed in the dialysis center of the Noor and Saint Ali Asghar University Hospital in Isfahan, Iran in 2012. Forty-six patients who underwent PD (28 males and 18 females and 46 similar patients undergoing HD (26 males and 20 females were compared. A standardized Persian version of the short form-36 (SF-36 tool was used to assess the quality of life and to assess the quality of dialysis weekly Kt/V in patients undergoing PD and single random Kt/V sampling in HD patients were assessed. Patients undergoing PD reported higher scores in physical functioning. The lowest scores in both groups were reported in mental health section. In physical functioning section, physical role functioning section and overall score of the SF-36 tool, PD patients reported significantly higher scores compared to the HD patients (P <0.05. There was no significant difference between the qualities of the dialysis in the two patient groups. Aspects of quality of life such as physical functioning, physical role functioning, bodily pain, general health perceptions, and overall score were significantly different between the two groups. If these results are substantiated by subsequent longitudinal studies, then the choice of dialysis could be better guided in patients by the quality of life issues.

  16. Successful Pregnancy in a 31-Year-Old Peritoneal Dialysis Patient with Bilateral Nephrectomy

    Directory of Open Access Journals (Sweden)

    Ahmed Abu-Zaid

    2013-01-01

    Full Text Available Frequency of pregnancy among childbearing age women with end-stage renal disease (ESRD undergoing long-term periodic dialysis ranges from 1% to 7%. Although pregnancy in dialysis women with ESRD is considered a largely high-risk pregnancy, occurrence of successful pregnancy is not impossible with success rates approaching 70%. Rates of successful pregnancy are greatly impacted by early pregnancy diagnosis and preserved residual renal functions. Herein, to the best of our knowledge, we report the first case of successful pregnancy (despite late diagnosis at 14 weeks of gestation in a 31-year-old peritoneal dialysis patient with bilateral nephrectomy and no whatsoever preserved residual renal function. Moreover, a literature review on pregnancy in dialysis patients is presented.

  17. Phosphate control in dialysis

    Directory of Open Access Journals (Sweden)

    Cupisti A

    2013-10-01

    Full Text Available Adamasco Cupisti,1 Maurizio Gallieni,2 Maria Antonietta Rizzo,2 Stefania Caria,3 Mario Meola,4 Piergiorgio Bolasco31Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; 2Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Milan, Italy; 3Territorial Department of Nephrology and Dialysis, ASL Cagliari, Italy; 4Sant'Anna School of Advanced Studies, University of Pisa, Pisa, ItalyAbstract: Prevention and correction of hyperphosphatemia is a major goal of chronic kidney disease–mineral and bone disorder (CKD–MBD management, achievable through avoidance of a positive phosphate balance. To this aim, optimal dialysis removal, careful use of phosphate binders, and dietary phosphate control are needed to optimize the control of phosphate balance in well-nourished patients on a standard three-times-a-week hemodialysis schedule. Using a mixed diffusive–convective hemodialysis tecniques, and increasing the number and/or the duration of dialysis tecniques are all measures able to enhance phosphorus (P mass removal through dialysis. However, dialytic removal does not equal the high P intake linked to the high dietary protein requirement of dialysis patients; hence, the use of intestinal P binders is mandatory to reduce P net intestinal absorption. Unfortunately, even a large dose of P binders is able to bind approximately 200–300 mg of P on a daily basis, so it is evident that their efficacy is limited in the case of an uncontrolled dietary P load. Hence, limitation of dietary P intake is needed to reach the goal of neutral phosphate balance in dialysis, coupled to an adequate protein intake. To this aim, patients should be informed and educated to avoid foods that are naturally rich in phosphate and also processed food with P-containing preservatives. In addition, patients should preferentially choose food with a low P-to-protein ratio. For example, patients could choose egg white or protein from a vegetable source

  18. Parameter estimation in six numerical models of transperitoneal transport of potassium in patients undergoing peritoneal dialysis

    DEFF Research Database (Denmark)

    Graff, J; Fugleberg, S; Joffe, P;

    1995-01-01

    The mechanisms of transperitoneal potassium transport during peritoneal dialysis were evaluated by validation of different mathematical models. The models were designed to elucidate the presence or absence of diffusive, non-lymphatic convective and lymphatic convective solute transport....... Experimental results were obtained from 26 non-diabetic patients undergoing peritoneal dialysis. The validation procedure demonstrated that models including both diffusive and non-lymphatic convective solute transport were superior to the other models. Lymphatic convective solute transport was not identifiable...

  19. Pharmacokinetics of Quinupristin-Dalfopristin in Continuous Ambulatory Peritoneal Dialysis Patients

    OpenAIRE

    Johnson, Curtis A.; Taylor, Claude A.; Zimmerman, Stephen W.; Bridson, William E.; Chevalier, Paul; Pasquier, Olivier; Baybutt, Robert I.

    1999-01-01

    Quinupristin-dalfopristin may be useful for treatment of organisms causing peritoneal dialysis-related peritonitis, including methicillin-resistant coagulase-negative staphylococci, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci. The pharmacokinetic profiles of single intravenous doses of this combination streptogramin antibiotic of 7.5 mg/kg of body weight were characterized for eight noninfected patients receiving continuous ambulatory peritoneal dialysis....

  20. The Danish Registry on Regular Dialysis and Transplantation: completeness and validity of incident patient registration

    DEFF Research Database (Denmark)

    Hommel, Kristine; Rasmussen, Søren; Madsen, Mette;

    2010-01-01

    The Danish National Registry on Regular Dialysis and Transplantation (NRDT) provides systematic information on the epidemiology and treatment of end-stage chronic kidney disease in Denmark. It is therefore of major importance that the registry is valid and complete. The aim of the present study...

  1. Comparison of Toxoplasma gondii seropositivity in hemodialysis and peritoneal dialysis patients

    Institute of Scientific and Technical Information of China (English)

    Faezeh Hamidi; Jalal Etemadi; Nader Ghabouli Mehrabani; Mahmoud Mahami Oskouei; Roza Motavalli; Mohammad RezaArdalan

    2015-01-01

    Objective: To compare the seropositivity of Toxoplasma gondii in a group of peritoneal dialysis patients with hemodialysis patients and a general local population as a control group in Tabriz, Northwest Iran. Methods: A total of 176 individuals were participated in the present study. Among them, 42 were peritoneal dialysis patients, 84 were hemodialysis patients and 50 were healthy volunteers. Anti-Toxoplasma immunoglobulin G and immunoglobulin M serologic study was administered on the collected serums and then the obtained data were analyzed using statistical methods. Results: In the present research, 70.2% of hemodialysis patients, 66.6% of peritoneal dialysis patients and 68% of control group had positive results for anti-Toxoplasma immunoglobulin G antibody. All individuals of the groups had negative serologic results for anti-Toxoplasma immunoglobulin M antibody. There was no significant difference between Toxoplasma gondii seropositivity in hemodialysis patients and peritoneal dialysis patients and general population (P> 0.05). Conclusions: The findings showed that either peritoneal dialysis or hemodialysis doesn’t increase the risk of Toxoplasma seropositivity in our region (Northwest Iran). It could be explained by the fact that the present research is carried out in a high seroprevalent area scale in which the majority of normal population had previous exposure to this parasitical infection.

  2. Comparison of Toxoplasma gondii seropositivity in hemodialysis and peritoneal dialysis patients

    Directory of Open Access Journals (Sweden)

    Faezeh Hamidi

    2015-08-01

    Full Text Available Objective: To compare the seropositivity of Toxoplasma gondii in a group of peritoneal dialysis patients with hemodialysis patients and a general local population as a control group in Tabriz, Northwest Iran. Methods: A total of 176 individuals were participated in the present study. Among them, 42 were peritoneal dialysis patients, 84 were hemodialysis patients and 50 were healthy volunteers. Anti-Toxoplasma immunoglobulin G and immunoglobulin M serologic study was administered on the collected serums and then the obtained data were analyzed using statistical methods. Results: In the present research, 70.2% of hemodialysis patients, 66.6% of peritoneal dialysis patients and 68% of control group had positive results for anti-Toxoplasma immunoglobulin G antibody. All individuals of the groups had negative serologic results for anti-Toxoplasma immunoglobulin M antibody. There was no significant difference between Toxoplasma gondii seropositivity in hemodialysis patients and peritoneal dialysis patients and general population (P > 0.05. Conclusions: The findings showed that either peritoneal dialysis or hemodialysis doesn’t increase the risk of Toxoplasma seropositivity in our region (Northwest Iran. It could be explained by the fact that the present research is carried out in a high seroprevalent area scale in which the majority of normal population had previous exposure to this parasitical infection.

  3. 临床护理路径应用于慢性肾衰竭患者腹膜透析治疗的体会%Nursing experiences on clinical nursing pathway used for patients with chronic renal failure undergoing therapy of peritoneal dialysis

    Institute of Scientific and Technical Information of China (English)

    姚巧玲; 邱淑丽

    2013-01-01

    目的 探讨临床护理路径(CNP)应用于慢性肾衰竭患者腹膜透析治疗的护理体会.方法 行腹膜透析治疗的98例慢性肾衰竭患者作为研究对象,随机分为观察组和对照组,对照组给予常规护理,观察组给予CNP护理.结果 健康知识掌握情况中,两组的慢性肾衰竭和腹膜透析相关知识掌握情况比较差异无统计学意义(P>0.05),观察组饮食,运动和心理调整等的掌握情况均显著优于对照组(P<0.01),透析操作掌握时间显著短于对照组(P<0.01),护理满意度显著高于对照组(P<0.01).结论 基于对患者进行个体性评估分析展开的CPN护理,对于促进患者身心方面的整体调整具有积极意义,体现了以患者为中心的护理服务理念,值得临床考虑.%Objective To explore the nursing experiences on clinical nursing pathway (CNP) used for patients with chronic renal failure (CRF) undergoing therapy of peritoneal dialysis.Methods 98 cases of patients with CRF undergoing therapy of peritoneal dialysis were divided into control group and experimental group,control group was given routine nursing and experimental group was given CNP care.Results The acquisition of knowledge about CRF and peritoneal dialysis in two groups had no significant difference (t=1.818,P>0.05; t=1.464,P>0.05),diet,sports and psychological recovery in experimental group were significantly better than those in control group (t=8.330,P<0.01 ; t=8.405,P<0.01 ; t=8.533,P<0.01).The mastering time of the dialysis operation in experimental group was significantly shorter than that in control group,satisfaction degree of nursing in experimental group was also significantly better than that in control group (x2=5.466,P<0.01; x 2=5.237,P<0.01).Conclusion The CNP nursing based on individual evaluation is meaningful for prompting integral adjustment of patients' mind and body,and shows the nursing principle of patientoriented,so it deserves consideration in

  4. Upper Tract Urothelial Carcinomas in Patients with Chronic Kidney Disease: Relationship with Diagnostic Challenge

    OpenAIRE

    Li-Jen Wang; Shen-Yang Lee; Bin Tean Teh; Cheng-Keng Chuang; Joëlle Nortier

    2014-01-01

    Chronic kidney disease and upper tract urothelial carcinomas display a bidirectional relationship. Review of the literature indicates that early diagnosis and correct localization of upper tract urothelial carcinomas in dialysis patients and kidney transplant recipients are important but problematic. Urine cytology and cystoscopy have limited sensitivity for the diagnosis of upper tract urothelial carcinomas in dialysis patients. Enhanced computed tomography and magnetic resonance imaging cou...

  5. Sclerosing encapsulating peritonitis in chronic ambulatory peritoneal dialysis;preoperative catheter drainage : a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Hoon [Dankook Univ. Hospital, Seoul (Korea, Republic of)

    1996-10-01

    Sclerosing encapsulating peritonitis is a well recognized, but uncommon, complication of chronic ambulatory peritoneal dialysis. I report a case of sclerosing encapsulating peritonitis in which percutaneous catheter drainage was performed preoperatively. Ultrasonography(US) and computed tomography(CT) showed a large multi-septated cystic mass which occupied nearly all the peritoneal cavity. Percutaneous drainage with two 8.5 French catheters was preoperatively performed under fluoroscopy and about 2100 ml of bloody fluid was drained for 20 days. On follow-up CT, the size of the cyst had significantly decreased and anoperation was performed. It is considered that percutaneous catheter drainage is useful in the preoperative decompression of sclerosing encapsulating peritonitis.

  6. Parathyroid ultrasonography and bone metabolic profile of patients on dialysis with hyperparathyroidism

    Science.gov (United States)

    Ribeiro, Cláudia; Penido, Maria Goretti Moreira Guimarães; Guimarães, Milena Maria Moreira; Tavares, Marcelo de Sousa; Souza, Bruno das Neves; Leite, Anderson Ferreira; de Deus, Leonardo Martins Caldeira; Machado, Lucas José de Campos

    2016-01-01

    AIM To evaluate the parathyroid ultrasonography and define parameters that can predict poor response to treatment in patients with secondary hyperparathyroidism due to renal failure. METHODS This cohort study evaluated 85 patients with chronic kidney disease stage V with parathyroid hormone levels above 800 pg/mL. All patients underwent ultrasonography of the parathyroids and the following parameters were analyzed: Demographic characteristics (etiology of chronic kidney disease, gender, age, dialysis vintage, vascular access, use of vitamin D), laboratory (calcium, phosphorus, parathyroid hormone, alkaline phosphatase, bone alkaline phosphatase), and the occurrence of bone changes, cardiovascular events and death. The χ2 test were used to compare proportions or the Fisher exact test for small sample frequencies. Student t-test was used to detect differences between the two groups regarding continuous variables. RESULTS Fifty-three patients (66.4%) had parathyroid nodules with higher levels of parathyroid hormone, calcium and phosphorus. Sixteen patients underwent parathyroidectomy and had higher levels of phosphorus and calcium × phosphorus product (P = 0.03 and P = 0.006, respectively). They also had lower mortality (32% vs 68%, P = 0.01) and lower incidence of cardiovascular or cerebrovascular events (27% vs 73%, P = 0.02). Calcium × phosphorus product above 55 mg2/dL2 [RR 1.48 (1.06, 2.08), P = 0.03], presence of vascular calcification [1.33 (1.01, 1.76), P = 0.015] and previous occurrence of vascular events [RR 2.25 (1.27, 3.98), P < 0.001] were risk factors for mortality in this population. There was no association between the occurrence of nodules and mortality. CONCLUSION The identification of nodules at ultrasonography strengthens the indication for parathyroidectomy in patients with secondary hyperparathyroidism due to renal failure. PMID:27648407

  7. 生脉承气汤配合结肠透析治疗慢性肾脏病3~4期疗效观察%Observation of curative effect of Shengmai Chengqi Tang combined with colon dialysis in patients with chronic kidney disease of 3-4 phase

    Institute of Scientific and Technical Information of China (English)

    张九芝

    2015-01-01

    Objective It is to investigate the clinical effect of Shengmai Chengqi Tang ( SMCQT) combined with colon di-alysis in patients with chronic kidney disease ( CKD) of 3—4 phase.Methods 120 patients with CKD of 3 ~4 phase were selected and randomly divided into research group and the control group with 60 cases in each, all patients were given basic treatment and colon dialysis therapy, on this basis, the patients in research group were treated with SMCQT for adjuvant thera-py.The differences related to clinical indicators of patients before and after treatment were compared between the two groups. Results After treatment, the levels of SCr, BUN, UA in the research group were significantly lower than those in the control group (all P0.05).Conclusion SMCQT with colon dialysis can significantly improve the clinical symptoms and renal function indicators of the patients with CKD of 3~4 phase, at the same time improve the nutritional status of patients.%目的:探讨中医生脉承气汤配合结肠透析治疗慢性肾脏病(CKD)3~4期患者的临床效果。方法选取120例CKD 3~4期患者,采用随机数字表法分为研究组和对照组各60例,2组均给予基础治疗、结肠透析治疗,研究组加用生脉承气汤治疗,比较2组治疗前后相关临床指标的差异。结果治疗后,研究组SCr、BUN、UA水平均显著低于对照组(P均<0.05),eGFR显著高于对照组(P<0.05);2组血清钙、钾、磷、HCO-、Hb、ALB水平均较治疗前显著好转(P均<0.05),研究组血Hb水平高于对照组(P<0.05);研究组临床证候总积分显著低于对照组(P<0.05);2组SGA分布较治疗前均显著好转(P<0.05),且2组SGA评估分布比较差异无统计学意义(P>0.05)。结论中医生脉承气汤配合结肠透析治疗CKD 3~4期患者能够显著改善患者的临床证候、肾功能指标,同时改善患者的营养状况。

  8. Diabetic Muscle Infarction: A Rare Cause of Acute Limb Pain in Dialysis Patients

    Directory of Open Access Journals (Sweden)

    G. De Vlieger

    2013-01-01

    Full Text Available Diabetic muscle infarction is a rare microangiopathic complication occurring in patients with advanced diabetes mellitus. Diabetic patients with chronic kidney disease stage Vd are prone to develop this complication. The presenting symptom is a localized painful swelling of the affected limb. Symptoms usually resolve spontaneously during the following weeks, but frequent relapse can occur and in some cases swelling may lead to compartment syndrome. Biochemical blood analyses show an elevated C-reactive protein, but creatine kinase is often normal. Diagnosis can be made on clinical presentation and imaging, with magnetic resonance imaging as the gold standard. Histology is often not contributive. Treatment consists of rest, analgesics, rigorous glycemic control and low-dose aspirin. Severe cases of compartment syndrome require fasciotomy. In the current paper, we present two diabetic patients with cystic fibrosis, who are treated with automated peritoneal dialysis and suffered from episodic lower limb infarction. We subsequently review 48 episodes of diabetic muscle infarction previously reported in the literature in patients with end-stage renal disease.

  9. Accuracy and limitations of the diagnosis of malnutrition in dialysis patients.

    Science.gov (United States)

    Kovesdy, Csaba P; Kalantar-Zadeh, Kamyar

    2012-07-01

    Uremic malnutrition, also known as protein-energy wasting (PEW), is a common phenomenon in maintenance dialysis patients and a risk factor for poor clinical outcomes including worse quality of life and increased hospitalization and mortality. The paradoxical association between traditional cardiovascular risk factors and better outcomes in dialysis patients also referred to as "reverse epidemiology," is a good example of the powerful effect-modifying impact of the nutritional status in this population. Measures of food intake, body composition tools, nutritional scoring systems, and laboratory values such as serum albumin are used to diagnose PEW and to assess the degree of severity of PEW without clearly validated diagnostic criteria. Some observational studies suggest that inflammation is a missing link between the PEW and poor clinical outcomes in dialysis patients, although PEW per se may also predispose to illness and inflammation. Ongoing debate as to whether such surrogates as serum albumin or prealbumin concentrations are markers of nutritional status, inflammation, comorbidity, or other conditions has led to confusion and diagnostic and therapeutic nihilism. Irrespective of the cause of hypoalbuminemia in dialysis patients, evidence suggests that nutritional interventions can increase serum albumin in dialysis patients. Hence, we should continue assessing serum albumin and other surrogates of nutritional status to risk-stratify patients and to allocate nutritional therapy, while well-designed, large-scale, randomized, controlled trials of the effects of nutritional intake on clinical outcomes are awaited. PMID:22731746

  10. Aluminum concentrations in serum, dialysate, urine and bone among patients undergoing continuous ambulatory peritoneal dialysis (CAPD)

    DEFF Research Database (Denmark)

    Joffe, P; Olsen, F; Heaf, J G;

    1989-01-01

    Aluminum (Al) concentration in serum, urine, and dialysate was estimated in 21 patients undergoing continuous ambulatory peritoneal dialysis (CAPD). In 12 of the patients bone Al concentration was measured as well. Mean serum Al level was 32.4 +/- 21.0 micrograms/l. The Al concentrations in the d......Aluminum (Al) concentration in serum, urine, and dialysate was estimated in 21 patients undergoing continuous ambulatory peritoneal dialysis (CAPD). In 12 of the patients bone Al concentration was measured as well. Mean serum Al level was 32.4 +/- 21.0 micrograms/l. The Al concentrations...

  11. Changes in biochemical, hemodynamic, and dialysis adherence parameters in hemodialysis patients during Ramadan.

    Science.gov (United States)

    Alshamsi, Shaikha; Binsaleh, Fatima; Hejaili, Fayez; Karkar, Ayman; Moussa, Dujana; Raza, Hamad; Parbat, Parkash; Al Suwida, Abdulkareem; Alobaili, Saad; AlSehli, R; Al Sayyari, Abdulla

    2016-04-01

    This paper aimed to study the effect of Ramadan fasting on biochemical and clinical parameters and compliance for dialysis. A prospective multicenter observational cross-sectional study comparing fasting with a non-fasting stable adult hemodialysis patients for demographic and biochemical parameters, compliance with dialysis, inter-dialytic weight gain, pre- and post-blood pressure, and frequency of intradialytic hypotensive episodes was carried out. Six hundred thirty-five patients, of whom 64.1% fasted, were studied. The fasters were younger (53.3 ± 16.2 vs. 58.4 ± 16.1 years; P = 0.001) but had similar duration on dialysis (P = 0.35). More fasters worked (22.0% vs. 14.6%; P = 0.001) and missed dialysis sessions during Ramadan. No differences were noted between groups in sex, diabetic status, or dialysis shift or day. There were no differences in the pre- and post-dialysis blood pressure; serum potassium, albumin or weight gain; diabetic status; sex; and dialysis shift time or days. However, serum phosphorous was significantly higher in the fasting group (2.78 ± 1.8 vs. 2.45 ± 1.6 mmol/L; P = 0.045). There were no intragroup differences in any of the parameters studied when comparing the findings during Ramadan with those in the month before Ramadan. Fasters were significantly younger and more likely to be working, to miss dialysis sessions, and to have higher serum phosphorous levels. No other differences were observed. PMID:26420510

  12. Influence of peritoneal dialysis solution biocompatibility on long-term survival of patients on continuous ambulatory peritoneal dialysis and the technique itself

    Directory of Open Access Journals (Sweden)

    Stanković-Popović Verica

    2013-01-01

    Full Text Available Background/Aim. Morbidity and mortality of continous ambulatory peritoneal dialysis (CAPD patients is still very high. The aim of the study was to evaluate the effects of peritoneal dialysis (PD solutions (standard vs biocompatible on long-term patients’ and the techique survival. Methods. A total of 42 stable patients on CAPD participated in this crosssectional study. They were prospectively followed-up during the twelve years. Patients with severe anemia (Hb 1 mm; carotid narrowing degree > 50%, presence of carotid plaques in both common carotide, ischaemic heart disease, cerebrovascular event and peripheral vascular disease with or without amputation were independent predictors of overall patient survival. Duration of dialysis was only independent predictor of overall technique survival. Conclusion. Although patients treated with biocompatible solutions showed significantly better survival, the role of biocompatibility of CAPD solutions in patients and technique survival have to be confirmed. Namely, multivariate analysis confirmed that duration of dialysis, serum triglyceride and cardiovascular score significantly predicted overall CAPD patients survival, while only duration of dialysis was found to be independent predictor of overall techique survival.

  13. Congestive heart failure in patients with chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Poskurica Mileta

    2014-01-01

    Full Text Available Cardiovascular disorders are the most frequent cause of death (46-60% among patients with advanced chronic renal failure (CRF, and on dialysis treatment. Uremic cardiomyopathy is the basic pathophysiologic substrate, whereas ischemic heart disease (IHD and anemia are the most important contributing factors. Associated with well-know risk factors and specific disorders for terminal kidney failure and dialysis, the aforementioned factors instigate congestive heart failure (CHF. Suspected CHF is based on the anamnesis, clinical examination and ECG, while it is confirmed and defined more precisely on the basis of echocardiography and radiology examination. Biohumoral data (BNP, NT-proBNP are not sufficiently reliable because of specific volemic fluctuation and reduced natural clearance. Therapy approach is similar to the one for the general population: ACEI, ARBs, β-blockers, inotropic drugs and diuretics. Hypervolemia and most of the related symptoms can be kept under control effectively by the isolated or ultrafiltation, in conjunction with dialysis, during the standard bicarbonate hemodialysis or hemodiafiltration. In the same respect peritoneal dialysis is efficient for the control of hypervolemia symptoms, mainly during the first years of its application and in case of the lower NYHA class (II°/III°. In general, heart support therapy, surgical interventions of the myocardium and valve replacement are rarely used in patients on dialysis, whereas revascularization procedures are beneficial for associated IHD. In selected cases the application of cardiac resynchronization and/or implantation of a cardioverter defibrillator are advisable.

  14. Palliative care for patients with malignancy and end-stage renal failure on peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Lv Jing

    2014-01-01

    Full Text Available Background: Many patients on peritoneal dialysis experience a poor quality of life because of a high burden of comorbid conditions. Dialysists must pay more attention to reducing a patient′s pain and suffering, both physical and psychological and improve the quality of life for the patients as much as possible. A consensus regarding eligibility for palliative care and the delivery of these inventions does not currently exist. Objective: The present study aimed to describe the implementation of palliative care for end-stage renal failure patients on peritoneal dialysis. Design: A report on three cases. Materials and Methods: This study included three outpatients on peritoneal dialysis who received palliative care and died between January 2008 and June 2010. Measurements: The patients′ comorbidities, nutritional status, and functional status were evaluated using the Charlson comorbidity score, subjective global assessment, and Karnofsky Performance Score index, respectively. The Hamilton depression and Hamilton anxiety scales were also employed. The patients′ clinical manifestations and treatments were reviewed. Results: Each patient displayed 11-16 symptoms. The Charlson comorbidity scores were from 11 to 13, the subjective global assessment indicated that two patients were class assigned to "C" and one to class "B", and the mean Karnofsky index was <40. Among these patients, all experienced depression and two experienced anxiety, Low doses of hypertonic glucose solutions, skin care, psychological services, and tranquillizers were intermittently used to alleviate symptoms, after making the decision to terminate dialysis. The patients died 5 days to 2 months after dialysis withdrawal. Conclusion: The considerable burden associated with comorbid conditions, malnutrition, poor functional status, and serious psychological problems are predictors of poor patient prognoses. Withdrawal of dialysis, palliative care, and psychological interventions

  15. [The management of dialysis patients seropositive for HBsAg, anti-HCV, or anti-HIV antibodies].

    Science.gov (United States)

    Fabrizi, Fabrizio; Messa, Piergiorgio

    2012-01-01

    Infections by hepatitis B or hepatitis C virus are still common among patients on maintenance dialysis in Western countries. The natural history of HBV and HCV in the dialysis population remains unclear; however, there is good evidence showing an adverse impact of an anti-HCV seropositive status on survival in dialysis patients. A recent meta-analysis of observational studies (n=7, 11,589 unique patients) reported that anti-HCV-positive patients on dialysis had a higher mortality rate than those who were anti-HCV negative (adjusted hazard ratio=1.35, 95% confidence interval, 1.13; 1.59, pdialysis. Standard precautions and specific procedures against the transmission of blood-borne agents have been recommended to control HCV infection within dialysis units. Isolation by dialysis machines, staff and rooms has been strongly recommended to control HBV. Vaccination is an important tool against transmission of HBV infection among patients on maintenance dialysis; however, the immune response towards the hepatitis B vaccine in uremic patients remains unsatisfactory. Monotherapy with lamivudine is currently used for dialysis patients with hepatitis B whereas combination antiviral therapy (pegylated interferon plus ribavirin) is the standard of care for hepatitis C in the dialysis population, even if various side effects have been observed.

  16. Darbepoetin alfa once every 2 weeks for treatment of anemia in dialysis patients

    DEFF Research Database (Denmark)

    Mann, J; Kessler, M; Villa, Giulio Palludan;

    2007-01-01

    in a large cohort of dialysis patients. METHODS: Data were combined from eight similarly designed 24-week phase 3b European studies, in which patients receiving EPO alfa or beta once-weekly were converted to Q2W darbepoetin alfa. Darbepoetin alfa dosage was titrated to maintain hemoglobin (Hb) between 10......-tolerated. CONCLUSIONS: Q2W darbepoetin alfa is effective in maintaining Hb levels in dialysis patients switched from weekly rHuEPO, regardless of the route of administration and with no notable increase in the weekly equivalent dose....

  17. Strategies to improve clinical outcomes in peritoneal dialysis patients: delivered dose and membrane transport.

    Science.gov (United States)

    Churchill, D N

    1998-12-01

    For patients with end-stage renal disease treated with peritoneal dialysis, prospective cohort studies using multivariate statistical analysis have shown an association between greater urea clearance and a decreased relative risk for death. The recommended weekly Kt/V for urea is 2.0, with the corresponding creatinine clearance (CrCl) of 60 L/1.73 m2. This is considered adequate dialysis but fails to define optimum urea and CrCl targets. The assumption that renal and peritoneal clearances are equivalent has been challenged by circumstantial data and is probably untenable. The relative importance of these clearances requires definition. The suggestion that CrCl is a more important indicator of adequacy of dialysis is confounded by association with renal, rather than peritoneal, clearance and perhaps by the early referral and initiation of dialysis. Recent reports have shown an association between increased peritoneal membrane transport and an increased relative risk for technique failure and/or death. Patients with higher peritoneal transport should have greater clearance of urea and creatinine and better clinical outcomes. Possible explanations for this apparent contradiction include the adverse effects of increased glucose absorption, malnutrition, and fluid overload, the latter caused by decreased ultrafiltration. Available data suggest an important role for the failure of ultrafiltration among patients treated with continuous ambulatory peritoneal dialysis (CAPD). Strategies to improve the clearance of urea and creatinine include the preservation of residual renal function and increased peritoneal clearance. Loss of residual renal function may be delayed by the avoidance of nephrotoxic drugs and angiographic dye. Peritoneal clearance can be enhanced by a combination of increased volume and frequency of peritoneal dialysis cycles. Ultrafiltration failure, but not protein loss, can be addressed with shorter cycles with nocturnal peritoneal dialysis. Development of

  18. Dementia in patients undergoing long-term dialysis: aetiology, differential diagnoses, epidemiology and management.

    Science.gov (United States)

    Rob, P M; Niederstadt, C; Reusche, E

    2001-01-01

    Dementia in patients undergoing long-term dialysis has not been clearly defined; however, four different entities have been described. Uraemic encephalopathy is a complication of uraemia and responds well to dialysis. Dialysis encephalopathy syndrome, the result of acute intoxication of aluminium caused by the use of an aluminium-containing dialysate, was a common occurrence prior to 1980. However, using modern techniques of water purification, such acute intoxication can now be avoided. Dialysis-associated encephalopathy/dementia (DAE) is always associated with elevated serum aluminium levels. Pathognomonic morphological changes in the brain have been described, but the mechanism for the entry of aluminium into the CNS is incompletely understood. The mechanisms involved in the pathogenesis of the neurotoxicity associated with aluminium are numerous. Although only a very small fraction of ingested aluminium is absorbed, the continuous oral aluminium intake from aluminium-based phosphate binders, and also of dietary or environmental origin, is responsible for aluminium overload in dialysis patients. Age-related dementia, especially vascular dementia, occurs in patients undergoing long-term dialysis as frequently as it does in the general population. The differential diagnoses of dialysis-associated dementias should include investigation for metabolic encephalopathies, heavy metal or trace element intoxications, and distinct structural neurological lesions such as subdural haematoma, normal pressure hydrocephalus, stroke and, particularly, hypertensive encephalopathy and multi-infarct dementia. To prevent DAE, dietary training programmes should aim to achieve the lowest phosphate intake and pharmacological tools should be used to keep serum phosphate levels below 2 mmol/L. To prevent vascular dementia, lifestyle modification should be undertaken, including optimal physical activity and fat intake, nicotine abstinence, and targeting optimal blood glucose, cholesterol

  19. Effect of diuretic use on 30-day postdialysis mortality in critically ill patients receiving acute dialysis.

    Directory of Open Access Journals (Sweden)

    Vin-Cent Wu

    Full Text Available BACKGROUND: The impact of diuretic usage and dosage on the mortality of critically ill patients with acute kidney injury is still unclear. METHODS AND RESULTS: In this prospective, multicenter, observational study, 572 patients with postsurgical acute kidney injury receiving hemodialysis were recruited and followed daily. Thirty-day postdialysis mortality was analyzed using Cox's proportional hazards model with time-dependent covariates. The mean age of the 572 patients was 60.8±16.6 years. Patients with lower serum creatinine (p = 0.031 and blood lactate (p = 0.033 at ICU admission, lower predialysis urine output (p = 0.001 and PaO(2/FiO(2 (p = 0.039, as well as diabetes (p = 0.037 and heart failure (p = 0.049 were more likely to receive diuretics. A total of 280 (49.0% patients died within 30 days after acute dialysis initiation. The analysis of 30-day postdialysis mortality by fitting propensity score-adjusted Cox's proportional hazards models with time-dependent covariates showed that higher 3-day accumulated diuretic doses after dialysis initiation (HR = 1.449, p = 0.021 could increase the hazard rate of death. Moreover, higher time-varying 3-day accumulative diuretic doses were associated with hypotension (p<0.001 and less intense hemodialysis (p<0.001 during the acute dialysis period. BACKGROUND AND SIGNIFICANCE: Higher time-varying 3-day accumulative diuretic dose predicts mortality in postsurgical critically ill patients requiring acute dialysis. Higher diuretic doses are associated with hypotension and a lower intensity of dialysis. Caution should be employed before loop diuretics are administered to postsurgical patients during the acute dialysis period.

  20. Serum vitamin A levels and associated abnormalities in patients on regular dialysis treatment.

    Science.gov (United States)

    Werb, R; Clark, W F; Lindsay, R M; Jones, E O; Linton, A L

    1979-08-01

    Multivitamin preparations are commonly administered to regular dialysis treatment (RDT) patients. Serum Vitamin A was measured in 72 patients on RDT. Elevated serum Vitamin A levels (102.29 +/- 26.95 microgram/dl [3.57 +/- 0.94 mumoles/l]) were found in the dialysis population (normal 40.98 +/- 6.71 microgram/dl [1.43 +/- 0.23 mumoles/l]; P less than 0.0005). Serum Vitamin A levels increased with duration (months) of dialysis but not with frequency of dialysis (twice or thrice weekly). Patients taking a VitaminA-containing multivitamin preparation had higher serum Vitamin A levels than those on a non-Vitamin A supplemented diet. Bilaterally nephrectomized patients had the highest serum Vitamin A levels while patients with obstructive uropathy had the lowest levels. Serum Vitamin A levels did not correlate with symptoms of uremia. Positive correlations were found with serum levels of calcium, cholesterol and triglycerides. Patients receiving a Vitamin A supplement had higher serum cholesterol levels than non-supplemented patients. Vitamin A might be a factor in the high incidence of cardiovascular disease in RDT patients. We therefore advise discontinuing the long-term administration of Vitamin A-containing multivitamin supplements to patients on RDT. PMID:527272

  1. Dialysis and Renal Transplantation in HIV-Infected Patients: a European Survey

    DEFF Research Database (Denmark)

    Trullas, Joan Carles; Mocroft, Amanda; Cofan, Federico;

    2010-01-01

    OBJECTIVES:: To determine prevalence and characteristics of end-stage renal diseases (ESRD) [dialysis and renal transplantation (RT)] among European HIV-infected patients. METHODS:: Cross-sectional multicenter survey of EuroSIDA clinics during 2008. RESULTS:: Prevalence of ESRD was 0.5%. Of 122...... patients with ESRD 96 were on dialysis and 26 had received a RT. Median age was 47 years, 73% were males and 43% were black. Median duration of HIV infection was 11 years. Thirty-three percent had prior AIDS; 91% were receiving antiretrovirals; and 88% had undetectable viral load. Median CD4T-cell count...... was 341 cells per cubic millimetre; 20.5% had hepatitis C coinfection. Most frequent causes of ESRD were HIV-associated nephropathy (46%) and other glomerulonephritis (28%). Hemodialysis (93%) was the most common dialysis modality; 34% of patients were on the RT waiting list. A poor HIV control...

  2. Pleuroperitoneal Leak: An Unusual Cause of Acute Shortness of Breath in a Peritoneal Dialysis Patient

    Directory of Open Access Journals (Sweden)

    D. P. Ramaema

    2014-01-01

    Full Text Available Introduction. Pleuroperitoneal leak is an uncommon complication of continuous ambulatory peritoneal dialysis (CAPD, with an estimated incidence of 1.6%. It should be suspected in these patients when they present with recurrent unilateral pleural effusions and/or acute shortness of breath following dialysate infusion. Case Presentation. We present the case of a 25-year-old female patient who had acute hydrothorax as a result of pleuroperitoneal leak complicating continuous ambulatory peritoneal dialysis (CAPD, which was confirmed on peritoneal scintigraphy. Conclusion. Continuous ambulatory peritoneal dialysis patients presenting with acute shortness of breath and/or recurrent unilateral pleural effusion should be investigated with peritoneal scintigraphy to exclude pleuroperitoneal leak.

  3. Peritonitis and catheter exit-site infection in patients on peritoneal dialysis at home1

    Science.gov (United States)

    Abud, Ana Cristina Freire; Kusumota, Luciana; dos Santos, Manoel Antônio; Rodrigues, Flávia Fernanda Luchetti; Damasceno, Marta Maria Coelho; Zanetti, Maria Lúcia

    2015-01-01

    Objective: to analyze the complications related to peritonitis and catheter exit-site infections, in patients on peritoneal dialysis at home. Method: quantitative and cross-sectional study, carried out with 90 patients on peritoneal dialysis at home, in a municipality in the Northeast region of Brazil. For data collection, it was used two structured scripts and consultation on medical records. Descriptive analysis and comparison tests among independent groups were used, considering p<0.05 as level of statistical significance. Results: by comparing the frequency of peritonitis and the length of treatment, it was found that patients over two years of peritoneal dialysis were more likely to develop peritonitis (X²=6.39; p=0.01). The number of episodes of peritoneal catheter exit-site infection showed association with the length of treatment (U=224,000; p=0.015). Conclusion: peritonitis and catheter exit-site infection are associated with the length of treatment. PMID:26487141

  4. Dialysis and Renal Transplantation in HIV-Infected Patients: a European Survey

    NARCIS (Netherlands)

    J.C. Trullas; A. Mocroft; F. Cofan; J. Tourret; A. Moreno; C.I. Bagnis; C.A. Fux; C. Katlama; P. Reiss; J. Lundgren; J.M. Gatell; O. Kirk; J.M. Miró

    2010-01-01

    Objectives: To determine prevalence and characteristics of end-stage renal diseases (ESRD) [dialysis and renal transplantation (RT)] among European HIV-infected patients. Methods: Cross-sectional multicenter survey of EuroSIDA clinics during 2008. Results: Prevalence of ESRD was 0.5%. Of 122 patient

  5. Differences in quality of life of hemodialysis patients between dialysis centers

    NARCIS (Netherlands)

    Mazairac, Albert H. A.; Grooteman, Muriel P. C.; Blankestijn, Peter J.; Penne, E. Lars; van der Weerd, Neelke C.; den Hoedt, Claire H.; van den Dorpel, Marinus A.; Buskens, Erik; Nube, Menso J.; ter Wee, Piet M.; de Wit, G. Ardine; Bots, Michiel L.

    2012-01-01

    Purpose Hemodialysis patients undergo frequent and long visits to the clinic to receive adequate dialysis treatment, medical guidance, and support. This may affect health-related quality of life (HRQOL). Although HRQOL is a very important management aspect in hemodialysis patients, there is a paucit

  6. Differences in quality of life of hemodialysis patients between dialysis centers.

    NARCIS (Netherlands)

    Mazairac, A.H.; Grooteman, M.P.C.; Blankestijn, P.J.; Lars Penne, E.; Weerd, N.C. van der; Hoedt, C.H. den; Dorpel, M.A. van den; Buskens, E.; Nube, M.J.; Wee, P.M. ter; Wit, G.A. de; Bots, M.L.; Hamersvelt, H.W. van

    2012-01-01

    PURPOSE: Hemodialysis patients undergo frequent and long visits to the clinic to receive adequate dialysis treatment, medical guidance, and support. This may affect health-related quality of life (HRQOL). Although HRQOL is a very important management aspect in hemodialysis patients, there is a pauci

  7. Differences in quality of life of hemodialysis patients between dialysis centers

    NARCIS (Netherlands)

    A.H.A. Mazairac (Albert); M.P.C. Grooteman (Muriel); P.J. Blankestijn (Peter); E. Lars Penne; N.C. van der Weerd (Neelke); C.H. den Hoedt (Claire); M.A. van den Dorpel (Marinus); E. Buskens (Erik); M.J. Nubé (Menso); P.M. ter Wee (Piet); G.A. de Wit (Ardine); M.L. Bots (Michiel)

    2011-01-01

    textabstractPurpose: Hemodialysis patients undergo frequent and long visits to the clinic to receive adequate dialysis treatment, medical guidance, and support. This may affect health-related quality of life (HRQOL). Although HRQOL is a very important management aspect in hemodialysis patients, ther

  8. Association between endothelial dysfunction and arterial stiffness in continuous ambulatory peritoneal dialysis patients

    Institute of Scientific and Technical Information of China (English)

    顾玥

    2014-01-01

    Objective To investigate the association between endothelial dysfunction and arterial stiffness in continuous ambulatory peritoneal dialysis(CAPD)patients.Methods Ninety-four stable CAPD patients from a single center were enrolled in this cross-sectional study.Ultrasound evaluation was conducted on brachial artery to estimate endothelial-dependent

  9. Efficacy and safety of sevelamer hydrochloride and calcium acetate in patients on peritoneal dialysis

    DEFF Research Database (Denmark)

    Evenepoel, Pieter; Selgas, Rafael; Caputo, Flavia;

    2009-01-01

    BACKGROUND: Inadequate phosphorus control is associated with increased morbidity and mortality in patients with CKD stage 5. Although phosphate binders are often used in patients on peritoneal dialysis (PD), no large randomized controlled studies evaluating their use solely in this population have...

  10. Metformin-associated risk of acute dialysis in patients with type 2 diabetes

    DEFF Research Database (Denmark)

    Carlson, Nicholas; Hommel, Kristine; Olesen, Jonas Bjerring;

    2016-01-01

    Recent guidelines governing anti-diabetic medications increasingly advocate metformin as first-line therapy in all patients with type 2 diabetes. However, metformin could be associated with increased risk of acute kidney injury (AKI), acute dialysis, and lactate acidosis in marginal patients. In ...

  11. Efficacy observation of peritoneal dialysis combined with hemodialysis in the treatment of the patients with chronic renal failure%腹膜透析联合血液透析对慢性肾功能衰竭的疗效观察

    Institute of Scientific and Technical Information of China (English)

    郭继磊

    2011-01-01

    Objective: To investigate the clinical efficacy of peritoneal dialysis(PD) combined with hemodialysis (HD) and peritoneal dialysis (PD) only in patients with chronic renal failure. Methods: 80 cases of patients with chronic renal failure in our hospital from October 2006 to October 2010 were divided into two groups, 32 cases in combination group were treated with PD combined with HD, 48 cases in PD group were only treated with PD. The efficacy of the two groups was observed. Results: Renal function improved in the two groups after treatment, Creatinine and blood urea nitrogen in combination group after treatment were all significantly lower than PD group(all P<0.05). The levels of albumin and hemoglobin in combination group after treatment were higher than PD group, and there were significant differences between the two groups (all P<0.05). The level of parathyroid hormone in combination group after treatment was lower than PD group, and there were significantly differences between them(P<0.05). Complications in combination group were significantly less than PD group in treatment(P<0.05). Conclusion: PD combined HD treating patients with chronic renal failure can significantly improve renal function, reduce complications, improve quality of life, and it is worthy of application.%目的:探讨血液透析联合腹膜透析与腹膜透析治疗慢性肾功能衰竭患者的临床疗效.方法:选取我院2006年10月~2010年10月收治的慢性肾功能衰竭患者80例,其中32例行腹膜透析联合血液透析治疗(联合组),48例仅进行腹膜透析(腹透组),观察两组疗效.结果:两组治疗后肾功能均得到改善,联合组肌酐、尿素氮均低于腹透组,差异均有统计学意义(均P<0.05);治疗后联合组血红蛋白及白蛋白水平高于腹透组,甲状旁腺素水平低于腹透组,差异均有统计学意义(均P<0.05);联合组治疗中并发症少于腹透组,差异有统计学意义(P<0.05).结论:腹膜透析联合血

  12. Clinical observation of febuxostat in treatment of hyperuricemia in patients with chronic renal failure and non dialysis%非布司他治疗慢性肾衰竭非透析患者高尿酸血症的疗效观察

    Institute of Scientific and Technical Information of China (English)

    秦萍; 刘蒙蒙; 孟志云; 杨兴; 赵洪军

    2016-01-01

    目的:观察非布司他片治疗慢性肾衰竭非透析患者高尿酸血症的临床疗效。方法选择2014年1月—2015年6月在潍坊市中医院肾内科的60例并发高尿酸血症的慢性肾功能衰竭的住院患者,随机分成对照组和治疗组,每组各30例。所有患者均给予低盐、低蛋白、低嘌呤饮食,并给予慢性肾功能不全的常规治疗。对照组口服别嘌醇片100 mg,3次/d;治疗组口服非布司他片40 mg,1次/d。两组均连续治疗12周。观察两组的临床疗效,并在治疗前及治疗后第1、2、4、6、8、10、12周检查生化指标血尿酸(SUA)、血肌酐(Scr)、血尿素氮(BUN)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、血浆白蛋白(ALB)、胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)及血常规相关指标白细胞(WBC)计数、血红蛋白(HB)。结果治疗后,对照组总有效率为80.00%,治疗组总有效率为96.67%,两组总有效率比较差异具有统计学意义(P<0.05)。治疗后,两组患者SUA、Scr、BUN水平均显著降低,同组治疗前后差异具有统计学意义(P<0.05);且治疗组这些观察指标的下降程度优于对照组,两组比较差异具有统计学意义(P<0.05)。两组患者治疗前后ALT、AST、ALB、TG、TC、HDL-C、LDL-C、WBC、HB均无明显改变,差异无统计学意义。结论非布司他片较别嘌醇片更能有效地降低慢性肾功能衰竭非透析患者的SUA水平,起效快,效果肯定,且无明显不良反应,具有一定的临床推广应用价值。%Objective To observe the effect of Febuxostat Tablets in treatment of hyperuricemia in patients with chronic renal failure and non dialysis. Methods Patients (60 cases) with chronic renal failure and non dialysis in Department of Urology of Weifang Traditional Chinese Hospital from January 2014 to

  13. [THE RISK FACTORS OF THE DIALYSIS PERITONITIS (THREE-YEARS PROSPECTIVE INVESTIGATION)].

    Science.gov (United States)

    Mishalov, V G; Zavodovskiy, E S; Markulan, L Yu; Goyda, S M

    2015-09-01

    The risk factors of the dialysis peritonitis occurrence were determined in patients with chronic renal disease, to whom a substitute renal therapy, using peritoneal dialysis, was conducted. The results of a three-year prospective investigation and treatment of 73 patients in Kyiv City Oleksandrivska Clinical Hospital on the base of the general surgery and nephrology departments in 2007 - 2010 yrs were studied. The dialysis peritonitis (first episode) have occurred in 42 (57.5%) patients. Cumulative rate of a dialysis peritonitis in accordance to a censored data (the dialysis peritonitis suspension or other causes) have constituted 67.7%. Due to the dialysis peritonitis occurrence the peritoneal dialysis was stopped in 14 (19.2%) patients. The obesity, raising of a serum albumin level, constipation, preliminary injection into the site of the catheter exit site we consider a risk factors for the dialysis peritonitis occurrence.

  14. Hepatitis C Virus Antibodies in Dialysis Patients in Tunisia: A Single Center Study

    Directory of Open Access Journals (Sweden)

    Sassi F

    2000-01-01

    Full Text Available Fifty-eight patients on maintenance hemodialysis in a dialysis unit at Tunis, Tunisia were tested for anti-hepatitis C virus (anti-HCV antibodies by second generation ELISA test, and for HCV-RNA by nested reverse transcriptase polymerase chain reaction (RT-PCR of 5′ non-coding region. Specificity of the antibodies was confirmed by immunoblot test. HCV genotype was defined using INNO-LIPA test. Twenty-seven out of 58 patients (46.5% were reactive by ELISA. Transaminase levels were assessed over a six-month period and showed normal average values. Fourteen of the 27 anti-HCV positive patients (51% were positive by RT-PCR. Type 1b HCV genotype was the most prevalent, seen in all the dialysis patients and one patient in addition, was co-infected with genotype 4. There was a significant correlation between the duration on dialysis (over five years and the prevalence of anti-HCV-positive patients (P< 0.005 while no correlation existed between the number of blood transfusions and the presence of anti-HCV antibodies. The present study illustrates the high prevalence of HCV infection among Tunisian dialysis patients (51% and indicates that the spread may be nosocomial rather than transfusion-related.

  15. EPIDEMIOLOGY AND ETIOLOGICAL FACTORS OF ERECTILE DYSFUNCTION IN PATIENTS ON DIALYSIS AND AFTER RENAL TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    E. A. Efremov

    2011-01-01

    Full Text Available Today the problem of better life quality of patients with end stage renal disease and after renal transplantation and their sexual adaptation is considered to be more impotent. The clinical part of the investigation is the obser- vation of 205 patients – men with terminal stage renal disease. Erectile dysfunction is represented in 91,4% (64 of patients getting haemodialysis, 92,3% (24 of patients getting peritoneal dialysis, 61,5% (67 of patients after renal transplantation. According to International Index of Erectile Function the mean score of erectile function is 16,7 ± 5,2 in haemodialysis patients, 19,46 ± 3,6 in peritoneal dialysis patients, 21,9 ± 5,6 in patients after renal transplantation. The analysis revealed great prevalence of erectile dysfunction and interest in improvement among the patients with end stage renal disease and after renal transplantation. 

  16. Speech and Language Disorders in a Dialysis Encephalopathy Patient and the Effect of Desferrioxamine and Reverse-Osmosis Water Treatment.

    Science.gov (United States)

    Lehtihalmes, Matti; And Others

    Dialysis encephalopathy is a progressive neurological disorder occurring after long-term hemodialysis in some renal failure patients. Accumulation of aluminum in the brain is suspected as its cause, and the use of reverse osmosis of the dialysis water and administration of desferrioxamine to the patient have been successful in reducing the…

  17. Sleep disorders in pediatric chronic kidney disease patients.

    Science.gov (United States)

    Stabouli, Stella; Papadimitriou, Eleni; Printza, Nikoleta; Dotis, John; Papachristou, Fotios

    2016-08-01

    The prevalence of sleep disorders during childhood has been estimated to range from 25 to 43 %. The aim of this review is to determine the prevalence of sleep disorders and possible associations with chronic kidney disease (CKD)-related factors and health-related quality of life (HRQOL) in children with CKD. An electronic systematic literature search for sleep disorders in children with CKD in Pubmed, Embase and the Cochrane Library Databases identified seven relevant articles for review, all of which reported an increased prevalence of sleep disorders in children with CKD. Five studies included children with CKD undergoing dialysis, and two studies included only non-dialysis patients. In all studies the presence of sleep disturbances was assessed by questionnaires; only one study compared the results of a validated questionnaire with laboratory-based polysomnography. The prevalence of any sleep disorder ranged from 77 to 85 % in dialysis patients, to 32-50 % in transplanted patients and 40-50 % in non-dialysis patients. The most commonly studied disorder was restless legs syndrome, which presented at a prevalence of 10-35 %. Three studies showed significant associations between presence of sleep disorders and HRQOL. We found consistent evidence of an increased prevalence of sleep disturbances in children with CKD, and these seemed to play a critical role in HRQOL. PMID:26482250

  18. Neuropathic arthropathy (Charcot's joint) in dialysis patients

    Energy Technology Data Exchange (ETDEWEB)

    Meneghello, A.; Bertoli, M.

    1984-08-01

    To the author's knowledge, uraemic neuropathy has not been previously reported as a cause of Charcot's joint. In this paper they present three cases in which the association between clinical and radiographic patterns suggest the diagnosis of neuropathic arthropathy. The features of uraemic neuropathy are stressed and the role of secondary hyperparathyroidism in the development of this type of arthropathy is discussed. The extremely severe hyperparathyroidism reported here, may cause tendon and ligament disease, especially at the site of their bone insertion. Uraemic tendon and ligament failures weaken joints and produce further instability, which may be a precipitating factor of uraemic Charcot's joint in patients undergoing chronic haemodialysis. 5 figs.

  19. Peritoneal Dialysis Reduces the Number of Hospitalization Days in Heart Failure Patients Refractory to Diuretics

    Science.gov (United States)

    Courivaud, Cécile; Kazory, Amir; Crépin, Thomas; Azar, Raymond; Bresson-Vautrin, Catherine; Chalopin, Jean-Marc; Ducloux, Didier

    2014-01-01

    ♦ Background: Previous small studies have reported favorable results of peritoneal dialysis (PD) in the setting of chronic refractory heart failure (CRHF). We evaluated the impact of PD in a larger cohort of patients with CHRF where end-stage renal disease was excluded. ♦ Methods: All patients who received PD therapy for CRHF between January 1995 and December 2010 in two medical centers in France were included in this retrospective study. Baseline characteristics were compared with clinical parameters during the first year after initiation of PD. Mortality, safety, and sustainability of PD were also analyzed. ♦ Results: The 126 patients included had a mean age of 72 ± 11 years and an estimated glomerular filtration rate of 33.5 ± 15.1 mL/min/1.73 m2. Mean time on PD was 16 ± 16.6 months. During the first year, patients with a left ventricular ejection fraction (LVEF) of 30% or less experienced improvement in cardiac function (30% ± 10% vs 20% ± 6%, p < 0.0001). We observed a significant reduction in the number of days of hospitalization for acute decompensated heart failure after PD initiation (3.3 ± 2.6 days/patient-month vs 0.3 ± 0.5 days/patient-month, p < 0.0001). One-year mortality was 42%. ♦ Conclusions: In CRHF, PD significantly reduces the number of days of hospitalization for acute heart failure. Improved LVEF may have led to the comparatively good 1-year survival in this cohort. PMID:23994842

  20. Peritoneal dialysis solution and nutrition.

    Science.gov (United States)

    Verger, Christian

    2012-01-01

    20-70% of peritoneal dialysis patients have some signs of malnutrition. Anorexia, protein and amino acid losses in dialysate, advanced age of elderly patients, inflammation and cardiac failure are among the main causes. Modern dialysis solutions aim to reduce these causes, but none of them is without side effects: glucose is relatively safe and brings additional energy but induces anorexia and lipid abnormalities, amino acids compensate dialysate losses but may increase uremia and acidosis, icodextrin helps control hyperhydration and chronic heart failure and minimizes glucose side effects, but may sometimes cause inflammation, and poly chamber bags allow the replacement of lactate by bicarbonate and are more biocompatible, decrease GDP, induce less inflammation and have a better effect on nutritional status. However, it appears that the management of nutrition with the different solutions available nowadays necessitates various combinations of solutions adapted to different patient profiles and there is not actually a single universal solution to minimize malnutrition in peritoneal dialysis patients. PMID:22652708

  1. Elderly Peritoneal Dialysis Compared with Elderly Hemodialysis Patients and Younger Peritoneal Dialysis Patients: Competing Risk Analysis of a Korean Prospective Cohort Study.

    Science.gov (United States)

    Kim, Hyunsuk; An, Jung Nam; Kim, Dong Ki; Kim, Myoung-Hee; Kim, Ho; Kim, Yong-Lim; Park, Ki Soo; Oh, Yun Kyu; Lim, Chun Soo; Kim, Yon Su; Lee, Jung Pyo

    2015-01-01

    The outcomes of peritoneal dialysis (PD) in elderly patients have not been thoroughly investigated. We aimed to investigate the clinical outcomes and risk factors associated with PD in elderly patients. We conducted a prospective observational nationwide adult end-stage renal disease (ESRD) cohort study in Korea from August 2008 to March 2013. Among incident patients (n = 830), patient and technical survival rate, quality of life, and Beck's Depression Inventory (BDI) scores of elderly PD patients (≥65 years, n = 95) were compared with those of PD patients aged ≤49 years (n = 205) and 50~64 years (n = 192); and elderly hemodialysis (HD) patients (n = 315). The patient death and technical failure were analyzed by cumulative incidence function. Competing risk regressions were used to assess the risk factors for survival. The patient survival rate of elderly PD patients was inferior to that of younger PD patients (Pelderly HD patients, the patient survival rate did not differ according to dialysis modality (P = 0.987). Elderly PD patients showed significant improvement in the BDI scores, as compared with the PD patients aged ≤49 years (P = 0.003). Low albumin, diabetes and low residual renal function were significant risk factors for the PD patient survival; and peritonitis was a significant risk factor for technical survival. Furthermore, low albumin and hospitalization were significant risk factors of patient survival among the elderly. The overall outcomes were similar between elderly PD and HD patients. PD showed the benefit in BDI and quality of life in the elderly. Additionally, the technical survival rate of elderly PD patients was similar to that of younger PD patients. Taken together, PD may be a comparable modality for elderly ESRD patients.

  2. Elderly Peritoneal Dialysis Compared with Elderly Hemodialysis Patients and Younger Peritoneal Dialysis Patients: Competing Risk Analysis of a Korean Prospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Hyunsuk Kim

    Full Text Available The outcomes of peritoneal dialysis (PD in elderly patients have not been thoroughly investigated. We aimed to investigate the clinical outcomes and risk factors associated with PD in elderly patients. We conducted a prospective observational nationwide adult end-stage renal disease (ESRD cohort study in Korea from August 2008 to March 2013. Among incident patients (n = 830, patient and technical survival rate, quality of life, and Beck's Depression Inventory (BDI scores of elderly PD patients (≥65 years, n = 95 were compared with those of PD patients aged ≤49 years (n = 205 and 50~64 years (n = 192; and elderly hemodialysis (HD patients (n = 315. The patient death and technical failure were analyzed by cumulative incidence function. Competing risk regressions were used to assess the risk factors for survival. The patient survival rate of elderly PD patients was inferior to that of younger PD patients (P<0.001. However, the technical survival rate was similar (P = 0.097. Compared with elderly HD patients, the patient survival rate did not differ according to dialysis modality (P = 0.987. Elderly PD patients showed significant improvement in the BDI scores, as compared with the PD patients aged ≤49 years (P = 0.003. Low albumin, diabetes and low residual renal function were significant risk factors for the PD patient survival; and peritonitis was a significant risk factor for technical survival. Furthermore, low albumin and hospitalization were significant risk factors of patient survival among the elderly. The overall outcomes were similar between elderly PD and HD patients. PD showed the benefit in BDI and quality of life in the elderly. Additionally, the technical survival rate of elderly PD patients was similar to that of younger PD patients. Taken together, PD may be a comparable modality for elderly ESRD patients.

  3. Accumulation of advanced glycation end products and chronic complications in ESRD treated by dialysis.

    Science.gov (United States)

    Meerwaldt, Robbert; Zeebregts, Clark J; Navis, Gerjan; Hillebrands, Jan-Luuk; Lefrandt, Joop D; Smit, Andries J

    2009-01-01

    Cardiovascular and connective tissue disorders are very common in patients with end-stage renal disease (ESRD), and the accumulation of advanced glycation end products (AGEs) is significantly increased in these patients. Accumulation of AGEs is believed to have a role in tissue protein aging and the pathogenesis of such age-related diseases as diabetes and ESRD. AGEs accumulate in patients with ESRD as a result of nonenzymatic glycation, oxidative stress, and diminished clearance of AGE precursors. Some AGEs show characteristic brown pigmentation and fluorescence, form protein-protein cross-links, and may ligate with AGE-specific receptors, inducing oxidative stress and cytokine production. This review focuses on the clinical relevance of AGE accumulation in patients with ESRD treated by dialysis for the development of long-term complications. The formation and accumulation of AGEs in patients with ESRD are discussed, as well as the relationship between AGE accumulation and such major complications of ESRD as cardiovascular and connective tissue disorders.

  4. Health-related quality of life in dialysis patients with constipation: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Zhang JS

    2013-06-01

    Full Text Available JiSheng Zhang,1,* CongYang Huang,1,* YanLi Li,1 Jun Chen,2 FangYuan Shen,1 Qiang Yao,3 JiaQi Qian,4 BeiYan Bao,1 XuPing Yao51Division of Nephrology, School of Medicine, Ningbo Urology and Nephrology Hospital, Ningbo University, Ningbo, Zhejiang, People's Republic of China; 2Blood Purification Center, School of Medicine, Ningbo Urology and Nephrology Hospital, Ningbo University, Ningbo, Zhejiang, People's Republic of China; 3Baxter Healthcare Pty Ltd, Shanghai, People's Republic of China; 4Division of Nephrology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China; 5Division of Urology, School of Medicine, Ningbo Urology and Nephrology Hospital, Ningbo University, Ningbo, Zhejiang, People's Republic of China *These authors contributed equally to this workObjectives: To evaluate differences in the health-related quality of life (HRQoL between patients with constipation receiving hemodialysis (HD and those receiving peritoneal dialysis (PD.Methods: In this cross-sectional study, 605 dialysis patients (478 HD cases and 127 PD cases; all patients were older than 18 years from our hospital were included. A questionnaire was used to evaluate their constipation statuses. The effect of constipation on HRQoL was assessed, using the Chinese version of the 12-item short-form (SF-12 general health survey. Karnofsky score, sociodemographic, and clinical data were also collected. We performed multiple logistic regression analysis to define independent risk factors for constipation and impaired HRQoL.Results: A total of 605 participants (326 men [53.9%] and 279 women [46.1%] were surveyed. The incidence of constipation was 71.7% in HD patients and 14.2% in PD patients. Dialysis patients with constipation had significantly lower mean SF-12 Physical Component Summary scale and Mental Component Summary scale scores than the nonconstipation group (P < 0.05, whereas HD patients had better SF-12 Physical Component

  5. Treatment of hyperlipemia in diabetic patients on dialysis with a physiological substance.

    Science.gov (United States)

    Coronel, F; Tornero, F; Torrente, J; Naranjo, P; De Oleo, P; Macia, M; Barrientos, A

    1991-01-01

    Hyperlipemia is a very frequent complication of the diabetic patient on dialysis. There is difficulty of treatment with the diet, because the dietary restriction already imposed on these patients and the secondary effects and toxicity of the available drugs in uremics aggravate the problem. We have treated 22 diabetic patients on dialysis (8 on hemodialysis and 14 on continuous ambulatory peritoneal dialysis) suffering from hyperlipemia with pantethine, a physiological substance and coenzyme A precursor in the Krebs cycle. With the administration of an oral dose of 900 mg/day we obtained a reduction of total cholesterol (275 +/- 72 vs. 231 +/- 54 mg/dl; p less than 0.001), very-low-density lipoprotein (VLDL)-cholesterol (66 +/- 36 vs. 46 +/- 18 mg/dl; p less than 0.01) and triglycerides (332 +/- 182 vs. 227 +/- 90 mg/dl; p less than 0.01) at 2 months. High-density lipoprotein (HDL)-cholesterol did not change, but the total cholesterol/HDL-cholesterol ratio decreased significantly (p less than 0.05). Total cholesterol, VLDL and triglycerides showed a progressive and significant reduction at 4 and 6 months. No changes were observed in serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, uric acid, blood glucose and glycosylated hemoglobin. Gastric discomfort in 2 patients and pruritus in another one were the secondary effects related. Pantethine was shown to be a very effective hypolipemic agent in diabetic patients on dialysis with a great tolerance. PMID:2048576

  6. [Immigrants and dialysis: a survey in Piedmont].

    Science.gov (United States)

    Forneris, Giacomo; Boero, Roberto; Massara, Carlo; Quarello, Francesco

    2011-01-01

    The number of immigrants has been rapidly increasing in Italy in the last decade, with potentially profound effects on the national health care system. Yet, few data are available on the clinical and demographic features of these subjects, or on their need for nephrological care and dialysis treatment. A survey was conducted in 19 dialysis facilities of Piedmont (a northwestern Italian region) about immigrants on chronic dialysis treatment. Data on native country, administrative position, clinical and dialysis aspects were anonymously collected. Overall, 93 immigrant dialysis patients coming from 24 foreign countries were registered. Most of them were young (mean age 46∓14 years) and on extracorporeal treatment (87%); late referral (38%) or starting dialysis in emergency (17%) were common modalities of presentation. Glomerular (33%) or unknown (31%) nephropathies were the most representative causes of end stage renal disease. No difference in incidence of HCV, HBV and HIV compared with native Italian patients was observed. Notably, more than 50% of the immigrant patients had low-level knowledge of Italian. As regards administrative position, 69% were regular foreign citizens, 19% were temporary foreign workers, and 9% had a residence permit. Our survey confirms the existence of a young immigrant population on dialysis in Piedmont, whose social and relational problems are more challenging than clinical aspects and call for new organizational models to manage this growing population on dialysis.

  7. Nutritional and behavioural aspects of nasogastric tube feeding in infants receiving chronic peritoneal dialysis.

    Science.gov (United States)

    Warady, B A; Kriley, M; Belden, B; Hellerstein, S; Alan, U

    1990-01-01

    Eight infants initiated chronic peritoneal dialysis and received nasogastric tube feedings during their first month of life. In each case, the nasogastric tube feedings were initiated because of poor oral intake and the desire to avert the development of an aversive feeding interaction between parent and child. The nutritional regimen was designed to allow normal or catch up weight gain appropriate for height age. The caloric and protein intake of the infants averaged 98.5 +/- 10.2 kcal/kg/day and 2.7 gm/kg/day, respectively, during the first year of life. Between 25% and 100% of the formula intake was provided by the nasogastric route. Group standard deviation score for height was -1.74 +/- 0.7 at one year. Five of the infants received behavioral therapy because of persistent food refusal. Therapy consisted of reinforcing prompted food acceptance and ignoring food refusal. This approach was conducted by a multidisciplinary team and successfully converted the non-oral feeder to a total oral feeding regimen in each case. PMID:1982822

  8. Continuous reduction of plasma paraoxonase activity with increasing dialysis vintage in hemodialysis patients

    DEFF Research Database (Denmark)

    Henning, Bernhard F; Holzhausen, Helge; Tepel, Martin

    2010-01-01

    Plasma paraoxonase (PON) is an enzyme that hydrolyzes organic phosphate and aromatic carboxylic acid esters. Reduced activity is associated with early events of atherogenesis. The relevance of PON phenotypes is not well characterized in hemodialysis patients. In a cross-sectional study we measure...... dialysis vintage (P...

  9. HEALTH EFFECTS ASSOCIATED WITH SUBLETHAL EXPOSURE TO MICROCYSTINS AMONG DIALYSIS PATIENTS, BRAZIL, 2001-2002

    Science.gov (United States)

    Background: During winter 2001-2002, an episode of microcystin exposure occurred among dialysis patients in Rio de Janiero, Brazil. During late November 2001, a cyanobacterial water bloom was detected in the Funil reservoir and the Guandu River, both of which supply drinking wate...

  10. Raoultella planticola peritonitis in a patient on continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    Kim, Sun Woo; Kim, Ji Eun; Hong, Yu Ah; Ko, Gang Jee; Pyo, Heui Jung; Kwon, Young Joo

    2015-12-01

    A 65-year-old man on continuous ambulatory peritoneal dialysis was admitted with peritonitis. Empirical antibiotic therapy was initiated, and Raoultella planticola was identified in the peritoneal fluid culture. We treated the patient with intraperitoneally administered ciprofloxacin and ceftazidime according to the antibiotic susceptibility. His condition improved, and he was well treated with a 2-week antibiotic course.

  11. Illness perceptions in dialysis patients and their association with quality of life.

    NARCIS (Netherlands)

    Timmers, L.; Thong, M.; Dekker, F.W.; Boeschoten, E.W.; Heijmans, M.; Rijken, M.; Weinman, J.; Kaptein, A.

    2008-01-01

    The present study explored illness perceptions of end stage renal disease (ESRD) patients on both haemodialysis (HD) and peritoneal dialysis (PD) treatment, and their associations with quality of life. Leventhal's self-regulation model (SRM) was used as a theoretical framework. Illness perceptions a

  12. 透析患者肾性骨病的药物治疗进展%Progress on drug therapy against renal osteopathy in dialysis patients

    Institute of Scientific and Technical Information of China (English)

    田寿福; 汪年松

    2011-01-01

    肾性骨病是慢性肾脏病(CKD)透析患者的常见并发症.随着透析技术的发展和普及,终末期肾衰透析患者生存期延长,肾性骨病成为影响透析患者生活质量和生存时间的重要因素.目前已开发的多种新药针对肾性骨病病理生理的多个环节进行干预.本文综述透析患者肾性骨病药物治疗研究进展.%Renal osteopathy is a common complication in dialysis patients with chronic kidney disease (CKD). As the development of dialysis technology and its popular application, the survival time of partients with end stage renal failure is extended. However, the renal osteopathy becomes an important factor affecting the life quality and survival time of dialysis patients. With the research progress on pathogenesis of renal osteopathy, some new drugs have been developed.This review focuses on the drug therapy against renal osteopathy in dialysis patients.

  13. Laparoscopic Placement of Peritoneal Dialysis Catheters in CAPD Patients: Complications and Survival

    Directory of Open Access Journals (Sweden)

    A Roueentan

    2008-06-01

    Full Text Available Background: Laparoscopic techniques for the placement of peritoneal dialysis catheters are becoming increasingly popular. Recently, with the improvements in laparoscopic surgery, various methods for the insertion of peritoneal dialysis catheters have been reported, indicating that the laparoscopic insertion is preferred over the open and percutaneous techniques. The aim of this study was to introduce and assess a simplified laparoscopic method for the insertion of peritoneal dialysis catheters in continuous ambulatory peritoneal dialysis (CAPD patients.Methods: We enrolled 79 consecutive end-stage renal patients (46 men and 33 women with a mean age of 50 years (range: 19-83 years in this study. During the surgery, a 5-mm trocar was placed in the left upper quadrant for the optics and another 5-mm trocar was placed to the left of the umbilicus. Using the second trocar, a tunnel was formed 2 cm left of the umbilical plane for the insertion of a Tenckhoff catheter. Under direct vision, the catheter was advanced into the abdomen. The catheter was tested for patency. Catheters of all subjects were capped for two weeks before dialysis initiation.Results: The mean duration of the operation was 15 minutes. Ten patients died during the follow-up period, all due to other medical problems, and six patients underwent renal transplantation; however, no deaths or complications were observed during surgery. Early onset complications were seen in 12 patients (15.1%. The most frequent late-onset medical and mechanical complications were peritonitis (6.3% and hernia (3.7%. During a follow-up period of four years, removal of the catheter was required in two patients as a result of peritonitis.Conclusion: We obtained a low complication rate and a high catheter survival rate with this laparoscopic insertion of the Tenckhoff catheter. We believe future experience will encourage the use of this safe, simple and quick procedure.

  14. Surgical revascularization versus amputation for peripheral vascular disease in dialysis patients: a cohort study

    Directory of Open Access Journals (Sweden)

    Ramkumar Nirupama

    2005-03-01

    Full Text Available Abstract Background Surgical treatment of peripheral vascular disease (PVD in dialysis patients is controversial. Methods We examined the post-operative morbidity and mortality of surgical revascularization or amputation for PVD in a retrospective analysis of United States Renal Data System. Propensity scores for undergoing amputation were derived from a multivariable logistic regression model of amputation. Results Of the Medicare patients initiated on dialysis from Jan 1, 1995 to Dec 31, 1999, patients underwent surgical revascularization (n = 1,896 or amputation (n = 2,046 in the first 6 months following initiation of dialysis were studied. In the logistic regression model, compared to claudication, presence of gangrene had a strong association with amputation [odds ratio (OR 19.0, 95% CI (confidence interval 13.86–25.95]. The odds of dying within 30 days and within1 year were higher (30 day OR: 1.85, 95% CI: 1.45–2.36; 1 yr OR: 1.46, 95% CI: 1.25–1.71 in the amputation group in logistic regression model adjusted for propensity scores and other baseline factors. Amputation was associated with increased odds of death in patients with low likelihood of amputation (rd percentile of propensity score and moderate likelihood of amputation (33rd to 66th percentile but not in high likelihood group (>66th percentile. The number of hospital days in the amputation and revascularization groups was not different. Conclusion Amputation might be associated with higher mortality in dialysis patients. Where feasible, revascularization might be preferable over amputation in dialysis patients.

  15. Imaging features of encapsulating peritoneal sclerosis in continuous ambulatory peritoneal dialysis patients.

    LENUS (Irish Health Repository)

    Ti, Joanna P

    2010-07-01

    OBJECTIVE: The purpose of this article is to present the spectrum of radiologic findings of encapsulating peritoneal sclerosis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). CONCLUSION: Although a rare diagnosis, encapsulating peritoneal sclerosis in patients undergoing CAPD has a high morbidity and mortality. Diagnosis is often delayed because clinical features are insidious and nonspecific. Radiologic imaging may be helpful in the early diagnosis of encapsulating peritoneal sclerosis and in facilitating timely intervention for CAPD patients with encapsulating peritoneal sclerosis.

  16. Evaluation of hepatitis B vaccine responsiveness in hemodialysis and peritoneal dialysis patients

    OpenAIRE

    Salama Elsayed Farag; Tarek A Ghonemy; Sameh A. Soliman; Ahmed Bihery

    2015-01-01

    Background: Hepatitis B Virus (HBV) infection is considered as a major cause of liver cirrhosis and hepatocellular carcinoma. Patients with End Stage Renal Disease (ESRD) are a risk group for HBV infection. The vaccine of hepatitis B has been recommended for prevention of HBV infection in ESRD patient especially on renal replacement therapy. Methods: Eighty seven patients with ESRD on peritoneal dialysis and hemodialysis requiring primary hepatitis B vaccination were enrolled in the stud...

  17. Aspergillus niger peritonitis in a patient on continuous ambulatory peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Usha Kalawat

    2013-07-01

    Full Text Available Fungal peritonitis is an uncommon condition which is associated with high morbidity and mortality in patients on continuous ambulatory peritoneal dialysis (CAPD. It is associated with several complications and many of the patients who develop this condition are unable to resume CAPD treatment and have to shift to haemodialysis. Here we report the rare occurrence of fungal peritonitis due to Aspergillus niger in a patient on CAPD.

  18. Reduction of elevated cytokine levels in acute/acute-on-chronic liver failure using super-large pore albumin dialysis treatment: an in vitro study.

    Science.gov (United States)

    Dominik, Adrian; Stange, Jan; Pfensig, Claudia; Borufka, Luise; Weiss-Reining, Helga; Eggert, Martin

    2014-08-01

    The removal of small water soluble toxins and albumin-bound toxins in acute liver failure patients (ALF) or acute-on-chronic liver failure (AocLF) patients has been established using extracorporeal liver support devices (e.g. Molecular Adsorbents Recirculating System; MARS). However, reduction of elevated cytokines in ALF/AocLF using MARS is still not efficient enough to lower patients' serum cytokine levels. New membranes with larger pores or higher cut-offs should be considered in extracorporeal liver support devices based on albumin dialysis in order to address these problems, as the introduction of super-large pore membranes could counterbalance high production rates of cytokines and further improve detoxification in vivo. Using an established in vitro two compartment albumin dialysis model, three novel membranes of different pore sizes were compared with the MARS Flux membrane for cytokine removal and detoxification qualities in vitro. Comparing the membranes, no improvement in the removal of water soluble toxins was found. Albumin-bound toxins were removed more efficiently using novel large (Emic2) to super-large pore sized membranes (S20; HCO Gambro). Clearance of cytokines IL-6 and tumor necrosis factor-α was drastically improved using super-large pore membranes. The Emic2 membrane predominantly removed IL-6. In vitro data suggest that the usage of larger pore sized membranes in albumin dialysis can efficiently reduce elevated cytokine levels and liver failure toxins. Using large to super-large pore membranes might exert effects on patients' serum cytokine levels. Combined with increased detoxification this could lead to higher survival in ALF/AocLF. Promising membranes for clinical evaluation have been identified. PMID:24215331

  19. Full loss of residual renal function causes higher mortality in dialysis patients; findings from a marginal structural model.

    NARCIS (Netherlands)

    Wal, W.M. van der; Noordzij, M.; Dekker, F.W.; Boeschoten, E.W.; Krediet, R.T.; Korevaar, J.C.; Geskus, R.B.

    2011-01-01

    BACKGROUND: Declining residual renal function, as indicated by the glomerular filtration rate (GFR), is associated with an increased mortality risk in patients with end-stage renal disease (ESRD) on dialysis. METHODS: We monitored GFR and mortality in 1800 haemodialysis (HD) and peritoneal dialysis

  20. Mild chronic kidney disease is associated with cognitive function in patients presenting at a memory clinic

    NARCIS (Netherlands)

    Romijn, Marloes D M; Van Marum, Rob J.; Emmelot-Vonk, Mariëlle H.; Verhaar, Harald J J; Koek, Huiberdina L.

    2015-01-01

    OBJECTIVE: In dialysis-dependent and severe chronic kidney disease (CKD) patients, cognitive impairment is found in 16-29%. In community-dwelling population without dementia mixed results have been observed. We investigated the relationship between renal function and cognition in patients from a mem

  1. Exercise and limitations in physical activity levels among new dialysis patients in the United States: an epidemiologic study.

    LENUS (Irish Health Repository)

    Stack, Austin G

    2008-12-01

    Epidemiologic studies of physical activity among patients with end-stage renal disease (ESRD) are lacking. The aim of this study was to describe the patterns of physical activity among new dialysis patients in the United States.

  2. Sexual function in women receiving maintenance dialysis.

    Science.gov (United States)

    Seethala, Srikanth; Hess, Rachel; Bossola, Maurizio; Unruh, Mark L; Weisbord, Steven D

    2010-01-01

    While substantial attention has been paid to the issue of sexual dysfunction in men on chronic dialysis, less is known about this problem in women with end-stage renal disease. We sought to assess sexual dysfunction in women on chronic dialysis and determine whether patients discuss this problem with their providers and receive treatment. We prospectively enrolled women receiving chronic hemodialysis or peritoneal dialysis in Pittsburgh, PA. We asked patients to complete the 19-item Female Sexual Function Index (FSFI) to assess sexual function and a 5-item survey that assessed whether patients had discussed sexual dysfunction with their providers and/or received treatment for this problem in the past. We enrolled 66 patients; 59 (89%) on hemodialysis and 7 (11%) on peritoneal dialysis. All patients completed the FSFI, of whom 53 (80%) had FSFI scores <26.55, consistent with the presence of sexual dysfunction. Of 37 patients who were married or residing with a significant other, 27 (73%) had sexual dysfunction. Among 24 participants who reported having been sexually active over the previous 4 weeks, 11 (46%) had sexual dysfunction. Only 21% of patients with sexual dysfunction had discussed this problem with their gynecologist, renal or primary provider, and 3 (6%) reported having received treatment. Sexual dysfunction is common in women on dialysis, even among patients who are married or residing with a significant other and those who are sexually active. However, few women discuss this issue with their providers or receive treatment.

  3. Continuous reduction of plasma paraoxonase activity with increasing dialysis vintage in hemodialysis patients.

    Science.gov (United States)

    Henning, Bernhard F; Holzhausen, Helge; Tepel, Martin

    2010-12-01

    Plasma paraoxonase (PON) is an enzyme that hydrolyzes organic phosphate and aromatic carboxylic acid esters. Reduced activity is associated with early events of atherogenesis. The relevance of PON phenotypes is not well characterized in hemodialysis patients. In a cross-sectional study we measured PON activity in 377 hemodialysis patients photometrically using the substrates 4-nitrophenylacetate and phenylacetate. The PON ratio was calculated from 4-nitrophenylacetate-derived activity divided by phenylacetate-derived activity. Frequency distribution of the PON ratio showed three different PON phenotypes. 74% of hemodialysis patients showed PON phenotype 1, 21% PON phenotype 2, and 5% PON phenotype 3. Compared to hemodialysis patients with PON 1, patients with PON 2 or 3 showed higher conversion rates for 4-nitrophenylacetate. We observed a significant reduction of PON ratio with increasing dialysis vintage (Pvintage. In conclusion, plasma PON ratio significantly declines with increasing dialysis vintage.

  4. The “phosphorus pyramid”: a visual tool for dietary phosphate management in dialysis and CKD patients

    OpenAIRE

    D’Alessandro, Claudia; Piccoli, Giorgina B.; Cupisti, Adamasco

    2015-01-01

    Phosphorus retention plays a pivotal role in the onset of mineral and bone disorders (MBD) in chronic kidney disease (CKD). Phosphorus retention commonly occurs as a result of net intestinal absorption exceeding renal excretion or dialysis removal. The dietary phosphorus load is crucial since the early stages of CKD, throughout the whole course of the disease, up to dialysis-dependent end-stage renal disease. Agreement exits regarding the need for dietary phosphate control, but it is quite ch...

  5. Successful treatment of refractory midgut bleeding with ocreotide and corticosteroids in a dialysis patient with suspected sarcoidosis.

    Science.gov (United States)

    Velasco, Nestor; Imtiaz, Toufeeq; Shah, Amir Ali; Koulaouzidis, Anastasios

    2016-01-01

    We present a case of severe and recurrent small-bowel bleeding, due to multiple intestinal angiodysplasias, in a female patient with chronic renal failure due to suspected sarcoidosis. Over the years, she required numerous admissions and >200 units of blood for symptomatic anaemia. However, following a small-bowel capsule endoscopy that revealed several small-bowel angiectasis, she was treated successfully with octreotide and corticosteroids. Her transfusion requirements and hospital admissions were reduced drastically. Moreover, hypercalcaemia and liver function tests also normalised after treatment and double-balloon enteroscopy confirmed the complete resolution of these angiodysplasias. This case presentation confirms the usefulness of octreotide in the management of small-bowel angiodysplasias in dialysis patients and highlights the additional benefit of corticosteroids in portal hypertension due to suspected sarcoidosis. PMID:27417989

  6. Effect of dialysis dose and membrane flux on hemoglobin cycling in hemodialysis patients.

    Science.gov (United States)

    He, Liyu; Fu, Min; Chen, Xian; Liu, Hong; Chen, Xing; Peng, Xiaofei; Liu, Fuyou; Peng, Youming

    2015-04-01

    Many studies found that hemoglobin (Hb) fluctuation was closely related to the prognosis of the maintenance hemodialysis patients. We investigated the association of factors relating dialysis dose and dialyzer membrane with Hb levels. We undertook a randomized clinical trial in 140 patients undergoing thrice-weekly dialysis and assigned patients randomly to a standard or high dose of dialysis; Hb level was measured every month for 12 months. In the standard-dose group, the mean (±SD) urea reduction ratio was 65.1% ± 7.3%, the single-pool Kt/V was 1.26 ± 0.11, and the equilibrated Kt/V was 1.05 ± 0.09; in the high-dose group, the values were 73.5% ± 8.7%, 1.68 ± 0.15, and 1.47 ± 0.11, respectively. The standard deviation (SD) and residual SD (liner regression of Hb) values of Hb were significantly higher in the standard-dose group and low-flux group. The percentage achievement of target Hb in the high-dose dialysis group and high-flux dialyzer group was significantly higher than the standard-dose group and low-flux group, respectively. Patients undergoing hemodialysis thrice weekly appear to have benefit from a higher dialysis dose than that recommended by current KDQQI (Kidney Disease Qutcome Quality Initiative) guidelines or from the use of a high-flux membrane, which is in favor of maintaining stable Hb levels.

  7. Ultrasound evaluation of intima media thickness of carotid arteries in dialysis patients and correlation with proposed risk factors

    Directory of Open Access Journals (Sweden)

    Damjanović Tatjana

    2003-01-01

    Full Text Available Atherosclerosis is significant risk factor for cardiovascular morbidity and mortality in dialysis patients. Aim of the study was ultrasound evaluation of intima media thickness on carotid arteries (as a marker of atherosclerosis, in dialysis patients and its correlation with proposed risk factors. Intima media thickness was measured in 45 dialysis patients with no signs of cardiovascular diseases (15 on peritoneal dialysis, group I,30 on hemodialysis, group II and 20 healthy controls. The mean carotid artery intima media thickness was significantly higher in dialysis patients than in control group. According to intima media thickness, dialysis patients were divided in group A (patient with intima media thickness less or equal 0,720 mm and group B (intima media thickness higher then 0,720mm. Intima media thickness in bout group was correlated with proposed risk factors. In group A there was not significant correlation of intima media thickness with risk factors. In group B significant correlation have been found between intima media thickness and LDL, VLDL cholesterol, body mass index and systolic, diastolic and mean blood pressure. Although atherosclerosis was not the only cause for cardiovascular morbidity and mortality, it has a dominant role in dialysis patients. Augmented intima media thickness could be early marker of atherosclerosis. The risk factors of great influence on intima media thickness are lipid disturbances, obesity and hypertension.

  8. Sitagliptin and risk of heart failure hospitalization in patients with type 2 diabetes on dialysis: A population-based cohort study.

    Science.gov (United States)

    Hung, Yi-Chih; Lin, Che-Chen; Huang, Wei-Lun; Chang, Man-Ping; Chen, Ching-Chu

    2016-01-01

    The incidence of heart failure hospitalization (HHF) after taking sitagliptin in type 2 diabetes (T2DM) patients with end stage renal disease (ESRD) on dialysis is unclear. In this population-based cohort study, we identified individuals with T2DM and ESRD on dialysis who were treated with sitagliptin between 2009 and 2011 and randomly selected a control cohort matched by age, sex, duration of T2DM, hypertension medications, use of statin and aspirin, sulfonylureas, glinides, and insulin usage, atherosclerotic heart disease, congestive heart failure and chronic obstructive pulmonary disease at a 1:4 ratio. Multivariable Cox proportional hazards regression analysis was used to evaluate HHF risk. The overall incidence of HHF was higher in the sitagliptin cohort than in the control cohort (1130 vs. 754 per 10000 person-years; adjusted hazard ratio (HR): 1.52, 95% CI = 1.21-1.90). There was a significant trend towards increased HHF risk associated with increased sitagliptin dose (p for trend ACE inhibitors treatment, with history of heart failure or receiving hemodialysis rather than peritoneal dialysis. In conclusion, use of sitagliptin was associated with an increased risk of HHF in patients with T2DM on dialysis. PMID:27460913

  9. Sitagliptin and risk of heart failure hospitalization in patients with type 2 diabetes on dialysis: A population-based cohort study

    Science.gov (United States)

    Hung, Yi-Chih; Lin, Che-Chen; Huang, Wei-Lun; Chang, Man-Ping; Chen, Ching-Chu

    2016-01-01

    The incidence of heart failure hospitalization (HHF) after taking sitagliptin in type 2 diabetes (T2DM) patients with end stage renal disease (ESRD) on dialysis is unclear. In this population-based cohort study, we identified individuals with T2DM and ESRD on dialysis who were treated with sitagliptin between 2009 and 2011 and randomly selected a control cohort matched by age, sex, duration of T2DM, hypertension medications, use of statin and aspirin, sulfonylureas, glinides, and insulin usage, atherosclerotic heart disease, congestive heart failure and chronic obstructive pulmonary disease at a 1:4 ratio. Multivariable Cox proportional hazards regression analysis was used to evaluate HHF risk. The overall incidence of HHF was higher in the sitagliptin cohort than in the control cohort (1130 vs. 754 per 10000 person-years; adjusted hazard ratio (HR): 1.52, 95% CI = 1.21–1.90). There was a significant trend towards increased HHF risk associated with increased sitagliptin dose (p for trend < 0.01). Subjects at greater risk of HHF after taking sitagliptin were those without severe hypoglycemia, without ACE inhibitors treatment, with history of heart failure or receiving hemodialysis rather than peritoneal dialysis. In conclusion, use of sitagliptin was associated with an increased risk of HHF in patients with T2DM on dialysis. PMID:27460913

  10. Glycemic Control and Mortality in Diabetic Patients Undergoing Dialysis Focusing on the Effects of Age and Dialysis Type: A Prospective Cohort Study in Korea.

    Directory of Open Access Journals (Sweden)

    Ji In Park

    Full Text Available Active glycemic control has been proven to delay the onset and slow the progression of diabetic retinopathy, nephropathy, and neuropathy in diabetic patients, but the optimal level is obscure in end-stage renal disease. In this study, we evaluated the effect of hemoglobin A1c (HbA1c on mortality of diabetic patients on dialysis, focusing on age and dialysis type.Of 3,302 patients enrolled in the prospective cohort for end-stage renal disease in Korea between August 2008 and October 2013, 1,239 diabetic patients who had been diagnosed with diabetes or having HbA1c≥6.5% at the time of enrollment were analyzed. Age was categorized as <55, 55-64 and ≥65 years old. Age, sex, modified Charlson comorbidity index, hemoglobin, primary renal disease, body mass index, and dialysis duration were adjusted.A total of 873 patients received hemodialysis (HD and 366 underwent peritoneal dialysis (PD. During the mean follow-up of 19.1 months, 141 patients died. Patients with poor glucose control (HbA1c≥8% showed worse survival than patients with HbA1c<8% (hazard ratio [HR], 2.2; 95% confidence interval [CI], 1.48-3.29; P<0.001. Subgroup analysis divided by age revealed that HbA1c≥8% was a predictor of mortality in age <55 (HR, 4.3; 95% CI, 1.78-10.41; P = 0.001 and age 55-64 groups (HR, 3.3; 95% CI, 1.56-7.05; P = 0.002, but not in age ≥65 group. Combining dialysis type and age, poor glucose control negatively affected survival only in age < 55 group among HD patients, but it was significant in age < 55 and age 55-64 groups in PD patients. Deaths from infection were more prevalent in the PD group, and poor glucose control tended to correlate with more deaths from infection in PD patients (P = 0.050.In this study, the effect of glycemic control differed according to age and dialysis type in diabetic patients. Thus, the target of glycemic control should be customized; further observational studies may strengthen the clinical relevance.

  11. Total knee arthroplasty in patients with dialysis: Early complications and mortality

    Directory of Open Access Journals (Sweden)

    Jen-Hung Chen

    2014-04-01

    Full Text Available Background: Total hip arthroplasty (THA in patients on long-term hemodialysis may result in a high prevalence of complications which related to nature of the disease, and associated cardiovascular conditions. However, the result of total knee artrhopalsty (TKA in those patients is not clear. The purpose of this study was to retrospectively evaluate the early mortality and complications of TKA performed in patients with dialysis. Methods: We retrospectively evaluated 15 dialysis patients (18 knees who underwent TKA using antibiotic-loaded cement fixation. Fourteen patients had maintained hemodialysis and one patient had continuous ambulatory peritoneal dialysis. The function of the knee was evaluated before operation and postoperatively using Knee Society evaluating system. Postoperative complications and mortality were recorded for all patients. The average follow up period was 25 months (6 to 59 months. Results: There were no mortalities including short-term (≤90 days or long-term (>90 days follow up. The mean knee and function scores improved from preoperative 36 points (27~46 and 19.4 points (10~35 to 79 points (68~87 and 81 points (70~95 respectively at the latest follow up. One (6.7% patient had early postoperative pneumonia (≤90 days. The late (>90 days complica-tion rate was 20% including 1 sepsis with toe gangrene, 1 recurrent stroke and 1 acute myocardiac infarction. There was no deep prosthetic joint infection or loosening of the components. Conclusion: TKA with antibiotic-loaded cement resulted in a substantial low short-term mortality and deep infections in 15 patients with dialysis. However, a longer term follow up is necessary.

  12. Risk of Cerebral Infarction in Japanese Hemodialysis Patients: Miyazaki Dialysis Cohort Study (MID study

    Directory of Open Access Journals (Sweden)

    Tatsunori Toida

    2016-07-01

    Full Text Available Background/Aims: Predictors including the preventive effects of antiplatelet and anticoagulant drugs on cerebral infarction (CI events have not yet been clarified in dialysis patients. The aim of the present study was to examine the risk of CI and preventive effects of these drugs in Japanese hemodialysis patients. Methods: Patients receiving maintenance hemodialysis (n=1,551, median age (interquartile range, 69.0 (59.0-78.0 years; 41.5% female were enrolled in the Miyazaki Dialysis Cohort Study and prospectively followed-up for 3 years. Kaplan-Meier and Cox's regression analyses were used to clarify the risk of CI. Results: Eighty-four patients developed CI at an incidence of 21.5/1000 patients per year. The presence of a previous history of CI, atrial fibrillation (AF, and diabetes mellitus in addition to age were also identified as predictive factors for new CI, whereas no relationship was observed between antiplatelet and/or anticoagulant usage and CI. Furthermore, no significant difference was noted in the frequency of CI events between patients with AF who received warfarin and those who did not. Conclusions: The incidence of CI was higher in dialysis patients with a previous history of CI and AF; however, the preventive effects of antiplatelet/anticoagulant drugs on the development of CI were not evident.

  13. Differential Effect of Viral Hepatitis Infection on Mortality among Korean Maintenance Dialysis Patients: A Prospective Multicenter Cohort Study.

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    Eugene Kwon

    Full Text Available The role of infection with hepatitis B virus (HBV and hepatitis C virus (HCV in terms of survival among dialysis patients remains incompletely understood. In the present multicenter prospective cohort study, we investigated the prevalences of HBV and HCV infection among 3,321 patients receiving maintenance dialysis in Korea, and assessed the impacts of these infections on survival. All included patients underwent hepatitis B antigen (HBsAg and HCV antibody (Ab testing, which revealed that 236 patients (7.1% were HBsAg-positive, and 123 patients (3.7% were HCV Ab-positive. HBsAg-positive and HCV Ab-positive patients were matched to hepatitis virus-negative patients using a propensity score at a ratio of 1:2. The prevalences of HBV and HCV infection did not significantly differ according to dialysis modality. Linear-by-linear association analysis revealed that hepatitis B prevalence significantly increased with increasing dialysis vintage (p = 0.001, and hepatitis C prevalence tended to be higher with increasing dialysis vintage (p = 0.074. We compared the survival of HBsAg-positive and HCV Ab-positive patients to that of hepatitis virus-negative patients. After propensity score matching, cumulative survival did not differ between HBsAg-positive and HBsAg-negative patients (p = 0.37, while HCV Ab-positive patients showed significantly lower survival than HCV Ab-negative patients (p = 0.03. The main conclusions of the present study are that HBV infection prevalence increased with longer dialysis vintage, and that both HBV and HCV infections were most prevalent among patients with the longest dialysis vintage. Additionally, HCV infection among maintenance dialysis patients is associated with an increased risk of mortality.

  14. Pilot validation of objective malnutrition—inflammation scores in pediatric and adolescent cohort on chronic maintenance dialysis

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    Franca M Iorember

    2014-10-01

    Full Text Available Background: In recognition of the challenges inherent with the use of single-item indices for the diagnosis of malnutrition–inflammation morbidity in pediatric dialysis patients, to enhance accuracy, we validated a composite scoring system in a pilot study. The objective malnutrition—inflammation score seeks to validate the use of a composite scoring system as a tool for assessing malnutrition—inflammation burden in a pediatric dialysis population. Methods: We enrolled 20 patients on hemodialysis (n = 14 and peritoneal dialysis (n = 6 over a period of 12 months. We derived composite scores from selected indices of renal pathology, nutrition, dialysis adequacy, protein catabolism, and dialysis modality. We assessed reliability by a test–retest method and measured validity by defining the relationship of the indices with serum C-reactive protein in a multiple regression analysis. We calculated sensitivity, specificity, accuracy, and precision for the malnutrition—inflammation score. Results: The mean age was 12.8 years (standard deviation = 6.1, and male–female ratio was 12:8. Patients (n = 8 with elevated serum C-reactive protein (>0.3 mg/dL had higher composite score for malnutrition—inflammation morbidity. Similarly, the pediatric cohort on hemodialysis had higher score than those on peritoneal dialysis. Upon reliability testing, a low value of typical error (0.07 and high correlation coefficient (r = 0.95 supported validity of the instrument. Moreover, multiple regression analysis showed a strong predictive relationship (R2 = 0.9, p = 0.03 between the indices and serum C-reactive protein. Sensitivity of malnutrition—inflammation score was 62.5%, specificity was 83%, accuracy was 75%, and precision was 71%. Conclusion: Using criterion-validation method, we established the potential use of multi-diagnostic approach to quantify malnutrition—inflammation morbidity in a pediatric dialysis cohort

  15. Endothelial Dysfunction Is Associated With Major Adverse Cardiovascular Events in Peritoneal Dialysis Patients

    OpenAIRE

    Lee, Mi Jung; Han, Seung Hyeok; Lee, Jung Eun; Choi, Hoon Young; Yoon, Chang-Yun; Kim, Eun Jin; Han, Jae Hyun; Han, Ji Suk; Oh, Hyung Jung; Park, Jung Tak; Kang, Shin-Wook; Yoo, Tae-Hyun

    2014-01-01

    Abstract Endothelial dysfunction is implicated in increased cardiovascular risk in nondialyzed population. However, the prognostic impact of endothelial dysfunction on cardiovascular outcome has not been investigated in peritoneal dialysis (PD) patients. We prospectively determined endothelial function by brachial artery endothelium-dependent vasodilation (flow-mediated dilation [FMD]) in 143 nondiabetic PD patients and 32 controls. Primary outcome was a major adverse cardiac and cerebrovascu...

  16. Long-Term Survival of Patients with IgA Nephropathy After Dialysis Therapy

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    Hiroyuki Komatsu

    2013-12-01

    Full Text Available Background/Aims: How dialysis affects the survival of patients with biopsy-proven IgA nephropathy (IgAN is not fully understood. The present long-term cohort study quantifies the survival rates and incidence of cardio-cerebrovascular diseases (CCVDs among such patients in Japan. Methods: Fifty-two of 433 patients with IgAN who had reached end-stage kidney disease underwent renal replacement therapy (RRT between 1981 and 2010. The overall survival rate and incidence of CCVDs in these patients were evaluated during follow-up for 11.3 ± 6.4 years. Results: The mean age at starting RRT was 42.8 ± 13.3 years. Only seven patients died during follow-up (mortality rate, 1.2/100 person-years and Kaplan-Meier analysis revealed favorable survival rates of 93.3% and 65.1% at 10 and 20 years, respectively, compared with that of patients with glomerulonephritis in the registry of the Japanese Society for Dialysis Therapy who required RRT. Malignancy and CCVDs were causes of death at 13.6 ± 4.8 and 3.9 ± 1.3 years, respectively, after starting RRT. Fatal and non-fatal CCVDs developed in 15 (incidence, 2.7/100 person-years patients and acute coronary syndrome and cerebral hemorrhage developed relatively soon after starting RRT. Cox proportional hazards models revealed that age at the time of starting RRT was a significant factor affecting the onset of CCVDs. Meanwhile, a history of having had corticosteroid as an initial treatment did not affect the onset of events. Conclusion: Although the survival of patients with IgAN is favorable after dialysis, the onset of CCVDs during the early phase of dialysis should be carefully monitored.

  17. Dialysis Exercise Team: The Way to Sustain Exercise Programs in Hemodialysis Patients

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    Alessandro Capitanini; Sara Lange; Claudia D'Alessandro; Emilio Salotti; Alba Tavolaro; Maria E. Baronti; Domenico Giannese; Adamasco Cupisti

    2014-01-01

    Patients affected by end-stage renal disease (ESRD) show quite lower physical activity and exercise capacity when compared to healthy individuals. In addition, a sedentary lifestyle is favoured by lack of a specific counseling on exercise implementation in the nephrology care setting. Increasing physical activity level should represent a goal for every dialysis patient care management. Three crucial elements of clinical care may contribute to sustain a hemodialysis exercise program: a) involv...

  18. Critical Care Dialysis System

    Science.gov (United States)

    1992-01-01

    Organon Teknika Corporation's REDY 2000 dialysis machine employs technology originally developed under NASA contract by Marquardt Corporation. The chemical process developed during the project could be applied to removing toxic waste from used dialysis fluid. This discovery led to the development of a kidney dialysis machine using "sorbent" dialysis, a method of removing urea from human blood by treating a dialysate solution. The process saves electricity and, because the need for a continuous water supply is eliminated, the patient has greater freedom.

  19. Effects of protein and omega-3 supplementation, provided during regular dialysis sessions, on nutritional and inflammatory indices in hemodialysis patients

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    Mat Daud ZA

    2012-03-01

    Full Text Available Zulfitri A Mat Daud1, Boniface Tubie2, Judy Adams2, Tracey Quainton2, Robert Osia2, Sharon Tubie2, Deepinder Kaur1, Pramod Khosla1, Marina Sheyman21Department of Nutrition and Food Science, Wayne State University, 2Great Lake Dialysis, LLC, Detroit, MI, USAPurpose: Malnutrition and chronic inflammation in dialysis patients negatively impacts prognosis. However, intervening to correct this problem (through nutritional supplementation is often hampered by poor compliance due to both medical and socioeconomic barriers. We have therefore performed a pilot study to investigate the technical feasibility of “directly observed treatment” of nutritional supplementation (protein and omega-3 fatty acids, administered during regular dialysis sessions. Secondary end points included observation of nutritional and inflammatory status of hypoalbuminemic patients undergoing hemodialysis.Methods: Main inclusion criteria were serum albumin ≤ 3.9 g/dL (3 months prior to the study. Sixty-three eligible patients agreed to participate. Two intervention groups received 30 mL of a liquid protein supplement plus either 2.4 g omega-3 (1800 mg eicosapentaenoic acid + 600 mg docosahexaenoic acid or a placebo, three times per week after their routine dialysis session for 6 months. Serum albumin, plasma lipids, and other indicators of nutritional and inflammatory status were measured.Results: Directly observed nutritional supplementation resulted in a significant improvement in the low density lipoprotein cholesterol/high density lipoprotein cholesterol ratio in the omega-3 group as compared to the placebo group (P = 0.043. For the omega-3 group, serum albumin was also marginally higher after 6 months as compared to baseline (P = 0.07. The observed increase in C-reactive protein in the placebo group over 6 months was not apparent in the omega-3 group, although there was no significant difference between groups. Nuclear factor kappa B, malnutrition-inflammation score

  20. Change of Nutritional Status Assessed Using Subjective Global Assessment Is Associated With All-Cause Mortality in Incident Dialysis Patients.

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    Kwon, Young Eun; Kee, Youn Kyung; Yoon, Chang-Yun; Han, In Mee; Han, Seung Gyu; Park, Kyoung Sook; Lee, Mi Jung; Park, Jung Tak; Han, Seung H; Yoo, Tae-Hyun; Kim, Yong-Lim; Kim, Yon Su; Yang, Chul Woo; Kim, Nam-Ho; Kang, Shin-Wook

    2016-02-01

    Subjective global assessment (SGA) is associated with mortality in end-stage renal disease (ESRD) patients. However, little is known whether improvement or deterioration of nutritional status after dialysis initiation influences the clinical outcome. We aimed to elucidate the association between changes in nutritional status determined by SGA during the first year of dialysis and all-cause mortality in incident ESRD patients. This was a multicenter, prospective cohort study. Incident dialysis patients with available SGA data at both baseline and 12 months after dialysis commencement (n = 914) were analyzed. Nutritional status was defined as well nourished (WN, SGA A) or malnourished (MN, SGA B or C). The patients were divided into 4 groups according to the change in nutritional status between baseline and 12 months after dialysis commencement: group 1, WN to WN; group 2, MN to WN; group 3, WN to MN; and group 4, MN to MN. Cox proportional hazard analysis was performed to clarify the association between changes in nutritional status and mortality. Being in the MN group at 12 months after dialysis initiation, but not at baseline, was a significant risk factor for mortality. There was a significant difference in the 3-year survival rates among the groups (group 1, 92.2%; group 2, 86.0%; group 3, 78.2%; and group 4, 63.5%; log-rank test, P nutritional status assessed by SGA during the first year of dialysis were associated with all-cause mortality in incident ESRD patients.

  1. Pre-dialysis patients' perceived autonomy, self-esteem and labor participation: associations with illness perceptions and treatment perceptions. A cross-sectional study

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    Kaptein Ad A

    2010-12-01

    Full Text Available Abstract Background Compared to healthy people, patients with chronic kidney disease (CKD participate less in paid jobs and social activities. The aim of the study was to examine a the perceived autonomy, self-esteem and labor participation of patients in the pre-dialysis phase, b pre-dialysis patients' illness perceptions and treatment perceptions, and c the association of these perceptions with autonomy, self-esteem and labor participation. Methods Patients (N = 109 completed questionnaires at home. Data were analysed using bivariate and multivariate analyses. Results The results showed that the average autonomy levels were not very high, but the average level of self-esteem was rather high, and that drop out of the labor market already occurs during the pre-dialysis phase. Positive illness and treatment beliefs were associated with higher autonomy and self-esteem levels, but not with employment. Multiple regression analyses revealed that illness and treatment perceptions explained a substantial amount of variance in autonomy (17% and self-esteem (26%. The perception of less treatment disruption was an important predictor. Conclusions Patient education on possibilities to combine CKD and its treatment with activities, including paid work, might stimulate positive (realistic beliefs and prevent or challenge negative beliefs. Interventions focusing on these aspects may assist patients to adjust to CKD, and ultimately prevent unnecessary drop out of the labor market.

  2. Prevalence of patients with end-stage renal disease on dialysis in the West Bank, Palestine

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    Mohammed I Khader

    2013-01-01

    Full Text Available This study was conducted to determine the point prevalence of patients with end-stage renal disease (ESRD on dialysis in the West Bank, Palestine. As part of this study, the following parameters were studied: District, gender, age and presumed cause. This cross-sectional study was undertaken during the period 26-30 December 2010 at all dialysis units in the West Bank, and included all cases of ESRD on dialysis. The total prevalence of patients with ESRD on dialysis during the study period was 240.3 per million population (PMP. The highest prevalence was seen in Jericho city. There were 57.7% males and 42.4% females in the study. The majority of patients (62.3% were living in villages, while 28.8% were living in cities and 8.9% were living in refugee camps. Most of the patients (45% were aged between 45 and 64 years. The vast majority of patients were either diabetic (22.5% or hypertensive (11.1% or both at the same time (10.6%. There were a considerable number of patients in whom the cause was undetermined (27.6%. The majority of recorded cases of congenital causes were from the Hebron, Jenin and Tubas districts. The prevalence of ESRD noted in our study is comparable with other regional countries but far below the rate recorded in industrialized countries. In the Palestinian territories, there is a general lack of national statistics and surveys, particularly in the public health section. Increased efforts and awareness should be focused on the prevention and treatment of diabetes mellitus and hypertension as they are the main causes of ESRD. There should also be an additional enhancement and implementation of strategies for the registration of data in order to conduct periodic comparisons and analytical studies to improve the management and quality of life of ESRD patients.

  3. Late calcific mitral stenosis after MitraClip procedure in a dialysis-dependent patient.

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    Pope, Nicolas H; Lim, Scott; Ailawadi, Gorav

    2013-05-01

    The EVEREST II trial investigated the MitraClip (Abbott Vascular, Menlo Park, CA) in patients with severe mitral regurgitation (MR) undergoing surgical procedures. Although mitral stenosis was not reported in this cohort, this trial excluded patients receiving dialysis. We report a case of a 43-year-old HIV-positive, dialysis-dependent patient with nonischemic cardiomyopathy and severe MR, who was considered at high operative risk because of frailty. She was treated with a MitraClip as part of the REALISM high-risk registry. Her symptomatic MR improved but severe symptomatic mitral stenosis developed 28 months after the MitraClip procedure. At that point, she was felt to be a better operative candidate but required open mitral valve replacement. Pathologic examination demonstrated significant calcification of the leaflets around the MitraClip devices.

  4. Correlation between visceral fat accumulation, leptin and eating disorder in peritoneal dialysis patients

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    Eating disorder may be a major factor for protein-energy malnutrition occurs in patients with chronic renal failure (CRF). Some peritoneal dialysis (PD) patients demonstrate eating disorder in association with massive visceral fat accumulation. Markedly elevated leptin levels have been documented in CRF patients, especially in those who are treated with PD. Leptin is secreted by adipocytes, regulates both body composition and appetite behavior. This study evaluated the correlation between visceral fat accumulation, leptin and eating disorder in PD patients. Plasma leptin, albumin, insulin-like growth factor-1 (IGF-1), normalized protein catabolic rate (nPCR), C-reactive protein (CRP) and body composition were measured in 46 PD patients (27 males and 19 females; median age 62.7 years). Computed tomography was used for determination of visceral fat area (VFA) and subcutaneous fat area (SFA), at the initial state and during PD. The VFA and the SFA increased during PD treatment, and the ratio of increase in each fat area was significantly higher in VFA than in SFA (1.47±0.63 vs. 1.23±0.41 p<0.01, respectively). Serum leptin elevated (19.5±21.9 ng/mL), and correlated significantly with the percentage of body fat (r=0.584), body mass index (BMI: r=0.574), VFA (r=0.476) and SFA (r=0.684). Dietary intake correlated inversely with the visceral fat mass, and the low nPCR group had a higher VFA/BMI ratio (p<0.05). A negative correlation was found between nPCR and either serum leptin (r=-0.52), leptin/BMI (r=-0.44), or CRP (r=-0.55). Our data suggest that visceral fat accumulation and hyperleptinemia in PD patients are closely associated with eating disorder. Therefore, a new peritoneal solution containing an alternative osmotic agent instead of glucose may be useful to prevent accumulation of visceral fat in PD patients. (author)

  5. Psychological characteristics of patients treated by chronic maintenance hemodialysis.

    Science.gov (United States)

    Pop-Jordanova, Nada D; Polenakovic, Momir H

    2013-02-01

    Studies related to psychological aspects of dialysis patients show that depression and anxiety are the most common characteristics. The aim of our study was to analyze the personality profile in patients on chronic maintenance dialysis and to evaluate more specifically the level of depression. The total number of patients was 68 (30 females and 38 males), with mean age 62.3 and 56.5 for females and males respectively. Mean duration of dialysis was 6.73 years for females and 6.68 years for men (the period varied from 0.5 to 18 years). For the evaluation of psychological characteristics, we used two psychometric instruments: Minnesota Multiphase Personality Inventory (MMPI- 201) and Beck Depression Inventory. The obtained results confirmed the presence of depression in patients treated with hemodialysis. The level of depression is variable (minimal is present in 21.43%; mild in 35.71%; moderate in 17.85% and severe in 14.28% of patients). The depression is significantly positively correlated with age (panxiety, low level of hostility, but very high passive aggression which destroys their social communications. Some response measures for depression such as relaxation training, psychological support, music therapy, or peripheral biofeedback are recommended. PMID:23335381

  6. Dialysis methods may affect carotid intima-media thickness in Chinese end-stage renal disease patients.

    Science.gov (United States)

    Shi, Zhanqin; Zhu, Ming; Guan, Jianming; Chen, Jianghua; He, Qiang; Zhang, Xiaohui; Zhu, Shaoming; Song, Xuequan; Wang, Xiaoyi; Jiang, Zhiqiang

    2012-01-01

    Atherosclerosis is the most common cause of cardiovascular morbidity in end-stage renal disease (ESRD) patients and carotid intima-media thickness (IMT) is an early independent predictor of atherosclerosis. The aim of this study is to compare the continuous ambulatory peritoneal dialysis (CAPD) and the maintenance hemodialysis (MHD) for carotid IMT in Chinese ESRD patients. A total of 72 CAPD patients, 92 MHD patients, and 50 age- and sex-matched healthy controls were included. Dialysis patients were divided into five subgroups according to dialysis duration: 3-6, 7-12, 13-59, 60-119, and 120-179 months. Carotid IMT and carotid plaques were detected for each patient. The carotid IMT and total plaque detection rate in the CAPD and MHD groups were considerably higher than in the healthy control group (p  0.05). However, after stratification by dialysis duration, the total carotid IMT in the CAPD subgroup was higher than in the MHD subgroup in dialysis duration of 60-119 and 120-179 months (p  0.05). Our study showed that both CAPD and MHD affect carotid IMT in Chinese ESRD patients, and the degree of atherosclerosis in CAPD patients might be higher than that in MHD patients after 5 years of dialysis.

  7. Recombinant Hepatitis B Vaccine Adjuvanted With AS04 in Dialysis Patients: A Prospective Cohort Study

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    Fabrizio Fabrizi

    2015-11-01

    Full Text Available Background/Aims: Patients undergoing maintenance dialysis have an unsatisfactory response to vaccination, including to hepatitis B vaccine. A recombinant HB vaccine containing a new adjuvant system AS04 (HBV-AS04 has been recently developed; a few data exist on the immunogenicity and safety of HBV-AS04 among patients undergoing regular dialysis. All hepatitis B virus-seronegative patients with undetectable antibody against HBsAg undergoing maintenance dialysis at two units were prospectively included. Methods: Patients received four 20-mcg doses of HBV-AS04 by intramuscular route (deltoid muscle at months 0,1,2, and 3. Anti-HB surface antibody concentrations were measured at intervals of 1, 2, 3, 4, and 12 months. Univariate and multivariate analyses determined which parameters predicted immunologic response to HBV-AS04 vaccine. Results: 102 patients were enrolled and 91 completed the study. At completion of the vaccination schedule, using per-protocol analysis, 76 of 91 (84% had antibody titers ≥10 mIU/mL with anti-HBs geometric antibody concentrations (GMCs of 385.25 mIU/mL. The sero-protection rate at month 12 was 84% (48/57 with lower GMCs (62.74 mIU/mL, PPConclusions: HBV-AS04 vaccine was highly immunogenic in our cohort of patients on maintenance dialysis even if a significant number of non-responders is still present. Prospective studies with HBV-AS04 on larger study groups and with longer follow-ups are under way.

  8. Pruritus in hemodialysis patients: Results from the Japanese Dialysis Outcomes and Practice Patterns Study (JDOPPS).

    Science.gov (United States)

    Kimata, Naoki; Fuller, Douglas S; Saito, Akira; Akizawa, Tadao; Fukuhara, Shunichi; Pisoni, Ronald L; Robinson, Bruce M; Akiba, Takashi

    2014-07-01

    Pruritus affects many patients undergoing hemodialysis (HD). In this study, pruritus and its relationship to morbidity, quality of life (QoL), sleep quality, and patient laboratory measures were analyzed in a large sample of Japanese patients undergoing HD. Severity of patient-reported pruritus symptoms experienced during a 4-week period was collected from 6480 Japanese patients undergoing HD in three phases of the Dialysis Outcomes and Practice Patterns Study (DOPPS; 1996-2008; 60-65 study facilities/phase). Adjusted linear and logistic regressions were used to identify associations of pruritus with treatment parameters and QoL outcomes. Adjusted Cox regressions examined the influence of pruritus severity on mortality. Moderate to extreme pruritus was experienced by 44% of prevalent patients undergoing HD in the Japanese Dialysis Outcomes and Practice Patterns Study. Many patient characteristics were significantly associated with pruritus, but this did not explain the large differences in pruritus among facilities (20-70%). Pruritus was slightly less common in patients starting HD than in patients on dialysis >1 year. Patients with moderate to extreme pruritus were more likely to feel drained (adjusted odds ratio = 2.2-5.8, P quality (adjusted odds ratio = 1.9-3.7, P < 0.0001), and have QoL mental and physical composite scores 2.3-6.7 points lower (P < 0.0001) than patients with no/mild pruritus. Pruritus in patients undergoing HD was associated with a 23% higher mortality risk (P = 0.09). The many poor outcomes associated with pruritus underscore the need for better therapeutic agents to provide relief for the 40-50% of prevalent patients undergoing HD substantially affected by pruritus. Pruritus in new patients with end-stage renal disease likely results from uremia or pre-existing conditions (not HD per se), indicating the need to understand development of pruritus before end-stage renal disease.

  9. Survival advantage of peritoneal dialysis relative to hemodialysis in the early period of incident dialysis patients: a nationwide prospective propensity-matched study in Korea.

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    Ji-Young Choi

    Full Text Available BACKGROUND: The impact of dialysis modality on survival is still somewhat controversial. Given possible differences in patients' characteristics and the cause and rate of death in different countries, the issue needs to be evaluated in Korean cohorts. METHODS: A nationwide prospective observational cohort study (NCT00931970 was performed to compare survival between peritoneal dialysis (PD and hemodialysis (HD. A total of 1,060 end-stage renal disease patients in Korea who began dialysis between September 1, 2008 and June 30, 2011 were followed through December 31, 2011. RESULTS: The patients (PD, 30.6%; HD, 69.4% were followed up for 16.3 ± 7.9 months. PD patients were significantly younger, less likely to be diabetic, with lower body mass index, and larger urinary volume than HD patients. Infection was the most common cause of death. Multivariate Cox regression with the entire cohort revealed that PD tended to be associated with a lower risk of death compared to HD [hazard ratio (HR 0.63, 95% confidence interval (CI 0.36-1.08]. In propensity score matched pairs (n=278 in each modality, cumulative survival probabilities for PD and HD patients were 96.9% and 94.1% at 12 months (P=0.152 and 94.3% and 87.6% at 24 months (P=0.022, respectively. Patients on PD had a 51% lower risk of death compared to those on HD (HR 0.49, 95% CI 0.25-0.97. CONCLUSIONS: PD exhibits superior survival to HD in the early period of dialysis, even after adjusting for differences in the patients' characteristics between the two modalities. Notably, the most common cause of death was infection in this Korean cohort.

  10. Antibody response following Hepatitis B vaccination in peritoneal dialysis patients: does normalized urea clearance matter?

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    Erkan Dervisoglu

    2011-01-01

    Full Text Available OBJECTIVES: Data on the factors that contribute to the antibody response to hepatitis B virus vaccination in peritoneal dialysis patients are scarce. The current study was conducted on a group of peritoneal dialysis patients to learn how the response to hepatitis B virus vaccination varies according to the patient's clearance of urea normalized to total body water (Kt/V. METHODS: A convenience sample of 33 peritoneal dialysis patients (13 women and 20 men, with a mean age of 49¡12 years was administered double doses (20 μg IM in each deltoid muscle of recombinant hepatitis B vaccine at 0, 1, 2, and 6 months. Response to immunization was measured at one to three months after the final dose of vaccine. The subjects were divided into groups according to the level of antibodies to hepatitis B surface antigen (anti-HBs, including non-responders ( 100 IU/L. RESULTS: Among non-responders, weak responders, and good responders, significant differences were found in age (54 ± 12 vs. 56 ± 9 vs. 45¡12 years, respectively; p = 0.049 and recombinant human erythropoietin use (20 vs. 29 vs. 76%, respectively; p = 0.016. No significant differences in weekly total Kt/V (p = 0.704, weekly peritoneal Kt/V (p = 0.064 and residual glomerular filtration rate (p = 0.355 were found across the three groups. CONCLUSIONS: Delivered clearance measured by weekly peritoneal Kt/V and total clearance measured by weekly total Kt/V did not predict the response to hepatitis B virus vaccination in patients on peritoneal dialysis.

  11. Association Between Anxiety and Depression With Dialysis Adequacy in Patients on Maintenance Hemodialysis

    Science.gov (United States)

    Najafi, Afshan; Keihani, Sorena; Bagheri, Nazila; Ghanbari Jolfaei, Atefeh; Mazaheri Meybodi, Azadeh

    2016-01-01

    Background Depression and anxiety are common among hemodialysis patients and affect their treatment outcomes. Dialysis adequacy also affects the hemodialysis patients’ survival rates. Objectives This study aimed to evaluate the correlation between anxiety and depression with dialysis adequacy. Patients and Methods In this cross-sectional study, 127 hemodialysis patients (73 males, 57.5%) with the mean age of 55.7 ± 17.5 were enrolled. Demographic and recent laboratory data were collected using self-administered questionnaires and by reviewing medical records. Dialysis adequacy measures including the Kt/V and urea reduction rate (URR) were calculated using standard formulas. The Hospital Anxiety and Depression Scale (HADS) was used to diagnose depression and anxiety. Independent sample t-test and Chi-square test were used to compare the values in different groups. Pearson correlations and linear regression were used to analyze the data using SPSS version 21. Results The prevalence rates of depression and anxiety (HADS score ≥ 8) were 31.5% and 41.7%, respectively. The prevalence of both conditions was significantly higher in women than in men (P < 0.05). The mean values of Kt/V and URR were not different in patients with and without depression or anxiety. The anxiety scores were correlated with age (P = 0.007, r = -0.24) and parathyroid hormone (P = 0.04, r = -0.19). Younger age and lower parathyroid hormone were the only factors that predicted higher scores of anxiety in linear regression. The Kt/V or URR were not significantly correlated with depression and anxiety scores. Conclusions Depression and anxiety are common among hemodialysis patients. There are no statistically significant correlation between depression and anxiety and dialysis adequacy.

  12. Measuring, managing, and improving quality in the end-stage renal disease treatment setting: peritoneal dialysis.

    Science.gov (United States)

    Nissenson, A R

    1994-08-01

    Peritoneal dialysis is now performed as an end-stage renal disease modality in nearly 70,000 patients worldwide. The use of this modality varies widely from less than 5% of all end-stage renal disease patients in Japan to over 95% of patients in Mexico. In addition to medical and psychosocial factors, modality selection involves many other factors, including financial reimbursement, educational deficiencies, resource availability, social mores, and cultural habits. Survival on chronic peritoneal dialysis is similar to that on hemodialysis, although older diabetic patients on peritoneal dialysis may have a higher mortality rate. Hospitalizations and transfer off modality are more common in patients on chronic peritoneal dialysis compared with patients on hemodialysis. The important factors contributing to outcome in patients on chronic peritoneal dialysis are unknown. Results of the Baxter Best-Demonstrated Practice Program suggest that process of care has a strong impact on outcome, at least in retention of patients on chronic peritoneal dialysis. Quality of life is another outcome that has been poorly assessed in chronic peritoneal dialysis patients. Available studies suffer from a lack of standardization of instruments used, no control groups, no random patient allocation to modalities, and short-term, small population groups. When chronic peritoneal dialysis and hemodialysis are compared, subjective quality of life is generally higher with chronic peritoneal dialysis. For objective quality of life, the balance of studies favor hemodialysis. It is clear that there is a dearth of information available on many aspects of delivery of chronic peritoneal dialysis. Future research should target patient factors that are important in morbidity and mortality with chronic peritoneal dialysis, facility factors ("process of care") that are important in morbidity and mortality with chronic peritoneal dialysis, quality of life in chronic peritoneal dialysis patients, and how

  13. Creatinine Index as a Surrogate of Lean Body Mass Derived from Urea Kt/V, Pre-Dialysis Serum Levels and Anthropometric Characteristics of Haemodialysis Patients

    Science.gov (United States)

    Canaud, Bernard; Granger Vallée, Alexandre; Molinari, Nicolas; Chenine, Leila; Leray-Moragues, Hélène; Rodriguez, Annie; Chalabi, Lotfi; Morena, Marion; Cristol, Jean-Paul

    2014-01-01

    Background and Objectives Protein-energy wasting is common in long-term haemodialysis (HD) patients with chronic kidney disease and is associated with increased morbidity and mortality. The creatinine index (CI) is a simple and useful nutritional parameter reflecting the dietary skeletal muscle protein intake and skeletal muscle mass of the patient. Because of the complexity of creatinine kinetic modeling (CKM) to derive CI, we developed a more simplified formula to estimate CI in HD patients. Design, Setting, Participants & Measurements A large database of 549 HD patients followed over more than 20 years including monthly CKM-derived CI values was used to develop a simple equation based on patient demographics, predialysis serum creatinine values and dialysis dose (spKt/V) using mixed regression models. Results The equation to estimate CI was developed based on age, gender, pre-dialysis serum creatinine concentrations and spKt/V urea. The equation-derived CI correlated strongly with the measured CI using CKM (correlation coefficient  = 0.79, p-value <0.001). The mean error of CI prediction using the equation was 13.47%. Preliminary examples of few typical HD patients have been used to illustrate the clinical relevance and potential usefulness of CI. Conclusions The elementary equation used to derive CI using demographic parameters, pre-dialysis serum creatinine concentrations and dialysis dose is a simple and accurate surrogate measure for muscle mass estimation. However, the predictive value of the simplified CI assessment method on mortality deserves further evaluation in large cohorts of HD patients. PMID:24671212

  14. Social support of adults and elderly with chronic kidney disease on dialysis

    Science.gov (United States)

    da Silva, Simone Márcia; Braido, Natalia Fernanda; Ottaviani, Ana Carolina; Gesualdo, Gabriela Dutra; Zazzetta, Marisa Silvana; Orlandi, Fabiana de Souza

    2016-01-01

    ABSTRACT Objective: to evaluate the instrumental and emotional social support of patients with chronic kidney disease on hemodialysis. Method: descriptive cross-sectional study. The sample was sized for convenience and included 103 participants under treatment in a Renal Replacement Therapy Unit. Data were collected through individual interviews, using the Social Support Scale. Results: the mean scores of the emotional and instrumental social support were 3.92 (± 0.78) and 3.81 (± 0.69) respectively, an indication of good support received. The most frequent sources of instrumental and emotional social support mentioned by participants were partners, spouse, companion or boyfriend and friends. Conclusion: patients with chronic kidney disease have high social support, both instrumental and emotional, and the main support comes from the family. PMID:27508920

  15. Dialysate interleukin-6 predicts increasing peritoneal solute transport rate in incident peritoneal dialysis patients

    OpenAIRE

    Cho, Yeoungjee; Johnson, David W.; Vesey, David A; Hawley, Carmel M; Pascoe, Elaine M.; Clarke, Margaret; Topley, Nicholas

    2014-01-01

    Background Repeated exposure to peritoneal dialysis (PD) solutions contributes to cumulative intraperitoneal inflammation and peritoneal injury. The present study aimed to explore the capacity of dialysate interleukin-6(IL-6) to a) predict peritoneal membrane function and peritonitis in incident PD patients, and b) to evaluate the influence of neutral pH, low glucose degradation product (GDP) PD solution on dialysate IL-6 levels. Methods The study included 88 incident participants from the ba...

  16. Anemia treatment and left ventricular hypertrophy in non-dialysis chronic kidney disease

    Institute of Scientific and Technical Information of China (English)

    Robert N. Foley; Peter A. McCullough

    2005-01-01

    @@ To this day, the target hemoglobin level that minimizes cardiovascular risk in chronic kidney disease (CKD) patients remains unclear. When one examines the many randomized trials of epoetin therapy in aggregate, enhanced quality of life provides the most cogent argument for hemoglobin levels above 110 g/L. It remains unclear whether treatment of anemia improves longevity, or even a surrogate marker (such as left ventricular [LV] mass index), especially when applied at earlier phases of CKD.

  17. Analysis on relationship between stiffness of large artery and variability of blood pressure in patients with chronic kidney disease without dialysis%非透析慢性肾脏病合并血压变异患者大动脉僵硬度分析

    Institute of Scientific and Technical Information of China (English)

    陈灿

    2015-01-01

    目的:探讨非透析慢性肾脏病(CKD)患者血压变异性与大动脉僵硬度的关系。方法选取2010年4月至2014年4月诊断为 CKD 3~5期非透析患者,检测24 h 动态血压,根据患者是否患有高血压以及血压变异性进行分组,分析各组各项指标的差异以及血压变异性与大动脉僵硬度的关系。结果共收集 CKD 合并高血压患者368例, CKD 血压正常患者64例。直线相关分析发现 CKD 合并高血压患者血压变异性与脉搏波传导速度(PWV)呈显著的负相关( r =-0.583,P ﹤0.05)。CKD 血压正常患者血压变异性与 PWV 呈显著的负相关( r =-0.844,P ﹤0.05)。多元线性回归分析患者各项观察指标与患者 PWV 的关系发现,CKD 合并高血压患者收缩压、舒张压、脉压、血压变异性、CKD 分期与患者 PWV 显著相关;CKD 血压正常患者血压变异性和 CKD 分期与患者 PWV 显著相关。结论 CKD 患者是否合并高血压,其血压的昼夜异常变化与患者大动脉僵硬度关系密切。%Objective To explore the relationship between variability of blood pressure and stiffness of large artery in patients with chronic kidney disease(CKD)without dialysis. Methods Patients with CKD at phase 3 ~ 5 without dialysis admitted in the department of internal medi-cine in this hospital during April 2010 to April 2014 were allocated in this study. Twenty four hours dynamic blood pressure had been examined, and patients were grouped according to whether they suffered from high blood pressure and variability of blood pressure. The difference in each in-dex of each group and the relationship between variability of blood pressure and stiffness of large artery had been analyzed. Results There were 368 patients with CKD and hypertension and 64 patients with CKD were allocated for this study. There was significant negative correlation between variability of blood pressure and PWV in patients with CKD and

  18. Impact of Individual Nutritional Management on the Quality of Life and Protein Energy Wasting in Patients with Non Dialysis Chronic Kidney Disease%个体化营养管理对非透析慢性肾脏病患者生存质量及蛋白质-能量消耗的影响∗

    Institute of Scientific and Technical Information of China (English)

    杨伊雅; 梁玉梅; 陈愔音

    2015-01-01

    Objective]To investigate the impact of individual nutritional management on the quality of life and protein en-ergy wasting(PEW)in patients with non dialysis chronic kidney disease(CKD staged4~5).[Methods]75 patients of chronic kidney disease stages 4~5 who were regularly followed up in CKD clinic services were recruited in this study.All of the pa-tients were randomly divided into two groups to receive either individua nutrition management for 12 months(group A)or not (group B).Kidney Disease Quality of Life Short Form (KDQOL-SFTM1.3)which was composed of short-form 36 health sur-vey(SF-36)and kidney disease target areas (KDTA)were used to evaluate the quality of life.Four categories mainly estab-lished are to be recognized for diagnosing PEW,including biochemical indices,unexpected lower body mass,muscle mass loss, lack of dietary protein and/or calorie intake.The scores of KDQOL-SF and clinical indicators before and after receiving indi-vidual nutrition management were compared.[Results](1)The incidence rate of PEW in patients pre-management was rather high(54.6%).(2)After 12 month management,the total scores of SF-36 (68.21±11.6),KDTA(66.7±10.2)and the scores of its several branch dimensions in group A were significantly higher than those in group B(61.1 ±9.8;60.3±8.4),and the difference is significant(P <0.05).(3)After receiving the individual nutrition management,the hemoglobin,total cholesterol levels and Body Mass Index(BMI)showed no significant changes.Protein intake decreased and maintained at a low protein diet. The Arm circumference,hand strength ,serum albumin level and dietary protein and/or calorie intake increased.Incidence of PEW in group A decreased to 39.5% and was significantly lower than that in group B(51.3%)(P <0.05).(4)The average decline rate of glomerular filtration rate (eGFR)in group A was(3.04±7.42)mL/(min·1.73 m2 ),slower than that in the group B (5.04±8.28)mL/(min·1.73 m2 ).[Conclusion]Individual nutrition management can

  19. Protein intake during hemodialysis maintains a positive whole body protein balance in chronic hemodialysis patients

    NARCIS (Netherlands)

    Veeneman, JM; Kingma, HA; Boer, TS; Stellaard, F; De Jong, PE; Reijngoud, DJ; Huisman, RM

    2003-01-01

    Protein energy malnutrition is present in 18 to 56% of hemodialysis patients. Because hemodialysis has been regarded as a catabolic event, we studied whether consumption of a protein- and energy-nriched meal improves the whole body protein balance during dialysis in chronic hemodialysis (CHD) patien

  20. Intradialytic Hypoxemia in Chronic Hemodialysis Patients.

    Science.gov (United States)

    Campos, Israel; Chan, Lili; Zhang, Hanjie; Deziel, Sheila; Vaughn, Cheryl; Meyring-Wösten, Anna; Kotanko, Peter

    2016-01-01

    When kidney failure occurs, patients are at risk for fluid overload states, which can cause pulmonary edema, pleural effusions, and upper airway obstruction. Kidney disease is also associated with impaired respiratory function, as in central sleep apnea or chronic obstructive pulmonary disease. Hence, respiratory and renal diseases are frequently coexisting. Hypoxemia is the terminal pathway of a multitude of respiratory pathologies. The measurement of oxygen saturation (SO2) is a basic and commonly used tool in clinical practice. Both arterial oxygen saturation (SaO2) and central venous oxygen saturation (ScvO2) can be easily obtained in hemodialysis (HD) patients, SaO2 from an arteriovenous access and ScvO2 from a central catheter. Here, we give a brief overview of the anatomy and physiology of the respiratory system, and the different technologies that are currently available to measure oxygen status in dialysis patients. We then focus on literature regarding intradialytic SaO2 and ScvO2. Lastly, we present clinical vignettes of intradialytic drops in SaO2 and ScvO2 in association with different symptoms and clinical scenarios with an emphasis on the pathophysiology of these cases. Given the fact that in the general population hypoxemia is associated with adverse outcomes, including increased mortality, cardiac arrhythmias and cardiovascular events, we posit that intradialytic SO2 may serve as a potential marker to identify HD patients at increased risk for morbidity and mortality. PMID:26765143

  1. Effects of nocturnal oxygen therapy on heart function in SDB patients undergoing dialysis.

    Science.gov (United States)

    Nakajima, Fumitaka; Furumatsu, Yoshiyuki; Yurugi, Takatomi; Amari, Yoshifumi; Iida, Takeshi; Uehara, Mitsuru; Fukunaga, Megumu

    2015-06-01

    There is a close relationship between sleep disordered breathing (SDB) and heart failure. We performed home oxygen therapy (HOT) in patients with SAS undergoing dialysis, and investigated its effects on the heart function. The subjects were 10 SDB patients on dialysis. On retiring at night, oxygen was transnasally administered at 1.0 L/min. The human atrial natriuretic peptide (hANP), brain natriuretic peptide (BNP), total protein, Alb, cholesterol and phosphorus levels were measured before the start of oxygen therapy and after 6 weeks. The mean SpO2 increased from 93.5% [91.5, 97.0] to 96.3% [94.8, 97.4] (median [interquartile range]) (p = 0.015). The hANP (p = 0.0039), BNP (p = 0.0098) and serum Alb (p = 0.015) levels significantly improved. There were no significant changes in the cholesterol, phosphorus or total protein levels. These results suggest that nocturnal oxygen therapy improves indices of heart failure, contributing to the prevention and treatment of heart failure in dialysis patients with SDB.

  2. Comparison of oral lesion prevalence between renal transplant patients and dialysis patients.

    Directory of Open Access Journals (Sweden)

    Arash Mansourian

    2013-12-01

    Full Text Available Renal transplantation is performed in patients with end stage renal disease as the best treatment plan. However, different complications may occur in these patients due to the direct consequences of the renal disease or drug-induced suppression of the body immune system. The main objective of the present study was to compare different oral lesions in patients receiving renal transplantation with the patients undergoing dialysis referred to two hospitals in Tehran, Iran.In this cross-sectional study, 93 renal transplant patients who had received renal transplant at least 6 months prior to our study, were selected from their records at the hospitals. Furthermore, 93 candidates of renal transplantation were selected as the control group. The patients in both case and control groups underwent oral examinations and the results were analyzed by chi-square test and Spearman correlation coefficient.At least one oral lesion was found in 30 (32.2% patients in the renal transplant group and 8 (8.6% patents in the control subjects. The difference between the two groups was statistically significant (p<0.0001. The most prevalent lesion was xerostomia observed in 20 patients of the renal transplant group and 4 patients in the control group. The odds ratio of cyclosporine and amlodipine and the effect of these in increasing the risk of oral lesions was 1.21 and 1.02, respectively in renal transplant recipients.The results of the study showed that renal transplantation significantly increases the risk of related oral lesions. Therefore, renal transplant recipients must undergo regular oral examinations in order to find any suspicious lesion(s as soon as possible to treat them.

  3. Recurrent Chronic Ambulatory Peritoneal Dialysis-Associated Infection due to Rothia dentocariosa

    Directory of Open Access Journals (Sweden)

    Shaun K Morris

    2004-01-01

    Full Text Available Rothia dentocariosa is a commensal organism of the human oropharynx. Clinical infection due to this organism is rare. A case of recurrent peritoneal dialysis-related peritonitis caused by R dentocariosa and a review of the literature is reported. Isolation of R dentocariosa from dialysate fluid should not be dismissed as a contaminant. Although there are no interpretive criteria for antimicrobial susceptibility testing, R dentocariosa appears to be susceptible to a variety of antibiotics including beta-lactams, vancomycin and aminoglycosides. Optimal therapy of peritoneal dialysis peritonitis caused by this organism may also require removal of the catheter.

  4. Assessment of degree of hydration in dialysis patients using whole body and calf bioimpedance analysis

    Science.gov (United States)

    Zhu, F.; Kotanko, P.; Handelman, G. J.; Raimann, J.; Liu, L.; Carter, M.; Kuhlmann, M. K.; Siebert, E.; Leonard, E. F.; Levin, N. W.

    2010-04-01

    Prescription of an appropriate post hemodialysis (HD) dialysis target weight requires accurate evaluation of the degree of hydration. The aim of this study was to investigate whether a state of normal hydration as defined by calf bioimpedance spectroscopy (cBIS) could be characterized in HD and normal subjects (NS). cBIS was performed in 62 NS (33 m/29 f) and 30 HD patients (16 m /14 f) pre- and post-dialysis to measure extracellular resistance. Normalized calf resistivity at 5 kHz (ρN,5) was defined as resistivity divided by body mass index. Measurements were made at baseline (BL) and at a state of normal hydration (NH) established following the progressive reduction of post-HD weight over successive dialysis treatments until the ρN,5 was in the range of NS. Blood pressures were measured pre- and post-HD treatment. ρN,5 in males and females differed significantly in NS (20.5±1.99 vs 21.7±2.6 10-2 Ωm3/kg, p>0.05). In patients, ρN,5 notably increased and reached NH range due to progressive decrease in body weight, and systolic blood pressure (SBP) significantly decreased pre- and post-HD between BL and NBH respectively. This establishes the use of ρN,5 as a new comparator allowing the clinician to incrementally monitor the effect of removal of extracellular fluid from patients over a course of dialysis treatments.

  5. Non-adherence in patients on peritoneal dialysis: a systematic review.

    Directory of Open Access Journals (Sweden)

    Konstadina Griva

    Full Text Available BACKGROUND: It has been increasingly recognized that non-adherence is an important factor that determines the outcome of peritoneal dialysis (PD therapy. There is therefore a need to establish the levels of non-adherence to different aspects of the PD regimen (dialysis procedures, medications, and dietary/fluid restrictions. METHODS: A systematic review of peer-reviewed literature was performed in PubMed, PsycINFO and CINAHL databases using PRISMA guidelines in May 2013. Publications on non-adherence in PD were selected by two reviewers independently according to predefined inclusion and exclusion criteria. Relevant data on patient characteristics, measures, rates and factors associated with non-adherence were extracted. The quality of studies was also evaluated independently by two reviewers according to a revised version of the Effective Public Health Practice Project assessment tool. RESULTS: The search retrieved 204 studies, of which a total of 25 studies met inclusion criteria. Reported rates of non-adherence varied across studies: 2.6-53% for dialysis exchanges, 3.9-85% for medication, and 14.4-67% for diet/fluid restrictions. Methodological differences in measurement and definition of non-adherence underlie the observed variation. Factors associated with non-adherence that showed a degree of consistency were mostly socio-demographical, such as age, employment status, ethnicity, sex, and time period on PD treatment. CONCLUSION: Non-adherence to different dimensions of the dialysis regimen appears to be prevalent in PD patients. There is a need for further, high-quality research to explore these factors in more detail, with the aim of informing intervention designs to facilitate adherence in this patient population.

  6. The association between body mass index and mortality in incident dialysis patients.

    Directory of Open Access Journals (Sweden)

    Sunil V Badve

    Full Text Available To study the body mass index (BMI trajectory in patients with incident end-stage kidney disease and its association with all-cause mortality.This longitudinal cohort study included 17022 adult patients commencing hemodialysis [HD] (n = 10860 or peritoneal dialysis [PD] (n = 6162 between 2001 and 2008 and had ≥6-month follow-up and ≥2 weight measurements, using the Australia and New Zealand Dialysis and Transplant Registry data. The association of time-varying BMI with all-cause mortality was explored using multivariate Cox regression models.The median follow-up was 2.3 years. There was a non-linear change in the mean BMI (kg/m2 over time, with an initial decrease from 27.6 (95% confidence interval [CI]: 27.5, 27.7 to 26.7 (95% CI: 26.6, 26.9 at 3-month, followed by increments to 27.1 (95% CI: 27, 27.2 at 1-year and 27.2 (95% CI: 26.8, 27.1 at 3-year, and a gradual decrease subsequently. The BMI trajectory was significantly lower in HD patients who died than those who survived, although this pattern was not observed in PD patients. Compared to the reference time-varying BMI category of 25.1-28 kg/m2, the mortality risks of both HD and PD patients were greater in all categories of time-varying BMI 28.1 kg/m2 among HD patients, but only in the category 28.1-31 kg/m2 among PD patients.BMI changed over time in a non-linear fashion in incident dialysis patients. Time-varying measures of BMI were significantly associated with mortality risk in both HD and PD patients.

  7. Niacin as a drug repositioning candidate for hyperphosphatemia management in dialysis patients

    Directory of Open Access Journals (Sweden)

    Shin S

    2014-10-01

    Full Text Available Sooyoung Shin, Sukhyang LeeAjou University College of Pharmacy, Yeongtong-gu, Suwon-si, Gyeonggi-do, Korea Abstract: Nearly all patients with end-stage renal disease develop hyperphosphatemia. These patients typically require oral phosphate binders for life-long phosphorus management, in addition to dietary restrictions and maintenance dialysis. Recently, niacin, a traditional antilipemic agent, drew attention as an experimental treatment for hyperphosphatemia. The purpose of this article was to report on new findings regarding niacin’s novel effects and to review the possibility of repurposing niacin for hyperphosphatemia treatment in dialysis patients by elucidating its safety and efficacy profiles along with its synergistic clinical benefits. Following approval from the Institutional Review Board, we tracked the yearly trends of order frequency of niacin in comparison with statins and sevelamer in a tertiary care hospital. Also, a Cochrane Library and PubMed literature search was performed to capture prospective clinical trials on niacin’s hypophosphatemic effects in dialysis patients. Niacin use in clinical settings has been on the wane, and the major contribution to that originates from the wide use of statins. Niacin use rates have further plummeted following a trial failure which prompted the suspension of the niacin-laropiprant (a flushing blocker combination product in the global market. Our literature search identified ten relevant articles. Overall, all studies demonstrated that niacin or nicotinamide (the metabolite form reduced serum phosphorus levels as well as Ca-P products significantly. Additive beneficial effects on lipid parameters were also observed. Sevelamer appeared superior to niacin in a comparative study, but the study design had several limitations. The intervention dosage for niacin ranged from 375 to 1,500 mg/day, with the average daily dose of approximately 1,000–1,500 mg. Niacin can be a patient

  8. Risk factors for the occurrence of cardiac arrhythmias in patients on continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    Canziani, M E; Saragoça, M A; Draibe, S A; Barbieri, A; Ajzen, H

    1993-01-01

    In order to evaluate the risk factors for the occurrence of ventricular arrhythmias (VA) in continuous ambulatory peritoneal dialysis (CAPD), we studied 47 patients by echocardiography, dipyridamole-thallium tests, and biochemical profile. We observed that the group with VA had a greater cardiac mass index dependent only on an increased left ventricular internal diameter. Septum and posterior wall thickness, as well as biochemical variables, were not associated with the presence of VA in CAPD patients. In addition, altered myocardial perfusion was not associated with VA in these patients. PMID:8399625

  9. Gangrenous appendicitis presenting as acute abdominal pain in a patient on automated peritoneal dialysis: a case report

    Directory of Open Access Journals (Sweden)

    Ekart Robert

    2012-09-01

    Full Text Available Abstract Introduction Presentations of abdominal pain in patients on peritoneal dialysis deserve maximal attention and careful differential diagnosis on admittance to medical care. In this case report a gangrenous appendicitis in a patient on automated peritoneal dialysis is presented. Case presentation We report the case of a 38-year-old Caucasian man with end-stage renal disease who was on automated peritoneal dialysis and developed acute abdominal pain and cloudy peritoneal dialysate. Negative microbiological cultures of the peritoneal dialysis fluid and an abdominal ultrasonography misleadingly led to a diagnosis of culture negative peritonitis. It was decided to remove the peritoneal catheter but the clinical situation of the patient did not improve. An explorative laparotomy was then carried out; diffuse peritonitis and gangrenous appendicitis were found. An appendectomy was performed. Myocardial infarction and sepsis developed, and the outcome was fatal. Conclusion A peritoneal dialysis patient with abdominal pain that persists for more than 48 hours after the usual antibiotic protocol for peritoneal dialysis-related peritonitis should immediately alert the physician to the possibility of peritonitis caused by intra-abdominal pathology. Not only peritoneal catheter removal is indicated in patients whose clinical features worsen or fail to resolve with the established intra-peritoneal antibiotic therapy but, after 72 hours, an early laparoscopy should be done and in a case of correct indication (intra-abdominal pathology an early explorative laparotomy.

  10. Upper Tract Urothelial Carcinomas in Patients with Chronic Kidney Disease: Relationship with Diagnostic Challenge

    Directory of Open Access Journals (Sweden)

    Li-Jen Wang

    2014-01-01

    Full Text Available Chronic kidney disease and upper tract urothelial carcinomas display a bidirectional relationship. Review of the literature indicates that early diagnosis and correct localization of upper tract urothelial carcinomas in dialysis patients and kidney transplant recipients are important but problematic. Urine cytology and cystoscopy have limited sensitivity for the diagnosis of upper tract urothelial carcinomas in dialysis patients. Enhanced computed tomography and magnetic resonance imaging could prove useful for the detection and staging of upper tract urothelial carcinomas in dialysis patients. Renal ultrasound can detect hydronephrosis caused by upper tract urothelial carcinomas in kidney transplant recipients but cannot visualize the carcinomas themselves. High detection rates for upper tract urothelial carcinomas in kidney transplant recipients have recently been demonstrated using computed tomography urography, which appears to be a promising tool. To detect carcinomas in dialysis patients and kidney transplant recipients as early as possible, regular screening in asymptomatic patients and diagnostic work-up in symptomatic patients should be performed using a combination of urological and imaging methods. Careful assessment of subsequent recurrence within the contralateral upper urinary tract and the urinary bladder is necessary for dialysis patients and kidney transplant recipients with upper tract urothelial carcinomas.

  11. Upper tract urothelial carcinomas in patients with chronic kidney disease: relationship with diagnostic challenge.

    Science.gov (United States)

    Wang, Li-Jen; Lee, Shen-Yang; Teh, Bin Tean; Chuang, Cheng-Keng; Nortier, Joëlle

    2014-01-01

    Chronic kidney disease and upper tract urothelial carcinomas display a bidirectional relationship. Review of the literature indicates that early diagnosis and correct localization of upper tract urothelial carcinomas in dialysis patients and kidney transplant recipients are important but problematic. Urine cytology and cystoscopy have limited sensitivity for the diagnosis of upper tract urothelial carcinomas in dialysis patients. Enhanced computed tomography and magnetic resonance imaging could prove useful for the detection and staging of upper tract urothelial carcinomas in dialysis patients. Renal ultrasound can detect hydronephrosis caused by upper tract urothelial carcinomas in kidney transplant recipients but cannot visualize the carcinomas themselves. High detection rates for upper tract urothelial carcinomas in kidney transplant recipients have recently been demonstrated using computed tomography urography, which appears to be a promising tool. To detect carcinomas in dialysis patients and kidney transplant recipients as early as possible, regular screening in asymptomatic patients and diagnostic work-up in symptomatic patients should be performed using a combination of urological and imaging methods. Careful assessment of subsequent recurrence within the contralateral upper urinary tract and the urinary bladder is necessary for dialysis patients and kidney transplant recipients with upper tract urothelial carcinomas.

  12. Patient characteristics and risk factors of early and late death in incident peritoneal dialysis patients.

    Science.gov (United States)

    Liu, Xinhui; Huang, Rong; Wu, Haishan; Wu, Juan; Wang, Juan; Yu, Xueqing; Yang, Xiao

    2016-01-01

    This study was conducted to identify key patient characteristics and risk factors for peritoneal dialysis (PD) mortality in terms of different time-point of death occurrence. The incident PD patients from January 1, 2006 to December 31, 2013 in our PD center were recruited and followed up until December 31, 2015. Patients who died in the early period (the first 3 months) were older, had higher neutrophil to lymphocyte ratio (N/L), serum phosphorus, and uric acid level, and had lower diastolic pressure, hemoglobin, serum albumin, and calcium levels. After adjustment of gender, age, and PD inception, higher N/L level [hazard ratio (HR) 1.115, P = 0.006], higher phosphorus lever (HR 1.391, P < 0.001), lower hemoglobin level (HR 0.596, P < 0.001), and lower serum albumin level (HR 0.382, P = 0.017) were risk factors for early mortality. While, presence of diabetes (HR 1.627, P = 0.001), presence of cardiovascular disease (HR 1.847, P < 0.001) and lower serum albumin level (HR 0.720, P = 0.023) were risk factors for late mortality (over 24 months). In conclusion, patient characteristics and risk factors associated with early and late mortality in incident PD patients were different, which indicated specific management according to patient characteristics at the initiation of PD should be established to improve PD patient survival. PMID:27576771

  13. Mortality and health-related quality of life in prevalent dialysis patients: Comparison between 12-items and 36-items short-form health survey

    Directory of Open Access Journals (Sweden)

    Østhus Tone Brit

    2012-05-01

    Full Text Available Abstract Background To assess health- related quality of life (HRQOL with SF-12 and SF-36 and compare their abilities to predict mortality in chronic dialysis patients, after adjusting for traditional risk factors. Methods The Short-Form Health Survey (SF-36 with the embedded SF-12 was applied in 301 dialysis patients cross-sectionally. Physical and mental component summary (PCS-36, MCS-36, PCS-12, and MCS-12 scores were calculated. Clinical and demographic data were collected. Mortality (followed for up to 4.5 years was analyzed with Kaplan Meier plots and Cox proportional hazards, after censoring for renal transplantation. Exclusion factors were observation time Results In 252 patients (60.2 ± 15.5 years, 65.9% males, dialysis vintage 9.0, IQR 5.0-23.0 months, mortality during follow-up was 33.7%.(85 deaths. Significant correlations were observed between PCS-36 and PCS-12 (ρ = 0.93, p ρ = 0.95, p χ2 = 15.3, p = 0.002 and PCS-36 (χ2 = 16.7, p = 0.001. MCS was not associated with mortality. Adjusted hazard ratios for mortality were 2.5 (95% CI 1.0-6.3, PCS-12 and 2.7 (1.1 – 6.4, PCS-36 for the lowest compared with the highest (“best perceived” quartile of PCS. Conclusion Compromised HRQOL is an independent predictor of poor outcome in dialysis patients. The SF-12 provided similar predictions of mortality as SF-36, and may serve as an applicable clinical tool because it requires less time to complete.

  14. Risk and Prognosis of Bacteremia and Fungemia among Peritoneal Dialysis Patients

    DEFF Research Database (Denmark)

    Dalgaard, Lars S; Nørgaard, Mette; Povlsen, Johan V;

    2016-01-01

    ♦ Background: The incidence of bacteremia and fungemia (BAF) is largely unknown in end-stage renal disease (ESRD) patients initiating peritoneal dialysis (PD). ♦ Objective: The main objective was to estimate and compare incidence rates of first episodes of BAF in incident PD patients and a compar......♦ Background: The incidence of bacteremia and fungemia (BAF) is largely unknown in end-stage renal disease (ESRD) patients initiating peritoneal dialysis (PD). ♦ Objective: The main objective was to estimate and compare incidence rates of first episodes of BAF in incident PD patients...... and a comparison cohort. A secondary objective was to compare causative agents and 30-day post-BAF mortality between PD patients and the comparison cohort. ♦ Methods: Design: Observational cohort study. SETTING: Central and North Denmark regions. PARTICIPANTS: patients who initiated PD during 1995 - 2010. For each...... and population controls. Incidence-rate ratios (IRRs) were calculated to compare these rates. Thirty-day mortality was estimated by Kaplan-Meier analysis. ♦ Results: Among 1,024 PD patients and 10,215 population controls, we identified 75 and 282 episodes of BAF, respectively. Incidence rates of BAF were 4.7 (95...

  15. Asaia bogorensis peritonitis identified by 16S ribosomal RNA sequence analysis in a patient receiving peritoneal dialysis.

    Science.gov (United States)

    Snyder, Richard W; Ruhe, Jorg; Kobrin, Sidney; Wasserstein, Alan; Doline, Christa; Nachamkin, Irving; Lipschutz, Joshua H

    2004-08-01

    Here the authors report a case of refractory peritonitis leading to multiple hospitalizations and the loss of peritoneal dialysis access in a patient on automated peritoneal dialysis, caused by Asaia bogorensis, a bacterium not previously described as a human pathogen. This organism was identified by sequence analysis of the 16S ribosomal RNA gene. Unusual microbial agents may cause peritonitis, and molecular microbiological techniques are important tools for identifying these agents.

  16. Laughter and humor therapy in dialysis.

    Science.gov (United States)

    Bennett, Paul N; Parsons, Trisha; Ben-Moshe, Ros; Weinberg, Melissa; Neal, Merv; Gilbert, Karen; Rawson, Helen; Ockerby, Cherene; Finlay, Paul; Hutchinson, Alison

    2014-01-01

    Laughter and humor therapy have been used in health care to achieve physiological and psychological health-related benefits. The application of these therapies to the dialysis context remains unclear. This paper reviews the evidence related to laughter and humor therapy as a medical therapy relevant to the dialysis patient population. Studies from other groups such as children, the elderly, and persons with mental health, cancer, and other chronic conditions are included to inform potential applications of laughter therapy to the dialysis population. Therapeutic interventions could range from humorous videos, stories, laughter clowns through to raucous simulated laughter and Laughter Yoga. The effect of laughter and humor on depression, anxiety, pain, immunity, fatigue, sleep quality, respiratory function and blood glucose may have applications to the dialysis context and require further research. PMID:24467450

  17. Meta-Analysis of Anticoagulation Use, Stroke, Thromboembolism, Bleeding, and Mortality in Patients With Atrial Fibrillation on Dialysis.

    Science.gov (United States)

    Wong, Christopher X; Odutayo, Ayodele; Emdin, Connor A; Kinnear, Ned J; Sun, Michelle T

    2016-06-15

    Atrial fibrillation (AF) is common in patients on dialysis. Although randomized trials of anticoagulation for AF have demonstrated striking reductions in stroke, these trials did not recruit patients on dialysis. We thus undertook this systematic review and meta-analysis of observational studies including patients with AF on dialysis that reported associations of anticoagulation use. Twenty studies involving 529,741 subjects and 31,321 patients with AF on dialysis were identified. Anticoagulation was associated with a 45% (95% CI 13% to 88%) increased risk of any stroke, reflecting a nonsignificant 13% (95% CI -4% to 34%) increased ischemic stroke risk and 38% (95% CI 3% to 85%) increased hemorrhagic stroke risk. There was also a 44% (95% CI 38% to 56%) lower risk of any thromboembolism, and a 31% (95% CI 12% to 53%) increased risk of any bleeding but no clear association with cardiovascular death (relative risk 0.99, 95% CI 0.86 to 1.15) or all-cause mortality (relative risk 0.97, 95% CI 0.90 to 1.04). Incident event rates were similar or worse in patients on anticoagulation. In conclusion, these observational analyses provide little supporting evidence of benefit, and instead suggest harm, from anticoagulation in patients on dialysis with AF. These results raise the possibility that the effects of anticoagulation in patients with AF on dialysis may not be similar to the clear benefit of anticoagulation seen in patients with AF without end-stage renal disease. Randomized trials are required to definitively evaluate the safety and efficacy of anticoagulation for AF in the dialysis setting. PMID:27237624

  18. Comparative Proteomic Analysis of Peritoneal Dialysate from Chronic Glomerulonephritis Patients

    Directory of Open Access Journals (Sweden)

    Hsin-Yi Wu

    2013-01-01

    Full Text Available Peritoneal dialysis (PD frequently contributes to peritoneal damage which cannot be easily identified without invasive techniques, implying the urgent need for biomarkers and revealing mechanisms. Chronic glomerulonephritis (CGN is one of the leading causes of receiving dialysis treatment. Here, we attempted to analyze the peritoneal dialysate collected from CGN patients when they receive continuous ambulatory peritoneal dialysis (CAPD treatment for the first time and after a year to reveal the protein changes that resulted from PD. Proteins were displayed by two-dimensional gel electrophoresis (2DE. Altered gel spots were digested followed by liquid chromatography-tandem mass spectrometry (LC-MS/MS analysis for protein identification. Eight proteins were found to have differential expression levels between two groups. Their differential expressions were validated by Western blots in other sets of peritoneal dialysates. Proteins identified with higher levels in the first-time dialysate suggested their dominant appearance in CGN patients, while those that showed higher levels in peritoneal dialysate collected after one year may result from initial peritoneal inflammation or changes in the permeability of the peritoneum to middle-sized proteins. All the identified proteins may provide a perceptiveness of peritoneal changes caused by PD and may function as potential biomarkers or drug targets.

  19. 慢性肾脏病及透析患儿的疫苗接种%Immunization in children with chronic renal diseases and undergoing dialysis

    Institute of Scientific and Technical Information of China (English)

    刘小荣; 姚开虎; 杨永弘

    2013-01-01

    Most children patients with chronic kidney disease show immune disorders and defects of immune functionality.There are significant increases in various pathogen infections,especially streptococcus pneumonia,hepatitis B virus,and influenza virus.Streptococcus pneumonia is the most common cause of bacterial pneumonia and otitis media worldwide,and the main pathogens of bacterial meningitis as well.Children treated by hemodialysis are in high risk circumstance susceptible to hepatitis B virus.Influenza is a highly contagious disease with extremely strong dissemination capability.The organizations of U.S.Advisory Committee on Immunization Practices (ACIP),and Kidney Disease:Improving Global Outcomes (KDIGO) specifically recommends 3 vaccines,namely,hepatitis B virus,influenza virus (inactivated),and pneumococcal vaccine for patients with chronic kidney disease and chronic dialysis.Vaccination is a specific preventive and an effective protective measure for patients of chronic kidney disease and undergoing dialysis.%慢性肾脏病患儿大多存在免疫紊乱及免疫功能缺陷.各种病原菌的感染率明显增高,尤其容易感染肺炎链球菌、HBV及流感病毒.在全球范围内,肺炎链球菌是细菌性肺炎和中耳炎的最常见病原,是细菌性脑膜炎的主要病原菌.血液透析的患儿更是HBV易感染的高危人群.流感是具有高度传染性及极其广泛的传播性疾病.美国免疫实践指南咨询委员会(ACIP)及改善全球肾脏病预后(KDIGO)特别推荐慢性肾脏病及慢性透析的患者接种的3种疫苗是HBV疫苗、灭活流感病毒疫苗及肺炎链球菌疫苗.接种疫苗是特异性的预防措施,可对慢性肾脏病及透析患者提供有效的预防保护.

  20. CCR5 Deletion Protects Against Inflammation-Associated Mortality in Dialysis Patients

    OpenAIRE

    Muntinghe, Friso L. H.; Verduijn, Marion; Zuurman, Mike W.; Grootendorst, Diana C; Carrero, Juan Jesus; Qureshi, Abdul Rashid; Luttropp, Karin; Nordfors, Louise; Lindholm, Bengt; Brandenburg, Vincent; Schalling, Martin; Stenvinkel, Peter; Boeschoten, Elisabeth W; Krediet, Raymond T; Navis, Gerjan

    2009-01-01

    The CC-chemokine receptor 5 (CCR5) is a receptor for various proinflammatory chemokines, and a deletion variant of the CCR5 gene (CCR5Δ32) leads to deficiency of the receptor. We hypothesized that CCR5Δ32 modulates inflammation-driven mortality in patients with ESRD. We studied the interaction between CCR5 genotype and levels of high-sensitivity C-reactive protein (hsCRP) in 603 incident dialysis patients from the multicenter, prospective NEtherlands COoperative Study on the Adequacy of Dialy...

  1. Outcome and Safety of Sorafenib in Metastatic Renal Cell Carcinoma Dialysis Patients: A Systematic Review.

    Science.gov (United States)

    Leonetti, Alessandro; Bersanelli, Melissa; Castagneto, Bruno; Masini, Cristina; Di Meglio, Giovanni; Pellegrino, Benedetta; Buti, Sebastiano

    2016-08-01

    Few data are available about sorafenib use in patients with metastatic renal cell carcinoma (mRCC) undergoing hemodialysis. No systematic review has been previously performed about this issue. The objective of the present review is to investigate pharmacokinetics and clinical outcomes of sorafenib in mRCC patients undergoing hemodialysis. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, all the literature about mRCC dialysis patients receiving sorafenib, published from January 1946 to August 2015, was evaluated. Applying inclusion/exclusion criteria, 11 articles were selected for the analysis; 1 patient from our department was also included. The investigated outcomes were pharmacokinetics, toxicity, response rate, progression-free survival, and overall survival where available. A total of 36 patients were included. Median treatment duration was 6.0 months on overall population; median progression-free survival was 6.3 months (calculated on 19 patients); response rate was 22% (on 29 patients); median overall survival was 14.9 months (on 28 patients). Of note, 24 patients started sorafenib at reduced dose; 6 of 36 patients (17%) required dose reduction due to adverse events (AEs). Sorafenib treatment was discontinued in 7 patients (19%) because of AEs. Most of AEs were Grade 1-2; severe toxicities (Grade 4-5) included G4 anemia (1 case), G4 hypertension (1 case), G4 cerebellar hemorrhage (1 patient), and a case of G5 subarachnoid hemorrhage. This review confirmed the efficacy of sorafenib treatment in mRCC patients receiving hemodialysis. Nevertheless, drug toxicity seems to be increased in these patients, despite the initiation of therapy at reduced doses; therefore, sorafenib should be used with caution in dialysis patients. PMID:26899142

  2. Quality of life, mental health and health beliefs: comparison between haemodialysis and peritoneal dialysis patients

    Directory of Open Access Journals (Sweden)

    Theofilou P

    2010-10-01

    Full Text Available Aim: The comparative study between in-centre haemodialysis (HD and continuous ambulatory peritoneal dialysis (PD patients regarding self-reported quality of life (QoL as well as some psychological dimensions that may affect and may be affected by the patient’s state of health, like health locus of control beliefs, depression and anxiety. Material and Method: The sample consists of 144 patients in-centre haemodialysis or continuous ambulatory peritoneal dialysis (CAPD. Patient-reported assessments included: a WHOQOL-BREF, b General Health Questionnaire (GHQ-28, c Multidimensional Health Locus of Control Questionnaire (MHLC, d State - Trait Anxiety Inventory (STAI I, II and e Center for Epidemiologic Studies Depression Scale (CES-D.Results: HD patients presented lower scores in WHOQOL-BREF domain of environment. Furthermore, they reported higher scores in the GHQ-28 sub-scales of anxiety/insomnia and severe depression as well as of the total score of the questionnaire. Regarding health beliefs, statistically significant difference was observed in HD patients, who presented higher scores in the internal health locus of control. Conclusions: Patients in HD treatment modality were experiencing a more compromised QoL indicating greater discontent with different aspects of their environment. Further, they reported more symptoms of anxiety, sleeping problems, depression or suicidal thoughts.

  3. Incremental Hemodialysis Schedule in Patients with Higher Residual Renal Function at the Start of Dialysis

    Directory of Open Access Journals (Sweden)

    Milagros Fernández Lucas

    2014-01-01

    Full Text Available We present an observational study to evaluate a progressive schedule of dose of dialysis, starting with 2 HD/week, when the renal clearance of urea was equal to or greater than 2,5 mL/min/1,73 m2 and the patient is in a stable clinical situation. From 2006 to 2011, 182 patients started hemodialysis in our center, of which 134 were included in the study. Residual renal function (RRF, Kt/V, eKru, nPCR, hemoglobin, weekly erythropoietin dose, and beta-2-microglobulin were determined at 6, 12, 18, 24, and 30 months after dialysis initiation. Seventy patients (52% began with the progressive schedule of 2 HD/week and 64 (48% patients began with the conventional thrice-weekly schedule (3 HD/week. The decline of RRF was lower in the group of 2 HD/week: 0,20 (0,02–0,53 versus 0,50 (0,14–1,08 mL/min/month (median and interquartile range, P=0,009. No relationship was found between the decline rate and the basal RRF. Survival analysis did not show differences between both groups. Our experience demonstrates that patients with higher residual renal function may require less than conventional 3 HD sessions per week at the start of dialysis. Twice-weekly hemodialysis schedule is safe and cost-effective and may have additional benefit in maintaining the residual renal function.

  4. Effectiveness of peritonaeal dialysis

    Directory of Open Access Journals (Sweden)

    Jovanović Nataša

    2005-01-01

    Full Text Available Introduction. In the last few years, an increasing number of patients suffering from terminal renal disease of various leading causes was treated with renal replacement therapy. Peritonaeal dialysis involves an exchange of water and solutes between blood in the peritonaeal capillaries and dialysate in the peritonaeal cavum throughout the peritonaeum. Effective dialysis treatment should provide good quality of life, decrease the number of physical complaints, and bring the incidence of morbidity and mortality closer to the incidence of morbidity and mortality in the healthy population. Aim. The aim of this study was the evaluation of peritonaeal transport characteristics and dialysis effectiveness in 58 patients affected by terminal renal disease who underwent peritonaeal dialysis treatment during August 2003 at the Clinic of Nephrology of the Clinical Centre of Serbia. Method. We examined 30 male and 28 female patients, with an average age of 52 years (range 26 to 78 years. The average duration of peritoneal dialysis treatment was 20 months (ranging from 2 to 66 months, and the end-stage renal failure was caused by different leading disease in our patients. We applied different dialysis modalities: continuous ambulatory peritonaeal dialysis (CAPD with three to five 2- or 3-litre exchanges daily, cyclic peritonaeal dialysis (CCPD, intermittent peritonaeal dialysis (IPD, or automatic peritonaeal dialysis (APD, according to the transport characteristics of the peritonaeal membrane, the residual renal function (RRF, and the clinical status of the patients, in order to perform adequate depuration as suggested by the new international criteria. A peritonaeal equilibrium test (PET was performed according to the new international advice; urea and creatinine clearances (Kt/V and Ccr as well as RRF were calculated using the internationally suggested formulas. Results. Most of our patients received effective dialysis treatment, thanks to the modulation of

  5. Hepatitis B Vaccination in Chronic Kidney Disease: Review of Evidence in Non-Dialyzed Patients

    OpenAIRE

    Grzegorzewska, Alicja E

    2012-01-01

    Context Hepatitis B vaccination of hemodialysis patients is performed all over the world. There are also recommendations from world health organizations to vaccinate patients with chronic kidney disease (CKD) prior dialysis commencement, but the implementation of a hepatitis B vaccination program is less common and not well organized. Evidence Acquisition This review article summarizes data indicating why, when and how to vaccinate CKD patients before they start renal replacement therapy. Pub...

  6. Impact of High-Cut-Off Dialysis on Renal Recovery in Dialysis-Dependent Multiple Myeloma Patients: Results from a Case-Control Study.

    Directory of Open Access Journals (Sweden)

    Hans U Gerth

    Full Text Available High-cut-off hemodialysis (HCO-HD can effectively reduce high concentrations of circulating serum free light chains (sFLC in patients with dialysis-dependent acute kidney injury (AKI due to multiple myeloma (MM. Therefore, the aim of this study was to analyze renal recovery in a retrospective single-center cohort of dialysis-dependent MM patients treated with either conventional HD (conv. HD or HCO-HD.The final cohort consisted of 59 patients treated with HCO-HD (n = 42 or conv. HD (n = 17. A sustained sFLC response was detected in a significantly higher proportion of HCO-HD patients (83.3% compared with conv. HD patients (29.4%; p = 0.007. The median duration of sFLC required to reach values <1000 mg/l was 14.5 days in the HCO-HD group and 36 days in the conv. HD group. The corresponding rates of renal recovery were 64.3% and 29.4%, respectively (chi-squared test, p = 0.014. Multivariate regression and decision tree analysis (recursive partitioning revealed HCO-HD (adjusted odds ratio [OR] 6.1 [95% confidence interval (CI 1.5-24.5], p = 0.011 and low initial uric acid values (adjusted OR 1.3 [95%CI 1.0-1.7], p = 0.045 as independent and paramount variables associated with a favorable renal outcome.In summary, the results from this retrospective case-control study suggest in addition to novel agent-based chemotherapy a benefit of HCO-HD in sFLC removal and renal outcome in dialysis-dependent AKI secondary to MM. This finding was especially pertinent in patients with low initial uric acid values, resulting in a promising renal recovery rate of 71.9%. Further prospective studies are warranted.

  7. Effects of mildly increasing dialysis sodium removal on renin and sympathetic system in hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    Shen Yang; Sun Fang; Liu Jing; Ma Lijie; Huang Jing; Zhou Yilun; Liu Wenhu

    2014-01-01

    Background It has been argued that the benefits of reducing sodium loading may be offset by increased activation of the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system.This study aimed to investigate the long-term effects of an increase in dialysis sodium removal on circulating RAAS and sympathetic system in hypertensive hemodialysis (HD) patients with "normal" post-HD volume status.Methods Thirty hypertensive HD patients were enrolled in this pilot trial.After one month period of dialysis with standard dialysate sodium of 138 mmol/L,the patients were followed up for a four months period with dialysate sodium set at 136 mmol/L,without changes in instructions regarding dietary sodium control.During the period of study,the dry weight was adjusted monthly under the guidance of bioimpedance spectroscopy to maintain post-HD volume status in a steady state; 44-hour ambulatory blood pressure,plasma renin,angiotensin Ⅱ (Ang Ⅱ),aldosterone,and norepinephrine (NE) were measured.Results After four months of HD with low dialysate sodium of 136 mmol/L,44-hour systolic and diastolic blood pressures (BPs) were significantly lower (-10 and-6 mmHg),in the absence of changes in antihypertensive medications.No significant changes were observed in plasma renin,Ang Ⅱ,aldosterone,and NE concentrations.The post-HD volume parameters were kept constant.Conclusion Mildly increasing dialysis sodium removal over 4 months can significantly improve BP control and does not activate circulating RAAS and sympathetic nervous system in hypertensive HD patients.

  8. Survival trends of US dialysis patients with heart failure: 1995 to 2005.

    LENUS (Irish Health Repository)

    Stack, Austin G

    2012-01-31

    BACKGROUND AND OBJECTIVES: Congestive heart failure (CHF) is a major risk factor for death in end-stage kidney disease; however, data on prevalence and survival trends are limited. The objective of this study was to determine the prevalence and mortality effect of CHF in successive incident dialysis cohorts. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a population-based cohort of incident US dialysis patients (n = 926,298) from 1995 to 2005. Age- and gender-specific prevalence of CHF was determined by incident year, whereas temporal trends in mortality were compared using multivariable Cox regression. RESULTS: The prevalence of CHF was significantly higher in women than men and in older than younger patients, but it did not change over time in men (range 28% to 33%) or women (range 33% to 36%). From 1995 to 2005, incident death rates decreased for younger men (<\\/=70 years) and increased for older men (>70 years). For women, the pattern was similar but less impressive. During this period, the adjusted mortality risks (relative risk [RR]) from CHF decreased in men (from RR = 1.06 95% Confidence intervals (CI) 1.02-1.11 in 1995 to 0.91 95% CI 0.87-0.96 in 2005) and women (from RR = 1.06 95% CI 1.01-1.10 in 1995 to 0.90 95% CI 0.85-0.95 in 2005 compared with referent year 2000; RR = 1.00). The reduction in mortality over time was greater for younger than older patients (20% to 30% versus 5% to 10% decrease per decade). CONCLUSIONS: Although CHF remains a common condition at dialysis initiation, mortality risks in US patients have declined from 1995 to 2005.

  9. Hijama improves overall quality of life in chronic renal failure patients: A pilot study.

    Science.gov (United States)

    Bilal, Muhammad; Khan, Rafeeq Alam; Danial, Khurram

    2015-09-01

    Present study assesses the therapeutic effectiveness of Hijama (blood letting) inpatients of chronic renal failure undergoing hemodialysis for past several years with almost no urinary output.24 patients from Sindh Government Qatar Hospital Karachi were selected randomly under going dialysis 2-3 times/week for an average of 3 years under supervision of Dr. Khurram Danial, in-charge nephrologist at dialysis Centre Sindh Government Qatar Hospital Karachi after the written consent from patients. Each patient was subjected to Hijama session once a week after dialysis for a period of one year in a nearby hospital Aligarh Shifa with the consent of the ethical committee of the hospital. Serum urea, creatinine, complete blood count and electrolytes were determined prior to Hijama as baseline values and were again recorded on monthly basis for twelve months of Hijama sessions. The patient's feedback regarding quality of life after each Hijama session shows that almost all the patients reported a significant recovery from severe fatigue which they used to face during the interval between the dialysis sessions. There was significant recovery in all patients from anorexia and insomnia with the improvement in quality of life as compared to patients not undergoing Hijama. Both systolic and diastolic blood pressures were shifted towards normal in almost all patients after Hijama. Serum Creatinine level was declined significantly, while electrolyte and hematological parameters were also improved significantly. The hemoglobin of all patients undergoing Hijama was maintained near normal without any blood transfusion, which was frequently needed in patients not undergoing Hijama sessions. There was insignificant improvement in Urinary output in 2 out of 24 patients. Results of the present study suggest that Hijama may be performed safely in patients of chronic renal failure on dialysis with overall improvement in quality of life, since there was reduction in fatigue, improvement in

  10. A report of the Malaysian dialysis registry of the National Renal Registry, Malaysia.

    Science.gov (United States)

    Lim, Y N; Lim, T O; Lee, D G; Wong, H S; Ong, L M; Shaariah, W; Rozina, G; Morad, Z

    2008-09-01

    The Malaysian National Renal Registry was set up in 1992 to collect data for patients on renal replacement therapy (RRT). We present here the report of the Malaysian dialysis registry. The objectives of this papar are: (1) To examine the overall provision of dialysis treatment in Malaysia and its trend from 1980 to 2006. (2) To assess the treatment rate according to the states in the country. (3) To describe the method, location and funding of dialysis. (4) To characterise the patients accepted for dialysis treatment. (5) To analyze the outcomes of the dialysis treatment. Data on patients receiving dialysis treatment were collected at initiation of dialysis, at the time of any significant outcome, as well as yearly. The number of dialysis patients increased from 59 in 1980 to almost 15,000 in 2006. The dialysis acceptance rate increased from 3 per million population in 1980 to 116 per million population in 2006, and the prevalence rate from 4 to 550 per million population over the same period. The economically advantaged states of Malaysia had much higher dialysis treatment rates compared to the less economically advanced states. Eighty to 90% of new dialysis patients were accepted into centre haemodialysis (HD), and the rest into the chronic ambulatory peritoneal dialysis (CAPD) programme. The government provided about half of the funding for dialysis treatment. Patients older than 55 years accounted for the largest proportion of new patients on dialysis since the 1990s. Diabetes mellitus has been the main cause of ESRD and accounted for more than 50% of new ESRD since 2002. Annual death rate averaged about 10% on HD and 15% on CAPD. The unadjusted 5-year patient survival on both HD and CAPD was about 80%. Fifty percent of dialysis patients reported very good median QoL index score. About 70% of dialysis patients were about to work full or part time. There has been a very rapid growth of dialysis provision in Malaysia particularly in the older age groups. ESRD

  11. Disability, Activities of Daily Living and Self Efficacy in Dialysis Patients

    Directory of Open Access Journals (Sweden)

    Mukadder Mollaoglu

    2011-04-01

    Full Text Available Purpose: The purpose of this study is to assess patients’ disability, activities of daily living and self-efficacy patients undergoing hemodialysis (HD and continuos ambulatory peritoneal dialysis (CAPD, to examine the relationship between them. Material and Methods: This study was carried with 152 patients as sample group. In this study, three instruments were used: Personal Information Form, Brief Disability Questionnaire, Katz\\'s Activity\\'s of Daily Living Index and Lawton and Brody\\'s Instrumental Activities of Daily Living Index and Self-efficacy Assessment Form. Data collected from the study was analyzed using percent, mean, Tukey test, significance test of two means, One-way variant analysis and Kruskal-Wallis test. Results: The study results demonstrate that while there is a correlation between self-care ability and age, education level, marital status and additional health problems, factors such as age, gender, education level, work status, income level, social insurance status and frequency of hemodialysis application determine self-efficacy. Furthermore, a negative correlation was found between patients’ disability and activities of daily living , self-efficacy. It was determined that as the level of disability increases self-efficiacy level decreases. Conclusions: Dialysis application affects patients’ disability, activities of daily living and self-efficacy levels. In view of this study’s results, it is recommended to organize education programs to increase self-efficacy levels of dialysis patients and prepare comprehensive plans including patients’ families. [TAF Prev Med Bull 2011; 10(2.000: 181-186

  12. Degree of Acute Kidney Injury before Dialysis Initiation and Hospital Mortality in Critically Ill Patients

    Directory of Open Access Journals (Sweden)

    Charuhas V. Thakar

    2013-01-01

    Full Text Available In a multicenter observational cohort of patients-admitted to intensive care units (ICU, we assessed whether creatinine elevation prior to dialysis initiation in acute kidney injury (AKI-D further discriminates risk-adjusted mortality. AKI-D was categorized into four groups (Grp based on creatinine elevation after ICU admission but before dialysis initiation: Grp I  > 0.3 mg/dL to <2-fold increase, Grp II ≥2 times but <3 times increase, Grp III ≥3-fold increase in creatinine, and Grp IV none or <0.3 mg/dl increase. Standardized mortality rates (SMR were calculated by using a validated risk-adjusted mortality model and expressed with 95% confidence intervals (CI. 2,744 patients developed AKI-D during ICU stay; 36.7%, 20.9%, 31.2%, and 11.2% belonged to groups I, II, III, and IV, respectively. SMR showed a graded increase in Grp I, II, and III (1.40 (95% CI, 1.29–1.42, 1.84 (1.66–2.04, and 2.25 (2.07–2.45 and was 0.98 (0.78–1.20 in Grp IV. In ICU patients with AKI-D, degree of creatinine elevation prior to dialysis initiation is independently associated with hospital mortality. It is the lowest in those experiencing minor or no elevations in creatinine and may represent reversible fluid-electrolyte disturbances.

  13. [Treatment of anemia in chronic kidney disease--position statement of the Croatian Society for Nephrology, Dialysis and Transplantation and review of the KDIGO and ERPB guidelines].

    Science.gov (United States)

    Rački, Sanjin; Bašić-Jukić, Nikolina; Kes, Petar; Ljutić, Dragan; Lovčić, Vesna; Prkačin, Ingrid; Radić, Josipa; Vujičić, Božidar; Bubić, Ivan; Jakić, Marko; Belavić, Žarko; Sefer, Siniša; Pehai, Mario; Klarić, Dragan; Gulin, Marijana

    2014-04-01

    Renal anemia is the result of chronic kidney disease (CKD) and deteriorates with disease progression. Anemia may be the first sign of kidney disease. In all patients with anemia and CKD, diagnostic evaluation is required. Prior to diagnosing renal anemia, it is necessary to eliminate the other possible causes. Direct correlation between the concentration of hemoglobin and the stage of renal failure is well known. Early development of anemia is common in diabetic patients. Correction of anemia may slow the progression of CKD. Anemia is an independent risk factor for developing cardiovascular disease in patients with CKD. Treatment of anemia in patients with CKD is based on current guidelines. Recently, the Kidney Disease: Improving Global Outcomes (KDIGO) group has produced comprehensive clinical practice guidelines for the management of anemia in CKD patients and ERBP (European Renal Best Practice) group its position statement and comments on the KDIGO guidelines. The Croatian Society of Nephrology, Dialysis and Transplantation (HDNDT) has already published its own guidelines based on the recommendations and positive experience of European and international professional societies, as well as on own experience. The latest version of Croatian guidelines was published in 2008. Since then, on the basis of research and clinical practice, there have been numerous changes in the modern understanding of the treatment of anemia in CKD. Consequently, HDNDT hereby publishes a review of the recent recommendations of international professional societies, expressing the attitude about treating anemia in CKD as a basis for new guidelines tailored to the present time.

  14. Optimising intraperitoneal gentamicin dosing in peritoneal dialysis patients with peritonitis (GIPD study

    Directory of Open Access Journals (Sweden)

    Lipman Jeffrey

    2009-12-01

    Full Text Available Abstract Background Antibiotics are preferentially delivered via the peritoneal route to treat peritonitis, a major complication of peritoneal dialysis (PD, so that maximal concentrations are delivered at the site of infection. However, drugs administered intraperitoneally can be absorbed into the systemic circulation. Drugs excreted by the kidneys accumulate in PD patients, increasing the risk of toxicity. The aim of this study is to examine a model of gentamicin pharmacokinetics and to develop an intraperitoneal drug dosing regime that maximises bacterial killing and minimises toxicity. Methods/Design This is an observational pharmacokinetic study of consecutive PD patients presenting to the Royal Brisbane and Women's Hospital with PD peritonitis and who meet the inclusion criteria. Participants will be allocated to either group 1, if anuric as defined by urine output less than 100 ml/day, or group 2: if non-anuric, as defined by urine output more than 100 ml/day. Recruitment will be limited to 15 participants in each group. Gentamicin dosing will be based on the present Royal Brisbane & Women's Hospital guidelines, which reflect the current International Society for Peritoneal Dialysis Peritonitis Treatment Recommendations. The primary endpoint is to describe the pharmacokinetics of gentamicin administered intraperitoneally in PD patients with peritonitis based on serial blood and dialysate drug levels. Discussion The study will develop improved dosing recommendations for intraperitoneally administered gentamicin in PD patients with peritonitis. This will guide clinicians and pharmacists in selecting the most appropriate dosing regime of intraperitoneal gentamicin to treat peritonitis. Trial Registration ACTRN12609000446268

  15. The evaluation of relationship between blood pressure and dialysate Na concentration in chronic hemodialysis patients

    Science.gov (United States)

    Zahed, Narges Sadat; Gharooi, Omid; Gachkar, Latif; Nikbakht, Hajar

    2016-01-01

    Introduction: Hypertension is one of the traditional risk factors of cardiovascular disease (CVD). Extra cellular volume expansion and Na retention remain the main cause of hypertension. Objectives: The aim of this study was to investigate the relation between concentration of Na dialysate and blood pressure (BP) in chronic hemodialysis (HD) patient. Patients and Methods: This cross-sectional study was performed on 266 adult patients undergoing HD for at least three months. Pre-HD systolic BP (SBP) and post-HD SBP during 4 weeks were measured in relation to Na dialysate concentration. The other main factors affecting the post-dialysis BP, such as body mass index (BMI), pump speed, dialysis solution temperature, duration of dialysis and intradialysis weight gain (IDWG) were also considered. Mean of ΔSBP (post-HD SBP – pre-HD SBP) in each patient in 12 session of HD was measured and statistically analyzed in relation to dialysate Na with SPSS 21. Backward multivariable linear regression analysis and Pearson’s correlation coefficients were used to evaluate the correlation between sodium gradient and ΔSBP. Results: SBP was significantly changed before and after dialysis in relation to dialysate Na (Pcorrelation between ΔSBP with dialysate sodium and blood flow rate (pump speed) were statistically significant(P<0.05). Conclusion: We found that changes in SBP before and after dialysis is significantly associated with dialysate sodium concentration.

  16. Systemic anticoagulation related to heparin locking of non-tunnelled venous dialysis catheters in intensive care patients.

    Science.gov (United States)

    Bong, Y C; Walsham, J

    2016-07-01

    Heparin locking of venous dialysis catheters is routinely performed in intensive care to maintain catheter patency when the catheters are not being used. Leakage of heparin into the circulation can potentially cause systemic anticoagulation and may present a risk to intensive care patients. To assess the effect of 5000 units per millilitre heparin locking of non-tunnelled dialysis catheters on systemic anticoagulation, we performed a prospective observational study of ten intensive care patients receiving heparin locking of dialysis catheters in an adult tertiary intensive care unit between July and September 2015. Activated partial thromboplastin time (APTT) was measured prior to, and three minutes after, heparin locking of catheter lumens with the manufacturer's recommended locking volume to assess the effect on systemic anticoagulation. Heparin locking of venous dialysis catheters resulted in a significant rise in APTT (P=0.002). The median rise was by 56 seconds (interquartile range 30-166.5). Following heparin locking, 80% of patients had APTT values within or above the range associated with therapeutic anticoagulation. Heparin locking of non-tunnelled venous dialysis catheters can cause systemic anticoagulation in intensive care patients and therefore poses a potential risk to patient safety.

  17. Systemic anticoagulation related to heparin locking of non-tunnelled venous dialysis catheters in intensive care patients.

    Science.gov (United States)

    Bong, Y C; Walsham, J

    2016-07-01

    Heparin locking of venous dialysis catheters is routinely performed in intensive care to maintain catheter patency when the catheters are not being used. Leakage of heparin into the circulation can potentially cause systemic anticoagulation and may present a risk to intensive care patients. To assess the effect of 5000 units per millilitre heparin locking of non-tunnelled dialysis catheters on systemic anticoagulation, we performed a prospective observational study of ten intensive care patients receiving heparin locking of dialysis catheters in an adult tertiary intensive care unit between July and September 2015. Activated partial thromboplastin time (APTT) was measured prior to, and three minutes after, heparin locking of catheter lumens with the manufacturer's recommended locking volume to assess the effect on systemic anticoagulation. Heparin locking of venous dialysis catheters resulted in a significant rise in APTT (P=0.002). The median rise was by 56 seconds (interquartile range 30-166.5). Following heparin locking, 80% of patients had APTT values within or above the range associated with therapeutic anticoagulation. Heparin locking of non-tunnelled venous dialysis catheters can cause systemic anticoagulation in intensive care patients and therefore poses a potential risk to patient safety. PMID:27456177

  18. HEARING ASSESSMENT IN CHRONIC RENAL FAILURE PATIENTS UNDERGOING HEMODIALYSIS

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    Arjun Singh

    2014-01-01

    Full Text Available The auditory sensitivity of 63 patient of chronic renal failure on hemodialysis was assessed in order to know the effect of dialysis on hearing threshold. All selected patient were non diabetic with normal tympanic membrane and with no history of ototoxic drug and any hereditary hearing problems. Pure tone audiometry was done before and after dialys is and all cases were followed for 3 month. A high incidence of high frequency sensorineural hearing loss was obtained which could not be attributed to age , noise exposure and ottotoxicity. An association between high frequency sensorineural hearing loss a nd hemodialysis is thus suggested KEYWORDS: Hemodialysis ; Pure tone audiometry ; High frequency sensorineural hearing loss ; Duration of disease ; Chronic renal failure

  19. Cardiovascular risk in Chinese patients with chronic kidney diseases: where do we stand?

    Institute of Scientific and Technical Information of China (English)

    HOU Fan-fan

    2005-01-01

    @@ Chronic kidney disease (CKD) is a worldwide public health problem. Kidney failure requiring renal replacement therapy is the most visible outcome of CKD. In China, there is a rising incidence and prevalence of end stage renal diseases (ESRD), with poor outcomes and high cost. The registered number of individuals with ESRD treated by dialysis was 41 755 in 1999 and is expected to surpass 140 000 by 2009.1 It is important to note that, as many developing countries, the registered number of dialysis patients accounts only for less than 10% of total ESRD population in China.

  20. Adequacy of dialysis: trace elements in dialysis fluids.

    Science.gov (United States)

    D'Haese, P C; De Broe, M E

    1996-01-01

    A number of considerations suggest that trace element disturbances might occur in dialysed patients. These must at least in part be ascribed to the dialysis treatment itself during which these constituents may either be transferred to or removed from the patient. Tap water must be considered as the main source of dialysate trace metal contamination. These can adequately be removed during water treatment provided that, in addition to softening and deionization, reverse osmosis is available. However, even in the presence of the latter devices the possibility of serious contamination of the dialysis fluids leading to either chronic or acute intoxications still exists. The addition of chemical concentrates may also contribute to the increased concentrations of a number of trace metals. The toxic effects of aluminium in dialysis patients are well known and at the present time the element is still responsible for the greater part of trace metal-related problems in dialysis patients. Hence, the need for regular monitoring of aluminium cannot be ruled out at present. Strategies for diagnosis and treatment of aluminium overload have been updated. Recent studies demonstrated the efficacy of low desferrioxamine doses in diagnosis and treatment of aluminium overload, and optimal schedules for administration of the chelator and duration of treatment have been presented. Recently, in an epidemiological survey serum silicon concentrations in dialysis patients were found to be increased up to 100-fold compared to subjects with normal renal function. Moreover, it was noted that silicon concentrations in the dialysis population differ from one centre to another and that increased levels are due to either the use of silicon-contaminated dialysis fluids or an increased oral intake of the element originating from a high silicon content in the drinking water. Besides aluminium and silicon, a transfer towards the patients during dialysis has also been reported for a number of other

  1. Abdominal Aortic Dissection in a Patient With Autosomal Dominant Polycystic Kidney Disease After Starting Peritoneal Dialysis

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    Yingying He

    2014-07-01

    Full Text Available Autosomal dominant polycystic kidney disease (ADPKD, one of the most common genetic disorders, is caused by mutations in the PKD1 or PKD2 gene. ADPKD primarily affects the kidneys, causing the development of multiple bilateral cysts that are characteristic of this condition. Besides renal abnormalities, other manifestations of ADPKD include hepatic, pancreatic, and splenic cysts, intracranial aneurysms, aortic aneurysms, and mitral valve prolapse. Reports of ADPKD-associated abdominal aortic dissections are not rare, but there have been no reports of an ADPKD patient developing intestinal obstruction and abdominal aortic dissection after initiating peritoneal dialysis. Herein, we present one such case.

  2. Febuxostat and Increased Dialysis as a Treatment for Severe Tophaceous Gout in a Hemodialysis Patient

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    Lynda Ann Frassetto

    2016-01-01

    Full Text Available Uric acid accumulates in renal failure and is thought to be a uremic toxin—that is, higher levels of uric acid are more damaging to the kidneys. Urate crystals can precipitate in the kidney tubules, cause urate stones, and promote inflammatory changes in the renal interstitium and vascular endothelium. Uric acid is also a small non-protein-bound molecule and therefore easily dialyzable. Here, we present the case of an anuric hemodialysis patient with severe tophaceous gout who regained some renal function and whose gout burden significantly decreased resulting in marked improvement in functional status using a new gout medication, febuxostat, and increased frequency of dialysis.

  3. Estimation of normal hydration in dialysis patients using whole body and calf bioimpedance analysis

    International Nuclear Information System (INIS)

    Prescription of an appropriate dialysis target weight (dry weight) requires accurate evaluation of the degree of hydration. The aim of this study was to investigate whether a state of normal hydration (DWcBIS) as defined by calf bioimpedance spectroscopy (cBIS) and conventional whole body bioimpedance spectroscopy (wBIS) could be characterized in hemodialysis (HD) patients and normal subjects (NS). wBIS and cBIS were performed in 62 NS (33 m/29 f) and 30 HD patients (16 m/14 f) pre- and post-dialysis treatments to measure extracellular resistance and fluid volume (ECV) by the whole body and calf bioimpedance methods. Normalized calf resistivity (ρN,5) was defined as resistivity at 5 kHz divided by the body mass index. The ratio of wECV to total body water (wECV/TBW) was calculated. Measurements were made at baseline (BL) and at DWcBIS following the progressive reduction of post-HD weight over successive dialysis treatments until the curve of calf extracellular resistance is flattened (stabilization) and the ρN,5 was in the range of NS. Blood pressures were measured pre- and post-HD treatment. ρN,5 in males and females differed significantly in NS. In patients, ρN,5 notably increased with progressive decrease in body weight, and systolic blood pressure significantly decreased pre- and post-HD between BL and DWcBIS respectively. Although wECV/TBW decreased between BL and DWcBIS, the percentage of change in wECV/TBW was significantly less than that in ρN,5 (−5.21 ± 3.2% versus 28 ± 27%, p < 0.001). This establishes the use of ρN,5 as a new comparator allowing a clinician to incrementally monitor removal of extracellular fluid from patients over the course of dialysis treatments. The conventional whole body technique using wECV/TBW was less sensitive than the use of ρN,5 to measure differences in body hydration between BL and DWcBIS

  4. A simple risk score predicts poor quality of life and non-survival at 1 year follow-up in dialysis patients

    NARCIS (Netherlands)

    de Jonge, P; Ruinemans, GMF; Huyse, FJ; ter Wee, PM

    2003-01-01

    Background. Quality of life (QoL) in end-stage renal disease patients has become an important focus of attention in evaluating dialysis. We studied risk factors of poor QoL at 1 year follow-up. Methods. Of a baseline sample of 80 dialysis patients, we contacted 60 patients who were alive at 1 year f

  5. [Conservative treatment, hemodialysis or peritoneal dialysis for elderly patients: The choice of treatment does not influence the survival].

    Science.gov (United States)

    Rouveure, Anne-Cécile; Bonnefoy, Marc; Laville, Maurice

    2016-02-01

    Hemodialysis is the predominant replacement therapy in the 70 year-old French population (18% in peritoneal dialysis, 72% in hemodialysis from the REIN registry). Managing older patients reaching the end stage renal disease poses many ethical questions, since outcomes balanced regarding survival and quality of life. The aim of this study was to compare the survival of patients aged over 70 years according to the ESRD treatment choice: conservative treatment without dialysis (CT), hemodialysis (HD) and peritoneal dialysis (PD). We included all patients over 70 years reaching stade IV CKD integrated in a predialysis information program between 01/01/2005 and 31/12/2010. We compared their survival from the start of their program, in function of their treatment choice: HD, PD or CT. On this period, 148 patients were included, we excluded from analysis 17 patients who had a contraindication to PD, 26 patients who did not make a choice because their kidney function was stabilized, 4 patients lost to follow-up and 12 patients who died before the treatment choice. The average age was 79±6 years, 40% of patients were women, and the mean eGFR was 16±9 mL/min/1.73 m(2) at the entry in the program. Among the 89 patients, 21 choose CT (24%), 68 accepted dialysis (76%), including 48 HD (71%) and 20 PD (29%). No significant eGFR difference at the inclusion time between the groups. The time initiation of dialysis was significantly shorter in the PD group (146 days vs 442 in the HD group; P=0.004). Survival between the groups of patients who accepted or refused dialysis was not statistically different (749 days or 2 years in the HD + PD group vs 562 days, or 1 year and 6 months in the CT group; P=0.95) and between the HD group (760 days or 2 years and 2 months) and the PD group (343 days or 11 months; P=0.32). As measured from the time they entered in the predialysis program, the survival of older patients over 70 years does not seem to depend on

  6. High-sensitivity C-reactive protein predicts mortality and technique failure in peritoneal dialysis patients.

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    Shou-Hsuan Liu

    Full Text Available INTRODUCTION: An elevated level of serum C-reactive protein (CRP is widely considered an indicator of an underlying inflammatory disease and a long-term prognostic predictor for dialysis patients. This cross-sectional cohort study was designed to assess the correlation between the level of high-sensitivity CRP (HS-CRP and the outcome of peritoneal dialysis (PD patients. METHODS: A total of 402 patients were stratified into 3 tertiles (lower, middle, upper according to serum HS-CRP level and and followed up from October 2009 to September 2011. During follow-up, cardiovascular events, infection episodes, technique failure, and mortality rate were recorded. RESULTS: During the 24-month follow-up, 119 of 402 patients (29.6% dropped out from PD, including 28 patients (7.0% who died, 81 patients (20.1% who switched to hemodialysis, and 10 patients (2.5% who underwent kidney transplantation. The results of Kaplan-Meier analysis and log-rank test demonstrated a significant difference in the cumulative patient survival rate across the 3 tertiles (the lowest rate in upper tertile. On multivariate Cox regression analysis, only higher HS-CRP level, older age, the presence of diabetes mellitus (DM, lower serum albumin level, and the occurrence of cardiovascular events during follow-up were identified as independent predictors of mortality. Every 1 mg/L increase in HS-CRP level was independently predictive of a 1.4% increase in mortality. Multivariate Cox regression analysis also showed that higher HS-CRP level, the presence of DM, lower hemoglobin level, lower serum albumin level, higher dialysate/plasma creatinine ratio, and the occurrence of infective episodes and cardiovascular events during follow-up were independent predictors of technique failure. CONCLUSIONS: The present study shows the importance of HS-CRP in the prediction of 2-year mortality and technique survival in PD patients independent of age, diabetes, hypoalbuminemia, and the occurrence of

  7. Iatrogenic Iron Overload in Dialysis Patients at the Beginning of the 21st Century.

    Science.gov (United States)

    Rostoker, Guy; Vaziri, Nosratola D; Fishbane, Steven

    2016-05-01

    Iron overload used to be considered rare in hemodialysis patients but its clinical frequency is now increasingly realized. The liver is the main site of iron storage and the liver iron concentration (LIC) is closely correlated with total iron stores in patients with secondary hemosideroses and genetic hemochromatosis. Magnetic resonance imaging is now the gold standard method for LIC estimation and monitoring in non-renal patients. Studies of LIC in hemodialysis patients by quantitative magnetic resonance imaging and magnetic susceptometry have demonstrated a strong relation between the risk of iron overload and the use of intravenous (IV) iron products prescribed at doses determined by the iron biomarker cutoffs contained in current anemia management guidelines. These findings have challenged the validity of both iron biomarker cutoffs and current clinical guidelines, especially with respect to recommended IV iron doses. Three long-term observational studies have recently suggested that excessive IV iron doses may be associated with an increased risk of cardiovascular events and death in hemodialysis patients. We postulate that iatrogenic iron overload in the era of erythropoiesis-stimulating agents may silently increase complications in dialysis patients without creating frank clinical signs and symptoms. High hepcidin-25 levels were recently linked to fatal and nonfatal cardiovascular events in dialysis patients. It is therefore tempting to postulate that the main pathophysiological pathway leading to these events may involve the pleiotropic master hormone hepcidin (synergized by fibroblast growth factor 23), which regulates iron metabolism. Oxidative stress as a result of IV iron infusions and iron overload, by releasing labile non-transferrin-bound iron, might represent a 'second hit' on the vascular bed. Finally, iron deposition in the myocardium of patients with severe iron overload might also play a role in the pathogenesis of sudden death in some patients

  8. Laparoscopic versus open catheter placement in peritoneal dialysis patients: a systematic review and meta-analysis

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    Xie Haiying

    2012-07-01

    Full Text Available Abstract Background Peritoneal dialysis has been proven to be a safe and effective mode of renal replacement therapy for patients with end-stage renal disease. The usage of laparoscopic catheter placement technique was increased in recent years. But the advantages and disadvantages between the laparoscopic catheter placement technique and open laparotomy technique were still http://in controversy. The objective of this study is to access the operation-related data and complications of catheter placement for peritoneal dialysis (PD patients, Then to determine the better method for catheter insertion. Methods We performed a systematic review and meta-analysis on published studies identified by the databases PubMed, EMBASE, Highwire, and the Cochrane Library. Analysis was performed using the statistical software Review Manager Version 5.0. Results We assessed the operation-related data and complications of four randomized controlled trials (RCTs and ten observational studies. The available data showed that laparoscope prolonged the time for catheter insertion in PD patients, however, the two groups did not significantly differ in hospital stays, early and late complications, including infection, dialysate leaks, catheter migration, pericannular bleeding, blockage and hernia. Conclusions The data showed that Laparoscopic catheter placement had no superiority to open surgery. However, this treatment still needs to be confirmed in a large, multi-center, well-designed RCT.

  9. Fibroblast Growth Factor 21 (FGF-21 in Peritoneal Dialysis Patients: Natural History and Metabolic Implications.

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    Elena González

    Full Text Available Human fibroblast growth factor 21 (FGF-21 is an endocrine liver hormone that stimulates adipocyte glucose uptake independently of insulin, suppresses hepatic glucose production and is involved in the regulation of body fat. Peritoneal dialysis (PD patients suffer potential interference with FGF-21 status with as yet unknown repercussions.The aim of this study was to define the natural history of FGF-21 in PD patients, to analyze its relationship with glucose homeostasis parameters and to study the influence of residual renal function and peritoneal functional parameters on FGF-21 levels and their variation over time.We studied 48 patients with uremia undergoing PD. Plasma samples were routinely obtained from each patient at baseline and at 1, 2 and 3 years after starting PD therapy.Plasma FGF-21 levels substantially increased over the first year and were maintained at high levels during the remainder of the study period (253 pg/ml (59; 685 at baseline; 582 pg/ml (60.5-949 at first year and 647 pg/ml (120.5-1116.6 at third year (p<0.01. We found a positive correlation between time on dialysis and FGF-21 levels (p<0.001, and also, those patients with residual renal function (RRF had significantly lower levels of FGF-21 than those without RRF (ρ -0.484, p<0.05. Lastly, there was also a significant association between FGF-21 levels and peritoneal protein losses (PPL, independent of the time on dialysis (ρ 0.410, p<0.05.Our study shows that FGF-21 plasma levels in incident PD patients significantly increase during the first 3 years. This increment is dependent on or is associated with RRF and PPL (higher levels in patients with lower RRF and higher PPL. FGF-21 might be an important endocrine agent in PD patients and could act as hormonal signaling to maintain glucose homeostasis and prevent potential insulin resistance. These preliminary results suggest that FGF-21 might play a protective role as against the development of insulin resistance over

  10. The relationship of initial transferrin saturation to cardiovascular parameters and outcomes in patients initiating dialysis.

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    Hyang Mo Koo

    Full Text Available BACKGROUND: The prognostic importance of anemia for cardiovascular (CV events and mortality has been extensively investigated. However, little is known about the impact of transferrin saturation (TSAT, a marker reflecting the availability of iron for erythropoiesis, on clinical outcome in dialysis patients. METHODS: A total of 879 anemic incident dialysis patients were recruited from the Clinical Research Center for End-Stage Renal Disease in Korea and were divided into 3 groups according to baseline TSAT of ≤20%, 20-40%, and >40%. RESULTS: There were no differences in hemoglobin levels and the proportion of patients on erythropoiesis-stimulating agents or iron supplements among the 3 groups. During a mean follow-up duration of 19.3 months, 51 (5.8% patients died. CV composite (11.71 vs. 5.55 events/100 patient-years, P = 0.001 and all-cause mortality rates (5.38 vs. 2.31 events/100 patient-years, P = 0.016 were significantly higher in patients with TSAT ≤20% compared to those with TSAT 20-40% (reference group. Cox regression analysis revealed that patients with TSAT ≤20% had 1.62- and 2.19-fold higher risks for CV composite outcome (P = 0.046 and all-cause mortality (P = 0.030. Moreover, TSAT ≤20% was significantly associated with left ventricular hypertrophy [odds ratio (OR  = 1.46], high-sensitivity C-reactive protein ≥3 mg/dL (OR = 2.09, N-terminal pro B-type natriuretic peptide ≥10000 pg/mL (OR  = 2.04, and troponin-T≥0.1 ng/mL (OR  = 2.02, on logistic regression analysis. CONCLUSIONS: Low TSAT was a significant independent risk factor for adverse clinical outcome in incident dialysis patients with anemia, which may be partly attributed to cardiac dysfunction and inflammation.

  11. Home Dialysis: A Dutch Perspective

    NARCIS (Netherlands)

    E.W. Boeschoten; W.M. Michels

    2011-01-01

    For patients with end-stage renal disease who are not (yet) eligible for renal transplantation, treatment with dialysis is mandatory for survival. Home dialysis modalities (home hemodialysis or peritoneal dialysis) offer patients more flexibility compared with in-center treatment and have been advoc

  12. Conversations with chronic schizophrenic patients.

    Science.gov (United States)

    Morgan, R

    1979-02-01

    An account is given of some of the topics discussed during a small informal weekly open group meeting of chronic schizophrenic patients, based on occasional notes compiled over eleven years. The main feature of the patients' condition as displayed was poverty--clinical, social, behavioural, material and financial--and certain features suggested an organic aetiology. Reasons are given for considering that the patients' condition was predominantly caused by schizophrenia rather than by institutionalism.

  13. Risk factors for the first episode of peritonitis in Southern Chinese continuous ambulatory peritoneal dialysis patients.

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    Xiaoguang Fan

    Full Text Available The first episode of peritonitis affects survival of the peritoneal membrane as a medium for dialysis as well as survival of patients. The aim of this study is to investigate risk factors associated with the first episode of peritonitis in Southern Chinese continuous ambulatory peritoneal dialysis (CAPD patients.This is a single-center, retrospective, cohort study. All incident CAPD patients from 1 January 2006 to 31 December 2010 were recruited, and followed up until their first episode of peritonitis or 31 December, 2012. Baseline demographic, socioeconomic, clinical and laboratory data were collected. Cox proportional model was used to determine the factors associated with the first episode of peritonitis.In a cumulative 30756.5 patient-months follow-up (the median vintage 26.1 months of 1117 CAPD patients, 309(27.7% patients presented the first episodes of peritonitis. The cumulative peritonitis-free survival was 86.2%, 78.1%, 71.4% and 57.8% at 1, 2, 3 and 5 year, respectively. The multivariate analysis showed that factors associated with risk for the first episode of peritonitis were elderly patients (>65 years [hazard ratio (HR = 1.427, 95% confidence interval (CI = 1.051 to 1.938, P = 0.023], male(HR = 1.315, 95% CI = 1.028 to 1.684, P = 0.030, lower education level (HR = 1.446, 95% CI: 1.127 to 1.855, P = 0.004 and albumin <38g/L (HR = 1.425, 95% CI: 1.112 to 1.825, P = 0.005.Older age, male, lower educational level and hypoalbuminemia at the commencement of PD were the risk factors associated with the first episode of peritonitis in Southern Chinese CAPD patients.

  14. Outcomes of predialysis nephrology care in elderly patients beginning to undergo dialysis.

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    Seon Ha Baek

    Full Text Available The proportion of elderly patients beginning to undergo dialysis is increasing globally. Whether early referral (ER of elderly patients is associated with favorable outcomes remains under debate. We investigated the influence of referral timing on the mortality of elderly patients.We retrospectively assessed mortality in 820 patients aged ≥70 years with end-stage renal disease (ESRD who initiated hemodialysis at a tertiary university hospital between 2000 and 2010. Mortality data was obtained from the time of dialysis initiation until December 2010. We assigned patients to one of two groups according to the time of their first encounters with nephrologists: ER (≥ 3 months and late referral (LR; < 3 months.During a mean follow-up period of 25.1 months, the ER group showed a 24% reduced risk of long-term mortality relative to the LR group (HR = 0.760, P = 0.009. Rate of reduction in 90-day mortality for ER patients was 58% (HR = 0.422, P=0.012. However, the statistical significance of the difference in mortality rates between ER and LR group was not observed across age groups after 90 days. Old age, LR, central venous catheter, high white blood cell count and corrected Ca level, and lower levels of albumin, creatinine, hemoglobin, and sodium were significantly associated with increased risk of mortality.Timely referral was also associated with reduced mortality in elderly ESRD patients who initiated hemodialysis. In particular, the initial 90-day mortality reduction in ER patients contributed to mortality differences during the follow-up period.

  15. Fluid status in peritoneal dialysis patients: the European Body Composition Monitoring (EuroBCM study cohort.

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    Wim Van Biesen

    Full Text Available BACKGROUND: Euvolemia is an important adequacy parameter in peritoneal dialysis (PD patients. However, accurate tools to evaluate volume status in clinical practice and data on volume status in PD patients as compared to healthy population, and the associated factors, have not been available so far. METHODS: We used a bio-impedance spectroscopy device, the Body Composition Monitor (BCM to assess volume status in a cross-sectional cohort of prevalent PD patients in different European countries. The results were compared to an age and gender matched healthy population. RESULTS: Only 40% out of 639 patients from 28 centres in 6 countries were normovolemic. Severe fluid overload was present in 25.2%. There was a wide scatter in the relation between blood pressure and volume status. In a multivariate analysis in the subgroup of patients from countries with unrestricted availability of all PD modalities and fluid types, older age, male gender, lower serum albumin, lower BMI, diabetes, higher systolic blood pressure, and use of at least one exchange per day with the highest hypertonic glucose were associated with higher relative tissue hydration. Neither urinary output nor ultrafiltration, PD fluid type or PD modality were retained in the model (total R² of the model = 0.57. CONCLUSIONS: The EuroBCM study demonstrates some interesting issues regarding volume status in PD. As in HD patients, hypervolemia is a frequent condition in PD patients and blood pressure can be a misleading clinical tool to evaluate volume status. To monitor fluid balance, not only fluid output but also dietary input should be considered. Close monitoring of volume status, a correct dialysis prescription adapted to the needs of the patient and dietary measures seem to be warranted to avoid hypervolemia.

  16. 腹膜透析患者的营养管理%Management of nutrition in patients undergoing peritoneal dialysis

    Institute of Scientific and Technical Information of China (English)

    李伟

    2015-01-01

    Patients undergoing peritoneal dialysis (PD)generally have malnutrition,which is the main reason for low survival,high hospitalization rate,and high mortality rate.The reasons for malnutrition are complex,including inflammation,inadequate dialysis,protein and calorie intake insufficiency,protein loss in the process of dialysis,high peritoneal transport,residual renal function (RRF)decline,chronic acidosis,high catabolism,and complications,that are all involved in the development and progression of malnutrition of PD patients. Malnutrition assessment requires a comprehensive judgement through a combination of history and examination indicators,such as subjective global assessment (SGA),protein nitrogen appearance rate (PNA),biochemical indicators,dual energy x-ray absorptiometry (DEXA),and bioimpedance analysis (BIA).It requires various comprehensive management to improve malnutrition in PD patients,including managing dietary intake,maintainning adequate dialysis dose,protecting RRF,and correcting acidosis;at the same time,attention should be paid to active prevention and treatment of peritonitis,maintainning the best balance of body fluids,using dialysate with good biocompatibility,and using drugs.%腹膜透析(PD)患者普遍存在营养不良,而营养不良是 PD 患者低生存率、高住院率、高死亡率的主要原因。PD 患者营养不良的原因复杂,炎症、透析不充分、蛋白与热量摄入不足、透析过程中蛋白质丢失、腹膜高转运、残余肾功能下降、慢性酸中毒、高分解代谢、各种并发症等,都参与了营养不良的发生发展。营养不良的评估需要结合病史和检查的各项指标来综合判定,如主观全面营养状态评价(SGA)、生化指标、蛋白质相当的总氮呈现率(PNA)、双能 X 射线吸收法(DEXA)、生物电阻抗分析(BIA)等。改善 PD 患者的营养不良需要进行多方面综合管理,如管理膳食摄入、保持足够的透

  17. Bortezomib-based triplets are associated with a high probability of dialysis independence and rapid renal recovery in newly diagnosed myeloma patients with severe renal failure or those requiring dialysis.

    Science.gov (United States)

    Dimopoulos, Meletios A; Roussou, Maria; Gavriatopoulou, Maria; Psimenou, Erasmia; Eleutherakis-Papaiakovou, Evangelos; Migkou, Magdalini; Matsouka, Charis; Mparmparousi, Despoina; Gika, Dimitra; Kafantari, Eftychia; Ziogas, Dimitrios; Fotiou, Despoina; Panagiotidis, Ioannis; Terpos, Evangelos; Kastritis, Efstathios

    2016-05-01

    Renal failure (RF) is a common and severe complication of symptomatic myeloma, associated with significant morbidity and mortality. Such patients are commonly excluded from clinical trials. Bortezomib/dexamethasone (VD)-based regimens are the backbone of the treatment of newly diagnosed MM patients who present with severe RF even those requiring dialysis. We analyzed the outcomes of 83 consecutive bortezomib-treated patients with severe RF (eGFR renal response criteria, 54 (65%) patients achieved at least MRrenal, including CRrenal in 35% and PRrenal in 12%. Triplet combinations (i.e., VD plus a third agent) versus VD alone were associated with higher rates of renal responses (72 vs. 50%; P = 0.06). Fifteen of the 31 (48%) patients became dialysis independent within a median of 217 days (range 11-724). Triplets were associated with a higher probability of dialysis discontinuation (57 vs. 35%). Serum free light chain (sFLC) level ≥11,550 mg/L was associated with lower rates of major renal response, longer time to major renal response, lower probability, and longer time to dialysis discontinuation. Rapid myeloma response (≥PR within the first month) was also associated with higher rates of renal response. Patients who became dialysis-independent had longer survival than those remaining on dialysis. In conclusion, VD-based triplets are associated with a significant probability of renal response and dialysis discontinuation, improving the survival of patients who became dialysis independent. Rapid disease response is important for renal recovery and sFLCs are predictive of the probability and of the time required for renal response.

  18. Relationship between Kt/V urea-based dialysis adequacy and nutritional status and their effect on the components of the quality of life in incident peritoneal dialysis patients

    Directory of Open Access Journals (Sweden)

    Chen Jin-Bor

    2012-06-01

    Full Text Available Abstract Background It is well known that the quality of life of patients with chronic kidney disease can be improved by dialysis. While previous studies have used retrospective designs and adhered to a standard target prescribed by clinical guidelines, our study prospectively investigates the association between the adequacy of peritoneal dialysis (PD and measures of nutritional status on quality-of-life domains in a cohort of incident PD patients. Methods It was a prospective 6-month observational study. Eighty incident PD participants who were treated in a hospital-based PD center were enrolled. The period of enrollment was January 2009–June 2010; follow-up continued until December 2010. PD adequacy indices, including Kt/V urea, weekly Ccr (WCcr, measures of nutritional status (albumin, BMI, and nPCR were measured at 1 month and 6 months after PD initiation. SF-36 health survey questionnaires were used to measure the quality of life. The outcomes were used to measure the changes in the domains of the SF-36 after 6 months of PD therapy. Results Seventy-seven incident patients who underwent PD for 6 months were included in the study. The mean age was 47.3 years, and the male-to-female ratio was 38:39. A peritoneal Kt/V urea value of 1.2, which was also the baseline cutoff value, was found to have the highest influence on SF-36 domains. Patients with baseline peritoneal Kt/V urea value of Limitations A small cohort and a short observation period. Conclusions The baseline level of peritoneal Kt/V urea affected the components of the quality of life after PD initiation. In contrast, a lower baseline nPCR level was associated with deterioration in the quality of life after PD therapy.

  19. Accepting or declining dialysis : considerations taken into account by elderly patients with end-stage renal disease

    NARCIS (Netherlands)

    Visser, A.; Dijkstra, G.J.; Kuiper, D.; de Jong, P.E.; Franssen, C.F.; Gansevoort, R.T.; Izaks, G.J.; Jager, K.J.; Reijneveld, S.A.

    2009-01-01

    Background: Elderly patients with end-stage renal disease have to make a difficult decision whether or not to start dialysis. This study explores the considerations taken into account by these patients in decision-making regarding renal replacement therapy. Method: In-depth interviews were conducted

  20. Accepting or declining dialysis: considerations taken into account by elderly patients with end-stage renal disease

    NARCIS (Netherlands)

    A. Visser; G.J. Dijkstra; D. Kuiper; P.E. de Jong; C.F.M. Franssen; R.T. Gansevoort; G.J. Izaks; K.J. Jager; S.A. Reijneveld

    2009-01-01

    Background: Elderly patients with end-stage renal disease have to make a difficult decision whether or not to start dialysis. This study explores the considerations taken into account by these patients in decision-making regarding renal replacement therapy. Method: In-depth interviews were conducted

  1. Scintigraphic diagnosis of infectious complications in renal failure patients undergoing hemodialysis, continuous ambulatory peritoneal dialysis or renal transplant

    Energy Technology Data Exchange (ETDEWEB)

    Garcia Vicente, Ana Maria; Ruiz Solis, Sebastian; Soriano Castrejon, Angel; Poblete Garcia, Victor Manuel; Talavera Rubio, Maria del Prado; Rodado Marina, Sonia; Cortes Romera, Montserrat [Ciudad Real General Hospital (Spain). Dept. of Nuclear Medicine

    2005-10-15

    Patients with end-stage renal disease have two therapeutic options, dialysis and renal transplantation. Infectious complications occurring in such patients will not only condition the effectiveness of such treatments, but are among the main causes of morbidity and mortality in such cases. Knowledge of the advantages and limitations of nuclear techniques is essential for management of these conditions. (author)

  2. A Report of Peritonitis from Aeromonas sobria in a Peritoneal Dialysis (PD) Patient with Necrotizing Fasciitis.

    Science.gov (United States)

    Janma, Jirayut; Linasmita, Patcharasarn; Changsirikulchai, Siribha

    2015-11-01

    A 70-years of age, male patient with underlying type 2 diabetes mellitus, hypertension, dyslipidemia and ischemic heart disease had undergone continuous ambulatory peritoneal dialysis (CAPD)for 3 years without any episodes of peritonitis. He was diagnosed with necrotizing fasciitis and later developed peritonitis after receiving a laceration from an aquatic injury suffered during the flood disaster of 2011. The blood culture, necrotic tissue and the clear dialysate collected upon admission had shown Aeromonas sobria. The route of peritonitis may be from the hematogenous spread of A. sobria resulting in necrotizing fasciitis. A. sobria should be considered as the pathogen of peritonitis in PD patients who have history of wounds from contaminated water. We suggest that the PD patients who present with septicemia and did not meet the criteria for peritonitis, the initial dialysate effluent should be sent for culture. The benefit of this is to allow early recognition and treatment of peritonitis.

  3. Fibromyalgia syndrome in chronic urticaria patients

    OpenAIRE

    Aylin Gözübüyükoğulları; Duru Tabanlıoğlu Onan; Nuran Allı

    2014-01-01

    Background and Design: The aim of our study was to determine the frequency of fibromyalgia syndrome in chronic urticaria patients. Materials and Methods: The study was carried out with the participation of 100 chronic urticaria patients and 61 control group patients. Chronic urticaria patients were investigated for the etiology of urticaria and the autologous serum skin test was performed in those patients. Both the chronic urticaria patients and the controls were evaluated for fibromyalgi...

  4. Glucose challenge test (50-g GCT) in detection of glucose metabolism disorders in peritoneal dialysis patients: preliminary study

    OpenAIRE

    Madziarska, Katarzyna; Zmonarski, Slawomir; Penar, Jozef; Krajewska, Magdalena; Mazanowska, Oktawia; Augustyniak-Bartosik, Hanna; Gołebiowski, Tomasz; Klak, Renata; Weyde, Waclaw; Klinger, Marian

    2014-01-01

    Background The aim was to evaluate the clinical utility of the oral glucose tolerance screening test (50-g GCT—glucose challenge test) for the detection of glucose metabolism disorders (GMD) in peritoneal dialysis (PD) patients with normal fasting glucose levels. Methods The 50-g GCT was performed in 20 prevalent patients without history of diabetes before PD treatment onset, who had been on dialysis for a median time of 15.34 months. In addition, other indicators of glucose metabolism were m...

  5. Chronic obstructive pulmonary disease in patients with end-stage kidney disease on hemodialysis.

    Science.gov (United States)

    Plesner, Louis L; Warming, Peder E; Nielsen, Ture L; Dalsgaard, Morten; Schou, Morten; Høst, Ulla; Rydahl, Casper; Brandi, Lisbet; Køber, Lars; Vestbo, Jørgen; Iversen, Kasper

    2016-01-01

    The objectives of this study were to assess the prevalence of chronic obstructive pulmonary disease (COPD) in hemodialysis patients with spirometry and to examine the effects of fluid removal by hemodialysis on lung volumes. Patients ≥18 years at two Danish hemodialysis centers were included. Forced expiratory volume in one second (FEV1 ), forced vital capacity (FVC), and FEV1 /FVC ratio were measured with spirometry before and after hemodialysis. The diagnosis of COPD was based on both the GOLD criteria and the lower limit of normal criteria. There were 372 patients in treatment at the two centers, 255 patients (69%) completed spirometry before dialysis and 242 of these (65%) repeated the test after. In the initial test, 117 subjects (46%) had airflow limitation indicative of COPD with GOLD criteria and 103 subjects (40.4%) with lower limit of normal criteria; COPD was previously diagnosed in 24 patients (9%). Mean FVC and FEV1 decreased mildly after dialysis (FVC: 2.84 to 2.79 L, P Spirometry should be considered in all patients on dialysis in order to address dyspnea adequately. Hemodialysis induced a small fall in mean FEV1 and FVC, which was more pronounced in patients with little or no fluid removal, but the FEV1 /FVC ratio and the number of subjects with airflow limitation indicative of COPD were not affected by dialysis. PMID:26245152

  6. Effect on hemo-dialysis on concentration of lactate dehyrogenase, creatine kinase and a-amylase in renal failure

    International Nuclear Information System (INIS)

    This study was conducted to compare the concentration of plasma enzymes in chronic renal failure pre dialysis (group A) and post dialysis (group B), and evaluate the concentration of these enzymes between pre and post dialysis. The study was performed in 25 samples of Sudanese patients (chronic renal failure) and compared with 15 samples as the control groups. plasma samples were analyzed using spectrophotometric methods, plasma concentration of these enzymes showed increase in chronic renal failure pre and post dialysis. The mean values of lactate dehydrogenase pre dialysis was 259IU/L, post dialysis was 276IU/L, the mean of creatine kinase pre dialysis was 252IU/L, and post dialysis was 241 IU/L but the mean of amylase pre and post dialysis was the same 144 IU/L. This study showed that there was no difference of concentration of amylase enzyme, but the different in concentration of CK and LDH between pre and post dialysis during chronic renal failure depend on normal range of this enzyme in control groups.(Author)

  7. Evaluation of continuous ambulatory peritoneal dialysis fluid C-reactive protein in patients with peritonitis.

    Science.gov (United States)

    Ramanathan, Kumaresan; Padmanabhan, Giri; Vijayaraghavan, Bhooma

    2016-05-01

    Severe peritonitis causing death is one of the most devastating complications of peritoneal dialysis (PD). Since the predictive value of C-reactive protein (CRP) in PD fluid has not been assessed, the objective of the present study is to evaluate its predictive value and clinical correlation in patients on PD with peritonitis. One hundred and twenty patients on continuous ambulatory PD (CAPD) were enrolled and their serum and fluid CRP (Fl. CRP) were evaluated at the start of CAPD. All patients who developed peritonitis were further evaluated for serum and fluid CRP. The patients were categorized into four groups, namely: normal patients (control group), patients with peritonitis, patients with peritonitis leading to catheter removal, and death due to peritonitis. Sixty-five patients developed peritonitis of whom, catheter removal was performed in eight patients. Five patients died due to peritonitis-related complications. Fl. CRP showed a significant difference among the three groups, unlike S. CRP. Estimation of CRP in the peritoneal fluid may be a useful marker to monitor the onset of peritonitis.

  8. Challenges for dialysis facility medical directors and impact on patient care.

    Science.gov (United States)

    Kossmann, Robert J

    2013-10-01

    My service within the RPA began with my need to be a part of the solution, to help navigate the direction of inevitable change, and to ensure we do not lose focus of our ultimate goal as nephrologists-the provision of excellent kidney care. I would encourage all of you to participate in this process as well. It is essential that we maintain our independence, ethics and principals, and excellence in our roles and responsibilities as nephrologists and dialysis unit medical directors, especially in challenging times such as these. Engaging with the RPA in advocating redress of the ESRD PPS proposed 9.4% cut and support for maintaining our critical role as independent dialysis unit medical directors is one way we can make a difference. Become involved in the process. Communicate your concerns to legislators and policy makers. Only with the support of our community and a firm commitment to our goals can we effect change and ensure nephrology patients continue to be well served in the years to come. PMID:24279209

  9. Improved glucose tolerance after high-load strength training in patients undergoing dialysis

    DEFF Research Database (Denmark)

    Mølsted, Stig; Harrison, Adrian Paul; Eidemak, Inge;

    2013-01-01

    glucose tolerance (n = 9). Conclusion: The conducted strength training was associated with a significant improvement in glucose tolerance in patients with impaired glucose tolerance or type 2 diabetes undergoing dialysis. The effect was apparently not associated with muscle hypertrophy, whereas the muscle...... a week. Muscle fiber size, composition and capillary density were analyzed in biopsies obtained in the vastus lateralis muscle. Glucose tolerance and the insulin response were measured by a 2-hour oral glucose tolerance test. Results: All outcome measures remained unchanged during the control period....... After strength training the relative area of type 2X fibers was decreased. Muscle fiber size and capillary density remained unchanged. After the strength training, insulin concentrations were significantly lower in patients with impaired glucose tolerance or type 2 diabetes (n = 14) (fasting insulin...

  10. Drug Dose Adjustment in Dialysis Patients Admitted in Clinics Other Than Internal Medicine.

    Science.gov (United States)

    Solak, Yalcin; Biyik, Zeynep; Gaipov, Abduzhappar; Kayrak, Mehmet; Ciray, Hilal; Cizmecioglu, Ahmet; Tonbul, Halil Zeki; Turk, Suleyman

    2016-01-01

    Many drugs that are administered during hospitalization are metabolized or excreted through kidneys, consequently require dosage adjustment. We aimed to investigate inappropriate prescription of drugs requiring renal dose adjustment (RDA) in various surgical and medical inpatient clinics. We retrospectively determined dialysis patients hospitalized between January 2007 and December 2010. Inpatient clinics, including cardiology, pulmonary medicine, neurology, infectious diseases (medical clinics) and cardiovascular surgery, orthopedics, general surgery, obstetrics and gynecology, and neurosurgery (surgical clinics), were screened via electronic database. Total and RDA medications were determined. RDA drugs correctly adjusted to creatinine clearance were labeled as RDA-A (appropriate), otherwise as RDA-I (inappropriate). Renal doses of RDA medications were based on the "American College of Physicians Drug Prescribing in Renal Failure, fifth Edition." Two hundred seventeen hospitalization records of 172 dialysis patients (92 men and 80 women) were included in the analysis. Mean age of patients was 59.4 ± 14.6 years, and the mean hospitalization duration was 8.5 ± 7.8 days. In total, 247 (84.3%, percentage in drugs requiring dose adjustment) and 175 (46.2%) drugs have been inadequately dosed in surgical and medical clinics, respectively. The percentage of