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Sample records for reached end-stage renal

  1. Periodic Peritoneal Dialysis in End Stage Renal Disease: Is it Still ...

    African Journals Online (AJOL)

    peritoneal dialysis (PD) in India has made renal replacement therapy out of reach of many patients with ... Keywords: Peritoneal dialysis, End stage renal disease, Renal replacement therapy ..... adherence to the dialysis program is often poor.

  2. Nephrolithiasis-induced end stage renal disease

    Directory of Open Access Journals (Sweden)

    M Ounissi

    2010-03-01

    Full Text Available M Ounissi¹, T Gargueh², M Mahfoudhi¹, K Boubaker¹, H Hedri¹, R Goucha¹, E Abderrahim¹, F Ben Hamida¹, T Ben Abdallah¹, F El Younsi¹, H Ben Maiz³, A Kheder¹1Internal Medicine Department, 2Pediatric Department, 3Laboratory of Kidney Diseases, Charles Nicolle Hospital, Tunis, TunisiaIntroduction: Nephrolithiasis still remains a too frequent and underappreciated cause of end stage renal disease (ESRD.Methods and patients: Of the entire cohort of 7128 consecutive patients who started maintenance dialysis in our nephrology department between January 1992 and December 2006, a total of 45 patients (26 women, 19 men had renal stone disease as the cause of ESRD. The type of nephrolithiasis was determined in 45 cases and etiology in 42. The treatment and evolution of stone disease and patient’s survival were studied.Results: The overall proportion of nephrolithiasis related ESRD was 0.63%. The mean age was 48.4 years. Infection stones (struvite accounted for 40%, calcium stones, 26.67% (primary hyperparathyroidism:15.56%; familial hypercalciuria: 4.44%, unknown etiology: 6.66%, primary hyperoxaluria type 1, 17.78% and uric acid lithiasis in 15.56% of cases. The mean delay of the evolution of the stone renal disease to chronic renal failure was 85.8 months. The feminine gender, obesity and elevated alkaline phosphatases >128 IU/L were significantly correlated with fast evolution of ESRD. The median evolution to ESRD was 12 months. The normal body mass index (BMI, medical treatment of stone and primary hyperoxaluria type 1 were correlated with fast evolution to ESRD. All patients were treated by hemodialysis during a mean evolution of 60 months. Sixteen patients died. The patient's survival rate at 1, 3 and 5 years was 97.6, 92.8 and 69% respectively. Hypocalcemia, cardiopathy and normal calcium-phosphate product were significantly correlated with lower survival rate.Conclusion: Severe forms of nephrolithiasis remain an underestimated cause of

  3. Pulp Stone, Haemodialysis, End-stage Renal Disease, Carotid Atherosclerosis

    OpenAIRE

    Patil, Santosh; Sinha, Nidhi

    2013-01-01

    Objectives: The aim of this study was to determine the relationship between the presence of pulp calcification and carotid artery calcification on the dental panoramic radiographs in End Stage Renal Disease (ESRD) patients who were on haemodialysis.

  4. Cost Evaluation of Haemodialysis for End Stage Renal Disease ...

    African Journals Online (AJOL)

    Cost Evaluation of Haemodialysis for End Stage Renal Disease Patients: Experience from Benin City, Nigeria. ... Annals of Biomedical Sciences ... Objectives: To assess the costs and use of haemodialysis in a Nigerian Teaching Hospital.

  5. End-Stage Renal Disease (ESRD) Quality Initiative

    Data.gov (United States)

    U.S. Department of Health & Human Services — The End Stage Renal Disease (ESRD) Quality Initiative promotes ongoing CMS strategies to improve the quality of care provided to ESRD patients. This initiative...

  6. End-Stage Renal Disease Prospective Payment System

    Data.gov (United States)

    U.S. Department of Health & Human Services — This final rule implements a case-mix adjusted bundled prospective payment system (PPS) for Medicare outpatient end-stage renal disease (ESRD) dialysis facilities...

  7. Very large polycystic kidneys presenting with end stage renal failure ...

    African Journals Online (AJOL)

    Autosomal Dominant Polycystic Kidney Disease (ADPKD) is the most common inherited cause of renal impairment and End Stage Renal Disease (ESRD). Apart from cysts in the kidneys and other organs such as the liver, pancreas and other organs, patients also develop abdominal hernia thought to be as a result of ...

  8. High prevalence of frailty in end-stage renal disease

    NARCIS (Netherlands)

    Drost, Diederik; Kalf, Annette; Vogtlander, Nils; van Munster, Barbara C.

    Purpose Prognosis of the increasing number of elderly patients with end-stage renal disease (ESRD) is poor with high risk of functional decline and mortality. Frailty seems to be a good predictor for those patients that will not benefit from dialysis. Varying prevalences between populations are

  9. End Stage Renal Disease: Racial Differences | Chijioke | Orient ...

    African Journals Online (AJOL)

    Objectives: The prevalence and aetiological of end stage renal disease (ESRD) differ from race to race and from location to location even among people of the same race. There is paucity of data on the comparison of ESDR in whites and blacks living in their native environment. The study was undertaken to retrospectively ...

  10. Medication Related Cutaneous Disorders in End Stage Renal ...

    African Journals Online (AJOL)

    TNHJOURNALPH

    BACKGROUND. In End Stage Renal Disease (ESRD) patients, a wide range of cutaneous manifestations are present which may be due to the medications prescribed. Most patients' with ESRD are on numerous medications for their primary ailment, with transplant patients needing long term steroids and cytotoxics for ...

  11. Quality of Life in End Stage Renal Failure Patients Undergoing ...

    African Journals Online (AJOL)

    We assessed the quality of life of 45 patients with end stage renal failure undergoing dialysis in Mauritius using the standard United Kingdom version of the Short Form 36 Items Health Survey (SF36) questionnaire. Our findings showed that gender, level of social and emotional support, marital status, and travel time were ...

  12. Senescence rates in patients with end-stage renal disease

    DEFF Research Database (Denmark)

    Koopman, J J E; Rozing, M P; Kramer, Ada

    2011-01-01

    function of the Gompertz equation as a superior descriptor of senescence rate. Here, we tested both measures of the rate of senescence in a population of patients with end-stage renal disease. It is clinical dogma that patients on dialysis experience accelerated senescence, whereas those with a functional...

  13. Bardet-biedl syndrome presenting with end stage renal failure

    International Nuclear Information System (INIS)

    Ansari, R.M.; Junejo, A. M.

    2006-01-01

    A young male presented in the Nephro-Urology Department with advanced renal failure, blindness in early childhood, polydactaly,obesity, decreased mentation and hypogonadism. With these phenotypical features and renal ultrasonographic findings, he was diagnosed as a case of Bardet-Biedl syndrome. Only one younger sister of patient had similar features. Renal impairment is frequent and an important cause of death. End stage renal disease (ESRD) is rarely seen in younger patient of Bardet-Biedl syndrome. However, ESRD in early age is associated with substantially reduced survival. (author)

  14. Technical aspects of renal denervation in end-stage renal disease patients with challenging anatomy.

    Science.gov (United States)

    Spinelli, Alessio; Da Ros, Valerio; Morosetti, Daniele; Onofrio, Silvia D; Rovella, Valentina; Di Daniele, Nicola; Simonetti, Giovanni

    2014-01-01

    We describe our preliminary experience with percutaneous renal denervation in end-stage renal disease patients with resistant hypertension and challenging anatomy, in terms of the feasibility, safety, and efficacy of this procedure. Four patients with end-stage renal disease patients with resistant hypertension (mean hemodialysis time, 2.3 years) who had been taking at least four antihypertensive medications underwent percutaneous renal denervation. Renal artery eligibility included the absence of prior renal artery interventions, vessel stenosis renal denervation is a feasible approach for end-stage renal disease patients with resistant hypertension with encouraging short-term preliminary results in terms of procedural efficacy and safety.

  15. End stage renal disease among ceramic workers exposed to silica

    OpenAIRE

    Rapiti, E.; Sperati, A.; Miceli, M.; Forastiere, F.; Di, L; Cavariani, F.; Goldsmith, D. F.; Perucci, C. A.

    1999-01-01

    OBJECTIVES: To evaluate whether ceramic workers exposed to silica experience an excess of end stage renal disease. METHODS: On the basis of a health surveillance programme, a cohort of 2980 male ceramic workers has been enrolled during the period 1974-91 in Civitacastellana, Lazio, Italy. For each worker, employment history, smoking data, and x ray film readings were available. The vital status was ascertained for all cohort members. All 2820 people still alive and resident in the Lazio...

  16. Tuberculosis in patients with end-stage renal disease

    International Nuclear Information System (INIS)

    Kim, Hyo Cheol; Goo, Jin Mo; Chung, Myung Jin; Moon, Min Hoan; Koh, Young Hwan; Im, Jung Gi

    2001-01-01

    The purpose of our study was to describe the clinical and radiological manifestations of tuberculosis in patients with end-stage renal disease. The medical records, chest radiographs, and CT scans of 42 patients with tuberculosis among 871 consecutive patients with end-stage renal disease were reviewed. Patterns of initial chest radiographs were categorized as primary, postprimary, miliary, or atypical, according to the predominant radiologic findings. Chest radiographs and CT scans revealed pulmonary tuberculosis in 28 patients and extrapulmonary tuberculosis in 15. The pattern of chest radiographs indicative of pulmonary tuberculosis was primary in 12 cases, postprimary in 11, miliary in one, demonstrated atypical infiltrates in three, and was normal in one. Tuberculosis involved the extrathoracic lymph nodes in six cases, the peritoneum in four, the spine in three, and the bone marrow in two. The primary pattern, seen in 12 patients, manifested as pleural effusion or segmental consolidation, and in ten of the twelve the former was dominant. The radiological pattern of pulmonary tuberculosis in end-stage renal disease is often primary, and extrapulmonary involvement is frequent

  17. Long term outcome of treatment of end stage renal failure.

    Science.gov (United States)

    Henning, P; Tomlinson, L; Rigden, S P; Haycock, G B; Chantler, C

    1988-01-01

    The most common causes of end stage renal failure in 46 children (mean age 11 years, range 4-14) treated between January 1972 and June 1977 were: reflux nephropathy (n = 12), cystinosis (n = 7), focal and segmental glomerulosclerosis (n = 6), and Schönlein-Henoch disease (n = 5). The quality of life, degree of renal function, and height attainment of the 31 survivors were assessed in June 1985, when their mean age was 22 years (range 14-27), using hospital records and a questionnaire designed to highlight social and psychological problems. Twenty six patients had a functioning transplanted kidney. Average growth during treatment for all survivors was normal, but most were disappointed with their 'final height'. Though five patients had some form of disabling bone disease, all 31 could walk and 27 could run. Sixteen (67%) were in full or part time employment and nine were living independently. A group of 32 patients with juvenile onset diabetes treated at this hospital for at least five years were also asked to complete the questionnaire and of these, 17 responded. On average, their data could usefully be compared with those of cases of end stage renal failure. More of the diabetics had jobs, but most sexually mature patients with renal disease were concerned about their physical appearance and had not achieved any stable long term sexual relationships. We suggest that a poor body image resulting in low self esteem may be responsible for the deficiency and believe that further study in this group is warranted.

  18. Diabetic nephropathy. Is end-stage renal disease inevitable?

    Science.gov (United States)

    Bogusky, R T

    1983-10-01

    The appearance of proteinuria in an insulin-dependent diabetic patient is an ominous sign. Proteinuria heralds the presence of diabetic nephropathy and early death, or chronic renal failure requiring dialysis or transplantation, in 50% of patients. The pathogenesis of diabetic nephropathy is unknown. Adequate insulin administration is the most important preventive measure. Hypertension, if present, should be aggressively treated to delay progression of renal disease. Good nutrition, prompt treatment of urinary tract infections, and caution in the use of radiocontrast agents are other important preventive measures. Hemodialysis, peritoneal dialysis, and transplantation are options for patients with end-stage renal disease. No matter which is selected, the patient may still have multiple amputations, blindness, congestive heart failure, infections, and uncontrolled glycemia. Advancements are being made, however, that promise a better future for insulin-dependent diabetics.

  19. End Stage and Chronic Kidney Disease: Associations with Renal Cancer

    International Nuclear Information System (INIS)

    Russo, Paul

    2012-01-01

    There is a well known association between end stage renal disease and the development of kidney cancer in the native kidney of patients requiring renal replacement therapy. There is now emerging evidence that lesser degrees of renal insufficiency (chronic kidney disease, CKD) are also associated with an increased likelihood of cancer in general and kidney cancer in particular. Nephropathological changes are commonly observed in the non-tumor bearing portions of kidney resected at the time of partial and radical nephrectomy (RN). In addition, patients with renal cancer are more likely to have CKD at the time of diagnosis and treatment than the general population. The exact mechanism by which renal insufficiency transforms normal kidney cells into tumor cells is not known. Possible mechanisms include uremic immune inhibition or increased exposure to circulating toxins not adequately cleared by the kidneys. Surgeons managing kidney tumors must have an increased awareness of their patient’s renal functional status as they plan their resection. Kidney sparing approaches, including partial nephrectomy (PN) or active surveillance in older and morbidly ill patients, can prevent CKD or delay the further decline in renal function which is well documented with RN. Despite emerging evidence that PN provides equivalent local tumor control to RN while at the same time preventing CKD, this operation remains under utilized in the United States and abroad. Increased awareness of the bi directional relationship between kidney function and kidney cancer is essential in the contemporary management of kidney cancer.

  20. Periodic Peritoneal Dialysis in End Stage Renal Disease: Is it Still ...

    African Journals Online (AJOL)

    ... replacement therapy out of reach of many patients with end stage renal disease (ESRD). Repeated puncture PD although inferior to HD biochemically, is easily and freely available across Rajasthan, India, and is simple to perform, and does not require sophisticated machines, thus making it an attractive option for dialysis ...

  1. Safety and efficacy of vemurafenib in end stage renal failure

    International Nuclear Information System (INIS)

    Iddawela, Mahesh; Crook, Sarah; George, Leah; Lakkaraju, Amit; Nanayakkara, Nihal; Hunt, Roland; Adam, William R

    2013-01-01

    Serine-threonine inhibitors, such as vemurafenib, are being used increasingly in cancer treatment, and the toxicity and therapeutic benefit need to be balanced carefully both before and during treatment. A patient with metastatic melanoma and end stage renal failure who was on peritoneal dialysis was treated with the serine-threonine kinase inhibitor, vemurafenib. After 5 months of treatment, a substantial response to vemurafenib was observed using imaging, but when he developed a prolonged QTc interval (common toxicity criteria (CTC) grade 3), treatment was interrupted. Vemurafenib was restarted at a reduced dose when the QTc interval returned to normal. The patient has had a significant response to vemurafenib and continued on treatment for 12 months after beginning the therapy. This is the first reported case of end stage renal failure in a patient who is taking vemurafenib. Although the patient developed QTc prolongation, it appears to be asymptomatic, and was managed with dose reduction. This case highlights the need for closer QTc monitoring at the start and during treatment

  2. End stage renal disease among ceramic workers exposed to silica.

    Science.gov (United States)

    Rapiti, E; Sperati, A; Miceli, M; Forastiere, F; Di Lallo, D; Cavariani, F; Goldsmith, D F; Perucci, C A

    1999-08-01

    To evaluate whether ceramic workers exposed to silica experience an excess of end stage renal disease. On the basis of a health surveillance programme, a cohort of 2980 male ceramic workers has been enrolled during the period 1974-91 in Civitacastellana, Lazio, Italy. For each worker, employment history, smoking data, and x ray film readings were available. The vital status was ascertained for all cohort members. All 2820 people still alive and resident in the Lazio region as in June 1994 were searched for a match in the regional end stage renal diseases registry, which records (since June, 1994) all patients undergoing dialysis treatment in public and private facilities of the region. Expected numbers of prevalent cases from the cohort were computed by applying the rate of patients on dialysis treatment by the age distribution of the cohort. A total of six cases was detected when 1.87 were expected (observed/expected (O/E) = 3.21; 95% confidence interval (95% CI) 1.17 to 6.98). The excess risk was present among non-smokers (O = 2; O/E = 4.34) and smokers (O = 4; O/E = 2.83), as well as among workers without silicosis (O = 4; O/E = 2.78) and workers with silicosis (O = 2; O/E = 4.54). The risk was higher among subjects with 20 years. These results provide further evidence that exposure to silica dust among ceramic workers is associated with nephrotoxic effects.

  3. Survival Analysis of Patients with End Stage Renal Disease

    Science.gov (United States)

    Urrutia, J. D.; Gayo, W. S.; Bautista, L. A.; Baccay, E. B.

    2015-06-01

    This paper provides a survival analysis of End Stage Renal Disease (ESRD) under Kaplan-Meier Estimates and Weibull Distribution. The data were obtained from the records of V. L. MakabaliMemorial Hospital with respect to time t (patient's age), covariates such as developed secondary disease (Pulmonary Congestion and Cardiovascular Disease), gender, and the event of interest: the death of ESRD patients. Survival and hazard rates were estimated using NCSS for Weibull Distribution and SPSS for Kaplan-Meier Estimates. These lead to the same conclusion that hazard rate increases and survival rate decreases of ESRD patient diagnosed with Pulmonary Congestion, Cardiovascular Disease and both diseases with respect to time. It also shows that female patients have a greater risk of death compared to males. The probability risk was given the equation R = 1 — e-H(t) where e-H(t) is the survival function, H(t) the cumulative hazard function which was created using Cox-Regression.

  4. Upper Gastrointestinal Disorders in Children with End -Stage Renal Disease

    Directory of Open Access Journals (Sweden)

    Esfahani S.T

    2009-04-01

    Full Text Available This study was undertaken to define the prevalence of the upper Gastrointestinal (GI lesions, dyspeptic symptoms, H.pylori infection, and the impact of duration of dialysis on upper GI symptoms and lesions of children with End-stage renal disease. We studied 69 children with ESRD who were under regular hemodialysis therapy in our department. The age of the patients were between 4-18 years (mean: 11.3. 57(82.6% of 69 patients had GI symptoms and 12(17.4% were symptom free, the prevalence of each symptom in 57 symptomatic children was as follows: anorexia 48(84.2%, nausea/vomiting 39 (68.4%, belching/heartburn 20(35%, abdominal distention 15(26.3%, and epigastric pain 8(14%. 65(92.4% of 69 patients with ESRD had pathologic lesions and the most common lesion was gastritis .There was no case of gastric angiodysplasia in our patients. 15(21.7% of 69 patients had H. pylori infection. The prevalence of H.pylori infection in non-uremic children with upper GI symptoms is about 27% in our pediatric gastroenterology department, so there was no significant difference in prevalence of H.pylori infection between uremic and non-uremic children in our study (p value = 0.4735. There was no significant relationship between duration of dialysis and dyspeptic symptoms or upper GI lesions (p values were 0.8775 and 0.7435, respectively. Conclusions: Upper GI disorders are very common in children with ESRD, even when they have no upper GI symptoms, the most common lesion is gastritis. The prevalence of H.pylori infection is not different between children with ESRD and non-uremic children with upper GI symptoms, and duration of hemodialysis therapy has no significant effect on prevalence of GI symptoms and lesions.

  5. End-stage Renal Failure as a Complication of Acute Tubulo-Interstitial Nephritis

    International Nuclear Information System (INIS)

    Reda, G.; Ali, R.; Abdelrehman, M.; Sinha, A. K.; Ayman, K.

    2005-01-01

    Acute tubulo-interstitial nephritis (ATIN) is an important cause of acute renal failure, where renal impairement tends to be variable but recovery is the rule. End-stage renal failure (ESRF) has been rarely reported as a complication of ATIN. We report here a case of idiopathic ATIN that resulted in severe acute renal failure. The patient developed ESRF, which required permanent renal replacement therapy. (author)

  6. End-stage renal failure and national resources: the Brazilian experience.

    Science.gov (United States)

    Zatz, Roberto; Romão, João Egídio

    2006-01-01

    Brazil is the fifth largest and the fifth most populous nation in the world. Its economy rivals Mexico as the strongest in Latin America and ranks among the 15 largest economies in the world. Despite these achievements, a substantial fraction of the Brazilian population still lives in poverty, and many still have limited access to medical assistance. There are currently about 380 patients on hemodialysis per million populations (pmp), approximately one third of the U.S. prevalence, suggesting that a large fraction of end-stage renal disease (ESRD) patients are not diagnosed and treated properly. In Brazil, access to renal replacement therapy (RRT), including renal transplantation, is universal, and the corresponding costs, including those of medications (immunosuppressors and treatment of ESRD complications), are covered by the Brazilian government. However, given the continuous growth of the ESRD population and of the costs incurred by RRT, the efficacy and reach of this system may be severely limited in years to come. In the current struggle against the ESRD epidemics, the Brazilian medical community and health authorities face a triple challenge: to limit the incidence of renal disease, slow or detain the progression of established chronic nephropathies, and ensure that access to quality RRT remains granted to all those who, despite all efforts, reach ESRD.

  7. End-stage renal disease and its treatment in Venezuela.

    Science.gov (United States)

    Bellorin-Font, Ezequiel; Milanés, Carmen Luisa; Rodríguez-Iturbe, Bernardo

    2002-09-01

    In Venezuela there are 3234 new cases (132 per million population [pmp]) requiring renal replacement therapy each year, and only 40% of these are admitted to the different modalities of dialysis. In the year 2000, there were 195 patients pmp in chronic hemodialysis (4700 patients). Diabetes, glomerular diseases, and hypertension account for more than 60% of the patients in chronic dialysis. Gross mortality in hemodialysis is around 20%, and cardiovascular causes are the primary cause of death (39.5%). Hospital admission in the dialysis patients amounts to 4.6 days/patient/year. Rehabilitation is inadequate. Only 45% of the dialysis patients report normal home or work activities. Transplantation in Venezuela has a general graft survival rate of 83% at 1 year (90% for living related grafts) and 50% (64% for living related grafts) at 10 years. Future tendencies include emphasis in preventive strategies, including early detection and treatment of diabetes and hypertension, as well as efforts to increase the rate of renal transplantation.

  8. Incidence and predictors of end-stage renal disease in outpatients with systolic heart failure

    DEFF Research Database (Denmark)

    Bosselmann, Helle; Gislason, Gunnar; Gustafsson, Finn

    2013-01-01

    Background- Renal dysfunction is an important prognostic factor in heart failure (HF), but whether this dysfunction progresses to end-stage renal disease (ESRD) is unknown. Therefore, we examined incidence and predictors of ESRD in outpatients with HF. Methods and Results- Patients with systolic ...

  9. End-stage renal disease and survival in people with diabetes: a national database linkage study

    OpenAIRE

    Bell, S.; Fletcher, E.H.; Brady, I.; Looker, H.C.; Levin, D.; Joss, N.; Traynor, J.P.; Metcalfe, W.; Conway, B.; Livingstone, S.; Leese, G.; Philip, S.; Wild, S.; Halbesma, N.; Sattar, N.

    2014-01-01

    Background: Increasing prevalence of diabetes worldwide is projected to lead to an increase in patients with end-stage renal disease (ESRD) requiring renal replacement therapy (RRT).Aim: To provide contemporary estimates of the prevalence of ESRD and requirement for RRT among people with diabetes in a nationwide study and to report associated survival.Methods: Data were extracted and linked from three national databases: Scottish Renal Registry, Scottish Care Initiative-Diabetes Collaboration...

  10. Intensified Multifactorial Intervention in Type 2 Diabetes and Microalbuminuria Reduces End Stage Renal Disease and Mortality

    DEFF Research Database (Denmark)

    Oellgaard, Jens; Gæde, Peter; Rossing, Peter

    2016-01-01

    -label trial. Duration of the intervention was 8 years, where after all patients were recommended intensified treatment. Total follow-up of up to 21 years of 24 hour urinary albumin excretion rate and GFR (51Cr-EDTA-clearance) assessed at 6 study visits. Information on end stage renal disease (ESRD......) and mortality was obtained from national registries. Outcome measures were progression to macroalbuminuria (>300 mg/24h), decline-rates of GFR and progression to end stage renal disease (ESRD) or death. Results: Progression to macroalbuminuria was reduced in the original intensive-therapy group with a hazard...

  11. Cardiac surgery in patients with end-stage renal disease on dialysis

    DEFF Research Database (Denmark)

    Bäck, Caroline; Hornum, Mads; Møller, Christian Joost Holdflod

    2017-01-01

    and 2015, 136 patients with end-stage renal disease initiating dialysis more than one month before surgery underwent cardiac surgery. Demographics, preoperative hemodynamic and biochemical data were collected from the patient records. Vital status and date of death was retrieved from a national register...... were age (p = .001), diabetes (p = .017) and active endocarditis (p = .012). CONCLUSION: No statistically significant difference in mortality was found between patients in hemo- or peritoneal dialysis. However, we observed that patients with end-stage renal disease on dialysis have two times higher...

  12. Alterations of bone microstructure and strength in end-stage renal failure

    NARCIS (Netherlands)

    Trombetti, A.; Stoermann, C.; Chevalley, T.; Rietbergen, van B.; Hermann, F.R.; Martin, P.Y.; Rizzoli, R.

    2013-01-01

    Summary End-stage renal disease (ESRD) patients have a high risk of fractures. We evaluated bone microstructure and finite-element analysis-estimated strength and stiffness in patients with ESRD by high-resolution peripheral computed tomography. We observed an alteration of cortical and trabecular

  13. Pneumocystis jirovecii pneumonia in patients with end-stage renal disease

    DEFF Research Database (Denmark)

    Leth, Steffen; Jensen-Fangel, Søren; Østergaard, Lars Jørgen

    2014-01-01

    Background: Data on occurrence and risk factors for pneumocystis pneumonia (PCP) in patients with end-stage renal disease (ESRD) are sparse. Methods: This was a nationwide population-based study assessing occurrence and risk factors for PCP among patients with ESRD and population controls over a 21...

  14. How End-Stage Renal Disease Patients Manage the Medicare Part D Coverage Gap

    Science.gov (United States)

    Kovacs, Pamela J.; Perkins, Nathan; Nuschke, Elizabeth; Carroll, Norman

    2012-01-01

    Medicare Part D was enacted to help elderly and disabled individuals pay for prescription drugs, but it was structured with a gap providing no coverage in 2010 between $2,830 and $6,440. Patients with end-stage renal disease (ESRD) are especially likely to be affected due to high costs of dialysis-related drugs and the importance of adherence for…

  15. 78 FR 8535 - Medicare Program: Comprehensive End-Stage Renal Disease Care Model Announcement

    Science.gov (United States)

    2013-02-06

    ... develop and test innovative health care payment and service delivery models that show promise of reducing... test innovative payment and service delivery models that reduce spending under Medicare, Medicaid or...] Medicare Program: Comprehensive End-Stage Renal Disease Care Model Announcement AGENCY: Centers for...

  16. Effect of folic acid on methionine and homocysteine metabolism in end-stage renal disease

    NARCIS (Netherlands)

    Stam, F.; van Guldener, C.; ter Wee, P.M.; Jakobs, C.A.J.M.; van der Meer, K.; Stehouwer, C.D.A.

    2005-01-01

    Background. The pathogenesis of hyperhomocysteinemia in end-stage renal disease (ESRD) is unclear. Folic acid lowers, but does not normalize, the plasma homocysteine level in patients with ESRD, but its effect on whole body metabolism of homocysteine is unknown. Methods We studied the effect of 3

  17. End-Stage Renal Disease From Cast Nephropathy in a Teenager With Neuroendocrine Carcinoma.

    Science.gov (United States)

    Butani, Lavjay; Ducore, Jonathan

    2016-07-01

    Cast nephropathy is the most common manifestation of renal injury in patients with multiple myeloma but is rarely reported in other conditions. We are reporting our experience in caring for a teenager with a metastatic neuroendocrine carcinoma who developed rapidly progressive kidney injury that advanced to end-stage renal disease. On renal biopsy extensive tubular necrosis and intratubular eosinophilic casts were noted. This previously unreported finding should prompt oncologists to closely monitor for such a complication in patients with secretory tumors. Whether early plasmapheresis could be of benefit, as has been tried in multiple myeloma, remains to be determined.

  18. A study of the impact of disease burden in quality of life of people with pre-End-Stage and End-Stage Renal Disease

    Directory of Open Access Journals (Sweden)

    Helen Georgiadou

    2017-10-01

    Full Text Available Introduction: Diabetes Mellitus (DM is a common chronic disease accompanied by severe complications. It is the leading cause of End-Stage Renal Disease (ESRD requiring management either by haemodialysis (HD or peritoneal dialysis (PD. The chronicity of the disease, and its complications, affects the psychological, family and social life of the patients and their Quality of Life (QoL. Aim: of the present study was to estimate the disease burden of patients with diabetic nephropathy (DN during pre-ESRD and during End-Stage Renal Disease. Methods: A sample of 103 patients with DN treated at the General Hospital of Veria were studied during May and June 2016. The study was conducted using the Dialysis Symptoms Index (DSI for the assessment of Chronic Kidney Disease (CKD symptom load and the European Quality of Life (EuroQol questionnaire for assessing the QoL of patients in the Renal Outpatient Clinic, Haemodialysis and Peritoneal Dialysis Unit. Results: It was found that the Renal Replacement Method (HD or PD, the presence of DM and CKD’s stage affect significantly the patients’ self-assessment regarding painful symptoms of DN. Furthermore, the above factors have major impact on some aspects of patients’ QoL, such as mobility and self-care. Conclusions: Pre-End Stage patients experience more severe painful symptoms of DN compared to patients on Renal Replacement Therapies.

  19. Bariatric Surgery as a Bridge to Renal Transplantation in Patients with End-Stage Renal Disease.

    Science.gov (United States)

    Al-Bahri, Shadi; Fakhry, Tannous K; Gonzalvo, John Paul; Murr, Michel M

    2017-11-01

    Obesity is a relative contraindication to organ transplantation. Preliminary reports suggest that bariatric surgery may be used as a bridge to transplantation in patients who are not eligible for transplantation because of morbid obesity. The Bariatric Center at Tampa General Hospital, University of South Florida, Tampa, Florida. We reviewed the outcomes of 16 consecutive patients on hemodialysis for end-stage renal disease (ESRD) who underwent bariatric surgery from 1998 to 2016. Demographics, comorbidities, weight loss, as well as transplant status were reported. Data is mean ± SD. Six men and ten women aged 43-66 years (median = 54 years) underwent laparoscopic Roux-en-Y gastric bypass (LRYGB, n = 12), laparoscopic adjustable gastric banding (LAGB, n = 3), or laparoscopic sleeve gastrectomy (LSG, n = 1). Preoperative BMI was 48 ± 8 kg/m 2 . Follow-up to date was 1-10 years (median = 2.8 years); postoperative BMI was 31 ± 7 kg/m 2 ; %EBWL was 62 ± 24. Four patients underwent renal transplantation (25%) between 2.5-5 years after bariatric surgery. Five patients are currently listed for transplantation. Five patients were not listed for transplantation due to persistent comorbidities; two of these patients died as a consequence of their comorbidities (12.5%) more than 1 year after bariatric surgery. Two patients were lost to follow-up (12.5%). Bariatric surgery is effective in patients with ESRD and improves access to renal transplantation. Bariatric surgery offers a safe approach to weight loss and improvement in comorbidities in the majority of patients. Referrals of transplant candidates with obesity for bariatric surgery should be considered early in the course of ESRD.

  20. Effect of renal replacement therapy on viscosity in end-stage renal disease patients.

    Science.gov (United States)

    Feriani, M; Kimmel, P L; Kurantsin-Mills, J; Bosch, J P

    1992-02-01

    Viscosity, an important determinant of microcirculatory hemodynamics, is related to hematocrit (HCT), and may be altered by renal failure or its treatment. To assess these factors, we studied the effect of dialysis on the viscosity of whole blood, plasma, and reconstituted 70% HCT blood of eight continuous ambulatory peritoneal dialysis (CAPD) and nine hemodialysis (HD) patients under steady shear flow conditions at different shear rates, before and after dialysis, compared with nine normal subjects. The density of the red blood cells (RBCs), a marker of cell hydration, was measured in HD patients by a nonaqueous differential floatation technique. Whole blood viscosity was higher in controls than patients, and correlated with HCT before treatment (P less than 0.05) at shear rates of 11.5 to 230 s-1) in HD patients, and 23 to 230 s-1 in all end-stage renal disease (ESRD) patients. In contrast, whole blood viscosity correlated with HCT in CAPD patients only at the lowest shear rates (2.3 and 5.75 s-1, P less than 0.05). Plasma viscosity was higher in CAPD patients than both HD patients before treatment and controls (P less than 0.05, analysis of variance [ANOVA]), despite lower plasma total protein, albumin, and similar fibrinogen concentration compared with HD patients. When all samples were reconstituted to 70% HCT, CAPD patients had higher whole blood viscosity than control subjects'. The high HCT blood viscosity of the ESRD patients was higher than control subjects' at capillary shear rates, suggesting increased RBC aggregation and decreased RBC deformability in patients with renal disease.(ABSTRACT TRUNCATED AT 250 WORDS)

  1. Pancreatitis with normal lipase and amylase in setting of end-stage renal disease.

    Science.gov (United States)

    Sharma, Anuj; Masood, Umair; Khan, Babar; Chawla, Kunal; Manocha, Divey

    2017-09-01

    Pancreatitis with normal lipase and amylase level is a rare phenomenon. This is especially true in patient with end-stage renal disease as lipase and amylase are renally excreted. Literature review reveals previous case report of pancreatitis with normal lipase and amylase level, however, none of them occurred in the setting of end-stage renal disease. Our case is the first such reported case of pancreatitis in such setting. Here we report a 30year old male with past medical history of end-stage renal disease who presented in emergency department with acute abdominal pain. Laboratory work up revealed normal lipase and amylase level. However, radiological work up was consistent with pancreatitis. This case report highlight the importance of taking the overall clinical picture rather than laboratory work up to rule in or rule out the diagnosis of pancreatitis. Furthermore, this should also serve an important reminder for clinicians to further investigate where clinical suspicion for pancreatitis is high. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Renal replacement therapy in Latin American end-stage renal disease.

    Science.gov (United States)

    Rosa-Diez, Guillermo; Gonzalez-Bedat, Maria; Pecoits-Filho, Roberto; Marinovich, Sergio; Fernandez, Sdenka; Lugon, Jocemir; Poblete-Badal, Hugo; Elgueta-Miranda, Susana; Gomez, Rafael; Cerdas-Calderon, Manuel; Almaguer-Lopez, Miguel; Freire, Nelly; Leiva-Merino, Ricardo; Rodriguez, Gaspar; Luna-Guerra, Jorge; Bochicchio, Tomasso; Garcia-Garcia, Guillermo; Cano, Nuria; Iron, Norman; Cuero, Cesar; Cuevas, Dario; Tapia, Carlos; Cangiano, Jose; Rodriguez, Sandra; Gonzalez, Haydee; Duro-Garcia, Valter

    2014-08-01

    The Latin American Dialysis and Renal Transplant Registry (RLADTR) was founded in 1991; it collects data from 20 countries which are members of Sociedad Latinoamericana de Nefrología e Hipertension. This paper presents the results corresponding to the year 2010. This study is an annual survey requesting data on incident and prevalent patients undergoing renal replacement treatment (RRT) in all modalities: hemodialysis (HD), peritoneal dialysis (PD) and living with a functioning graft (LFG), etc. Prevalence and incidence were compared with previous years. The type of renal replacement therapy was analyzed, with special emphasis on PD and transplant (Tx). These variables were correlated with the gross national income (GNI) and the life expectancy at birth. Twenty countries participed in the surveys, covering 99% of the Latin American. The prevalence of end stage renal disease (ESRD) under RRT in Latin America (LA) increased from 119 patients per million population (pmp) in 1991 to 660 pmp in 2010 (HD 413 pmp, PD 135 pmp and LFG 111 pmp). HD proportionally increased more than PD, and Tx HD continues to be the treatment of choice in the region (75%). The kidney Tx rate increased from 3.7 pmp in 1987 to 6.9 pmp in 1991 and to 19.1 in 2010. The total number of Tx's in 2010 was 10 397, with 58% deceased donors. The total RRT prevalence correlated positively with GNI ( r 2 0.86; P chronic kidney disease (CKD) and its associated risk factors. PD is still an underutilized strategy for RRT in the region. Even though renal Tx is feasible, its growth rate is still not as fast as it should be in order to compensate for the increased prevalence of patients on waiting lists. Diagnostic and prevention programs for hypertension and diabetes, appropriate policies promoting the expansion of PD and organ procurement as well as transplantation as cost-effective forms of RRT are needed in the region. Regional cooperation among Latin American countries, allowing the more developed to

  3. Predictors of advanced chronic kidney disease and end-stage renal disease in HIV-positive persons

    DEFF Research Database (Denmark)

    Nielsen, Lene Ryom; Mocroft, Amanda; Kirk, Ole

    2014-01-01

    Whilst several antiretroviral drugs have been associated with moderate chronic kidney disease (CKD), their contribution to advanced CKD and end-stage renal disease (ESRD) remain unknown.......Whilst several antiretroviral drugs have been associated with moderate chronic kidney disease (CKD), their contribution to advanced CKD and end-stage renal disease (ESRD) remain unknown....

  4. The antioxidant acetylcysteine reduces cardiovascular events in patients with end-stage renal failure: a randomized, controlled trial

    DEFF Research Database (Denmark)

    Tepel, Martin; van der Giet, Markus; Statz, Mario

    2003-01-01

    Patients with end-stage renal failure have increased oxidative stress and show elevated cardiovascular mortality. Whether increased cardiovascular events can be prevented by the administration of antioxidants is unknown.......Patients with end-stage renal failure have increased oxidative stress and show elevated cardiovascular mortality. Whether increased cardiovascular events can be prevented by the administration of antioxidants is unknown....

  5. Acetylcysteine reduces plasma homocysteine concentration and improves pulse pressure and endothelial function in patients with end-stage renal failure

    DEFF Research Database (Denmark)

    Scholze, Alexandra; Rinder, Christiane; Beige, Joachim

    2004-01-01

    Increased oxidative stress, elevated plasma homocysteine concentration, increased pulse pressure, and impaired endothelial function constitute risk factors for increased mortality in patients with end-stage renal failure.......Increased oxidative stress, elevated plasma homocysteine concentration, increased pulse pressure, and impaired endothelial function constitute risk factors for increased mortality in patients with end-stage renal failure....

  6. Effectiveness of group cognitive behavioral therapy with mindfulness in end-stage renal disease hemodialysis patients

    OpenAIRE

    Bo Kyung Sohn; Yun Kyu Oh; Jung-Seok Choi; Jiyoun Song; Ahyoung Lim; Jung Pyo Lee; Jung Nam An; Hee-Jeong Choi; Jae Yeon Hwang; Hee-Yeon Jung; Jun-Young Lee; Chun Soo Lim

    2018-01-01

    Background : Many patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) experience depression. Depression influences patient quality of life (QOL), dialysis compliance, and medical comorbidity. We developed and applied a group cognitive behavioral therapy (CBT) program including mindfulness meditation for ESRD patients undergoing HD, and measured changes in QOL, mood, anxiety, perceived stress, and biochemical markers. Methods : We conducted group CBT over a 12-week period...

  7. Physical and psychOLOGical functions in Patients WITH THE END-STAGE RENAL DISEASE

    OpenAIRE

    Andrea Mahrova; Klara Svagrova; Vaclav Bunc

    2012-01-01

    Understanding the physical and psychological status in patients with the end-stage renal disease (ESRD) on renal dialysis treatment (RDT) is a current issue of high importance due to a rising number of elderly patients. The aims of the study in ESRD patients were: 1) to test physical and psychological functions; 2) to propose suitable physical activities. Group of patients: (M/F,n=34/33, age 67.0±12.7yrs/64.0±13.1yrs). For testing we used Senior Fitness Test Manual, KDQOL–SFTM-questionnaire S...

  8. Renal replacement therapy in Latin American end-stage renal disease

    Science.gov (United States)

    Rosa-Diez, Guillermo; Gonzalez-Bedat, Maria; Pecoits-Filho, Roberto; Marinovich, Sergio; Fernandez, Sdenka; Lugon, Jocemir; Poblete-Badal, Hugo; Elgueta-Miranda, Susana; Gomez, Rafael; Cerdas-Calderon, Manuel; Almaguer-Lopez, Miguel; Freire, Nelly; Leiva-Merino, Ricardo; Rodriguez, Gaspar; Luna-Guerra, Jorge; Bochicchio, Tomasso; Garcia-Garcia, Guillermo; Cano, Nuria; Iron, Norman; Cuero, Cesar; Cuevas, Dario; Tapia, Carlos; Cangiano, Jose; Rodriguez, Sandra; Gonzalez, Haydee; Duro-Garcia, Valter

    2014-01-01

    The Latin American Dialysis and Renal Transplant Registry (RLADTR) was founded in 1991; it collects data from 20 countries which are members of Sociedad Latinoamericana de Nefrología e Hipertension. This paper presents the results corresponding to the year 2010. This study is an annual survey requesting data on incident and prevalent patients undergoing renal replacement treatment (RRT) in all modalities: hemodialysis (HD), peritoneal dialysis (PD) and living with a functioning graft (LFG), etc. Prevalence and incidence were compared with previous years. The type of renal replacement therapy was analyzed, with special emphasis on PD and transplant (Tx). These variables were correlated with the gross national income (GNI) and the life expectancy at birth. Twenty countries participed in the surveys, covering 99% of the Latin American. The prevalence of end stage renal disease (ESRD) under RRT in Latin America (LA) increased from 119 patients per million population (pmp) in 1991 to 660 pmp in 2010 (HD 413 pmp, PD 135 pmp and LFG 111 pmp). HD proportionally increased more than PD, and Tx HD continues to be the treatment of choice in the region (75%). The kidney Tx rate increased from 3.7 pmp in 1987 to 6.9 pmp in 1991 and to 19.1 in 2010. The total number of Tx's in 2010 was 10 397, with 58% deceased donors. The total RRT prevalence correlated positively with GNI (r2 0.86; P < 0.05) and life expectancy at birth (r2 0.58; P < 0.05). The HD prevalence and the kidney Tx rate correlated significantly with the same indexes, whereas the PD rate showed no correlation with these variables. A tendency to rate stabilization/little growth was reported in the most regional countries. As in previous reports, the global incidence rate correlated significantly only with GNI (r2 0.63; P < 0.05). Diabetes remained the leading cause of ESRD. The most frequent causes of death were cardiovascular (45%) and infections (22%). Neoplasms accounted for 10% of the causes of death. The

  9. Pulmonary Hypertension Among End-Stage Renal Failure Patients Following Hemodialysis Access Thrombectomy

    International Nuclear Information System (INIS)

    Harp, Richard J.; Stavropoulos, S. William; Wasserstein, Alan G.; Clark, Timothy W.I.

    2005-01-01

    Purpose: Percutaneous hemodialysis thrombectomy causes subclinical pulmonary emboli without short-term clinical consequence; the long-term effects on the pulmonary arterial vasculature are unknown. We compared the prevalence of pulmonary hypertension between patients who underwent one or more hemodialysis access thrombectomy procedures with controls without prior thrombectomy.Methods: A retrospective case-control study was performed. Cases (n = 88) had undergone one or more hemodialysis graft thrombectomy procedures, with subsequent echocardiography during routine investigation of comorbid cardiovascular disease. Cases were compared with controls without end-stage renal disease (ESRD) (n = 100, group 1), and controls with ESRD but no prior thrombectomy procedures (n = 117, group 2). The presence and velocity of tricuspid regurgitation on echocardiography was used to determine the prevalence and grade of pulmonary hypertension; these were compared between cases and controls using the chi-square test and logistic regression.Results: The prevalence of pulmonary hypertension among cases was 52% (46/88), consisting of mild, moderate and severe in 26% (n = 23), 10% (n = 9) and 16% (n = 14), respectively. Prevalence of pulmonary hypertension among group 1 controls was 26% (26/100), consisting of mild, moderate and severe pulmonary hypertension in 14%, 5% and 7%, respectively. Cases had 2.7 times greater odds of having pulmonary hypertension than group 1 controls (p = 0.002). The prevalence of pulmonary hypertension among group 2 controls was 42% (49/117), consisting of mild, moderate and severe pulmonary arterial hypertension in 25% (n = 49), 10% (n = 12) and 4% (n = 5), respectively. Cases were slightly more likely to have pulmonary hypertension than group 2 controls (OR = 1.5), although this failed to reach statistical significance (p = 0.14).Conclusion: Prior hemodialysis access thrombectomy does not appear to be a risk factor for pulmonary arterial hypertension

  10. End Stage and Chronic Kidney Disease:Associations with Renal Cancer

    Directory of Open Access Journals (Sweden)

    Paul eRusso

    2012-04-01

    Full Text Available There is a well known association between end stage renal disease and the development of kidney cancer in the native kidney of patients requiring renal replacement therapy. There is now emerging evidence that lesser degrees of renal insufficiency (chronic kidney disease, CKD are also associated with an increased likelihood of cancer in general and kidney cancer in particular. Nephro pathological changes are commonly observed in the non tumor bearing portions of kidney resected at the time of partial and radical nephrectomy. In addition, patients with renal cancer are more likely to have CKD at the time of diagnosis and treatment than the general population. The exact mechanism by which renal insufficiency transforms normal kidney cells into tumor cells is not known. Possible mechanisms include uremic immune inhibition or increased exposure to circulating toxins not adequately cleared by the kidneys. Surgeons managing kidney tumors must have an increased awareness of their patient’s renal functional status as they plan their resection. Kidney sparing approaches, including partial nephrectomy or active surveillance in older and morbidly ill patients, can prevent CKD or delay the further decline in renal function which is well documented with radical nephrectomy. Despite emerging evidence that partial nephrectomy provides equivalent local tumor control to radical nephrectomy while at the same time preventing CKD, this operation remains under utilized in the United States and abroad. Increased awareness of the bi directional relationship between kidney function and kidney cancer is essential in the contemporary management of kidney cancer.

  11. Differentiation of reversible ischemia from end-stage renal failure in nephrotic children with 131I-hippurate dynamic scintigraphy

    International Nuclear Information System (INIS)

    Hattner, R.S.; Maltz, H.E.; Holliday, M.A.

    1977-01-01

    In renal failure associated with the nephrotic syndrome, therapeutic strategy is highly dependent upon the cause of the renal failure. Dynamic hippurate scintigraphy was studied in five pediatric patients. Four had nephrotic syndrome, and of these, three had acute renal failure. The fifth patient had end-stage renal failure. Specific alteration in renal hippurate kinetics offers a noninvasive assessment of renal failure in this clinical setting

  12. Renal Failure in Patients with End Stage Liver Disease and its Impact on Clinical Outcome

    International Nuclear Information System (INIS)

    Qureshi, M. O.; Shafqat, F.; Dar, F. S.; Salih, M.; Khokhar, N.

    2014-01-01

    Objective: To evaluate the prevalence of renal failure (RF) in the patients of end stage liver disease (ESLD), to determine the causes of RF in these patients and its impact on patient's outcome. Study Design: Descriptive, analytical study. Place and Duration of Study: Shifa International Hospital, Islamabad, Pakistan, from May 2011 to March 2013. Methodology: A total of 523 patients with end stage liver disease (ESLD) were evaluated, renal failure (RF) and its causes were recognized in these patients according to established criteria. Outcome of these patients was assigned as reversal of RF or mortality. Data was analyzed using SPSS version 16. Chi-square test was used for comparing proportions and t-test was used for comparing mean values. P < 0.05 was considered significant. Results: Out of 523 patients, 261 (49.9%) had RF. Acute kidney injury (AKI) was the most common presentation seen in 160 (61%) patients. Hypovolemia and infections were the most frequent causes of RF. Mortality was significantly higher in the patients with RF, when compared to the patients without RF (31% vs. 4.5%, p < 0.001). Reversal of RF was seen in 98 (37%) of the affected patients. Reversal was more common in the patients with hypovolemia. The mortality was higher in the patients with hepatorenal syndrome (HRS) and infections. Conclusion: Renal failure in the end stage liver disease is an important prognostic factor. Etiology of RF is the key factor in patients' outcome. Patients of ESLD with RF had higher mortality. Majority of the cases of RF were reversible in patients of ESLD coming in the setup. (author)

  13. Coping with chronic illness: A study with end-stage renal disease patients

    Directory of Open Access Journals (Sweden)

    Mónica Cassaretto

    2006-06-01

    Full Text Available This study identifies coping styles and strategies used by 40 end-stage renal disease patients over 20 years old who receive treatment in a general hospital in Peru. The instruments applied were a personal sociodemographic questionnaire and the Coping Inventory (Carver, Scheier & Weintraub, 1989. Results showed that emotion focused coping were most frequently used followed by problem focused coping. Planning, acceptance and positive reinterpretation-growth coping strategies were more frequently used by these patients, whereas mental disengagement, suppression of competing activities and behavioral disengagement were the less frequently used coping strategies. Other differences between coping styles and strategies and sociodemographic and medical variables were analyzed.

  14. Quality of life of patients with end-stage renal disease in Guinea

    Directory of Open Access Journals (Sweden)

    Alpha Oumar Bah

    2014-01-01

    Full Text Available This questionnaire-based study included 69 patients from the Republic of Guinea with end-stage renal disease (ESRD and was conducted over 12 months. The factors that affected their quality of life (QoL were determined. The included ESRD patients had an estimated creatinine clearance (CCr of 4, P = 0.01. Good QoL was associated with younger age, fewer comorbidities, less severe physical pain, and fewer physical or social limitations. QoL could be increased by improving comorbidity treatments, giving more effective pain control, and providing more assistance for social and physical limitations.

  15. Severe pulmonary hypertension in a young patient with end-stage renal disease on chronic hemodialysis

    International Nuclear Information System (INIS)

    Sharma, Satyavan; Kirpalani, Ashok L; Kulkarni, Amit

    2010-01-01

    Severe pulmonary hypertension in a teenager with end-stage renal disease on chronic hemodialysis via arteriovenous access is reported. Clinical presentation included persistent volume overload and pericardial effusion. Serial hemodynamic data obtained at cardiac catheterization confirmed the diagnosis. In addition, detailed biochemical and imaging data (echo- Doppler, computed tomography of chest, computed tomographic pulmonary angiography, VQ lung scan, etc.) were obtained to find out the mechanism. The exact cause of pulmonary hypertension remains unclear, and a multi- factorial mechanism is postulated. This rare case is presented to highlight the role of aggressive dialysis, pericardiocentesis, and use of sildenafil and bosentan in the management

  16. Asymptomatic pontine and extra-pontine lesions in a patient with end-stage renal disease

    Directory of Open Access Journals (Sweden)

    Raj Kanwar Yadav

    2016-01-01

    Full Text Available Osmotic demyelination syndrome leading to central pontine/extra-pontine myelinolysis (CPM/EPM occurs mainly in patients with history of alcohol abuse, malnourishment, following liver transplantation and less commonly, in association with other systemic diseases. Asymptomatic CPM/EPM is rare. Patients with end-stage renal disease (ESRD who develop CPM/EPM are usually symptomatic with florid neurologic manifestations. Herein, we present a patient with ESRD on maintenance hemodialysis who was incidentally detected to have pontine and extra-pontine lesions suggestive of myelinolysis without any neurologic signs or symptoms.

  17. End-stage renal disease in Nigeria: An overview of the epidemiology and the pathogenetic mechanisms

    Directory of Open Access Journals (Sweden)

    M O Odubanjo

    2011-01-01

    Full Text Available There is paucity of information on the magnitude of the burden of renal disease in our environment. Obtaining accurate data is hampered by the poor socioeconomic status of most patients with lack of access to specialized care in tertiary institutions, where most of the data is generated. The incidence of chronic renal failure (CRF and end-stage renal disease (ESRD in any specified area is known to be influenced by the prevalence of specific disease entities resulting in CRF. Hypertension, glomerulonephritis (GN, sickle cell disease, quartan malaria nephropathy, urinary tract schistosomiasis and other parasite-related forms of chronic GN are known to contribute significantly to the incidence of CRF in Nigeria. As is the situation in other parts of the world, diabetic nephropathy appears to be of increasing importance in the causation of ESRD in Nigeria. Even though the underlying cause of renal disease can often not be treated, extensive studies in experimental animals and preliminary studies in humans suggest that progression in chronic renal disease may largely be due to secondary factors, attention to which may be important in the prevention and/or control of renal disease.

  18. The epidemiology of end-stage renal disease in Nigeria: the way forward.

    Science.gov (United States)

    Odubanjo, M O; Oluwasola, A O; Kadiri, S

    2011-09-01

    The incidence of CKD (Chronic kidney disease) in Nigeria has been shown by various studies to range between 1.6 and 12.4%. We have shown that the burden of renal disease in Nigeria is probably significantly higher than any previous study on end-stage renal disease (ESRD) has documented, as most studies are hospital-based and fail to include the many patients who do not have access to hospital care. The increased prevalence of ESRD among blacks in the United States and South Africa compared with other races also suggests that ESRD may be more prevalent in Africa than in the United States and other developed nations. Common causes of CKD in Nigerian adults are glomerulonephritis and hypertension, while common causes in children are glomerulonephritis and posterior urethral valves. In the United States, diabetes and hypertension are the commonest causes of CKD and glomerulonephritis plays a less important role. Access to renal replacement therapy (RRT) in Nigeria is limited, and mortality rates are very high, ranging between 40 and 50%. Important steps towards improving the situation are the development of prevention programmes and increased funding to ensure increased availability of RRT. To achieve this, health policies concerning CKD must be formulated, and the lack of a renal registry makes it difficult for this to be done. There is need for the development of a functional organizational structure for the reporting of CKD in Nigeria, the Nigerian Renal Registry.

  19. Comparison of clinical and laboratory parameters in patients with end-stage renal failure in the outcome of chronic glomerulonephritis and patients with end-stage renal failure in the outcome of other diseases.

    Science.gov (United States)

    Popova, J A; Yadrihinskaya, V N; Krylova, M I; Sleptsovа, S S; Borisovа, N V

    frequent complications of hemodialysis treatments are coagulation disorders. This is due to activation of the coagulation of blood flow in the interaction with a dialysis membrane material vascular prostheses and extracorporeal circuit trunks. In addition, in hemodialysis patients receiving heparin for years, there is depletion of stocks in endothelial cells in tissue factor inhibitor, inhibits the activity of an external blood clotting mechanism. the aim of our study was to evaluate the hemostatic system parameters in patients with end-stage renal failure, depending on the cause of renal failure. to evaluate the hemostatic system parameters in patients with end-stage renal failure, depending on the cause of renal failure and hemodialysis treatment duration conducted a study that included 100 patients observed in the department of chronic hemodialysis and nephrology hospital №1 Republican National Medical Center in the period of 2013-2016. in patients with end-stage renal failure in the outcome of chronic glomerulonephritis, a great expression of activation of blood coagulation confirm increased the mean concentration of fibrinogen, whereas in the group, which included patients with end-stage renal failure in the outcome of other diseases, such is not different from the norm, and a higher rate of hyperfibrinogenemia, identified in 2/3 patients in this group. it was revealed that the state of homeostasis in patients with end-stage renal failure in increasingly characterizes the level of fibrinogen and the activation of the hemostatic markers: soluble fibrin monomer complexes, D-dimers.

  20. Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, and End-Stage Renal Disease Quality Incentive Program. Final rule.

    Science.gov (United States)

    2017-11-01

    This rule updates and makes revisions to the end-stage renal disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2018. It also updates the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI). This rule also sets forth requirements for the ESRD Quality Incentive Program (QIP), including for payment years (PYs) 2019 through 2021.

  1. Increased Sympathetic Renal Innervation in Hemodialysis Patients Is the Anatomical Substrate of Sympathetic Hyperactivity in End-Stage Renal Disease.

    Science.gov (United States)

    Mauriello, Alessandro; Rovella, Valentina; Anemona, Lucia; Servadei, Francesca; Giannini, Elena; Bove, Pierluigi; Anselmo, Alessandro; Melino, Gerry; Di Daniele, Nicola

    2015-11-26

    Renal denervation represents an emerging treatment for resistant hypertension in patients with end-stage renal disease, but data about the anatomic substrate of this treatment are lacking. Therefore, the aim of this study was to investigate the morphological basis of sympathetic hyperactivity in the setting of hemodialysis patients to identify an anatomical substrate that could warrant the use of this new therapeutic approach. The distribution of sympathetic nerves was evaluated in the adventitia of 38 renal arteries that were collected at autopsy or during surgery from 25 patients: 9 with end-stage renal disease on dialysis (DIAL group) and 16 age-matched control nondialysis patients (CTRL group). Patients in the DIAL group showed a significant increase in nerve density in the internal area of the peri-adventitial tissue (within the first 0.5 mm of the beginning of the adventitia) compared with the CTRL group (4.01±0.30 versus 2.87±0.28×mm(2), P=0.01). Regardless of dialysis, hypertensive patients with signs of severe arteriolar damage had a greater number of nerve endings in the most internal adventitia, and this number was significantly higher than in patients without hypertensive arteriolar damage (3.90±0.36 versus 2.87±0.41×mm(2), P=0.04), showing a correlation with hypertensive arteriolar damage rather than with hypertensive clinical history. The findings from this study provide a morphological basis underlying sympathetic hyperactivity in patients with end-stage renal disease and might offer useful information to improve the use of renal denervation in this group of patients. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  2. YKL-40 in patients with end-stage renal disease receiving haemodialysis

    DEFF Research Database (Denmark)

    Nielsen, Ture Lange; Plesner, Louis Lind; Warming, Peder Emil

    2018-01-01

    PURPOSE: This study aimed to determine serum YKL-40 in patients with end-stage renal disease (ESRD) on haemodialysis (HD) and to evaluate the prognostic value of serum YKL-40. METHODS: Patients >18 years on maintenance HD were included. Serum YKL-40 was measured using ELISA before and after...... a single HD treatment. RESULTS: A total of 306 patients were included. Median serum YKL-40 concentration was 238 µgL-1(IQR: 193-291 µgL-1) before HD treatment and 198 µgL-1(IQR: 147-258 µgL-1) after HD treatment, which corresponded to age-corrected 93th percentile in healthy subjects. All-cause mortality...

  3. Efficacy of dietary interventions in end-stage renal disease patients; a systematic review

    Directory of Open Access Journals (Sweden)

    Nazar Chaudhary Muhamamd Juniad

    2016-01-01

    Full Text Available Cardiovascular disease (CVD and chronic kidney disease (CKD are common comorbid conditions. Life style, particularly diet is a critical component of treatment for these conditions. Register dietitians play a key role in bridging the gap between the science of nutrition and the empowerment of individuals to alter their lifestyles in a healthy manner. A range of dietary manipulations has been reported to reduce risk factors and decrease risk of CVD and CKD outcomes. However, many studies provided food to participants or were limited to adjustment of few specific nutrients. Diet intervention in relation with end-stage renal disease (ESRD is really complicated topic. As multiple co morbid conditions such as hypertension, CVD, CKD, and diabetes mellitus (DM are associated with ESRD, which made the scenario really worse while fixing the dose of any diet. Still a lot of research work is required to understand this topic.

  4. Neurological and cardiac complications in a cohort of children with end-stage renal disease

    Directory of Open Access Journals (Sweden)

    Jumana H Albaramki

    2016-01-01

    Full Text Available Adult patients with chronic kidney disease are at risk of major neurologic and cardiac complications. The purpose of this study is to review the neurological and cardiac complications in children with end-stage renal disease (ESRD. A retrospective review of medical records of children with ESRD at Jordan University Hospital was performed. All neurological and cardiac events were recorded and analyzed. Data of a total of 68 children with ESRD presenting between 2002 and 2013 were reviewed. Neurological complications occurred in 32.4%; seizures were the most common event. Uncontrolled hypertension was the leading cause of neurological events. Cardiac complications occurred in 39.7%, the most common being pericardial effusion. Mortality from neurological complications was 45%. Neurological and cardiac complications occurred in around a third of children with ESRD with a high mortality rate. More effective control of hypertension, anemia, and intensive and gentle dialysis are needed.

  5. Identifying Depression in South Asian Patients with End-Stage Renal Disease: Considerations for Practice

    Directory of Open Access Journals (Sweden)

    Shivani Sharma

    2011-12-01

    Full Text Available Depression is a prevalent burden for patients with end-stage renal disease (ESRD and one that is under-recognized and consequently under-treated. Although several studies have explored the association between depression symptoms, treatment adherence and outcomes in Euro-American patient groups, quantitative and qualitative exploration of these issues in patients from different cultural and ethnic backgrounds has been lacking. This review discusses the methodological issues associated with measuring depression in patients of South Asian origin who have a 3- to 5-fold greater risk of developing ESRD. There is a need to advance research into the development of accurate screening practices for this patient group, with an emphasis on studies utilizing rigorous approaches to evaluating the use of both emic (culture-specific and etic (universal or culture-general screening instruments.

  6. Spontaneous Hemocholecyst in an End-Stage Renal Failure Patient on Low Molecular Weight Heparin Hemodialysis

    Directory of Open Access Journals (Sweden)

    Konstantinos Blouhos

    2012-01-01

    Full Text Available The present paper describes a case of spontaneous hemocholecyst in a patient with end-stage renal failure on low molecular weight heparin hemodialysis. The patient presented with acute right upper quadrant pain. An initial ultrasound scan demonstrated a distended gallbladder containing echogenic bile without stones. During hospitalization the patient became febrile, and jaundiced, developed leukocytosis, and had an elevation in serum bilirubin, transaminases, and alkaline phosphatase. A new ultrasound demonstrated a thick-walled gallbladder containing echogenic bile and pericholecystic fluid. MRI depicted a distended gallbladder containing material of mixed signal intensity and a normal biliary tract. Open cholecystectomy revealed a gallbladder filled with blood and clots, and transcystic common bile duct exploration flushed blood clots out of the bile duct. To our knowledge this is the second case of spontaneous hemocholecyst reported in the literature as a consequence of uremic bleeding and LMWH hemodialysis in the absence of other pathology.

  7. A retrospective study of end-stage renal disease in captive polar bears (Ursus maritimus).

    Science.gov (United States)

    LaDouceur, Elise E B; Davis, Barbara; Tseng, Flo

    2014-03-01

    This retrospective study summarizes 11 cases of end-stage renal disease (ESRD) in captive polar bears (Ursus maritimus) from eight zoologic institutions across the United States and Canada. Ten bears were female, one was male, and the mean age at the time of death was 24 yr old. The most common clinical signs were lethargy, inappetence, and polyuria-polydipsia. Biochemical findings included azotemia, anemia, hyperphosphatemia, and isosthenuria. Histologic examination commonly showed glomerulonephropathies and interstitial fibrosis. Based on submissions to a private diagnostic institution over a 16-yr period, ESRD was the most commonly diagnosed cause of death or euthanasia in captive polar bears in the United States, with an estimated prevalence of over 20%. Further research is needed to discern the etiology of this apparently common disease of captive polar bears.

  8. Long-term neurocognitive outcomes of patients with end-stage renal disease during infancy.

    Science.gov (United States)

    Johnson, Rebecca J; Warady, Bradley A

    2013-08-01

    End-stage renal disease (ESRD) during infancy has been associated with poor short-term neurocognitive outcomes. Limited information exists regarding long-term outcomes. Neurocognitive outcomes for 12 patients diagnosed with ESRD during the first 16 months of life were assessed. Nine patients (mean age: 11 years) were compared to their healthy siblings (mean age: 10 years) on measures of intellectual and executive functioning, memory, and academic achievement using paired-samples t tests. Patients' Full Scale IQ (FSIQ) scores (M = 78, SD = 16.1) were significantly lower than sibling controls (M = 94, SD = 18.9; p executive functioning, memory, and academic achievement. In summary, patients diagnosed with ESRD as infants had intellectual and metacognitive functioning significantly lower than sibling controls. Fewer months on dialysis and younger age at transplant were associated with better outcomes.

  9. [Bilateral nephrectomy in patients with end-stage renal failure and chronic active pyelonephritis].

    Science.gov (United States)

    Lysenko, M A; Vtorenko, V I; Trushkin, R N; Lubennikov, A E; Sysoev, A M; Sokolov, A A

    2016-02-01

    This study analyzed the results of bilateral nephrectomy in 14 patients with end-stage renal disease (ESRD) and chronic active pyelonephritis. Seven patients had urosepsis, and 10 patients had a purulent form of pyelonephritis, which was one-sided in 7 of them. In the early postoperative period, on average, after 9.3 days, 9 patients died. Statistically significant risk factors for death were: chronic hemodialysis, long-term antibiotic therapy, and existing sepsis. Intraoperative complications and postoperative morbidity were not significantly associated with death. The study results imply the need of differentiated approach to bilateral nephrectomy in patients with ESRD and risk factors for fatal outcome. It must be performed on the strong indications since the intervention does not lead to eradication of sepsis. It is advisable to perform "preventive, sanation" bilateral nephrectomy in the "cold period" in patients at risk for developing urosepsis.

  10. Secondary Hyperparathyroidism in End-Stage Renal Disease: No Longer a Matter for Surgeons?

    Science.gov (United States)

    Cozzolino, Mario; Elli, Francesca; Carugo, Stefano; Ciceri, Paola

    2016-01-01

    Hyperphosphatemia, hypocalcemia and vitamin D deficiency are the main factors involved in the pathogenesis of secondary hyperparathyroidism (SHPT). Moreover, the skeletal resistance to parathyroid hormone is not only a high-turnover bone accompanying SHPT, but may also play a crucial role in the onset of low-turnover bone disease in uremia. However, a growing body of evidence suggests that other hormones play a key role in this disease, such as fibroblast growth factor 23, Klotho and sclerostin. SHPT causes both bone-associated and non-skeletal consequences, including cardiovascular calcifications. Furthermore, vitamin D and calcium (Ca)-containing phosphate binders may increase Ca load. Anyway, the rate of parathyroidectomy in end-stage renal disease has greatly decreased during the last decade. Is there any room left for surgeons? © 2016 S. Karger AG, Basel.

  11. Self-Motivation Is Associated With Phosphorus Control in End-Stage Renal Disease.

    Science.gov (United States)

    Umeukeje, Ebele M; Merighi, Joseph R; Browne, Teri; Victoroff, Jacquelyn N; Umanath, Kausik; Lewis, Julia B; Ikizler, T Alp; Wallston, Kenneth A; Cavanaugh, Kerri

    2015-09-01

    Hyperphosphatemia is common in end-stage renal disease and associates with mortality. Phosphate binders reduce serum phosphorus levels; however, adherence is often poor. This pilot study aims to assess patients' self-motivation to adhere to phosphate binders, its association with phosphorus control, and potential differences by race. Cross sectional design. Subjects were enrolled from one academic medical center dialysis practice from July to November 2012. Self-motivation to adhere to phosphate binders was assessed with the autonomous regulation (AR) scale (range: 1-7) and self-reported medication adherence with the Morisky Medication Adherence Scale. Linear regression models adjusting for age, sex, health literacy, and medication adherence were applied to determine associations with serum phosphorus level, including any evidence of interaction by race. Among 100 participants, mean age was 51 years (±15 years), 53% were male, 72% were non-white, 89% received hemodialysis, and mean serum phosphorus level was 5.7 ± 1.6 mg/dL. More than half (57%) reported the maximum AR score (7). Higher AR scores were noted in those reporting better health overall (P = .001) and those with higher health literacy (P = .01). AR score correlated with better medication adherence (r = 0.22; P = .02), and medication adherence was negatively associated with serum phosphorus (r = -0.40; P motivation was associated with phosphate binder adherence and phosphorus control, and this differed by race. Additional research is needed to determine if personalized, culturally sensitive strategies to understand and overcome motivational barriers may optimize mineral bone health in end-stage renal disease. Published by Elsevier Inc.

  12. 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.

  13. Bone aluminum measurements in patients with end-stage renal disease

    International Nuclear Information System (INIS)

    Ellis, K.J.; Kelleher, S.P.

    1986-01-01

    Long-term use of aluminum-based phosphate binders and trace aluminum contamination of dialysate solution have led to increased body burden of this metal in patients with end-stage renal disease. Aluminum accumulates in bone and has been associated with the development of a renal osteodystrophy, called aluminum-induced osteomalacia. At present, bone biopsy is the method of diagnosis of this condition. When examined by quantitative histomorphometry, the aluminum accumulation was reported to correlate with the severity of the osteomalacia. This project was therefore undertaken to investigate the possibility of developing a non-invasive technique using neutron activation analysis for the direct in vivo assessment of bone aluminum levels. A bilateral exposure of the patient's hand is performed at the patient port of the Brookhaven Medical Research Reactor. The induced activity is then counted for 5 min using four 4'' x 4'' x 16'' NaI(T1) detectors arranged in a quasi-4! geometry. In addition to Al, Ca is also detected and serves as each individual's internal standard for the volume of bone mass irradiated. The Al/Ca ratio provides an index of the amount of elevated aluminum per unit bone mass. When this ratio is multiplied by the total body calcium value, an estimate of total skeletal aluminum is obtained. These measurements will be presented for a pilot study of ten asymptomatic renal patients

  14. (131)I treatment in Differentiated Thyroid Cancer and End-Stage Renal Disease.

    Science.gov (United States)

    Ortega, A J M; Vázquez, R G; Cuenca, J I C; Brocca, M A M; Castilla, J; Martínez, J M M; González, E N

    2016-01-01

    Radioiodine (RAI) is a cornerstone in the treatment of Differentiated Thyroid Cancer (DTC). In patients on haemodialysis due to End-Stage Renal Disease (ESRD), it must be used cautiously, considering the renal clearance of this radionuclide. Also, the safety of the procedure and subsequent long-term outcome is still not well defined. In 2001, we described a dosimetric method and short-term results in three patients, with a good safety profile. We hypothesize that our method is safe in a long-term scenario without compromising the prognosis of both renal and thyroid disease. Descriptive-retrospective study. A systematic search was carried out using our clinical database from 2000 to 2014. DTC and radioiodine treatment while on haemodialysis. peritoneal dialysis. Final sample n=9 patients (n=5 males), age 48 years (median age 51 years males, 67 years female group); n=8 papillary thyroid cancer, n=1 follicular thyroid cancer; n=5 lymph node invasion; n=1 metastatic disease. Median RAI dose administered on haemodialysis 100mCi. 7.5 years after radioiodine treatment on haemodialysis, n=7 deemed free of thyroid disease, n=1 persistent non-localised disease. No complications related to the procedure or other target organs were registered. After 3.25 years, n=4 patients underwent successful renal transplantation; n=4 patients did not meet transplantation criteria due to other conditions unrelated to the thyroid disease or its treatment. One patient died due to ischemic cardiomyopathy (free of thyroid disease). Radioiodine treatment during haemodialysis is a long-term, safe procedure without worsening prognosis of either renal or thyroid disease. Copyright © 2015 Elsevier España, S.L.U. and SEMNIM. All rights reserved.

  15. Renal Replacement Therapy in End-Stage Sickle Cell Nephropathy: Presentation of Two Cases and Literature Review

    International Nuclear Information System (INIS)

    Al-Mueilo, Samir H.

    2005-01-01

    Chronic renal failure develops in 4-18% of patients with sickle cell anemia. Hemodialysis and kidney transplant are viable options in the management of end-stage renal disease in patients with sickle cell diseases (SCD). Information on kidney disease among Saudi patients with SCD is non-existing. In this report, the clinical course of two adult males with end-stage sickle cell nephropathy from Eastern Saudi Arabia is described. Literature on renal replacement therapy in sickle cell anemia (SCA) is discussed. (author)

  16. Renal Artery Embolization - A First Line Treatment Option For End-Stage Hydronephrosis

    International Nuclear Information System (INIS)

    Mitra, Kakali; Prabhudesai, Vikramaditya; James, R. Lester; Jones, Robert W. A.; French, Michael E.; Cowling, Mark; West, David J.

    2004-01-01

    Conventionally poorly functioning hydronephrotic kidneys have been removed if they are symptomatic. In our unit, patients are offered renal artery embolization as an alternative treatment option. Patients and Methods: Fifteen patients (11 male, 4 female) with a mean age of 32.9 yr (20-51 yrs) have undergone renal artery embolization for symptomatic hydronephrosis with poor function. Mean follow-up was 64.13 weeks (range 14-200). All patients had loin pain and hydronephrosis. Twelve patients had primary pelvi-ureteric junction obstruction (PUJO). Two patients had poorly functioning hydronephrotic kidneys secondary to chronic calculous obstruction. One patient had chronic pain in an obstructed but reasonably functioning kidney following a previous pyeloplasty for PUJO which demanded intervention. Mean split function on renography was 11% (range 0-46%). Selective renal artery embolization was carried out under antibiotic cover using a 7 Fr balloon occlusion catheter and absolute alcohol, steel coils, and polyvinyl alcohol particles.Results: Nine patients developed post-embolization syndrome of self-limiting pain and pyrexia with no evidence of sepsis. One patient required readmission with this condition. One patient developed a hematoma at the puncture site. Mean hospital stay was 2.3 days. Fourteen patients are happy with the result and are completely pain free. One patient has minor discomfort but is delighted with the result. Nine patients have had follow-up ultrasound confirming resolution of the hydronephrosis. Conclusion: Renal artery embolization is an effective, safe, well-tolerated minimally invasive treatment option in end-stage hydronephrosis and we routinely offer it as an alternative to nephrectomy

  17. Misdiagnosis of Addison's disease in a patient with end-stage renal disease.

    Science.gov (United States)

    Kocyigit, Ismail; Unal, Aydin; Tanriverdi, Fatih; Hayri Sipahioglu, Murat; Tokgoz, Bulent; Oymak, Oktay; Utas, Cengiz

    2011-01-01

    Addison's disease is a rare disorder in patients with end-stage renal disease (ESRD). In patients, the diagnosis of Addison's disease is difficult in clinical practice because most of the clinical findings of this disease are similar to those of the renal failure. We present a 51-year-old male patient, who underwent hemodialysis therapy for 8 years, diagnosed with Addison's disease after having myalgia, skin hyperpigmentation, weight loss, sweating, and nausea for the past few weeks. The physical examination was completely normal except for muscle weakness, hyperpigmentation on labial mucosa and skin in a patient. The laboratory tests revealed anemia and hypoglycemia. Serum cortisol, adrenocorticotropic hormone (ACTH) levels, and ACTH stimulation test results were consistent with Addison's disease. Adrenal computerized tomography revealed bilateral atrophic glands. Additionally, it was found that elevated serum thyroid stimulating hormone levels and antithyroid peroxidase antibody titer were positive. Our purpose is to emphasize that physicians should be alert to the potential for additional different conditions particularly in terms of adrenal failure in patients with ESRD.

  18. Nutritional status, functional capacity and exercise rehabilitation in end-stage renal disease.

    Science.gov (United States)

    Mercer, T H; Koufaki, P; Naish, P F

    2004-05-01

    A significant percentage of patients with end-stage renal disease are malnourished and/or muscle wasted. Uremia is associated with decreased protein synthesis and increased protein degradation. Fortunately, nutritional status has been shown to be a modifiable risk factor in the dialysis population. It has long been proposed that exercise could positively alter the protein synthesis-degradation balance. Resistance training had been considered as the only form of exercise likely to induce anabolism in renal failure patients. However, a small, but growing, body of evidence indicates that for some dialysis patients, favourable improvements in muscle atrophy and fibre hypertrophy can be achieved via predominantly aerobic exercise training. Moreover, some studies tentatively suggest that nutritional status, as measured by SGA, can also be modestly improved by modes and patterns of exercise training that have been shown to also increase muscle fibre cross-sectional area and improve functional capacity. Functional capacity tests can augment the information content of basic nutritional status assessments of dialysis patients and as such are recommended for routine inclusion as a feature of all nutritional status assessments.

  19. End-stage renal disease in both husband and wife in Taiwan.

    Science.gov (United States)

    Chang, C-H; Fang, Y-W; Chen, H-S

    2009-10-01

    The incidence and prevalence of end-stage renal disease (ESRD) are extremely high in Taiwan. It is an interesting fact that both the husband and wife in some families of Taiwan suffer from ESRD. Therefore, we attempted to identify the potential risk factors of such couples. This is a retrospective observational study. Six couples receiving maintenance dialysis in our hospital from 1996 to 2006 were enrolled in this study. Detailed medical history; drugs history including over-the-counter drugs (OCD), analgesics and herbal remedies; occupational history and onset of transitional cell carcinoma (TCC) were recorded. These data are correlated with pre-dialysis laboratory findings. The outcomes of dialysis and TCC were also recorded and analyzed. Two males were Chinese herbal medicine practitioners. All the patients (12/12) had taken Chinese herbs and most of them (10/12) had also taken OCD (especially cold remedies and analgesics). We found all of them had bilateral contracted kidneys, mild proteinuria and trace glucosuria. One patient's renal biopsy revealed Chinese herb nephropathy. Four patients (33%) suffered from TCC. Three patients expired during follow up due to hyperkalemia, extensive TCC and suicide, respectively. The prevalence of Chinese herbs or compound analgesics abuse is high in couples with ESRD. The clinical features and high incidence of TCC are compatible with drug related chronic tubulointerstitial nephritis. Abuse of offending agents should be considered as a risk factor in family members with ESRD.

  20. Increased risk for cardiovascular mortality among malnourished end-stage renal disease patients.

    Science.gov (United States)

    Fung, Frank; Sherrard, Donald J; Gillen, Daniel L; Wong, Craig; Kestenbaum, Bryan; Seliger, Steven; Ball, Adrianne; Stehman-Breen, Catherine

    2002-08-01

    Studies have shown that protein-energy malnutrition (PEM) is a strong predictor of total mortality among patients with end-stage renal disease (ESRD). The aim of this study is to assess the relationship between nutritional indices and cardiovascular (CV) mortality among patients with ESRD by using data from the US Renal Data System (USRDS) Dialysis Morbidity and Mortality Study Wave I (DMMS-1). Demographic and medical data were abstracted from 5,058 patients who participated in the USRDS DMMS-1. Nutritional measurements of interest included subjective assessment of malnutrition, serum albumin level, body mass index (BMI), and cholesterol level. The USRDS provided follow-up data on mortality through July 1998. The Cox proportional hazard model was used to estimate the risk for CV death associated with nutritional markers. The risk for CV death was 39% greater for each 1-g/dL (10-g/L) decrement in serum albumin level (95% confidence interval [CI], 1.20 to 1.60; P history of CVD at the study start. Both PEM at baseline and worsening PEM over time are associated with a greater risk for CV death. This finding persists among dialysis patients without preexisting CVD at baseline. Copyright 2002 by the National Kidney Foundation, Inc.

  1. Brain Microstructural Abnormalities Are Related to Physiological Alterations in End-Stage Renal Disease.

    Directory of Open Access Journals (Sweden)

    Zhigang Bai

    Full Text Available To study whole-brain microstructural alterations in patients with end-stage renal disease (ESRD and examine the relationship between brain microstructure and physiological indictors in the disease.Diffusion tensor imaging data were collected from 35 patients with ESRD (28 men, 18-61 years and 40 age- and gender-matched healthy controls (HCs, 32 men, 22-58 years. A voxel-wise analysis was then used to identify microstructural alterations over the whole brain in the ESRD patients compared with the HCs. Multiple biochemical measures of renal metabolin, vascular risk factors, general cognitive ability and dialysis duration were correlated with microstructural integrity for the patients.Compared to the HCs, the ESRD patients exhibited disrupted microstructural integrity in not only white matter (WM but also gray matter (GM regions, as characterized by decreased fractional anisotropy (FA and increased mean diffusivity (MD, axial diffusivity (AD and radial diffusivity (RD. Further correlation analyses revealed that the in MD, AD and RD values showed significantly positive correlations with the blood urea nitrogen in the left superior temporal gyrus and significantly negative correlations with the calcium levels in the left superior frontal gyrus (orbital part in the patients.Our findings suggest that ESRD is associated with widespread diffusion abnormalities in both WM and GM regions in the brain, and microstructural integrity of several GM regions are related to biochemical alterations in the disease.

  2. Patients with end stage renal disease: a registry at Sultanah Aminah Hospital, Johor Bahru, Malaysia.

    Science.gov (United States)

    Liu, W J; Hooi, L S

    2007-08-01

    The epidemiology of new patients presenting to Sultanah Aminah Hospital Johor Bahru (HSAJB) with end-stage renal disease (ESRD) in 2003 and 2004 was analysed. Patients with ESRD were prospectively registered in the renal replacement therapy (RRT) database in the nephrology unit. The incidence of ESRD and the RRT provision rate in the district of Johor Bahru were calculated according to gender and race. There were 306 new patients in 2003 and 299 in 2004. Diabetic nephropathy contributed 56.8% new patients in 2003 and 57.9% in 2004. The mean age was 50.8 + 15.1 years in 2003 and 51.3 + 14.2 years in 2004. Males accounted for 53.3% in 2003 and 47.8% in 2004. Haemodialysis was the commonest form of RRT (60.5% in 2003, 69.9% in 2004), followed by continuous ambulatory peritoneal dialysis (30.1% in 2003, 19.4% in 2004) and renal transplantation (5.5% in 2003, 2.3% in 2004). Ninety-one percent of patients in 2003 and 90% in 2004 were alive at the end of the year they presented. The incidence of ESRD in the district of Johor Bahru was estimated as 136 per million population (p.m.p.) in 2003 and 151 p.m.p. in 2004. In the two year period the incidence of ESRD was higher among females (154 p.m.p.) than males (134 p.m.p.). Malays (194 p.m.p.) had higher ESRD incidence compared to Chinese (126 p.m.p.) and Indians (134 p.m.p.). RRT provision in Johor Bahru (92.7%) did not differ significantly with gender or race. The increasing number of patients presenting to HSAJB with ESRD especially those with diabetic nephropathy is a major concern. Prevention strategies at the primary care level may curb the burden of this chronic disease.

  3. Syndrome of rapid onset end stage renal disease in incident Mayo Clinic chronic hemodialysis patient

    Directory of Open Access Journals (Sweden)

    M. A. C. Onuigbo

    2014-01-01

    Full Text Available Despite decades of research, a full understanding of chronic kidney disease (CKD-end stage renal disease (ESRD progression remains elusive. The common consensus is a predictable, linear, progressive and time-dependent decline of CKD to ESRD. Acute kidney injury (AKI on CKD is usually assumed to be transient, with recovery as the expected outcome. AKI-ESRD association in current nephrology literature is blamed on the so-called "residual confounding." We had previously described a relationship between AKI events and rapid onset yet irreversible ESRD happening in a continuum in a high-risk CKD cohort. However, the contribution of the syndrome of rapid onset-ESRD (SORO-ESRD to incident United States ESRD population remained conjectural. In this retrospective analysis, we analyzed serum creatinine trajectories of the last 100 consecutive ESRD patients in 4 Mayo Clinic chronic hemodialysis units to determine the incidence of SORO-ESRD. Excluding 9 patients, 31 (34% patients, including two renal transplant recipients, had SORO-ESRD: 18 males and 13 females age 72 (range 50-92 years. Precipitating AKI followed pneumonia (8, acutely decompensated heart failure (7, pyelonephritis (4, post-operative (5, sepsis (3, contrast-induced nephropathy (2, and others (2. Time to dialysis was shortest following surgical procedures. Concurrent renin angiotensin aldosterone system blockade was higher with SORO-ESRD - 23% versus 5%, P = 0.0113. In conclusion, SORO-ESRD is not uncommon among the incident general US ESRD population. The implications for ESRD care planning, AV-fistula-first programs, general CKD care and any associations with renal ageing/senescence warrant further study.

  4. End-stage renal disease from hemolytic uremic syndrome in the United States, 1995-2010.

    Science.gov (United States)

    Sexton, Donal J; Reule, Scott; Solid, Craig A; Chen, Shu-Cheng; Collins, Allan J; Foley, Robert N

    2015-10-01

    Management of hemolytic uremic syndrome (HUS) has evolved rapidly, and optimal treatment strategies are controversial. However, it is unknown whether the burden of end-stage renal disease (ESRD) from HUS has changed, and outcomes on dialysis in the United States are not well described. We retrospectively examined data for patients initiating maintenance renal replacement therapy (RRT) (n = 1,557,117), 1995-2010, to define standardized incidence ratios (SIRs) and outcomes of ESRD from HUS) (n = 2241). Overall ESRD rates from HUS in 2001-2002 were 0.5 cases/million per year and were higher for patients characterized by age 40-64 years (0.6), ≥65 years (0.7), female sex (0.6), and non-Hispanic African American race (0.7). Standardized incidence ratios remained unchanged (P ≥ 0.05) between 2001-2002 and 2009-2010 in the overall population. Compared with patients with ESRD from other causes, patients with HUS were more likely to be younger, female, white, and non-Hispanic. Over 5.4 years of follow-up, HUS patients differed from matched controls with ESRD from other causes by lower rates of death (8.3 per 100 person-years in cases vs. 10.4 in controls, P < 0.001), listing for renal transplant (7.6 vs. 8.6 per 100 person-years, P = 0.04), and undergoing transplant (6.9 vs. 9 per 100 person-years, P < 0.001). The incidence of ESRD from HUS appears not to have risen substantially in the last decade. However, given that HUS subtypes could not be determined in this study, these findings should be interpreted with caution. © 2015 International Society for Hemodialysis.

  5. Reversal of end-stage renal disease after aortic dissection using renal artery stent: a case report

    Directory of Open Access Journals (Sweden)

    Parikh Chirag R

    2004-05-01

    Full Text Available Abstract Background Medical management is the conventional treatment for Stanford Type B aortic dissections as surgery is associated with significant morbidity and mortality. The advent of endovascular interventional techniques has revived interest in treating end-organ complications of Type B aortic dissection. We describe a patient who benefited from endovascular repair of renal artery stenosis caused by a dissection flap, which resulted in reversal of his end-stage renal disease (ESRD. Case presentation A 69 y/o male with a Type B aortic dissection diagnosed two months earlier was found to have a serum creatinine of 15.2 mg/dL (1343.7 μmol/L on routine visit to his primary care physician. An MRA demonstrated a rightward spiraling aortic dissection flap involving the origins of the celiac artery, superior mesenteric artery, and both renal arteries. The right renal artery arose from the false lumen with lack of blood flow to the right kidney. The left renal artery arose from the true lumen, but an intimal dissection flap appeared to be causing an intermittent stenosis of the left renal artery with compromised blood flow to the left kidney. Endovascular reconstruction with of the left renal artery with stent placement was performed. Hemodialysis was successfully discontinued six weeks after stent placement. Conclusion Percutaneous intervention provides a promising alternative for patients with Type B aortic dissections when medical treatment will not improve the likelihood of meaningful recovery and surgery entails too great a risk. Nephrologists should therefore be aggressive in the workup of ischemic renal failure associated with aortic dissection as percutaneous intervention may reverse the effects of renal failure in this population.

  6. Optimal management of bone mineral disorders in chronic kidney disease and end stage renal disease.

    Science.gov (United States)

    Lundquist, Andrew L; Nigwekar, Sagar U

    2016-03-01

    The review summarizes recent studies on chronic kidney disease-mineral bone disorders, with a focus on new developments in disease management. The term chronic kidney disease-mineral bone disorder has come to describe an increasingly complex network of alterations in minerals and skeletal disorders that contribute to the significant cardiovascular morbidity and mortality seen in patients with chronic kidney disease and end stage renal disease. Clinical studies continue to suggest associations with clinical outcomes, yet current clinical trials have failed to support causality. Variability in practice exists as current guidelines for management of mineral bone disorders are often based on weak evidence. Recent studies implicate novel pathways for therapeutic intervention in clinical trials. Mineral bone disorders in chronic kidney disease arise from alterations in a number of molecules in an increasingly complex physiological network interconnecting bone and the cardiovascular system. Despite extensive associations with improved outcomes in a number of molecules, clinical trials have yet to prove causality and there is an absence of new therapies available to improve patient outcomes. Additional clinical trials that can incorporate the complexity of mineral bone disorders, and with the ability to intervene on more than one pathway, are needed to advance patient care.

  7. Prevalence of and factors associated with sarcopenia in elderly patients with end-stage renal disease.

    Science.gov (United States)

    Kim, Jwa-Kyung; Choi, Sun Ryoung; Choi, Myung Jin; Kim, Sung Gyun; Lee, Young Ki; Noh, Jung Woo; Kim, Hyung Jik; Song, Young Rim

    2014-02-01

    We investigated the prevalence of sarcopenia in elderly patients with end-stage renal disease (ESRD) and its relationship with various markers of nutrition, cognitive function, depressive symptoms, inflammation and β2-microglobulin. A cross-sectional study was conducted with 95 patients having ESRD aged over 50 years. Sarcopenia was defined as a decline in both muscle mass and strength. The mean age was 63.9 ± 10.0 years; 56.8% were men and 52.6% had diabetes. Sarcopenia was highly prevalent in elderly patients with ESRD (37.0% in men and 29.3% in women). Subjective Global Assessment (SGA), inflammatory markers and β2-microglobulin levels were significantly associated with sarcopenia, even after adjustment for age, gender, diabetes, and body mass index. Additionally, patients with depressive symptoms showed a higher risk of sarcopenia relative to those without depressive symptoms (odds ratio, OR = 6.87, 95% confidence interval, CI = 2.06-22.96) and sarcopenia was more likely to be present in patients with mild cognitive dysfunction (OR = 6.35, 95% CI = 1.62-34.96). Sarcopenia is highly prevalent in elderly patients with ESRD and is closely associated with SGA, inflammatory markers, β2-microglobulin, depression and cognitive dysfunction. Copyright © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  8. Outcome of Early Initiation of Peritoneal Dialysis in Patients with End-Stage Renal Failure

    Science.gov (United States)

    Oh, Kook-Hwan; Hwang, Young-Hwan; Cho, Jung-Hwa; Kim, Mira; Ju, Kyung Don; Joo, Kwon Wook; Kim, Dong Ki; Kim, Yon Su; Ahn, Curie

    2012-01-01

    Recent studies reported that early initiation of hemodialysis may increase mortality. However, studies that assessed the influence of early initiation of peritoneal dialysis (PD) yielded controversial results. In the present study, we evaluated the prognosis of early initiation of PD on the various outcomes of end stage renal failure patients by using propensity-score matching methods. Incident PD patients (n = 491) who started PD at SNU Hospital were enrolled. The patients were divided into 'early starters (n = 244)' and 'late starters (n = 247)' on the basis of the estimated glomerular filtration rate (eGFR) at the start of dialysis. The calculated propensity-score was used for one-to-one matching. After propensity-score-based matching (n = 136, for each group), no significant differences were observed in terms of all-cause mortality (P = 0.17), technique failure (P = 0.62), cardiovascular event (P = 0.96) and composite event (P = 0.86) between the early and late starters. Stratification analysis in the propensity-score quartiles (n = 491) exhibited no trend toward better or poorer survival in terms of all-cause mortality. In conclusion, early commencement of PD does not reduce the mortality risk and other outcomes. Although the recent guidelines suggest that initiation of dialysis at higher eGFR, physicians should not determine the time to initiate PD therapy simply rely on the eGFR alone. PMID:22323864

  9. Prophylactic antibiotic therapy prior to dental treatment for patients with end-stage renal disease.

    Science.gov (United States)

    Werner, C W; Saad, T F

    1999-01-01

    In the United States, there is a large and growing population of patients undergoing dialysis because of end-stage renal disease (ESRD). These patients present special management considerations for dentists, including antibiotic prophylaxis for the prevention of bacterial endocarditis (BE). ESRD patients, particularly those with an arteriovenous shunt for hemodialysis access, are predisposed to valvular endocarditis. Thus, BE prevention is the primary goal of antibiotic prophylaxis prior to dental or other invasive procedures in these patients. Bacteremia may predispose to infection of synthetic vascular access grafts, although this form of endovascular infection in ESRD patients has not been as well-characterized as BE. Antibiotic prophylaxis may be of some benefit for prevention of synthetic graft infections as well as BE. Poor dentist and physician compliance with BE prophylaxis regimens, as well as errors in dosing, timing, or duration of prophylaxis, have been reported. These problems are of particular concern in the treatment of chronically ill patients. In this article, we review the rationale for prophylactic antibiotic therapy prior to dental procedures in ESRD patients with vascular access. We also elaborate on the current American Heart Association guidelines for BE prophylaxis, and address special considerations for ESRD patients.

  10. Factors Associated with the Choice of Peritoneal Dialysis in Patients with End-Stage Renal Disease

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    Pei-Chun Chiang

    2016-01-01

    Full Text Available Background. The purpose of this study was to analyze the factors associated with receiving peritoneal dialysis (PD in patients with incident end-stage renal disease (ESRD in a hospital in Southern Taiwan. Methods. The study included all consecutive patients with incident ESRD who participated in a multidisciplinary predialysis education (MPE program and started their first dialysis therapy between January 1, 2008, and June 30, 2013, in the study hospital. We provided small group teaching sessions to advanced CKD patients and their family to enhance understanding of various dialysis modalities. Multivariate logistic regression models were used to analyze the association of patient characteristics with the chosen dialysis modality. Results. Of the 656 patients, 524 (80% chose hemodialysis and 132 chose PD. Our data showed that young age, high education level, and high scores of activities of daily living (ADLs were positively associated with PD treatment. Patients who received small group teaching sessions had higher percentages of PD treatment (30.5% versus 19.5%; P=0.108 and preparedness for dialysis (61.1% versus 46.6%; P=0.090. Conclusion. Young age, high education level, and high ADL score were positively associated with choosing PD. Early creation of vascular access may be a barrier for PD.

  11. Cardiovascular disease in patients with end-stage renal disease on hemodialysis in a developing country

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    Leila S. V. Silva

    2012-01-01

    Full Text Available Cardiovascular disease is the main cause of death among patients with end-stage renal disease (ESRD. The present study was undertaken to identify the main cardiovascular diseases and their risk factors in 160 patients with ESRD on hemodialysis (HD in Brazil. Their mean age was 47 ± 39 years. The main risk factors for cardiovascular diseases were arterial hypertension (89.4%, dyslipidemia (78.3%, low high-density lipoprotein levels (84.2% and low physical activity (64.1%. Family history of coronary insufficiency and high low-density lipoprotein levels were significantly associated with coronary artery disease (P = 0.005 and P = 0.029, respectively. Sedentary life style, diabetes mellitus, secondary hyperparathyroidism and hyperglycemia also showed a significant association with the underlying vascular disease (P = 0.017, P = 0.039, P = 0.037 and P = 0.030, respectively. Hypercalcemia, hypertension and black race were factors significantly associated with left ventricular systolic dysfunction (P = 0.01, P = 0.0013 and P = 0.024, respectively. Our study shows that the most prevalent cardiovascular diseases in patients with ESRD were left ventricular hypertrophy, atherosclerotic disease, valvular disease and coronary artery disease. Hypertension and dyslipidemia were the common risk factors associated with cardiovascular diseases. The present study was undertaken to identify the main cardiovascular diseases and their risk factors in 160 patients with ESRD on HD in a single center in Brazil.

  12. Arterial Stiffness and Walk Time in Patients with End-Stage Renal Disease

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    Abbi D. Lane

    2013-04-01

    Full Text Available Background: End-stage renal disease patients experience increased prevalence of cardiovascular disease. Heart-artery interaction may be shifted, impacting blood pressure lability, and exercise tolerance. The coupling ratio consists of the ratio of indexed arterial elastance (EaI, arterial load to ElvI, a measure of cardiac contractility or stiffness. Our purpose was to explore the relationship between elastances and functional capacity. We hypothesized that arterial stiffness (central pulse wave velocity, PWV and elastances would be correlated to shuttle walk time. Methods: We used applanation tonometry, ultrasonography, and a shuttle walk test to evaluate our hypothesis. Spearman's correlations were used to assess relationships between variables. Block regression was also performed. Results: Forty-two subjects on maintenance hemodialysis participated. Average age=44±5 years, body surface area=2.01 kg/m2. Mean EaI=4.45 and mean ElvI=6.89; the coupling ratio=0.82. Mean aortic pulse pressure=51 mmHg and PWV=9.6 m/s. PWV(r=-0.385 and EaI (r=-0.424 were significantly and inversely related to walking time while stroke volume index (SVI was positively correlated to shuttle walk time (r=0.337, pConclusions: We conclude that, like other clinical populations, both arterial and heart function predict walking ability and represent potential targets for intervention; arterial stiffness and SVI are strongly related to shuttle walk time in patients with ESRD.

  13. Association between circulating fibroblast growth factor 21 and mortality in end-stage renal disease.

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    Marina Kohara

    Full Text Available Fibroblast growth factor 21 (FGF21 is an endocrine factor that regulates glucose and lipid metabolism. Circulating FGF21 predicts cardiovascular events and mortality in type 2 diabetes mellitus, including early-stage chronic kidney disease, but its impact on clinical outcomes in end-stage renal disease (ESRD patients remains unclear. This study enrolled 90 ESRD patients receiving chronic hemodialysis who were categorized into low- and high-FGF21 groups by the median value. We investigated the association between circulating FGF21 levels and the cardiovascular event and mortality during a median follow-up period of 64 months. A Kaplan-Meier analysis showed that the mortality rate was significantly higher in the high-FGF21 group than in the low-FGF21 group (28.3% vs. 9.1%, log-rank, P = 0.034, while the rate of cardiovascular events did not significantly differ between the two groups (30.4% vs. 22.7%, log-rank, P = 0.312. In multivariable Cox models adjusted a high FGF21 level was an independent predictor of all-cause mortality (hazard ratio: 3.98; 95% confidence interval: 1.39-14.27, P = 0.009. Higher circulating FGF21 levels were associated with a high mortality rate, but not cardiovascular events in patient with ESRD, suggesting that circulating FGF21 levels serve as a predictive marker for mortality in these subjects.

  14. Association between circulating fibroblast growth factor 21 and mortality in end-stage renal disease.

    Science.gov (United States)

    Kohara, Marina; Masuda, Takahiro; Shiizaki, Kazuhiro; Akimoto, Tetsu; Watanabe, Yuko; Honma, Sumiko; Sekiguchi, Chuji; Miyazawa, Yasuharu; Kusano, Eiji; Kanda, Yoshinobu; Asano, Yasushi; Kuro-O, Makoto; Nagata, Daisuke

    2017-01-01

    Fibroblast growth factor 21 (FGF21) is an endocrine factor that regulates glucose and lipid metabolism. Circulating FGF21 predicts cardiovascular events and mortality in type 2 diabetes mellitus, including early-stage chronic kidney disease, but its impact on clinical outcomes in end-stage renal disease (ESRD) patients remains unclear. This study enrolled 90 ESRD patients receiving chronic hemodialysis who were categorized into low- and high-FGF21 groups by the median value. We investigated the association between circulating FGF21 levels and the cardiovascular event and mortality during a median follow-up period of 64 months. A Kaplan-Meier analysis showed that the mortality rate was significantly higher in the high-FGF21 group than in the low-FGF21 group (28.3% vs. 9.1%, log-rank, P = 0.034), while the rate of cardiovascular events did not significantly differ between the two groups (30.4% vs. 22.7%, log-rank, P = 0.312). In multivariable Cox models adjusted a high FGF21 level was an independent predictor of all-cause mortality (hazard ratio: 3.98; 95% confidence interval: 1.39-14.27, P = 0.009). Higher circulating FGF21 levels were associated with a high mortality rate, but not cardiovascular events in patient with ESRD, suggesting that circulating FGF21 levels serve as a predictive marker for mortality in these subjects.

  15. Behavioural research in patients with end-stage renal disease: a review and research agenda.

    Science.gov (United States)

    Kaptein, Ad A; van Dijk, Sandra; Broadbent, Elizabeth; Falzon, Louise; Thong, Melissa; Dekker, Friedo W

    2010-10-01

    To suggest a behavioural research agenda for patients with end-stage renal disease (ESRD) based on a concise review of seven stages of psychosocial research, a literature review, and current behavioural research in other chronic somatic diseases. Historical behavioural ESRD research was classified. The specialized register of the Cochrane Behavioral Medicine Field was also checked, and additional papers were selected by screening reference lists and related behavioural science journals, to identify promising areas for future research. The top-five topics identified via the literature search pertain to (1) psychological aspects and interventions, (2) adaptation, coping, and depression, (3) exercise, (4) counseling and education, and (5) compliance. 'Illness and treatment beliefs', 'sexuality', 'suicide', 'family support', and 'self-management interventions', were identified on the basis of research in other chronic illnesses as topics for future research. Regarding theory, the Common-Sense Model (CSM) was judged to offer useful theoretical perspectives; regarding methods, qualitative methods can be a valuable addition to quantitative research methods. Illness beliefs, treatment beliefs, and self-management behaviours are promising concepts in the assessment and clinical care of ESRD-patients. Cognitive-behavioural treatments appear to have potential and should be specified and elaborated for specific categories and problems of ESRD-patients. This research agenda is in line with moves towards patient-centred disease-management to improve the quality of medical care for ESRD-patients. (c) 2009 Elsevier Ireland Ltd. All rights reserved.

  16. Anti-citrullinated protein antibody and rheumatoid factor in patients with end-stage renal disease.

    Science.gov (United States)

    Romic, Zeljko; Unic, Adriana; Derek, Lovorka; Zivkovic, Marcela; Marijancevic, Domagoj; Kes, Petar; Pehar, Mario

    2009-01-01

    Patients with end-stage renal disease (ESRD) and on hemodialysis (HD) are at increased risk for developing rheumatoid arthritis (RA), as a result of defective immunity. Our aim was to examine if ESRD and the length of HD treatment impact the clinical utility of antibodies to cyclic citrullinated peptides (anti-CCP) and rheumatoid factor (RF) as diagnostic tools for RA. We included 94 subjects in our study: 37 healthy volunteers and 57 patients with ESRD who had been undergoing HD for 1-12 years, and without confirmed RA. In order to test our hypothesis, we measured and correlated anti-CCP and RF as laboratory markers of RA. Our study showed that there is no significant difference between values for anti-CCP (p=0.11) and RF (p=0.98) in control subjects as well as in patients undergoing HD, regardless of the length of time that patients had been undergoing HD treatment. Our study indicates that HD does not impair the specificity of anti-CCP and RF for RA in patients where the disease has not yet developed. Future prospective studies may show whether there is any use in determinating RF, and especially anti-CCP, as early predictors of RA in patients with ESRD who are at greater risk of developing this condition.

  17. Cytokine Signature in End-Stage Renal Disease Patients on Hemodialysis

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    Danyelle Romana Alves Rios

    2017-01-01

    Full Text Available Hemodialysis is a modality of blood filtration in which accumulated toxins and water are removed from the body. This treatment is indicated for patients at the end stage of renal disease. Vascular access complications are responsible for 20–25% of all hospitalizations in dialyzed patients. The occurrence of thrombosis in the vascular access is a serious problem that may severely compromise or even make the hemodialysis impossible, which is vital for the patient. The aim of this study was to investigate inflammatory profile in patients undergoing hemodialysis as well as the association between these alterations and vascular access thrombosis. A total of 195 patients undergoing hemodialysis have been evaluated; of which, 149 patients had not experienced vascular access thrombosis (group I and 46 patients had previously presented this complication (group II. Plasma levels of cytokines including interleukin (IL- 2, IL-4, IL-5, IL-10, TNF-α, and IFN-γ were measured by cytometric bead array. Our results showed that patients with previous thrombotic events (group II had higher levels of the IL-2, IL-4, IL-5, and IFN-γ when compared to those in group I. Furthermore, a different cytokine signature was detected in dialyzed patients according to previous occurrences or not of thrombotic events, suggesting that elevated levels of T-helper 1 and T-helper 2 cytokines might, at least in part, contribute to this complication.

  18. Aberrant functional connectome in neurologically asymptomatic patients with end-stage renal disease.

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    Xiaofen Ma

    Full Text Available This study aimed to investigate the topological organization of intrinsic functional brain networks in patients with end-stage renal disease (ESRD.Resting-state functional MRI data were collected from 22 patients with ESRD (16 men, 18-61 years and 29 age- and gender-matched healthy controls (HCs, 19 men, 32-61 years. Whole-brain functional networks were obtained by calculating the interregional correlation of low-frequency fluctuations in spontaneous brain activity among 1,024 parcels that cover the entire cerebrum. Weighted graph-based models were then employed to topologically characterize these networks at different global, modular and nodal levels.Compared to HCs, the patients exhibited significant disruption in parallel information processing over the whole networks (P < 0.05. The disruption was present in all the functional modules (default mode, executive control, sensorimotor and visual networks although decreased functional connectivity was observed only within the default mode network. Regional analysis showed that the disease disproportionately weakened nodal efficiency of the default mode components and tended to preferentially affect central or hub-like regions. Intriguingly, the network abnormalities correlated with biochemical hemoglobin and serum calcium levels in the patients. Finally, the functional changes were substantively unchanged after correcting for gray matter atrophy in the patients.Our findings provide evidence for the disconnection nature of ESRD's brain and therefore have important implications for understanding the neuropathologic substrate of the disease from disrupted network organization perspective.

  19. Risk of serous retinal detachment in patients with end-stage renal disease on dialysis.

    Directory of Open Access Journals (Sweden)

    Yuh-Shin Chang

    Full Text Available The aim of this retrospective, nationwide, matched cohort study was to investigate the association of serous retinal detachment with having end-stage renal disease (ESRD while on dialysis. The cohort study included 94,024 patients with ESRD on dialysis registered between January 2000 to December 2009 in the Taiwan National Health Insurance Research Database. An age- and sex-matched control group comprised 94,024 patients selected from the Taiwan Longitudinal Health Insurance Database 2000. Information for each patient was collected from the index date until December 2011. Twenty-seven ESRD patients and 11 controls developed serous retinal detachment (P < 0.001 during follow-up, demonstrating a significantly increased risk of serous retinal detachment in patients with ESRD on dialysis compared with controls (incidence rate ratio = 3.39, 95% confidence interval [CI] = 1.68-6.83. After adjustment for potential confounders, patients were 3.86 times more likely to develop serous retinal detachment than the full cohort (adjusted HR = 3.86, 95% CI = 1.15-12.96. In conclusion, patients with ESRD on dialysis demonstrate an increased risk of serous retinal detachment. Interdisciplinary collaboration between nephrologists and ophthalmologists is important to deal with serous retinal detachment in patients with ESRD on dialysis and prevent impairments of visual acuity.

  20. Use of Complementary and Alternative Medicine among Patients with End-Stage Renal Disease

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    Gurjeet S. Birdee

    2013-01-01

    Full Text Available Among patients with end-stage renal disease (ESRD, few studies have examined the use of complementary and alternative medicine (CAM and patients’ interest in learning mind-body interventions to address health issues. We surveyed 89 adult patients (response rate 84% at an outpatient hemodialysis center in Brookline, MA, USA regarding the utilization of CAM, including mind-body practices, and willingness to learn mind-body practices. Of respondents, 47% were female, 63% were black, and mean age was 62 years. 61% reported using CAM for health in their lifetime, and 36% reported using CAM within a month of the survey. The most frequent CAM modalities reported in ones’ lifetime and in the last month were mind-body practices (42% and 27%, resp.. Overall lifetime CAM use did not differ significantly by sex, race, dialysis vintage, diagnosis of ESRD, employment status, or education level. Subjects reported that mind-body interactions were very important to health with a median score of 9 on a 10-point Likert scale (ranging from 0 for not important to 10 for extremely important. Most patients (74% reported interest in learning mind-body practices during maintenance hemodialysis. In summary, CAM use, particularly mind-body practice, is frequent among patients with ESRD providing opportunities for future clinical research.

  1. Effectiveness of group cognitive behavioral therapy with mindfulness in end-stage renal disease hemodialysis patients.

    Science.gov (United States)

    Sohn, Bo Kyung; Oh, Yun Kyu; Choi, Jung-Seok; Song, Jiyoun; Lim, Ahyoung; Lee, Jung Pyo; An, Jung Nam; Choi, Hee-Jeong; Hwang, Jae Yeon; Jung, Hee-Yeon; Lee, Jun-Young; Lim, Chun Soo

    2018-03-01

    Many patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) experience depression. Depression influences patient quality of life (QOL), dialysis compliance, and medical comorbidity. We developed and applied a group cognitive behavioral therapy (CBT) program including mindfulness meditation for ESRD patients undergoing HD, and measured changes in QOL, mood, anxiety, perceived stress, and biochemical markers. We conducted group CBT over a 12-week period with seven ESRD patients undergoing HD and suffering from depression. QOL, mood, anxiety, and perceived stress were measured at baseline and at weeks 8 and 12 using the World Health Organization Quality of Life scale, abbreviated version (WHOQOL-BREF), the Beck Depression Inventory II (BDI-II), the Hamilton Rating Scale for Depression (HAM-D), the Beck Anxiety Inventory (BAI), and the Perceived Stress Scale (PSS). Biochemical markers were measured at baseline and after 12 weeks. The Temperament and Character Inventory was performed to assess patient characteristics before starting group CBT. The seven patients showed significant improvement in QOL, mood, anxiety, and perceived stress after 12 weeks of group CBT. WHOQOL-BREF and the self-rating scales, BDI-II and BAI, showed continuous improvement across the 12-week period. HAM-D scores showed significant improvement by week 8; PSS showed significant improvement after week 8. Serum creatinine levels also improved significantly following the 12 week period. In this pilot study, a CBT program which included mindfulness meditation enhanced overall mental health and biochemical marker levels in ESRD patients undergoing HD.

  2. Living well with end stage renal disease: patients' narratives interrupted from a virtue perspective.

    Science.gov (United States)

    Dekker, Wim; Uerz, Inez; Wils, Jean-Pierre

    2005-01-01

    Over the last few decades there has been a revival of interest in virtue ethics, with the emphasis on the virtuous caregiver. This paper deals with the 'virtuous patient', specifically the patient with End Stage Renal Disease (ESRD). We believe that a virtue approach provides insights not available to current methods of studying coping styles and coping strategies. Data are derived from seven semi-structured in-depth interviews. The transcripts of the interviews were subjected to an Interpretative Phenomenological Analysis (IPA). The focus of the analysis was on 'living well with chronic illness.' It appears that the moral challenges faced by patients with ESRD are manifold. When they are invited to tell the story of their illness, they do not explicitly speak of virtues, but they often refer to moral qualities, and to attitudes that can be regarded as virtuous. We identify several such concepts in the narratives of patients with ESRD. We conclude that the Aristotelian model of virtue ethics is particularly descriptively (and possibly also normatively) relevant to the explanation of the life narratives and the moral challenges of patients with an ESRD.

  3. Kidney transplantation restored uncoupled bone turnover in end-stage renal disease.

    Science.gov (United States)

    Kawarazaki, Hiroo; Shibagaki, Yugo; Kido, Ryo; Nakajima, Ichiro; Fuchinoue, Shohei; Ando, Katsuyuki; Fujita, Toshiro; Fukagawa, Masafumi; Teraoka, Satoshi; Fukumoto, Seiji

    2012-07-01

    While kidney transplantation (KTx) reverses many disorders associated with end-stage renal disease (ESRD), patients who have received KTx often have chronic kidney disease and bone and mineral disorder (CKD-MBD). However, it is unknown how bone metabolism changes by KTx. Living donor-KTx recipients (n = 34) at Tokyo Women's Medical University were prospectively recruited and the levels of bone-specific alkaline phosphatase (BAP) and serum cross-linked N-telopeptides of Type 1 collagen (NTX) were measured before, 6 and 12 months after transplantation. Before KTx, serum BAP was within the reference range in more than half of patients while NTX was high in most patients. Serum NTX was higher in patients with longer dialysis durations compared to that with shorter durations before KTx. However, there was no difference in serum BAP between these patients. After KTx, BAP increased while NTX decreased along with the decline of PTH. In addition, the numbers of patients who showed high BAP and NTX were comparable after KTx. These results suggest that bone formation is suppressed and uncoupled with bone resorption in patients with ESRD and this uncoupling is restored by KTx. Further studies are necessary to clarify the mechanism of bone uncoupling in patients with ESRD.

  4. Comparing VA and private sector healthcare costs for end-stage renal disease.

    Science.gov (United States)

    Hynes, Denise M; Stroupe, Kevin T; Fischer, Michael J; Reda, Domenic J; Manning, Willard; Browning, Margaret M; Huo, Zhiping; Saban, Karen; Kaufman, James S

    2012-02-01

    Healthcare for end-stage renal disease (ESRD) is intensive, expensive, and provided in both the public and private sector. Using a societal perspective, we examined healthcare costs and health outcomes for Department of Veterans Affairs (VA) ESRD patients comparing those who received hemodialysis care at VA versus private sector facilities. Dialysis patients were recruited from 8 VA medical centers from 2001 through 2003 and followed for 12 months in a prospective cohort study. Patient demographics, clinical characteristics, quality of life, healthcare use, and cost data were collected. Healthcare data included utilization (VA), claims (Medicare), and patient self-report. Costs included VA calculated costs, Medicare dialysis facility reports and reimbursement rates, and patient self-report. Multivariable regression was used to compare costs between patients receiving dialysis at VA versus private sector facilities. The cohort comprised 334 patients: 170 patients in the VA dialysis group and 164 patients in the private sector group. The VA dialysis group had more comorbidities at baseline, outpatient and emergency visits, prescriptions, and longer hospital stays; they also had more conservative anemia management and lower baseline urea reduction ratio (67% vs. 72%; Pprivate sector dialysis group (Pprivate sector settings is critical in informing health policy options for patients with complex chronic illnesses such as ESRD.

  5. Depression Is Associated With Muscle Mass And Strength In Patients With End Stage Renal Disease

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    Young Rim Song

    2012-06-01

    Full Text Available Depression is the most common psychiatric complication in patients with end-stage renal disease (ESRD. Sarcopenia, defined as loss of muscle mass and strength, is expected to be associated with depression, because both are closely linked to physical inactivity and functional impairment. We investigated the association of sarcopenia with depression in patients with ESRD. A total of 115 patients undergoing hemodialysis (HD were included in this study. Muscle mass was assessed by lean tissue index (LTI using portable whole body bioimpedance spectroscopy, and muscle strength was measured with handgrip strength (HGS. Depression was defined as Beck Depression Inventory-II (BDI-II score ≥16. About 60% of prevalent HD patients had depression. Compared to subjects without depression, depressed patients had a higher prevalence of sarcopenia (45.5 vs. 8.2%, p<0.001 and significantly increased serum IL-6 and hs-CRP level. However, (prealbumin and body mass index (BMI failed to correlate with BDI-II. HGS and LTI had a consistent negative effect on BDI-II even after adjusting other parameters including inflammation. In multivariate analysis, lower , increased IL-6 and β2-microglobulin,and sarcopenia were significant predictors for depression; sarcopenia was most powerful [odds ratio 9.01, 95% CI 3.60-12.22, p=0.001]. In conclusion, the prevalence of sarcopenia and depression was considerably high and and the presence of sarcopenia was an important predictor for depression.

  6. Exposure to radiologic contrast media and an increased risk of treated end-stage renal disease.

    Science.gov (United States)

    Muntner, Paul; Coresh, Josef; Klag, Michael J; Whelton, Paul K; Perneger, Thomas V

    2003-12-01

    Radiologic contrast media can cause acute renal failure, but whether their repeated use is associated with end-stage renal disease (ESRD) is unknown. We compared 716 incident case subjects of treated ESRD with 361 control subjects, frequency matched on age, drawn from the general population (age, 20-65 years). Participants were interviewed by telephone regarding their previous exposure (before initiation of dialysis for case subjects and the study interview for control subject) to various imaging procedures. As expected, the case subjects reported having more imaging procedures of the kidneys than did control subjects. Excluding persons who had been subjected to examinations of their kidney from the analysis and adjusting for ultrasound examinations and several possible confounders, persons who had a history of one [odds ratio (OR), 2.0; 95% confidence interval (CI), 1.0, 4.0], 2 or 3 (OR, 2.6; 95% CI, 1.2,5.9), or 4 or more (OR, 3.6; 95% CI, 1.0, 12.5) radiocontrast examinations were at higher risk of treated ESRD than persons who reported not having had such procedures. Ultrasound examinations and a history of barium enema were not associated with an increased risk of treated ESRD. In the current study, a graded association was present between increasing exposure to radiologic contrast media and higher risk of treated ESRD. Whether exposure to contrast media accelerates progression to ESRD or is merely a noncausal accompaniment to multiple disease processes occurring concurrently cannot be determined from our observational data. However, if these results are confirmed in future prospective studies, they will have important clinical implications.

  7. Safety and Efficacy of Liraglutide in Patients With Type 2 Diabetes and End-Stage Renal Disease

    DEFF Research Database (Denmark)

    Idorn, Thomas; Knop, Filip K; Jørgensen, Morten B

    2016-01-01

    OBJECTIVE: To evaluate parameters related to safety and efficacy of liraglutide in patients with type 2 diabetes and dialysis-dependent end-stage renal disease (ESRD). RESEARCH DESIGN AND METHODS: Twenty-four patients with type 2 diabetes and ESRD and 23 control subjects with type 2 diabetes...

  8. 76 FR 40497 - Medicare Program; Changes to the End-Stage Renal Disease Prospective Payment System for CY 2012...

    Science.gov (United States)

    2011-07-08

    ... problems accessing any of the Addenda to the proposed and final rules that are posted on the CMS Web site.... Statement of Need 3. Overall Impact B. Detailed Economic Analysis 1. CY 2012 End-Stage Renal Disease... transition) period during which ESRD facilities receive a blend of payments under the prior basic case-mix...

  9. 42 CFR 413.210 - Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.

    Science.gov (United States)

    2010-10-01

    ... disease (ESRD) prospective payment system. 413.210 Section 413.210 Public Health CENTERS FOR MEDICARE... § 413.210 Conditions for payment under the end-stage renal disease (ESRD) prospective payment system... prospective payment system described in § 413.215 through § 413.235 of this part. (a) Qualifications for...

  10. Fatal case of Herbaspirillum seropedicae bacteremia secondary to pneumonia in an end-stage renal disease patient with multiple myeloma.

    Science.gov (United States)

    Suwantarat, Nuntra; Adams, La'Tonzia L; Romagnoli, Mark; Carroll, Karen C

    2015-08-01

    Herbaspirillum spp. are rare causes of human infections associated primarily with bacteremia in cancer patients. We report the first fatal case of bacteremia secondary to pneumonia caused by Herbaspirillum seropedicae in a 65-year-old man with end-stage renal disease and multiple myeloma. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Causes and timing of end-stage renal disease after living kidney donation.

    Science.gov (United States)

    Matas, Arthur J; Berglund, Danielle M; Vock, David M; Ibrahim, Hassan N

    2018-05-01

    End-stage renal disease (ESRD) is a risk after kidney donation. We sought, in a large cohort of kidney donors, to determine the causes of donor ESRD, the interval from donation to ESRD, the role of the donor/recipient relationship, and the trajectory of the estimated GFR (eGFR) from donation to ESRD. From 1/1/1963 thru 12/31/2015, 4030 individuals underwent living donor nephrectomy at our center, as well as ascertainment of ESRD status. Of these, 39 developed ESRD (mean age ± standard deviation [SD] at ESRD, 62.4 ± 14.1 years; mean interval between donation and ESRD, 27.1 ± 9.8 years). Donors developing ESRD were more likely to be male, as well as smokers, and younger at donation, and to have donated to a first-degree relative. Of donors with a known cause of ESRD (n = 25), 48% was due to diabetes and/or hypertension; only 2 from a disease that would have affected 1 kidney (cancer). Of those 25 with an ascertainable ESRD cause, 4 shared a similar etiology of ESRD with their recipient. Almost universally, thechange of eGFR over time was stable, until new-onset disease (kidney or systemic). Knowledge of factors contributing to ESRD after living kidney donation can improve donor selection and counseling, as well as long-term postdonation care. © 2018 The American Society of Transplantation and the American Society of Transplant Surgeons.

  12. Carotid intima-media thickness in children with end-stage renal disease on dialysis.

    Science.gov (United States)

    Gheissari, A; Sirous, M; Hajzargarbashi, T; Kelishadi, R; Merrikhi, A; Azhir, A

    2010-01-01

    Cardiovascular morbidity and mortality are common in end stage renal disease (ESRD) patients. There is scarce data on carotid and bulb intima-media thickness (IMT-C and IMT-B) as an early marker of atherosclerosis and related factors in children on hemodialysis (HD) and peritoneal dialysis (PD). Since we did not have enough information about our patients, this study was carried on all ESRD children (hemodialysis and peritoneal dialysis) in a referral center. Data was collected from 16 ESRD children under 18 years with seven patients on PD and nine on HD. Lab tests and biochemical parameters including serum von Willebrand factor (vWF), homocystein, apo lipoprotein A, apo lipoprotein B and quantitative CRP were measured in fasting patients just before initiating dialysis. IMT-C and IMT-B were measured by gray scale ultrasound using 7.5 MHZ probe. The mean of age was 12.76+/-4.5 years. The mean duration of dialysis in HD and PD patients were not significantly different; 11.88+/-3.25 months and 10.14+/-2.4 months respectively. Mean of systolic blood pressure in HD group was significantly higher than PD group, 135.55+/-25.54 mmHg versus 121.42+/-12.14 mmHg, Phomocystein and IMT-C. However, we could not demonstrate any difference between IMT-B in case and control group. After adjusting for age, partial correlation showed significant correlation between IMT-C and following factors: N-PTH and serum alkaline phosphatase. Longitudinal studies with large size samples are needed to clarify the contributing factors with intima-media thickness in ESRD children.

  13. Self-motivation is associated with phosphorus control in End-Stage Renal Disease

    Science.gov (United States)

    Umeukeje, Ebele M; Merighi, Joseph R; Browne, Teri; Carlsson, Jacquelyn N; Umanath, Kausik; Lewis, Julia B; Ikizler, T. Alp; Wallston, Kenneth A.; Cavanaugh, Kerri

    2015-01-01

    Summary Objective Hyperphosphatemia is common in end-stage renal disease (ESRD), and associates with mortality. Phosphate binders reduce serum phosphorus; however, adherence is often poor. This pilot study aims to assess patients’ self-motivation to adhere to phosphate binders, its association with phosphorus control, and potential differences by race. Design Cross-sectional Participants and measurements Subjects were enrolled from one academic medical center dialysis practice from July–November 2012. Self-motivation to adhere to phosphate binders was assessed with the Autonomous Regulation (AR) scale (range: 1–7), and self-reported medication adherence with the Morisky Medication Adherence Scale (MMAS). Linear regression models adjusting for age, gender, health literacy and medication adherence were applied to determine associations with serum phosphorus level, including any evidence of interaction by race. Results Among 100 participants, mean age was 51 years (± 15), 53% were male, 72% were non-white, 89% received hemodialysis, and mean serum phosphorus level was 5.7 [±1.6] mg/dL. More than half (57%) reported the maximum AR score (7). Higher AR scores were noted in those reporting better health overall (p=0.001) and those with higher health literacy (p=0.01). AR score correlated with better medication adherence (r=0.22; p=0.02), and medication adherence was negatively associated with serum phosphorus (r= −0.40; pSelf-motivation was associated with phosphate binder adherence and phosphorus control, and this differed by race. Additional research is needed to determine if personalized, culturally sensitive strategies to understand and overcome motivational barriers may optimize mineral bone health in ESRD. PMID:25912398

  14. Mechanisms of endothelial dysfunction in resistance arteries from patients with end-stage renal disease.

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    Leanid Luksha

    Full Text Available The study focuses on the mechanisms of endothelial dysfunction in the uremic milieu. Subcutaneous resistance arteries from 35 end-stage renal disease (ESRD patients and 28 matched controls were studied ex-vivo. Basal and receptor-dependent effects of endothelium-derived factors, expression of endothelial NO synthase (eNOS, prerequisites for myoendothelial gap junctions (MEGJ, and associations between endothelium-dependent responses and plasma levels of endothelial dysfunction markers were assessed. The contribution of endothelium-derived hyperpolarizing factor (EDHF to endothelium-dependent relaxation was impaired in uremic arteries after stimulation with bradykinin, but not acetylcholine, reflecting the agonist-specific differences. Diminished vasodilator influences of the endothelium on basal tone and enhanced plasma levels of asymmetrical dimethyl L-arginine (ADMA suggest impairment in NO-mediated regulation of uremic arteries. eNOS expression and contribution of MEGJs to EDHF type responses were unaltered. Plasma levels of ADMA were negatively associated with endothelium-dependent responses in uremic arteries. Preserved responses of smooth muscle to pinacidil and NO-donor indicate alterations within the endothelium and tolerance of vasodilator mechanisms to the uremic retention products at the level of smooth muscle. We conclude that both EDHF and NO pathways that control resistance artery tone are impaired in the uremic milieu. For the first time, we validate the alterations in EDHF type responses linked to kinin receptors in ESRD patients. The association between plasma ADMA concentrations and endothelial function in uremic resistance vasculature may have diagnostic and future therapeutic implications.

  15. Alterations of bone microstructure and strength in end-stage renal failure.

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    Trombetti, A; Stoermann, C; Chevalley, T; Van Rietbergen, B; Herrmann, F R; Martin, P-Y; Rizzoli, R

    2013-05-01

    End-stage renal disease (ESRD) patients have a high risk of fractures. We evaluated bone microstructure and finite-element analysis-estimated strength and stiffness in patients with ESRD by high-resolution peripheral computed tomography. We observed an alteration of cortical and trabecular bone microstructure and of bone strength and stiffness in ESRD patients. Fragility fractures are common in ESRD patients on dialysis. Alterations of bone microstructure contribute to skeletal fragility, independently of areal bone mineral density. We compared microstructure and finite-element analysis estimates of strength and stiffness by high-resolution peripheral quantitative computed tomography (HR-pQCT) in 33 ESRD patients on dialysis (17 females and 16 males; mean age, 47.0 ± 12.6 years) and 33 age-matched healthy controls. Dialyzed women had lower radius and tibia cortical density with higher radius cortical porosity and lower tibia cortical thickness, compared to controls. Radius trabecular number was lower with higher heterogeneity of the trabecular network. Male patients displayed only a lower radius cortical density. Radius and tibia cortical thickness correlated negatively with bone-specific alkaline phosphatase (BALP). Microstructure did not correlate with parathyroid hormone (PTH) levels. Cortical porosity correlated positively with "Kidney Disease: Improving Global Outcomes" working group PTH level categories (r = 0.36, p microstructure and calculated bone strength are altered in ESRD patients, predominantly in women. Bone microstructure and biomechanical assessment by HR-pQCT may be of major clinical relevance in the evaluation of bone fragility in ESRD patients.

  16. Effectiveness of group cognitive behavioral therapy with mindfulness in end-stage renal disease hemodialysis patients

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    Bo Kyung Sohn

    2018-03-01

    Full Text Available Background : Many patients with end-stage renal disease (ESRD undergoing hemodialysis (HD experience depression. Depression influences patient quality of life (QOL, dialysis compliance, and medical comorbidity. We developed and applied a group cognitive behavioral therapy (CBT program including mindfulness meditation for ESRD patients undergoing HD, and measured changes in QOL, mood, anxiety, perceived stress, and biochemical markers. Methods : We conducted group CBT over a 12-week period with seven ESRD patients undergoing HD and suffering from depression. QOL, mood, anxiety, and perceived stress were measured at baseline and at weeks 8 and 12 using the World Health Organization Quality of Life scale, abbreviated version (WHOQOL-BREF, the Beck Depression Inventory II (BDI-II, the Hamilton Rating Scale for Depression (HAM-D, the Beck Anxiety Inventory (BAI, and the Perceived Stress Scale (PSS. Biochemical markers were measured at baseline and after 12 weeks. The Temperament and Character Inventory was performed to assess patient characteristics before starting group CBT. Results : The seven patients showed significant improvement in QOL, mood, anxiety, and perceived stress after 12 weeks of group CBT. WHOQOL-BREF and the self-rating scales, BDI-II and BAI, showed continuous improvement across the 12-week period. HAM-D scores showed significant improvement by week 8; PSS showed significant improvement after week 8. Serum creatinine levels also improved significantly following the 12 week period. Conclusion : In this pilot study, a CBT program which included mindfulness meditation enhanced overall mental health and biochemical marker levels in ESRD patients undergoing HD.

  17. Effects of hemodialysis therapy on sit-to-walk characteristics in end stage renal disease patients.

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    Soangra, Rahul; Lockhart, Thurmon E; Lach, John; Abdel-Rahman, Emaad M

    2013-04-01

    Patients with end stage renal diseases (ESRD) undergoing hemodialysis (HD) have high morbidity and mortality due to multiple causes; one of which is dramatically higher fall rates than the general population. In spite of the multiple efforts aiming to decrease the high mortality and improve quality of life in ESRD patients, limited success has been achieved. If adequate interventions for fall prevention are to be achieved, the functional and mobility mechanisms consistent with falls in this population must be understood. Human movements such as sit-to-walk (STW) tasks are clinically significant, and analysis of these movements provides a meaningful evaluation of postural and locomotor performance in elderly patients with functional limitations indicative of fall risks. In order to assess the effects of HD therapy on fall risks, 22 sessions of both pre- and post-HD measurements were obtained in six ESRD patients utilizing customized inertial measurement units (IMU). IMU signals were denoised using ensemble empirical mode decomposition and Savistky-Golay filtering methods to detect relevant events for identification of STW phases. The results indicated that patients were slower to get out of the chair (as measured by trunk flexion angular accelerations, time to peak trunk flexion, and overall STW completion time) following the dialysis therapy session. STW is a frequent movement in activities of daily living, and HD therapy may influence the postural and locomotor control of these movements. The analysis of STW movement may assist in not only assessing a patient's physical status, but in identifying HD-related fall risk as well. This preliminary study presents a non-invasive method of kinematic measurement for early detection of increased fall risk in ESRD patients using portable inertial sensors for out-patient monitoring. This can be helpful in understanding the pathogenesis better, and improve awareness in health care providers in targeting interventions to

  18. End-stage renal disease in Taiwan: a case-control study.

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    Tsai, Su-Ying; Tseng, Hung-Fu; Tan, Hsiu-Fen; Chien, Yu-Shu; Chang, Chia-Chu

    2009-01-01

    Taiwan has the highest incidence of end-stage renal disease (ESRD) in the world. The epidemiologic features of ESRD, however, have not been investigated. In this case-control study, we evaluated the risk of ESRD associated with a number of putative risk factors. We studied 200 patients among whom ESRD had been newly diagnosed between 1 January 2005 and 31 December 2005; 200 controls were selected from among relatives of patients treated in the general surgery unit. Using a structured questionnaire, we collected information related to socioeconomic factors, history of disease, regular blood or urine screening, lifestyle, environmental exposure, consumption of vitamin supplements, and regular drug use at 5 years before disease onset. Our primary multivariate risk models indicated that low socioeconomic status was a strong predictor of ESRD (education: odds ratio [OR], 2.78; 95% confidence interval [CI], 1.49-5.19; income: OR, 2.86, 95% CI, 1.48-5.52), even after adjusting for other risk factors. Other significant predictors for ESRD were a history of hypertension (OR, 3.63-3.90), history of diabetes (OR, 3.85-5.50), and regular intake of folk remedies or over-the-counter Chinese herbs (OR, 10.84-12.51). Regular intake of a multivitamin supplement 5 years before diagnosis was associated with a decreased risk of ESRD (OR, 0.12-0.14). Our findings indicate that low socioeconomic status, history of hypertension, diabetes, and regular use of folk remedies or over-the-counter Chinese herbs were significant risk factors for ESRD, while regular intake of a multivitamin supplement was associated with a decreased risk of ESRD.

  19. End-stage Renal Disease in Taiwan: A Case–Control Study

    Science.gov (United States)

    Tsai, Su-Ying; Tseng, Hung-Fu; Tan, Hsiu-Fen; Chien, Yu-Shu; Chang, Chia-Chu

    2009-01-01

    Background Taiwan has the highest incidence of end-stage renal disease (ESRD) in the world. The epidemiologic features of ESRD, however, have not been investigated. In this case–control study, we evaluated the risk of ESRD associated with a number of putative risk factors. Methods We studied 200 patients among whom ESRD had been newly diagnosed between 1 January 2005 and 31 December 2005; 200 controls were selected from among relatives of patients treated in the general surgery unit. Using a structured questionnaire, we collected information related to socioeconomic factors, history of disease, regular blood or urine screening, lifestyle, environmental exposure, consumption of vitamin supplements, and regular drug use at 5 years before disease onset. Results Our primary multivariate risk models indicated that low socioeconomic status was a strong predictor of ESRD (education: odds ratio [OR], 2.78; 95% confidence interval [CI], 1.49–5.19; income: OR, 2.86, 95% CI, 1.48–5.52), even after adjusting for other risk factors. Other significant predictors for ESRD were a history of hypertension (OR, 3.63–3.90), history of diabetes (OR, 3.85–5.50), and regular intake of folk remedies or over-the-counter Chinese herbs (OR, 10.84–12.51). Regular intake of a multivitamin supplement 5 years before diagnosis was associated with a decreased risk of ESRD (OR, 0.12–0.14). Conclusions Our findings indicate that low socioeconomic status, history of hypertension, diabetes, and regular use of folk remedies or over-the-counter Chinese herbs were significant risk factors for ESRD, while regular intake of a multivitamin supplement was associated with a decreased risk of ESRD. PMID:19542686

  20. Prognosis of bedridden patients with end-stage renal failure after starting hemodialysis.

    Science.gov (United States)

    Sugaya, Kimio; Hokama, Asanori; Hayashi, Eiri; Naka, Hidekatsu; Oda, Masami; Nishijima, Saori; Miyazato, Minoru; Hokama, Sanehiro; Ogawa, Yoshihide

    2007-06-01

    The mean age of starting hemodialysis (HD) in patients with end-stage renal failure is gradually increasing in Japan. It is not uncommon for HD to be commenced in bedridden elderly patients who cannot give informed consent, because of brain damage. However, we have not been able to provide useful advice to their families because there was no relevant information available about the prognosis of bedridden patients on HD. Therefore, we examined the prognosis of bedridden HD patients. Two hundred and nineteen patients who received HD were enrolled. These subjects were divided into five groups; (aged or=80 years at the commencement of HD), and we compared the overall prognosis between bedridden and nonbedridden patients, as well as that for each age group. There were 76 bedridden patients among the 219 HD patients, and the main cause of their bedridden state before starting HD was cerebrovascular disease. The 50% survival time after the start of HD was 120 months for the nonbedridden patients versus 56 months for bedridden patients. However, the mean (+/-SD) age of the bedridden patients was higher than that of nonbedridden patients (70 +/- 13 versus 64 +/- 14 years). In patients under age 50 years at the start of dialysis, the survival rate was lower in the bedridden than in the nonbedridden patients, but there were no differences between survival rates for bedridden and nonbedridden patients in the other four age groups. The prognosis of HD patients is poor compared with the general life expectancy of the Japanese population, but whether these patients are bedridden or not has little influence on their survival.

  1. Effect of dialysis on cerebral blood flow in depressive end-stage renal disease patients

    International Nuclear Information System (INIS)

    Nam, Hyun-Yeol; Kim, Seong-Jang; Song, Sang-Heon

    2011-01-01

    The aim of this study was to investigate regional cerebral blood flow (rCBF) changes of end-stage renal disease (ESRD) patients with depressive symptoms during dialysis. Fourteen patients with ESRD underwent Tc-99m ethylcysteinate dimer (Tc-99m ECD) brain single photon emission computed tomography (SPECT) and were evaluated the severity of depressive mood at pre-dialytic period and at least 6 months after dialysis initiation. rCBF was analyzed using statistical parametric mapping (SPM) in brain SPECT image. The responder was defined as a decrease of ≥25% in Hamilton Depression Rating Scale (HDRS) score from baseline HDRS score. Pre-dialysis brain SPECT did not show any rCBF differences between responders and non-responders. The follow-up brain SPECT revealed a significant higher perfusion in left middle temporal gyrus of responder group when compared with non-responder (hemisphere coordinate X, Y, Z; -58, -2, -16, peak Z=3.36, p=0.046). In responder, a significant increase in rCBF was found in right parahippocampal gyrus (hemisphere coordinate X, Y, Z; 30, -40, -14, peak Z=3.51, p=0.043). In non-responder, there were significant decreases in rCBF in left superior frontal gyrus (hemisphere coordinate X, Y, Z; -22, 30, 42, peak Z=3.86, p=0.032) and right orbitofrontal cortex (hemisphere coordinate X, Y, Z; 10, 58, -6, peak Z=3.81, p=0.046). The present findings showed the characteristic patterns of rCBF changes in depressive ESRD patients having maintenance dialysis. Further investigations in brain blood flow and glucose metabolism are needed to elucidate the effect of dialysis itself and the difference of according to dialysis modality in patients having depression and ESRD. (author)

  2. Burden of end-stage renal disease in sub-Saharan Africa.

    Science.gov (United States)

    Naicker, S

    2010-11-01

    To review prevalence, causes and management of end-stage renal disease (ESRD) in sub-Saharan Africa (SSA). Review of literature and data. Approximately 70% of the least developed countries of the world are in SSA. Rapid urbanization is occurring in many parts of the continent, contributing to overcrowding and poverty. While infections and parasitic diseases are still the leading cause of death in Africa, non-communicable diseases are coming to the forefront. There is a continuing "brain drain" of healthcare workers (physicians and nurses) from Africa to more affluent regions. There are large rural areas of Africa that have no health professionals to serve these populations. There are no nephrologists in many parts of SSA; the numbers vary from 0.5 per million population (pmp) in Kenya to 0.6 pmp in Nigeria, 0.7 pmp in Sudan and 1.1 pmp in South Africa. Chronic kidney disease affects mainly young adults aged 20 - 50 years in SSA and is primarily due to hypertension and glomerular diseases. HIV- related glomerular disease often presents late, with patients requiring dialysis. Diabetes mellitus affects 9.4 million people in Africa. The prevalence of diabetic nephropathy is estimated to be 6 - 16% in SSA. The current dialysis treatment rate is Africa, Nigeria, Mauritius and Ghana, with most of the transplants being living donor transplants, except in South Africa where the majority are from deceased donors. Chronic kidney disease care is especially challenging in SSA, with large numbers of ESRD patients, inadequate facilities, funding and support.

  3. Plasma ascorbic acid concentrations in prevalent patients with end-stage renal disease on hemodialysis.

    Science.gov (United States)

    Sirover, William D; Liu, Yuguan; Logan, Amanda; Hunter, Krystal; Benz, Robert L; Prasad, Deepali; Avila, Jose; Venkatchalam, Thaliga; Weisberg, Lawrence S; Handelman, Garry J

    2015-05-01

    To determine the prevalence of vitamin C (ascorbic acid [AA]) deficiency in patients with end-stage renal disease, the effect of supplemental AA on plasma AA concentrations, and the extrinsic and intrinsic factors that affect plasma AA concentrations in this patient population. In study 1, we compared the effect of hemodialysis (HD) on plasma AA concentrations between patients with low and high pre-HD AA concentrations. In study 2, we analyzed kinetic and nonkinetic factors for their association with increased plasma AA concentrations in patients on maintenance HD. Study 1 was performed in a single outpatient HD clinic in Cherry Hill, New Jersey. Study 2 was performed in 4 outpatient HD clinics in Southern New Jersey. In study 1, we collected plasma samples from 8 adult patients on maintenance HD at various time points around their HD treatment and assayed them for AA concentration. In study 2, we enrolled 203 adult patients and measured pre-HD plasma AA concentrations. We ascertained supplemental AA use and assessed dietary AA intake. In study 1, plasma AA concentrations were compared during the intradialytic and interdialytic period. In study 2, pre-HD plasma AA concentrations were correlated with supplement use and demographic factors. Study 1 showed that over the course of a single HD treatment, the plasma AA concentration decreased by a mean (±standard deviation) of 60% (±6.6). In study 2, the median pre-HD plasma AA concentration was 15.7 μM (interquartile range, 8.7-66.8) in patients who did not take a supplement and 50.6 μM (interquartile range, 25.1-88.8) in patients who did take a supplement (P HD plasma AA concentration ≥30 μM. HD depletes plasma AA concentrations, and AA supplementation allows patients to achieve higher plasma AA concentrations. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  4. Nutritional Status Predicts 10-Year Mortality in Patients with End-Stage Renal Disease on Hemodialysis

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    Shin Sook Kang

    2017-04-01

    Full Text Available Protein-energy wasting (PEW is associated with mortality in patients with end-stage renal disease (ESRD on maintenance hemodialysis. The correct diagnosis of PEW is extremely important in order to predict clinical outcomes. However, it is unclear which parameters should be used to diagnose PEW. Therefore, this retrospective observational study investigated the relationship between mortality and nutritional parameters in ESRD patients on maintenance hemodialysis. A total of 144 patients were enrolled. Nutritional parameters, including body mass index, serum albumin, dietary intake, normalized protein catabolic rate (nPCR, and malnutrition inflammation score (MIS, were measured at baseline. Fifty-three patients died during the study. Survivors had significantly higher nPCR (1.10 ± 0.24 g/kg/day vs. 1.01 ± 0.21 g/kg/day; p = 0.048, energy intake (26.7 ± 5.8 kcal/kg vs. 24.3 ± 4.2 kcal/kg; p = 0.009 and protein intake (0.91 ± 0.21 g/kg vs. 0.82 ± 0.24 g/kg; p = 0.020, and lower MIS (5.2 ± 2.3 vs. 6.1 ± 2.1, p = 0.039. In multivariable analysis, energy intake <25 kcal/kg (HR 1.860, 95% CI 1.018–3.399; p = 0.044 and MIS > 5 (HR 2.146, 95% CI 1.173–3.928; p = 0.013 were independent variables associated with all-cause mortality. These results suggest that higher MIS and lower energy intake are harmful to ESRD patients on maintenance hemodialysis. Optimal energy intake could reduce mortality in these patients.

  5. Clinical profile of haemodialysis patients with diabetic nephropathy leading to end stage renal disease

    International Nuclear Information System (INIS)

    Gazzaz, Z.J.; Dhafar, K.O.; Tashkandi, M.A.; Farooq, M.U.

    2010-01-01

    To know the characteristics of the diabetic patients on regular dialysis at Al-noor Specialist Hospital, Makkah, Saudi Arabia. The data had been collected retrospectively from 13-11-2005 to 12-12-2005 from the diabetic patients directly those were on dialysis due to end stage renal disease (ESRD) and from their files. The total study subjects were 51 with mean age of Diabetics was (55.2 years +-7.9) showing male predominance 31(60.8%). All were Saudies. The mean duration of Diabetes mellitus and dialysis were (16.8years) and (22 months), respectively. The mean age of start of Diabetes mellitus and dialysis was (37.4 years) and (53.5 years). The mean duration of onset of diabetes to dialysis was (16.1 years). Out of the total, 29(56.9%) were non-smoker. Patients with family history of diabetes with other associated illnesses were 23(45%) followed by 15(29.4%) had family history of only diabetes. Type II diabetics were 40(78.4%). Regarding metabolic profile, patients with high blood glucose level were 10(19.6%) while 3(5.9%), 50(98%) and 18(35.3%) patients had high cholesterol, low density lipoprotein and triglyceride levels, respectively. Maximum number of patients were in sixth decade of life. Up to three fourth patients had family history of diabetes. Most of the subjects had only diabetic nephropathy. Maximum patients had high low density lipoprotein level. (author)

  6. Echocardiographic strain and mortality in Black Americans with end-stage renal disease on hemodialysis.

    Science.gov (United States)

    Pressman, Gregg S; Seetha Rammohan, Harish Raj; Romero-Corral, Abel; Fumo, Peter; Figueredo, Vincent M; Gorcsan, John

    2015-11-15

    End-stage renal disease (ESRD) presents a significant health burden and is associated with high cardiovascular morbidity and mortality. This is particularly true in African Americans who generally have higher rates of cardiovascular mortality. Outcomes in ESRD are related to extent of cardiovascular disease, but markers for outcome are not clearly established. Global longitudinal strain (GLS) has emerged as an important measure of left ventricular systolic function that is additive to traditional ejection fraction (EF). It can be measured on routine digital echocardiography and is reproducible. This study tested the hypothesis that GLS is associated with mortality in black Americans with ESRD and preserved EF. Forty-eight outpatients undergoing hemodialysis, 59.4 ± 13.3 years, with EF ≥50% were prospectively enrolled. GLS, measured by an offline speckle tracking algorithm, ranged from -8.6% to -22.0% with a mean of -13.4%, substantially below normal (-16% or more negative). The prevalence of left ventricular systolic dysfunction, as determined by GLS, was 89%. Patients were followed for an average of 1.9 years; all-cause mortality was 19% (9 deaths). GLS was significantly associated with mortality (hazard ratio 1.15, 95% confidence interval 1.02 to 1.30, p = 0.02), whereas EF was not. After adjustment for multiple potential confounders (age, gender, race, smoking, hypertension, diabetes, hyperlipidemia, coronary disease, heart failure, and EF), GLS remained strongly associated with mortality (hazard ratio 1.30, 95% confidence interval 1.10 to 1.56, p = 0.002). In conclusion, GLS is an important index in patients with ESRD, which is additive to EF as a marker for mortality in this high-risk group. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Safety Outcomes of Apixaban Compared With Warfarin in Patients With End-Stage Renal Disease.

    Science.gov (United States)

    Sarratt, Stefanie C; Nesbit, Ross; Moye, Robert

    2017-06-01

    Current guidelines make no specific recommendations on the selection of direct oral anticoagulants for the prevention and treatment of venous thromboembolism in patients with end-stage renal disease (ESRD) receiving hemodialysis. Based on these guidelines, warfarin remains the anticoagulant of choice in these patients. To compare bleeding rates in patients receiving apixaban or warfarin with ESRD undergoing chronic hemodialysis. This was a single-center, retrospective, institutional review board-approved cohort analysis. Patients with ESRD undergoing chronic hemodialysis and receiving anticoagulation therapy with either apixaban or warfarin were included in this study. All data were collected from paper charts and electronic medical records and included documentation of bleeding events and related interventions. The primary outcome of this study was clinically relevant major bleeding events. Secondary outcomes included clinically relevant nonmajor bleeding events and minor bleeding events. A total of 160 patients were included in this study (warfarin group, n = 120; apixaban group, n = 40). There were 7 major bleeding events in the warfarin group compared with zero in the apixaban group ( P = 0.34). There were similar rates of clinically relevant nonmajor bleeding events (12.5% vs 5.8%, P = 0.17) and minor bleeding (2.5% vs 2.5%, P = 0.74) events in patients receiving apixaban and warfarin. There were no observed differences in bleeding rates in patients receiving apixaban compared with those receiving warfarin. Apixaban may be a cautious consideration in hemodialysis patients until there is further insight into the effect of subsequent, multiple doses on drug accumulation and clinical outcomes.

  8. Orofacial Disorders of Patients with End Stage Renal Disease Undergoing Haemodialysis

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    Yohana Gowara

    2015-05-01

    Full Text Available Several orofacial disorders in patients with end stage renal disease (ESRD undergoing hemodialysis have been reported. However, up to the present, particularly in Indonesia, such data still limited. Objective: the purpose of this study was to assess the orofacial disorders in patients with ESDR undergoing hemodialysis at Cipto Mangunkusumo Hospital, Indonesia. Methods: The study was conducted through observation using a cross-sectional design. The subjects were selected by consecutive sampling. Ninety-three patients fulfilled the inclusion criteria and enrolled in this study. They participated in the structural interview-using questionnaire assessing subjective complaints; clinical examinations; and salivary measurements. Results: Xerostomia (82.8% dysgeusia (66.7%, metal taste (57%, perioral anesthesia (24.7% were the common symptoms. Clinical findings consisted of tongue coating (100%, calculus deposits (97.8%, pallor of oral mucous (94.6%, sialosis (75.3%, uremic odor (40,9%, haemorrhagic spot (39.8%, angular cheilitis (37.7%, gingival bleeding (15.1%, and oral candidiasis (3.2% were also found. Salivary changes showed the increase of salivary viscosity (86%, pH (80.6%, buffer capacity (76.3% whereas decrease of mucous hydration level (79.6% and the flow rates of unstimulated (22.6% and stimulated (31.2% whole saliva were observed. Conclusion: The findings of orofacial disorders required attention and further comprehensive management to enhance the quality of life of patients with ESDR.DOI: 10.14693/jdi.v21i3.262

  9. Healthcare decision-making in end stage renal disease-patient preferences and clinical correlates.

    Science.gov (United States)

    Jayanti, Anuradha; Neuvonen, Markus; Wearden, Alison; Morris, Julie; Foden, Philip; Brenchley, Paul; Mitra, Sandip

    2015-11-14

    Medical decision-making is critical to patient survival and well-being. Patients with end stage renal disease (ESRD) are faced with incrementally complex decision-making throughout their treatment journey. The extent to which patients seek involvement in the decision-making process and factors which influence these in ESRD need to be understood. 535 ESRD patients were enrolled into the cross-sectional study arm and 30 patients who started dialysis were prospectively evaluated. Patients were enrolled into 3 groups- 'predialysis' (group A), 'in-centre' haemodialysis (HD) (group B) and self-care HD (93 % at home-group C) from across five tertiary UK renal centres. The Autonomy Preference Index (API) has been employed to study patient preferences for information-seeking (IS) and decision-making (DM). Demographic, psychosocial and neuropsychometric assessments are considered for analyses. 458 complete responses were available. API items have high internal consistency in the study population (Cronbach's alpha > 0.70). Overall and across individual study groups, the scores for information-seeking and decision-making are significantly different indicating that although patients had a strong preference to be well informed, they were more neutral in their preference to participate in DM (p gender, marital status; higher API IS scores and white ethnicity background were significant predictors of preference for decision-making. DM scores were subdivided into tertiles to identify variables associated with high (DM > 70: and low DM (≤30) scores. This shows association of higher DM scores with lower age, lower comorbidity index score, higher executive brain function, belonging in the self-caring cohort and being unemployed. In the prospectively studied cohort of predialysis patients, there was no change in decision-making preference scores after commencement of dialysis. ESRD patients prefer to receive information, but this does not always imply active involvement in

  10. [Long-term outcome with end-stage renal disease - survival is not enough: does dialysis or kidney transplantation matter?].

    Science.gov (United States)

    Schulz, K-H; Thaiss, F

    2012-04-01

    Patients with end-stage renal disease require renal replacement therapy with either dialysis or kidney transplantation. Survival and quality of life (QoL) after transplantation are superior to chronic dialysis. Early living donor kidney transplantation is best for patient and graft survival. Preemptive living-related kidney transplantation therefore is the best medical treatment option for these patients. Patients with end-stage renal disease suffer from multiple physical and psychological complaints. The prevalence of depressive disorders is 20-25% in this population. Studies on QoL in children after kidney transplantation show a reduced physical QoL, but an overall good psychological QoL. Alarming results of numerous studies are the high non-adherence rates in adolescents. Especially exercise interventions during dialysis and after kidney transplantation show promising results. Whether QoL of patients will improve with new approaches to immunosuppressive therapy remains to be evaluated in future studies.

  11. End stage renal disease in French Guiana (data from R.E.I.N registry): South American or French?

    Science.gov (United States)

    Rochemont, Dévi Rita; Meddeb, Mohamed; Roura, Raoul; Couchoud, Cécile; Nacher, Mathieu; Basurko, Célia

    2017-06-30

    End-Stage renal disease (ESRD) causes considerable morbidity and mortality, and significantly alters patients' quality of life. There are very few published data on this problem in the French Overseas territories. The development of a registry on end stage renal disease in French Guiana in 2011 allowed to describe the magnitude of this problem in the region for the first time. Using data from the French Renal Epidemiology and Information Network registry (R.E.I.N). Descriptive statistics on quantitative and qualitative variables in the registry were performed on prevalent cases and incident cases in 2011, 2012 and 2013. French Guiana has one of the highest ESRD prevalence and incidence in France. The two main causes of ESRD were hypertensive and diabetic nephropathies. The French Guianese population had a different demographic profile (younger, more women, more migrants) than in mainland France. Most patients had at least one comorbidity, predominantly (95.3%) hypertension. In French Guiana dialysis was initiated in emergency for 71.3% of patients versus 33% in France (p < 0.001). These first results give important public health information: i) End stage renal disease has a very high prevalence relative to mainland France ii) Patients have a different demographic profile and enter care late in the course of their renal disease. These data are closer to what is observed in the Caribbean or in Latin America than in Mainland France.

  12. Epidemiologic study of end stage renal disease and related risk factors in patients under hemodialysis in Lorestan province

    Directory of Open Access Journals (Sweden)

    babak Hadian

    2015-01-01

    Full Text Available Background: Prevalence of End Stage Renal Disease (ESRD is increasing in the world. Because of clinical importance of ESRD and absence of significant data, we studied the epidemiology of end stage renal failure in patients under hemodialysis in Lorestan province. Material and methods: This descriptive cross sectional study was carried out between January 2012 and January 2013 in dialysis centers of Lorestan university of medical sciences .Subject were selected by census method and data galhered using a questionnaire. At the end, collected data were analyzed by SPSS software, descriptive statistics and Chi-square test. Results: All the patients under hemodialysis were 318 cases, 182 out of them (57.2% and 136(42.8% were male and female respectively. The mean age of the subjects was 53.2± 16.4 years. The cause of renal failure in 38.1% of the patients were hypertension, diabetes (19.2% and unknown factors (27.4%. As well as 5.97% of the patients infected by HCV, HBV or HIV . A significant statistical difference was observed between causes of chronic renal failure and different ages of the subjects (p=0.002. Conclusion: Augmentation of screening programs and especially, early referral of high risk subjects to nephrologists is recommended for prevention of end stage renal disease.

  13. Coronary Artery Calcium Distribution and Interscan Measurement Variability in End-Stage Renal and Coronary Heart Disease Patients

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    Serafin, Z.; Laskowska, K.; Marzec, M.; Lasek, W. (Dept. of Radiology and Diagnostic Imaging, Nicolaus Copernicus Univ., Collegium Medicum, Bydgoszcz (Poland)); Sinjab, T.A.; Wlodarczyk, Z. (Dept. of Transplantology, Nicolaus Copernicus Univ., Collegium Medicum, Bydgoszcz (Poland))

    2009-04-15

    Background: Coronary heart disease patients and end-stage renal disease patients have been documented to have an increased amount of coronary artery calcifications (CAC). Purpose: To evaluate the distribution of CAC and its influence on interscan variability of measurement in end-stage renal disease and coronary heart disease patients, proven to have calcifications. Material and Methods: 69 patients having CAC, including 34 with coronary heart disease and 35 with end-stage renal disease, were scanned twice with multidetector-row computed tomography (MDCT). Amount of CAC was determined as the number of calcified lesions (CN), total calcium score (CS), calcium volume (CV), and calcium mass (CM). Distribution of CAC was evaluated on a per-patient basis as the median CS and CM of a single lesion. Density of the calcifications was calculated as the patient's CM divided by CV. Results: The overall median CS was 457.2, and the median CM was 75.6 mg. There were no significant differences in the number of calcified lesions, CS, or CM between the two groups. Both CS and CM of a single lesion, as well as the mean calcium density were lower in renal disease patients (P<0.05) than in coronary heart disease subjects. The relative interscan variability of coronary calcium measurement was higher in the renal disease group (P<0.05). There was a negative correlation between the calcium concentration and the relative interscan variability. Conclusion: The results indicate that the coronary calcium distribution influences the measurement interscan reproducibility, and the distribution may differ between end-stage renal disease patients and coronary heart disease patients, reflecting the dissimilar nature of coronary calcifications in those groups.

  14. Coronary Artery Calcium Distribution and Interscan Measurement Variability in End-Stage Renal and Coronary Heart Disease Patients

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    Serafin, Z.; Laskowska, K.; Marzec, M.; Lasek, W.; Sinjab, T.A.; Wlodarczyk, Z.

    2009-01-01

    Background: Coronary heart disease patients and end-stage renal disease patients have been documented to have an increased amount of coronary artery calcifications (CAC). Purpose: To evaluate the distribution of CAC and its influence on interscan variability of measurement in end-stage renal disease and coronary heart disease patients, proven to have calcifications. Material and Methods: 69 patients having CAC, including 34 with coronary heart disease and 35 with end-stage renal disease, were scanned twice with multidetector-row computed tomography (MDCT). Amount of CAC was determined as the number of calcified lesions (CN), total calcium score (CS), calcium volume (CV), and calcium mass (CM). Distribution of CAC was evaluated on a per-patient basis as the median CS and CM of a single lesion. Density of the calcifications was calculated as the patient's CM divided by CV. Results: The overall median CS was 457.2, and the median CM was 75.6 mg. There were no significant differences in the number of calcified lesions, CS, or CM between the two groups. Both CS and CM of a single lesion, as well as the mean calcium density were lower in renal disease patients (P<0.05) than in coronary heart disease subjects. The relative interscan variability of coronary calcium measurement was higher in the renal disease group (P<0.05). There was a negative correlation between the calcium concentration and the relative interscan variability. Conclusion: The results indicate that the coronary calcium distribution influences the measurement interscan reproducibility, and the distribution may differ between end-stage renal disease patients and coronary heart disease patients, reflecting the dissimilar nature of coronary calcifications in those groups

  15. Exploring caregiver burden experienced by family caregivers of patients with End-Stage Renal Disease in Nigeria

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    Yemisi Okikiade Oyegbile

    Full Text Available Background: Family caregivers in many African countries bear the burden of caregiving alone, with the paucity of research, especially for caregivers of End-Stage Renal Disease patients, having concealed their needs. Aim: To explore the caregiver burden of family caregivers of End-Stage Renal Disease (ESRD patients in South-West Nigeria. Design: Following a complementary mixed method data collection strategy, the quantitative data was collected using the Zarit Burden Interview questionnaire to measure the burden of caregiving. Qualitative data was thereafter obtained through in-depth, individual interviews and was analysed using content analysis. Settings: The three research settings consisted of two state hospitals and one private hospital that provide renal care in South-West Nigeria. Result: The mean burden of caregiving for the sample was 50.18 thus indicating that family caregivers experienced moderate to severe burden, which is high compared to the other studies. The participants’ experiences of caregiving revealed the following categories: total dependence, acceptance of caregiving role, competing responsibilities, financial sacrifice and “not making mistakes”. Conclusion: Understanding the extent of caregiver burden, what constitutes burden to family caregivers in low/middle-income countries, and the difficulties associated with caregiving for care-recipients with ESRD, allows appropriate strategies and interventions to be developed. Keywords: End Stage Renal Disease, Family caregivers, Caregiver burden, Complementary mixed methods, Nigeria

  16. A STUDY ON INCIDENCE OF ACUTE CARDIOVASCULAR COMPLICATIONS DURING MAINTENANCE HAEMODIALYSIS OF END-STAGE RENAL FAILURE PATIENTS

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    Darimireddi Siva Kumar

    2016-09-01

    Full Text Available BACKGROUND To study the incidence of acute cardiovascular complications during haemodialysis in patients with chronic kidney disease with end-stage renal failure on maintenance haemodialysis. METHODS Patients with chronic kidney disease with end-stage renal failure on maintenance haemodialysis at King George Hospital, Andhra Medical College, Visakhapatnam, India, were studied during the period of June 2015 to August 2016. In our study, all the 100 patients underwent 8510 haemodialysis sessions during 1-year period of study. RESULTS Cardiovascular complications are the most common intradialytic complications occurred during the study. Hypotension is the commonest of all the intradialytic as well as cardiovascular complications with a frequency of 1278, which account for 15.01% of the haemodialysis sessions. This was followed by 879 episodes of hypertension (10.32%, 190 episodes of cardiac arrhythmias (2.23%, which include complex ventricular arrhythmias and supraventricular arrhythmias and 162 episodes of chest pain (1.90%. Of the 100 patients, 37% of patients developed cardiac arrhythmias during haemodialysis. The frequency of arrhythmic episodes was 190 (2.23%. Among these, Supraventricular Arrhythmias (SVA and Complex Ventricular Arrhythmic (CVA episodes account for 159 (83.68% and 31 (16.31%, respectively. CVA and SVA occurred in 29% and 19% of patients in the study group, respectively. Both CVA and SVA occurred in 12% of patients. CONCLUSION Intradialytic hypotension is the most common acute intradialytic complication in patients with chronic kidney disease with endstage renal failure undergoing maintenance haemodialysis. This is followed by intradialytic hypertension. Sudden cardiac arrest is the most common cause of death during haemodialysis in patients with end-stage renal disease on haemodialysis. Mortality is high in patients with end-stage renal failure in maintenance haemodialysis with ischaemic heart disease.

  17. Factors affecting dermatological manifestations in patients with end stage renal disease

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    Anees, M.; Gull, S.; Nazeer, A.

    2018-01-01

    To determine skin changes in patients of End Stage Renal Disease (ESRD) on maintenance hemodialysis (MHD) and factors affecting these changes. Study Design:Cross-sectional observational study. Place and Duration of Study:Nephrology Department, Mayo Hospital, Lahore in collaboration with Dermatology Department, King Edward Medical University, Lahore, from October 2015 to January 2016. Methodology:Two hundred patients who were undergoing MHD for more than three months were included in the study. Patients' demographic data, laboratory reports and dialysis records were noted in a predesigned questionnaire. Skin examination was carried out by consultant dermatologist after patient's permission. Results:Among 200 patients included in study, 105 were males and rest of them were females. Major causes of ESRD were Diabetes Mellitus (n=83, 41.5%, followed by Hypertension (n=80, 40%), Nephrolithiasis (n=15, 7.5%) and Chronic glomerulonephritis (n=5, 2.5%). At least one cutaneous finding was present in every patient. Common skin findings observed were pigmentation (86%), xerosis (83%), pallor (79%), pruritus (69%), acquired ichthyosis (50.5%), and bacterial skin infections (18.5%). Among them, nail manifestations were half-and-half nails (52%), nychomycosis (30.5%), onycholysis (20.5%), subungual hyperkeratosis (23.5%), and Mee's lines (7.5). Among hair changes were sparse scalp hair (38.5%), brittle and lustreless hair (28%). The factors contributing to skin changes were patient's age, cause of ESRD, anti HCV positivity, high urea and creatinine levels, duration and frequency of hemodialysis, hemoglobin levels, calcium phosphate product and socioeconomic status. Some skin manifestations were interrelated with each other like xerosis with pruritus (p<0.001), pruritus with bacterial infection (p<0.022), acquired Ichthyosis (p=0.008) and hair changes (p=0.035). Conclusion:ESRD patients on hemodialysis develop various skin changes during the course of disease

  18. Nail Changes in End-Stage Renal Failure Patients on Hemodialysis

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    Jamal Arshad

    2000-01-01

    Full Text Available To evaluate the fingernail changes in patients with end-stage renal failure (ESRF on regular hemodialysis (HD, we reviewed 69 patients (male 25, female 44; age 40 ± 14.8 years who have been on HD at Samtah General Hospital, Gizan, Kingdom of Saudi Arabia for a mean of 4.3 ± 3.06 years. They were free from congenital, systemic or primary skin disorders contributing to nail changes. The patients were also free from ornamental dyes like henna, traumatic injuries or infections in the fingernails. They were also clinically free from features suggestive of the carpal tunnel syndrome or vascular steal syndrome secondary to arteriovenous fistula (AVF created for vascular access. Their nails were examined under bright day light by the authors independently. The findings consistent among all three observers were taken for analysis. Hemoglobin and serum albumin levels were also estimated. We compared these changes according to age, sex, and duration on chronic hemodialysis, AVF, and the levels of serum albumin and hemoglobin. One or more nail changes were observed in 44/69 (64% patients. The commonest abnormality was the so-called "Half-and-half nail changes", which was observed in the finger nails of 18/69 (26% of the study patients (males to female ratio was 2:1. Typically, the half-and-half nails are nails where the distal portion of the nail bed is red, pink or brown, occupies 20-60% of the total nail length and is always sharply demarcated with the proximal portion. The latter has a dull whitish ground glass appearance and when pressure is applied, the distal discoloration does not fade completely. Non-specific nail changes were observed 26/69 (38% patients. The hemoglobin and serum albumin levels were not significantly different of those with ′half-and-half′ nail, non-specific nail changes or no nail changes. We conclude that various fingernail changes are observed in ESRF patients on HD. These nail changes are independent of the age of the

  19. A registry of patients with end stage renal disease--the experience at hospital Sultanah Aminah, Johor Baru.

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    Hooi, L S

    1993-06-01

    A registry of patients with end stage renal disease was started from 1st January 1990 at Hospital Sultanah Aminah, Johor Baru. There were 126 patients in 1990 and 129 in 1991. The peak age was 31 to 60 years old; males outnumbered females 1.5:1. Forty-three to fifty-six percent presented with small kidneys. Seventeen to twenty percent of patients had diabetes mellitus. In 1991, the racial distribution of patients was Malay: 50.4%, Chinese: 39.5%, Indian: 7.8% and others: 2.3%. The incidence of end stage renal disease in Johor Baru district was 79 per million per year in 1990 and 86 per million in 1991.

  20. END STAGE RENAL DISEASE IN PATIENTS WITH WILMS TUMOR: RESULTS FROM THE NATIONAL WILMS TUMOR STUDY GROUP AND THE U.S. RENAL DATA SYSTEM

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    Breslow, Norman E.; Grigoriev, Yevgeny A.; Peterson, Susan M.; Collins, Allan J.; Ritchey, Michael L.; Green, Daniel M.

    2005-01-01

    Purpose: To accurately assess the full spectrum of end stage renal disease (ESRD) in Wilms tumor survivors by combining the unique resources of the National Wilms Tumor Study Group (NWTSG) and the U.S. Renal Data System (USRDS), and to confirm preliminary reports of an increased incidence of ESRD in those with the Wilms tumor-aniridia (WAGR) syndrome.

  1. The Lived Experience of Patients Receiving Hemodialysis Treatment for End-Stage Renal Disease: A Qualitative Study.

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    Chiaranai, Chantira

    2016-06-01

    End-stage renal disease (ESRD), the last stage of chronic kidney disease, is the point at which the kidneys are no longer able to support the body's needs. Thus, ESRD significantly impacts the day-to-day life of patients. To improve bodily functions and prolong life, patients with ESRD require renal replacement therapy in the form of either hemodialysis (HD) or kidney transplantation. Research has documented the impact of ESRD and HD on quality of life. There is a lack of qualitative studies that describe how ESRD sufferers in Thailand cope with daily life. This study aimed to better understand the daily life experiences of Thai patients with ESRD who are on HD. This study used a phenomenological approach and a semistructured interview guide. Thai men and women with ESRD and on HD were purposively recruited from an HD unit at one hospital in Thailand between February and May 2013. Inclusion criteria included (a) currently being treated for HD, (b) ability to communicate in Thai, and (c) age of over 18 years. Participants were asked to describe their problems, feelings, thoughts, and attitudes as well as how they experienced their lives. Data saturation was reached after the completion of 26 interviews. The data were analyzed using thematic analysis. The following themes emerged from the data: (a) facing life's limitations, (b) living with uncertainty, and (c) dependence on medical technology. The authors hope that the findings increase the understanding of healthcare providers about the lived experience of Thai patients with ESRD on HD. Greater understanding is critical in helping healthcare providers identify the changes in practice that will be necessary to better care for and integrate the best holistic practices into standardized care for this population.

  2. Advanced glycation end-products and skin autofluorescence in end-stage renal disease : a review

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    Arsov, Stefan; Graaff, Reindert; van Oeveren, Wim; Stegmayr, Bernd; Sikole, Aleksandar; Rakhorst, Gerhard; Smit, Andries J.

    Chronic kidney disease (CKD), especially in its end stage, is marked by extremely high cardiovascular rates of morbidity and mortality; hemodialysis patients have a five-fold shorter life expectancy than healthy subjects of the same age. In CKD the metabolic products that accumulate in the body are

  3. [The influence of hypothyroidism on the conversion and binding of thyroid hormones in patients with end-stage renal disease].

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    Dubczak, Iwanna; Niemczyk, Longin; Bartoszewicz, Zbigniew; Szamotulska, Katarzyna; Saracyn, Marek; Niemczyk, Stanisław

    2017-03-21

    Hypothyroidism in patients with renal failure (RF) causes many metabolic and clinical problems, and both these diseases can mutually exacerbate their disturbances. The aim of this study was to evaluate the effect of hypothyroidism, and end-stage renal disease (ESRD) on conversion of thyroid hormones (TH) in patients with ESRD treated with chronic hemodialysis (HD). The study was performed in 74 patients, including 41 women (K) and 33 men (M) aged 28-83 y.o. in 4 groups: G1 - 12 people with ESRD treated with HD and with newly diagnosed hypothyroidism without substitution (6 K and M 6) aged 66,83±12,90 y.o., G2 - 26 patients with ESRD treated with HD without hypothyroidism (10 F, 16 M) aged 58,85±15,52 y.o., G3 - 11 hypothyroid patients without RF (9 K, 2 M) aged 54,73±21,26 y.o., G4 - 25-persons from control group of healthy subjects (16 M, 9 M) aged 51,24±12,58 y.o. In all subjects the concentration of TSH and TH (T4, T3, fT4, TSH, FT3, rT3) were measured and values of conversion factors (T3/T4, FT3/ fT4, rT3/fT4 and rT3/fT3) and binding TH to protein factors (fT4/T4 and fT3/T3) were calculated. Lower concentration of T3 (p=0.012), fT3 (phypothyroidism than in healthy subjects. Renal failure with concomitant hypothyroidism intensify the disturbances of T4 to T3 conversion (p=0.034) and hypothyroidism with concomitant renal failure disrupts binding of T3 to proteins (p=0.001). FT3 to fT4 ratio in renal failure with concomitant hypothyroidism group was significantly lower than in each other group. rT3 concentrations were the highest in healthy subjects. Concomitance of hypothyroidism and end-stage renal disease reduces the conversion of thyroxine to triiodothyronine, but does not increase the production of rT3. Hypothyroidism significantly increases the disorders of thyroid hormones in end-stage renal disease. There is decreased tendency to bind of thyroid hormone to protein in hypothyroidism in patients with end-stage renal disease.

  4. Retrospective review of bone mineral metabolism management in end-stage renal disease patients wait-listed for renal transplant

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    Chavlovski A

    2012-09-01

    Full Text Available Anna Chavlovski,1 Greg A Knoll,1–3 Timothy Ramsay,4 Swapnil Hiremath,1–3 Deborah L Zimmerman1–31University of Ottawa, 2Ottawa Hospital, 3Kidney Research Centre, Ottawa Hospital Research Institute, 4Ottawa Methods Centre, Ottawa, ON, CanadaBackground: In patients with end-stage renal disease, use of vitamin D and calcium-based phosphate binders have been associated with progression of vascular calcification that might have an impact on renal transplant candidacy. Our objective was to examine management of mineral metabolism in patients wait-listed for renal transplant and to determine the impact on cardiac perfusion imaging.Methods: Data was collected retrospectively on patients wait-listed for a renal transplant (n = 105, being either active (n = 73 and on hold (n = 32. Demographic data, medications, serum concentrations of calcium, phosphate, parathyroid hormone, and cardiac perfusion imaging studies were collected from the electronic health record. Chi-square and Student’s t-tests were used to compare active and on-hold patients as appropriate. Logistic regression was used to examine variables associated with worsening cardiac imaging studies.Results: The wait-listed patients were of mean age 56 ± 14 years and had been on dialysis for 1329 ± 867 days. On-hold patients had received a significantly greater total dose of calcium (2.35 ± .94 kg versus 1.49 ± 1.52 kg; P = 0.02 and were more likely to have developed worsening cardiovascular imaging studies (P = 0.03. Total doses of calcium and calcitriol were associated with worsening cardiovascular imaging studies (P = 0.05.Conclusion: Patients on hold on the renal transplant waiting list received higher total doses of calcium. A higher total dose of calcium and calcitriol was also associated with worsening cardiovascular imaging. Time on dialysis before transplant has been associated with worse post-transplant outcomes, and it is possible that the total calcium and calcitriol dose

  5. Association of RAC1 Gene Polymorphisms with Primary End-Stage Renal Disease in Chinese Renal Recipients.

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    Yani Liu

    Full Text Available RAC1 gene could influence susceptibility to renal failure by altering the activity and expression of Rac1, which is a member of the Rho family of small GTP-binding proteins. In clinical practice, renal transplantation provides the optimal treatment for people with end-stage renal disease (ESRD. The objective of this present study was to determine whether the RAC1 gene polymorphisms were associated with primary ESRD susceptibility in Chinese renal recipients.Six single nucleotide polymorphisms (SNPs of RAC1 gene, including rs836488 T>C, rs702482 A>T, rs10951982 G>A, rs702483 A>G, rs6954996 G>A, and rs9374 G>A, were genotyped in 300 renal transplant recipients (cases and 998 healthy Chinese subjects (controls by using TaqMan SNP genotyping assay. Allele, genotype, and haplotype frequencies of the six SNPs were compared between cases and controls. Odds ratios (OR and 95% confidence intervals (CI were calculated in logistic regression models to evaluate the associations of the six SNPs with ESRD risk.The genotype distributions for the six SNPs in controls were consistent with Hardy-Weinberg equilibrium (P > 0.05. Association analysis revealed that three SNPs were significantly associated with ESRD risk. Positive associations with ESRD risk were found for the rs836488, rs702482, and rs702483 in the co-dominant model (minor allele homozygotes versus major allele homozygotes; specifically, the frequencies of the minor allele homozygotes and the minor allele for the three SNPs were higher in the cases than in the controls. In addition, these three SNPs also had associations with increased ESRD risk under the additive model (P 0.05. In haplotype analysis, carriers with "C-T-G-G-G-G" haplotype had a significantly higher risk of ESRD compared with the most common haplotype "T-A-G-A-G-G" (P = 0.011, OR = 1.46, 95% CI = 1.09-1.94.This study suggested that polymorphisms of RAC1 gene might influence the susceptibility to ESRD in Chinese Han population. Further

  6. The drama of the continuous increase in end-stage renal failure in patients with type II diabetes mellitus.

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    Rychlík, I; Miltenberger-Miltenyi, G; Ritz, E

    1998-01-01

    Type II diabetes mellitus has become the leading cause of end-stage renal failure in many countries of Western Europe. In all European countries, even in those with a relatively low prevalence of diabetic nephropathy, the number of patients with type II diabetes mellitus admitted for renal replacement therapy has recently increased continuously. Survival and medical rehabilitation of patients with type II diabetes on renal replacement therapy is significantly worse than in non-diabetic patients. It is obvious that in order to stem the tide, intense efforts are necessary (i) to inform the medical community about the renal risk of type II diabetes and the striking effectiveness of preventive measures, (ii) to provide better care for diabetic patients, and (iii) to reduce the high prevalence of diabetes in the population by modification of the Western life style.

  7. United States Renal Data System public health surveillance of chronic kidney disease and end-stage renal disease.

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    Collins, Allan J; Foley, Robert N; Gilbertson, David T; Chen, Shu-Cheng

    2015-06-01

    The United States Renal Data System (USRDS) began in 1989 through US Congressional authorization under National Institutes of Health competitive contracting. Its history includes five contract periods, two of 5 years, two of 7.5 years, and the fifth, awarded in February 2014, of 5 years. Over these 25 years, USRDS reporting transitioned from basic incidence and prevalence of end-stage renal disease (ESRD), modalities, and overall survival, as well as focused special studies on dialysis, in the first two contract periods to a comprehensive assessment of aspects of care that affect morbidity and mortality in the second two periods. Beginning in 1999, the Minneapolis Medical Research Foundation investigative team transformed the USRDS into a total care reporting system including disease severity, hospitalizations, pediatric populations, prescription drug use, and chronic kidney disease and the transition to ESRD. Areas of focus included issues related to death rates in the first 4 months of treatment, sudden cardiac death, ischemic and valvular heart disease, congestive heart failure, atrial fibrillation, and infectious complications (particularly related to dialysis catheters) in hemodialysis and peritoneal dialysis patients; the burden of congestive heart failure and infectious complications in pediatric dialysis and transplant populations; and morbidity and access to care. The team documented a plateau and decline in incidence rates, a 28% decline in death rates since 2001, and changes under the 2011 Prospective Payment System with expanded bundled payments for each dialysis treatment. The team reported on Bayesian methods to calculate mortality ratios, which reduce the challenges of traditional methods, and introduced objectives under the Health People 2010 and 2020 national health care goals for kidney disease.

  8. Effect of food additives on hyperphosphatemia among patients with end-stage renal disease: a randomized controlled trial.

    Science.gov (United States)

    Sullivan, Catherine; Sayre, Srilekha S; Leon, Janeen B; Machekano, Rhoderick; Love, Thomas E; Porter, David; Marbury, Marquisha; Sehgal, Ashwini R

    2009-02-11

    High dietary phosphorus intake has deleterious consequences for renal patients and is possibly harmful for the general public as well. To prevent hyperphosphatemia, patients with end-stage renal disease limit their intake of foods that are naturally high in phosphorus. However, phosphorus-containing additives are increasingly being added to processed and fast foods. The effect of such additives on serum phosphorus levels is unclear. To determine the effect of limiting the intake of phosphorus-containing food additives on serum phosphorus levels among patients with end-stage renal disease. Cluster randomized controlled trial at 14 long-term hemodialysis facilities in northeast Ohio. Two hundred seventy-nine patients with elevated baseline serum phosphorus levels (>5.5 mg/dL) were recruited between May and October 2007. Two shifts at each of 12 large facilities and 1 shift at each of 2 small facilities were randomly assigned to an intervention or control group. Intervention participants (n=145) received education on avoiding foods with phosphorus additives when purchasing groceries or visiting fast food restaurants. Control participants (n=134) continued to receive usual care. Change in serum phosphorus level after 3 months. At baseline, there was no significant difference in serum phosphorus levels between the 2 groups. After 3 months, the decline in serum phosphorus levels was 0.6 mg/dL larger among intervention vs control participants (95% confidence interval, -1.0 to -0.1 mg/dL). Intervention participants also had statistically significant increases in reading ingredient lists (Pfood knowledge scores (P = .13). Educating end-stage renal disease patients to avoid phosphorus-containing food additives resulted in modest improvements in hyperphosphatemia. clinicaltrials.gov Identifier: NCT00583570.

  9. NT-pro-BNP is an independent predictor of mortality in patients with end-stage renal disease.

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    Svensson, M; Gorst-Rasmussen, A; Schmidt, E B; Jorgensen, K A; Christensen, J H

    2009-04-01

    Patients with end-stage renal disease (ESRD) have an increased mortality from cardiovascular disease (CVD). N-terminal pro-brain natriuretic peptide (NT-pro-BNP) is an independent predictor of mortality in patients with ischemic heart disease and congestive heart failure. Previous data have shown markedly elevated levels of NT-pro-BNP in patients with ESRD, while the prognostic value of elevated levels of NT-pro-BNP in patients with ESRD is largely unknown. The aim of the present study was to examine if the level of NT-pro-BNP predicts mortality in patients with ERSD and CVD. We prospectively followed 206 patients with ESRD and documented CVD. Levels of NT-pro-BNP were measured at baseline, and patients were followed for 2 years or until they reached the predefined endpoint of all-cause mortality. During follow-up, the total mortality was 44% (90/206). Patients who died were followed for a median of 314 days (interquartile range 179 - 530). Using Cox regression analysis, age, female sex, systolic blood pressure, dialysis efficiency and plasma levels of NT-pro-BNP were independent prognostic risk factors of mortality. In receiver operating characteristic curve analysis a cut off value for NT-pro-BNP was determined. Patients with values of NT-pro-BNP above 12.200 pg/ml had a 3 times higher risk of death than patients below the cut-off value (HR 3.05 95% CI 1.96 - 4.77, p pro-BNP, NT-pro-BNP is still an independent predictor of mortality and might add prognostic information in patients with ESRD and documented CVD.

  10. Family caregiver's experiences of providing care to patients with End-Stage Renal Disease in South-West Nigeria.

    Science.gov (United States)

    Oyegbile, Yemisi Okikiade; Brysiewicz, Petra

    2017-09-01

    To describe the experiences of family caregivers providing care for patients living with End-Stage Renal Disease in Nigeria BACKGROUND: Family caregiving is where an unpaid volunteer, usually a close family member, attends to the needs of a loved one with a chronic, disabling illness within the home. Much research has been conducted in the area of family caregiving in high-income countries. However, the same cannot be said for many of the low-resource, multicultural African countries. Qualitative descriptive study. This qualitative descriptive study used manifest content analysis to analyse data from semi-structured, individual interviews, with 15 purposively selected family caregivers. Two tertiary institutions providing renal care in South-Western Nigeria: the research setting for this study. Five categories were identified, and these included disconnectedness with self and others, never-ending burden, 'a fool being tossed around', obligation to care and promoting a closer relationship. Experiences associated with the caregiving of patients diagnosed with End-Stage Renal Disease evoked a number of emotions from the family caregivers, and the study revealed that caregiving imposed some burdens that are specific to low-resource countries on participants. Nurses need to engage family caregivers on disease-specific teachings that might promote understanding of the disease process and role expectation. Family caregivers may benefit from social support services. © 2016 John Wiley & Sons Ltd.

  11. Effects of hemodialysis on iodine-131 biokinetics in thyroid carcinoma patients with end-stage chronic renal failure.

    Science.gov (United States)

    Yeyin, Nami; Cavdar, Iffet; Uslu, Lebriz; Abuqbeitah, Mohammad; Demir, Mustafa

    2016-03-01

    Radioiodine therapy could be challenging in chronic renal failure patients requiring hemodialysis. The aim of this study was to establish the effects of hemodialysis on elimination of radioiodine from the body in thyroid carcinoma patients with end-stage chronic renal failure and to determine its effects on environmental radiation dose. Three end-stage chronic renal failure patients (four cases) diagnosed with differentiated thyroid carcinoma requiring radioiodine therapy were included in our study. Each patient was given 50-75 mCi (1850-2775 MBq) iodine-131 with 50% dose reduction. Dose rate measurement was performed at the 2nd, 24th, and 48th hour (immediately before and after hemodialysis) after radioiodine administration. The Geiger-Müller probe was held at 1 m distance at the level of the midpoint of the thorax for the dose rate measurement. The effective half-life of iodine-131 for three patients was found to be 44 h. In conclusion, the amount of radioiodine excreted per hemodialysis session was calculated to be 51.25%.

  12. CHANGES IN CHOROIDAL THICKNESS IN AND OUTSIDE THE MACULA AFTER HEMODIALYSIS IN PATIENTS WITH END-STAGE RENAL DISEASE.

    Science.gov (United States)

    Chang, In Boem; Lee, Jeong Hyun; Kim, Jae Suk

    2017-05-01

    To evaluate changes in choroidal thickness in and outside the macula as a result of hemodialysis (HD) in patients with end-stage renal disease. Patients with end-stage renal disease treated with maintenance HD in the Dialysis Unit of Sanggye Paik Hospital, Seoul, South Korea, were included in this study. The choroidal thickness was measured in and outside the macula before and after HD (paired t-test). Choroidal thickness in the macula was measured at the foveal center and 1.5 mm temporal to the foveal center and outside the macula was measured at superior, inferior, and nasal area 3.5 mm from the optic disk margin. Peripapillary retinal nerve fiber layer thickness, intraocular pressure, central corneal thickness, and systemic parameters such as serum osmolarity and blood pressure (BP) were measured before and after HD (paired t-test). We divided patients into two groups, diabetic and nondiabetic groups to compare the changes in choroidal thickness. Patients with diabetes were subdivided into two groups: severe retinal change group and moderate retinal change group (Mann-Whitney test). Pearson's correlation test was used to evaluate the correlations between choroidal thickness and changes in serum osmolarity, BP, and body weight loss. Choroidal thickness and peripapillary retinal nerve fiber layer thickness were measured using spectral-domain optical coherence tomography. Fifty-four eyes of 31 patients with end-stage renal disease were included. After HD, the mean intraocular pressure was significantly decreased from 14.8 ± 2.5 mmHg to 13.0 ± 2.6 mmHg (P macula.

  13. Lupus Nephritis in Males: Clinical Features, Course, and Prognostic Factors for End-Stage Renal Disease

    Directory of Open Access Journals (Sweden)

    Andrés Urrestarazú

    2017-09-01

    Discussion: LN in males usually presents as nephrotic syndrome, and type IV LN is the most frequent form. An estimated glomerular filtration rate < 60 ml/min at the time of renal biopsy is associated with poor renal outcomes. There were no differences in remission or progression of LN in males when compared with a cohort of female patients with LN.

  14. Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality.

    Science.gov (United States)

    Coresh, Josef; Turin, Tanvir Chowdhury; Matsushita, Kunihiro; Sang, Yingying; Ballew, Shoshana H; Appel, Lawrence J; Arima, Hisatomi; Chadban, Steven J; Cirillo, Massimo; Djurdjev, Ognjenka; Green, Jamie A; Heine, Gunnar H; Inker, Lesley A; Irie, Fujiko; Ishani, Areef; Ix, Joachim H; Kovesdy, Csaba P; Marks, Angharad; Ohkubo, Takayoshi; Shalev, Varda; Shankar, Anoop; Wen, Chi Pang; de Jong, Paul E; Iseki, Kunitoshi; Stengel, Benedicte; Gansevoort, Ron T; Levey, Andrew S

    2014-06-25

    The established chronic kidney disease (CKD) progression end point of end-stage renal disease (ESRD) or a doubling of serum creatinine concentration (corresponding to a change in estimated glomerular filtration rate [GFR] of −57% or greater) is a late event. To characterize the association of decline in estimated GFR with subsequent progression to ESRD with implications for using lesser declines in estimated GFR as potential alternative end points for CKD progression. Because most people with CKD die before reaching ESRD, mortality risk also was investigated. Individual meta-analysis of 1.7 million participants with 12,344 ESRD events and 223,944 deaths from 35 cohorts in the CKD Prognosis Consortium with a repeated measure of serum creatinine concentration over 1 to 3 years and outcome data. Transfer of individual participant data or standardized analysis of outputs for random-effects meta-analysis conducted between July 2012 and September 2013, with baseline estimated GFR values collected from 1975 through 2012. End-stage renal disease (initiation of dialysis or transplantation) or all-cause mortality risk related to percentage change in estimated GFR over 2 years, adjusted for potential confounders and first estimated GFR. The adjusted hazard ratios (HRs) of ESRD and mortality were higher with larger estimated GFR decline. Among participants with baseline estimated GFR of less than 60 mL/min/1.73 m2, the adjusted HRs for ESRD were 32.1 (95% CI, 22.3-46.3) for changes of −57% in estimated GFR and 5.4 (95% CI, 4.5-6.4) for changes of −30%. However, changes of −30% or greater (6.9% [95% CI, 6.4%-7.4%] of the entire consortium) were more common than changes of −57% (0.79% [95% CI, 0.52%-1.06%]). This association was strong and consistent across the length of the baseline period (1 to 3 years), baseline estimated GFR, age, diabetes status, or albuminuria. Average adjusted 10-year risk of ESRD (in patients with a baseline estimated GFR of 35 mL/min/1.73 m2

  15. Health promotion behaviors and related factors in end stage renal disease patients treated with continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    Wechpradit, Apinya; Thaiyuenwong, Jutiporn; Kanjanabuch, Talerngsak

    2011-09-01

    To present study health promotion behaviors and related factors in end stage renal disease (ESRD) patients treated with continuous ambulatory peritoneal dialysis (CAPD). Questionnaires of Pender to evaluate health promotion behaviors which measure 5 aspects of health-affected behaviors were examined in 90 CAPD patients at dialysis unit of Udornthani Hospital. Results were categorized into 3 groups according to Bloom's scale as follows: high, moderate, and low levels. The data were displayed as ranges or means +/- standard deviation, according to the characteristics of each variable, with a 5% (p cherish health behaviors of the patients.

  16. Association of GSTO1 and GSTO2 Polymorphism with Risk of End-Stage Renal Disease Development and Patient Survival

    Directory of Open Access Journals (Sweden)

    Cimbaljevic Slavica

    2016-09-01

    Full Text Available Background: Oxidative stress in patients with end-stage renal disease (ESRD is associated with long-term cardiovascular complications. The cytosolic family of glutathione S-transferases (GSTs is involved in the detoxication of various toxic compounds and antioxidant protection. GST omega class members, GSTO1 and GSTO2 possess, unlike other GSTs, dehydroascorbate reductase and deglutathionylation activities. The aim of this study was to clarify the role of genetic polymorphisms of GSTO1 (rs4925 and GSTO2 (rs156697 as risk determinants for ESRD development, as well as in the survival of these patients.

  17. Advanced renal disease, end-stage renal disease and renal death among HIV-positive individuals in Europe

    DEFF Research Database (Denmark)

    Ryom, L; Kirk, O; Lundgren, Jens

    2012-01-01

    followed from baseline (first eGFR after 1/1/2004) until last eGFR, ARD/ESRD/renal death; whichever occurred first. Poisson regression was used to identify predictors. 8817 persons were included, the majority were white (87.3%), males (73.9%) infected though homosexual contact (41.5%) and with a median age...

  18. Pharmacokinetics of dexmedetomidine administered to patients with end-stage renal failure and secondary hyperparathyroidism undergoing general anaesthesia.

    Science.gov (United States)

    Zhong, W; Zhang, Y; Zhang, M-Z; Huang, X-H; Li, Y; Li, R; Liu, Q-W

    2018-06-01

    The primary objective of this study was to compare the pharmacokinetics of dexmedetomidine in patients with end-stage renal failure and secondary hyperparathyroidism with those in normal individuals. Fifteen patients with end-stage renal failure and secondary hyperparathyroidism (Renal-failure Group) and 8 patients with normal renal and parathyroid gland function (Control Group) received intravenous 0.6 μg/kg dexmedetomidine for 10 minutes before anaesthesia induction. Arterial blood samples for plasma dexmedetomidine concentration analysis were drawn at regular intervals after the infusion was stopped. The pharmacokinetics were analysed using a nonlinear mixed-effect model with NONMEM software. The statistical significance of covariates was examined using the objective function (-2 log likelihood). In the forward inclusion and backward deletion, covariates (age, weight, sex, height, lean body mass [LBM], body surface area [BSA], body mass index [BMI], plasma albumin and grouping factor [renal failure or not]) were tested for significant effects on pharmacokinetic parameters. The validity of our population model was also evaluated using bootstrap simulations. The dexmedetomidine concentration-time curves fitted best with the principles of a two-compartmental pharmacokinetic model. No covariate of systemic clearance further improved the model. The final pharmacokinetic parameter values were as follows: V 1  = 60.6 L, V 2  = 222 L, Cl 1  = 0.825 L/min and Cl 2  = 4.48 L/min. There was no influence of age, weight, sex, height, LBM, BSA, BMI, plasma albumin and grouping factor (renal failure or not) on pharmacokinetic parameters. Although the plasma albumin concentrations (35.46 ± 4.13 vs 44.10 ± 1.12 mmol/L, respectively, P Renal-failure Group than in the Control Group (81.68 ± 18.08 vs 63.07 ± 13.45 μg/kg/min, respectively, P renal failure and hyperparathyroidism were similar to those in patients with normal renal function. Further

  19. Peritonitis outcomes in patients with HIV and end-stage renal failure on peritoneal dialysis: a prospective cohort study.

    Science.gov (United States)

    Ndlovu, Kwazi C Z; Sibanda, Wilbert; Assounga, Alain

    2017-02-03

    Few studies have investigated the management of human immunodeficiency virus (HIV)-associated end-stage renal failure particularly in low-resource settings with limited access to renal replacement therapy. We aimed to evaluate the effects of HIV infection on continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis outcomes and technique failure in highly active antiretroviral therapy (HAART)-treated HIV-positive CAPD populations. We conducted a single-center prospective cohort study of consecutive incident CAPD patients recruited from two hospitals in Durban, South Africa from September 2012-February 2015. Seventy HIV-negative and 70 HIV-positive end-stage renal failure patients were followed monthly for 18 months at a central renal clinic. Primary outcomes of peritonitis and catheter failure were assessed for the first 18 months of CAPD therapy. We assessed risk factors for peritonitis and catheter failure using Cox regression survival analysis. The HIV-positive cohort had a significantly increased rate of peritonitis compared to the HIV-negative cohort (1.86 vs. 0.76 episodes/person-years, respectively; hazard ratio [HR], 2.41; 95% confidence interval [CI], 1.69-3.45, P peritonitis rate rose to 3.69 episodes/person-years (HR 4.54, 95% CI 2.35-8.76, P peritonitis rate of 1.60 episodes/person-years (HR 2.10, CI 1.39-3.15, P = 0.001). HIV was associated with increased hazards of peritonitis relapse (HR, 3.88; CI, 1.37-10.94; P = 0.010). Independent predictors associated with increased peritonitis risk were HIV (HR, 1.84; CI, 1.07-3.16; P = 0.027), diabetes (HR, 2.09; CI, 1.09-4.03; P = 0.027) and a baseline CD4 count Peritonitis (HR, 14.47; CI, 2.79-75.00; P = 0.001), average hemoglobin concentrations (HR, 0.75; CI, 0.59-0.95; P = 0.016), and average serum C-reactive protein levels were independent predictors of catheter failure. HIV infection in end-stage renal disease patients managed by CAPD was associated with

  20. Clearance of glucoregulatory peptide hormones during haemodialysis and haemodiafiltration in non-diabetic end-stage renal disease patients

    DEFF Research Database (Denmark)

    Jørgensen, Morten B; Idorn, Thomas; Knop, Filip K

    2015-01-01

    BACKGROUND: Patients with end-stage renal disease (ESRD) have increased fasting concentrations and disturbed postprandial responses of several glucoregulatory hormones. We aimed to evaluate the impact of high-flux haemodialysis (HD) and high-volume haemodiafiltration (HDF) on fasting and postpran......BACKGROUND: Patients with end-stage renal disease (ESRD) have increased fasting concentrations and disturbed postprandial responses of several glucoregulatory hormones. We aimed to evaluate the impact of high-flux haemodialysis (HD) and high-volume haemodiafiltration (HDF) on fasting...... and postprandial plasma levels of glucoregulatory pancreatic and gut peptide hormones in ESRD patients. METHODS: Ten non-diabetic HD-treated ESRD patients were included to undergo a 3-h standardized liquid mixed meal test 1 h into an HD and an HDF, respectively. On a third, optional, examination day, the meal test...... during HDF and four completed the optional meal test without dialysis. All plasma hormone concentrations declined significantly during the first fasting hour of dialysis with no differences between HD and HDF. Significant clearance of the investigated hormones was observed for both dialysis modalities...

  1. Comparative study: Oral mucosal lesions, signs and symptoms in diabetes mellitus patients with end stage renal disease with analogous findings in diabetes mellitus patients with non-end stage renal disease

    Directory of Open Access Journals (Sweden)

    Balasubramani Senthil

    2017-01-01

    Full Text Available Aim: The aim of this study is to compare oral signs, symptoms and oral lesions type and prevalence, in end stage renal disease (ESRD with non-end stage renal disease (NESRD in diabetes mellitus (DM patients. Methodology: Two groups of DM patients were studied, Group 1 includes 100 patients with ESRD, who were under hemodialysis therapy, and Group 2 includes100 patients with NESRD whose serum creatinine level is <2.0 mg/dl. The DM status and other laboratory investigations were recorded, with the patients consent and thorough oral examination was performed and the findings were recorded. All the data were entered into Microsoft Excel sheets. Statistical analysis including Pearson's correlation analysis, Chi-square test, and t-test were done using SPSS software SYSTAT version 7.0. Results: On thorough clinical examination, the prevalence of oral lesions was found to be higher in ESRD patients. The most common lesions such as saburral tongue (P ≤ 0.002, petechiae/ecchymoses (P ≤ 0.000, pale mucosa (P ≤ 0.000, stomatitis medicamentosa (P ≤ 0.043 fissured tongue, smooth tongue, candidiasis, dry and fissured lips, angular cheilitis, uremic stomatitis, signs such as uremic fetor (P ≤ 0.000, xerostomia and symptoms like burning tongue, unpleasant taste are noted. Conclusion: The high prevalence of uremic fetor, saburral tongue, pale mucosa, and petechiae/ecchymoses in ESRD patient group can be considered as a possible sign of undiagnosed advanced stage of renal disease in other diabetic patients.

  2. HIV and end-stage renal disease: Practical issues in management ...

    African Journals Online (AJOL)

    However, since the introduction of highly active antiretroviral therapy (HAART) and optimal prevention of opportunistic infections, a life expectancy of 10 - 20 years can be expected. Unfortunately patients infected with HIV are often excluded from renal replacement therapy (RRT) programmes despite such encouraging ...

  3. Smoking and hyperparathyroidism in patients with end-stage renal disease (ESRD)

    NARCIS (Netherlands)

    G.L. Tripepi (Giovanni); F.U.S. Mattace Raso (Francesco); P. Pizzini (Patrizia); S. Cutrupi (Sebastiano); J.C.M. Witteman (Jacqueline); C. Zoccali (Carmine); F. Mallamaci (Francesca)

    2012-01-01

    textabstractBackground and methods: Smoking is associated with hyperparathyroidism in the elderly general population and nicotine, the main component of tobacco smoke, stimulates PTH release in experimental models. Although smoking is a persisting problem in patients with endstage renal disease

  4. End-stage renal disease in sub-Saharan and South Africa.

    Science.gov (United States)

    Naicker, Saraladevi

    2003-02-01

    The major health problems in Africa are AIDS, tuberculosis, malaria, gastroenteritis and hypertension; hypertension affects about 20% of the adult population. Renal disease, especially glomerular disease, is more prevalent in Africa and seems to be of a more severe form than that found in Western countries. The most common mode of presentation is the nephrotic syndrome, with the age of onset at five to eight years. It is estimated that 2 to 3% of medical admissions in tropical countries are due to renal-related complaints, the majority being the glomerulonephritides. There are no reliable statistics for ESRD in all African countries. Statistics of the South African Dialysis and Transplant Registry (SADTR) reflect the patients selected for renal replacement therapy (RRT) and do not accurately reflect the etiology of chronic renal failure (CRF), where public sector state facilities will offer RRT only to patients who are eligible for a transplant. In 1994, glomerulonephritis was recorded as the cause of ESRD in 1771 (52.1%) and hypertension in 1549 (45.6%) of patients by the SADTR. In a six-year study of 3632 patients with ESRD, based on SADTR statistics, hypertension was reported to be the cause of ESRD in 4.3% of whites, 34.6% of blacks, 20.9% mixed race group and 13.8% of Indians. Malignant hypertension is an important cause of morbidity and mortality among urban black South Africans, with hypertension accounting for 16% of all hospital admissions. In a ten-year study of 368 patients with chronic renal failure in Nigeria, the etiology of renal failure was undetermined in 62%. Of the remaining patients whose etiology was ascertained, hypertension accounted for 61%, diabetes mellitus for 11% and chronic glomerulonephritis for 5.9%. Patients with CRF constituted 10% of all medical admissions in this center. Chronic glomerulonephritis and hypertension are principal causes of CRF in tropical Africa and East Africa, together with diabetes mellitus and obstructive

  5. Hepcidin-25 in diabetic chronic kidney disease is predictive for mortality and progression to end stage renal disease.

    Directory of Open Access Journals (Sweden)

    Martin Wagner

    Full Text Available Anemia is common and is associated with impaired clinical outcomes in diabetic chronic kidney disease (CKD. It may be explained by reduced erythropoietin (EPO synthesis, but recent data suggest that EPO-resistance and diminished iron availability due to inflammation contribute significantly. In this cohort study, we evaluated the impact of hepcidin-25--the key hormone of iron-metabolism--on clinical outcomes in diabetic patients with CKD along with endogenous EPO levels.249 diabetic patients with CKD of any stage, excluding end-stage renal disease (ESRD, were enrolled (2003-2005, if they were not on EPO-stimulating agent and iron therapy. Hepcidin-25 levels were measured by radioimmunoassay. The association of hepcidin-25 at baseline with clinical variables was investigated using linear regression models. All-cause mortality and a composite endpoint of CKD progression (ESRD or doubling of serum creatinine were analyzed by Cox proportional hazards models.Patients (age 67 yrs, 53% male, GFR 51 ml/min, hemoglobin 131 g/L, EPO 13.5 U/L, hepcidin-25 62.0 ng/ml were followed for a median time of 4.2 yrs. Forty-nine patients died (19.7% and forty (16.1% patients reached the composite endpoint. Elevated hepcidin levels were independently associated with higher ferritin-levels, lower EPO-levels and impaired kidney function (all p<0.05. Hepcidin was related to mortality, along with its interaction with EPO, older age, greater proteinuria and elevated CRP (all p<0.05. Hepcidin was also predictive for progression of CKD, aside from baseline GFR, proteinuria, low albumin- and hemoglobin-levels and a history of CVD (all p<0.05.We found hepcidin-25 to be associated with EPO and impaired kidney function in diabetic CKD. Elevated hepcidin-25 and EPO-levels were independent predictors of mortality, while hepcidin-25 was also predictive for progression of CKD. Both hepcidin-25 and EPO may represent important prognostic factors of clinical outcome and have the

  6. The role of interventional radiology in management of patients with end-stage renal disease

    International Nuclear Information System (INIS)

    Surlan, M.; Popovic, P.

    2003-01-01

    The aim of the paper is to review the role of interventional radiology in the management of hemodialysis vascular access and complications in renal transplantation. The evaluation of patients with hemodialysis vascular access is complex. It includes the radiology/ultrasound (US) evaluation of the peripheral veins of the upper extremities with venous mapping and the evaluation of the central vein prior to the access placement and radiological detection and treatment of the stenosis and thrombosis in misfunctional dialysis fistulas. Preoperative screening enables the identification of a suitable vessel to create a hemodynamically-sound dialysis fistula. Clinical and radiological detection of the hemodynamically significant stenosis or occlusion demands fistulography and endovascular treatment. Endovascular prophylactic dilatation of stenosis greater than 50% with associated clinical abnormalities such as flow-rate reduction is warranted to prolong access patency. The technical success rates are over 90% for dilatation. One-year primary patency rate in forearm fistula is 51%, versus graft 40%. Stents are placed only in selected cases; routinely in central vein after dilatation, in ruptured vein and elastic recoil. Thrombosed fistula and grafts can be declotted by purely mechanical methods or in combination with a lytic drug. The success rate of the technique is 89-90%. Primary patency rate is 8-26% per year and secondary 75% per year. The most frequently radiologically evaluated and treated complications in renal transplantation are perirenal and renal fluid collection and abnormalities of the vasculature and collecting system. US is often the method of choice for the diagnostic evaluation and management of the percutaneous therapeutic procedures in early and late transplantation complications. Computed tomography and magnetic resonance are valuable alternatives when US is inconclusive. Renal and perirenal fluid collection are usually treated successfully with

  7. High prevalence of ACE DD genotype among north Indian end stage renal disease patients

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    Pandirikkal Baburajan Vinod

    2006-10-01

    Full Text Available Abstract Background The Renin-Angiotensin system (RAS is a key regulator of both blood pressure and kidney functions and their interaction. In such a situation, genetic variability in the genes of different components of RAS is likely to contribute for its heterogeneous association in the renal disease patients. Angiotensin converting enzyme-1 (ACE-1 is an important component of RAS which determines the vasoactive peptide Angiotensin-II. Methods In the present study, we have investigated 127 ESRD patients and 150 normal healthy controls from north India to deduce the association between ACE gene polymorphism and ESRD. The inclusion criteria for patients included a constantly elevated serum creatinine level above normal range (ranging from 3.4 to 15.8 and further the patients were recommended for renal transplantation. A total of 150 normal healthy controls were also genotyped for ACE I/D polymorphism. The criterion of defining control sample as normal was totally based on the absence of any kidney disease determined from the serum creatinin level. Genotyping of ACE I/D were assayed by polymerase chain reaction (PCR based DNA amplification using specific flanking primers Based on the method described elsewhere. Results The difference of DD and II genotypes was found highly significant among the two groups (p = 0.025; OR = 3.524; 95%CI = 1.54-8.07. The combined genotype DD v/s ID+II comparison validated that DD genotype is a high risk genotype for ESRD (p = 0.001; OR = 5.74; 95%CI limit = 3.4-8.5. However, no correlation was obtained for different biochemical parameters of lipid profile and renal function among DD and non DD genotype. Interestingly, ~87% of the DD ESRD patients were found hypertensive in comparison to the 65% patients of non DD genotype Conclusion Based on these observations we conclude that ACE DD genotype implicate a strong possible role in the hypertensive state and in renal damage among north Indians. The study will help in

  8. Withdrawal from long-term hemodialysis in patients with end-stage renal disease in Taiwan.

    Science.gov (United States)

    Lai, Chun-Fu; Tsai, Hung-Bin; Hsu, Su-Hsuan; Chiang, Chih-Kang; Huang, Jenq-Wen; Huang, Sheng-Jean

    2013-10-01

    Withdrawal from dialysis is ethically appropriate for some patients with multiple comorbidities and a shortened life expectancy. Taiwan has the highest prevalence of dialysis patients in the world, and the National Health Insurance (NHI) program offers renal replacement therapy free of charge. In this review, we discuss its current status and many background issues related to withdrawing dialysis from patients with advanced renal failure in Taiwan. Compared with dialysis therapy, the medical resources for hospice care are relatively sparse. Since the announcement of the Statute for Palliative Care in 2000, there has been a gradual improvement in the laws and health polices supporting dialysis withdrawal. Culture and social customs also have a significant impact on the practice of hospice care. Based on current evidence and in accordance with the local environment, we propose recommendations for the clinical practice of dialysis withdrawal and hospice care. There remains a need to expand upon the community-based hospice care and home care systems to better serve patients. In conclusion, there are cross-cultural differences relating to dialysis withdrawal between Taiwan and Western countries. Our experience and clinical recommendations may be helpful for the countries with NHI systems or for the Eastern countries. Copyright © 2013. Published by Elsevier B.V.

  9. Hydration status of patients with end-stage renal disease after kidney transplantation.

    Science.gov (United States)

    Gueutin, Victor; Ficheux, Maxence; Châtelet, Valérie; Lecouf, Angélique; Henri, Patrick; Hurault de Ligny, Bruno; Ryckelynck, Jean-Philippe; Lobbedez, Thierry

    2011-01-01

    This study was carried out to estimate the modification of hydration status within the first three months of renal transplantation. Fifty patients who underwent a first kidney allograft were prospectively followed for three months after renal transplantation to assess hydration status by bioimpedance spectroscopy. Two hours before the transplant procedure, 10/42 (23.8%) patients were overhydrated. Two days after surgery, 32/40 (80.0%) patients were overhydrated and at three months, 14/27 (51.9%) patients remained fluid-overloaded. Peritoneal dialysis (PD) patients had a lower hydration status (-0.60 L) than hemodialysis (HD) patients (0.70 L; p hydration status before transplantation (p = 0.031). At three months, 12/14 of the overhydrated patients had a creatinine clearance between 30 and 60 mL/min/1.73 m(2) . Patients receiving a first kidney transplant frequently have a hydration disorder. Transplantation is associated with increased hydration status, which seems to persist if DGF or SGF occurs. © 2011 John Wiley & Sons A/S.

  10. Lactulose efficacy in reduction of nitrogen products, blood potassium and fluid overload in patients with end-stage renal failure

    Directory of Open Access Journals (Sweden)

    Negin Aleagha

    2017-06-01

    Full Text Available Introduction: Chronic kidney disease (CKD is a major public health problem that often goes unrecognized until its late-stage. Patients with chronic kidney disease face uremic toxins and hyperkalemia. Also, fluid overload in CKD patients is associated with rapid decline in kidney function. Lactulose is a hyperosmotic agent and as a prebiotic, it plays an important role in regulating serum urea and potassium levels and has some effects on fluid overload. The aim of this study was to evaluate the effect of lactulose on serum levels of biochemical products in patients with CKD. Materials and Methods: In this interventional study, 17 patients with end stage of CKD ( 76.47 % men; mean age 65.88 ± 13.4 were evaluated.All patients received lactulose, 10 ml, 3 times per day for 3 months. Blood samples from all participants were collected before and at the end of intervention to examine changes in biochemical parameters, including potassium, urea, creatinine and uric acid. Results: Lactulose significantly decreased urea levels (p=0.001, blood potassium (0.001 and fluid overload(considering the patient’s weight p=0.001 in patients with end-stage renal failure. The decrease in serum creatinine and uric acid were not significant. Conclusion: Lactulose administration in CKD patients could decrease levels of various deleterious elements, especially urea and blood potassium and its daily use can be recommended in these patients.

  11. Improved survival with renal transplantation for end-stage renal disease due to granulomatosis with polyangiitis: data from the United States Renal Data System.

    Science.gov (United States)

    Wallace, Zachary S; Wallwork, Rachel; Zhang, Yuqing; Lu, Na; Cortazar, Frank; Niles, John L; Heher, Eliot; Stone, John H; Choi, Hyon K

    2018-05-14

    Renal transplantation is the optimal treatment for selected patients with end-stage renal disease (ESRD). However, the survival benefit of renal transplantation among patients with ESRD attributed to granulomatosis with polyangiitis (GPA) is unknown. We identified patients from the United States Renal Data System with ESRD due to GPA (ESRD-GPA) between 1995 and 2014. We restricted our analysis to waitlisted subjects to evaluate the impact of transplantation on mortality. We followed patients until death or the end of follow-up. We compared the relative risk (RR) of all-cause and cause-specific mortality in patients who received a transplant versus non-transplanted patients using a pooled logistic regression model with transplantation as a time-varying exposure. During the study period, 1525 patients were waitlisted and 946 received a renal transplant. Receiving a renal transplant was associated with a 70% reduction in the risk of all-cause mortality in multivariable-adjusted analyses (RR=0.30, 95% CI 0.25 to 0.37), largely attributed to a 90% reduction in the risk of death due to cardiovascular disease (CVD) (RR=0.10, 95% 0.06-0.16). Renal transplantation is associated with a significant decrease in all-cause mortality among patients with ESRD attributed to GPA, largely due to a decrease in the risk of death to CVD. Prompt referral for transplantation is critical to optimise outcomes for this patient population. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. Risk of Infective Endocarditis in Patients with End Stage Renal Disease

    DEFF Research Database (Denmark)

    Chaudry, Mavish S; Carlson, Nicholas; Gislason, Gunnar H

    2017-01-01

    BACKGROUND AND OBJECTIVES: Endocarditis is a serious complication in patients treated with RRT. The study aimed to examine incidence and risk factors of endocarditis in patients with ESRD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The Danish National Registry on Regular Dialysis...... and Transplantation contains data on all Danish patients receiving renal replacement (hemodialysis, peritoneal dialysis, or kidney transplantation) for ESRD. Incidence of endocarditis was estimated for each RRT modality. Independent risk factors of endocarditis were identified in multivariable Cox regression models....... RESULTS: From January 1st, 1996 to December 31st, 2012, 10,612 patients (mean age 63 years, 36% female) initiated RRT (7233 hemodialysis, 3056 peritoneal dialysis, 323 pre-emptive kidney transplantation). Endocarditis developed in 267 (2.5%); of these 31 (12%) underwent valve surgery. The overall...

  13. Hemodialysis knowledge and medical adherence in African Americans diagnosed with end stage renal disease: results of an educational intervention.

    Science.gov (United States)

    Wells, Janie R

    2011-01-01

    The purpose of this three-group quasi-experimental research study was to describe the relationship between hemodialysis knowledge and perceived medical adherence to a prescribed treatment regimen in African Americans diagnosed with end stage renal disease and to determine if an educational intervention improved hemodialysis knowledge and medical adherence. Eighty-five African Americans participated in this study using the Life Options Hemodialysis Knowledge Test and the Medical Outcomes Study Measures of Patient Adherence tools. No significant correlation was found between hemodialysis knowledge and medical adherence. Paired sample t-tests revealed significantly higher hemodialysis knowledge scores in the post-test group compared to the pre-test group, t(26) = -3.79, p adherence. This study suggests that more education is needed to improve the knowledge level of African-American patients on hemodialysis.

  14. Spontaneous Retroperitoneal Hematoma Simulating Ruptured Infrarenal Aortic Aneurysm in a Patient with End-Stage Renal Disease

    Science.gov (United States)

    Li, JYY; Chan, YC; Qing, KX; Cheng, SW

    2014-01-01

    We reported a case of spontaneous retroperitoneal hematoma (SRH) simulating a ruptured infrarenal aortic aneurysm. A 72-year-old man with a history of infrarenal aortic aneurysm and end-stage renal disease on hemodialysis presented with malaise and nonspecific central abdominal pain and left loin discomfort. An emergency computed tomography scan showed a large retroperitoneal hematoma and clinical suspicion of ruptured infrarenal aortic aneurysm. However, the hematoma was discontinuous with the aneurysm sac and raised the clinical suspicion on dual pathology. The SRH was treated conservatively with transfusion of blood products, and the aneurysm was treated with nonemergency endovascular repair electively. This case demonstrates the importance of recognizing different clinical and radiological characteristics and be aware of dual pathology. PMID:28031651

  15. Influence of maintained hemodialysis on viral load in patients with end-stage renal disease with HBV infection

    Directory of Open Access Journals (Sweden)

    ZHANG Huifang

    2017-07-01

    Full Text Available In the patients with end-stage renal disease (ESRD with hepatitis B virus (HBV infection who underwent hemodialysis, the viral load of HBV DNA is relatively low and stable. For this phenomenon, some studies suggest that hemodialysis can reduce the HBV DNA load. The mechanism, which remains unclear, may be as follows: when HBV DNA enters the dialysate through the dialysis membrane, it was adsorbed onto the dialysis membrane; some virus particles were destroyed, and antiviral substances were produced in the course of hemodialysis. At present, there is no consensus on the mechanism responsible for the influence of maintained hemodialysis on the viral load of HBV DNA. This article reviews the factors involved in the influence of maintained hemodialysis on the viral load in ESRD patients with HBV infection and the recent progress.

  16. Waiting for a kidney transplant: the experience of patients with end-stage renal disease in South Korea.

    Science.gov (United States)

    Chong, Hye Jin; Kim, Hyun Kyung; Kim, Sung Reul; Lee, Sik

    2016-04-01

    To explore the experiences of Korean patients with end-stage renal disease awaiting kidney transplantation. The need for kidney transplantation has increased worldwide, while the number of kidney donors has not increased commensurately. This mismatch is a serious issue in South Korea. Prolonged waits for transplantation may cause physical and psychosocial issues and lead to poor outcomes. Nevertheless, the experience of waiting for kidney transplantation in South Korea has never been explored in depth. A qualitative descriptive design was used. The participants were eight patients diagnosed with end-stage renal disease on the waiting list for kidney transplantation in South Korea. Data were collected through individual in-depth interviews. All conversations during interviews were recorded and transcribed verbatim. Transcribed data were analysed using conventional content analysis. The experience of waiting for kidney transplantation consisted of six categories: (1) the light at the end of the tunnel, (2) being on call without any promise, (3) a tough tug of war between excitement and frustration, (4) doubts in the complexity, (5) A companion on the hard journey and (6) getting ready for D-day. Kidney transplantation candidates experience psychosocial difficulties and concerns while waiting for long periods of time without any assurance of resolution. Systematic education and psychosocial support from health care professionals and family members help patients get through what they describe as a difficult journey. Comprehensive management programs for kidney transplantation candidates are needed. Health care professionals need to recognise the psychosocial concerns of patients awaiting kidney transplantation. Clinicians should provide patients with information and support throughout the waiting period. © 2016 John Wiley & Sons Ltd.

  17. The importance of accurate measurement of aortic stiffness in patients with chronic kidney disease and end-stage renal disease.

    Science.gov (United States)

    Adenwalla, Sherna F; Graham-Brown, Matthew P M; Leone, Francesca M T; Burton, James O; McCann, Gerry P

    2017-08-01

    Cardiovascular (CV) disease is the leading cause of death in chronic kidney disease (CKD) and end-stage renal disease (ESRD). A key driver in this pathology is increased aortic stiffness, which is a strong, independent predictor of CV mortality in this population. Aortic stiffening is a potentially modifiable biomarker of CV dysfunction and in risk stratification for patients with CKD and ESRD. Previous work has suggested that therapeutic modification of aortic stiffness may ameliorate CV mortality. Nevertheless, future clinical implementation relies on the ability to accurately and reliably quantify stiffness in renal disease. Pulse wave velocity (PWV) is an indirect measure of stiffness and is the accepted standard for non-invasive assessment of aortic stiffness. It has typically been measured using techniques such as applanation tonometry, which is easy to use but hindered by issues such as the inability to visualize the aorta. Advances in cardiac magnetic resonance imaging now allow direct measurement of stiffness, using aortic distensibility, in addition to PWV. These techniques allow measurement of aortic stiffness locally and are obtainable as part of a comprehensive, multiparametric CV assessment. The evidence cannot yet provide a definitive answer regarding which technique or parameter can be considered superior. This review discusses the advantages and limitations of non-invasive methods that have been used to assess aortic stiffness, the key studies that have assessed aortic stiffness in patients with renal disease and why these tools should be standardized for use in clinical trial work.

  18. Cemento-Ossifying Fibroma in a Patient with End-Stage Renal Disease

    Directory of Open Access Journals (Sweden)

    Divya Gopinath

    2013-01-01

    Full Text Available The presence of chronic renal disease (CRD is a predisposing factor for the occurrence of soft and hard tissue lesions in the oral cavity. The cemento-ossifying fibroma (COF is an uncommon benign fibroosseous lesion composed of fibrocellular component and calcified materials like cementum and woven bone. A 37-year-old female patient undergoing chronic haemodialysis reported to our institution with a complaint of slow growing, nontender swelling of mandible of 6-month duration. Computed tomography disclosed an ill-defined lesion showing thinning and expansion of buccal as well as lingual cortical plate with flecks of radiopacity in centre. Incision biopsy revealed histological characteristics consistent with cemento-ossifying fibroma. The lesion was excised under local anesthesia. The histopathological examination revealed irregularly shaped bone and cementum-like hard tissue calcifications contained within hypercellular fibrous tissue stroma, leading to a confirmation of the diagnosis of cemento-ossifying fibroma. This paper aims to provide light to the fact that the soft and hard tissues of the oral region may become susceptible to the development of pathological growths in case of some particular systemic conditions.

  19. Hepatitis C virus Genotypes in Patients with End-Stage Renal Disease in East Azerbaijan, Iran

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    Somi Mohammad

    2008-01-01

    Full Text Available Information about the genotypes and associated risk factors in hepatitis C virus (HCV infected patients in Iran is limited. The aim of this study was to identify the HCV genotypes and associated risk factors in a group of HCV infected patients on dialysis therapy in Iran. The sera of 753 patients with chronic renal failure from fifteen dialysis units in East Azerbaijan Province were screened for anti-HCV antibodies as well as HCV RNA; viral RNA was extracted for the genotype specific primer approach. Patients were questioned concerning documented risk factors. Genotyping analysis was performed in 55 patients with positive anti-HCV and HCV-RNA. Genotypes 1 and 3 were found in 46 (83.7% and three (5.5% patients, respectively. The most frequent HCV subtype was 1a (76.4%, followed by 3a and 1b and 1b (5.5% each while one patient was infected with both 1a and 1b. There was no statistically significant difference between the risk factors analyzed and the acqui-sition of HCV infection. This study gives added evidence of the predominant HCV genotypes in Iran, which is different than reports from other Arab countries and similar with the pattern of genotype in both Europe and United States.

  20. Cemento-ossifying fibroma in a patient with end-stage renal disease.

    Science.gov (United States)

    Gopinath, Divya; Beena, V T; Sugirtharaj, G; Vidhyadharan, K; Salmanul Faris, K; Kumar, Sajai J

    2013-01-01

    The presence of chronic renal disease (CRD) is a predisposing factor for the occurrence of soft and hard tissue lesions in the oral cavity. The cemento-ossifying fibroma (COF) is an uncommon benign fibroosseous lesion composed of fibrocellular component and calcified materials like cementum and woven bone. A 37-year-old female patient undergoing chronic haemodialysis reported to our institution with a complaint of slow growing, nontender swelling of mandible of 6-month duration. Computed tomography disclosed an ill-defined lesion showing thinning and expansion of buccal as well as lingual cortical plate with flecks of radiopacity in centre. Incision biopsy revealed histological characteristics consistent with cemento-ossifying fibroma. The lesion was excised under local anesthesia. The histopathological examination revealed irregularly shaped bone and cementum-like hard tissue calcifications contained within hypercellular fibrous tissue stroma, leading to a confirmation of the diagnosis of cemento-ossifying fibroma. This paper aims to provide light to the fact that the soft and hard tissues of the oral region may become susceptible to the development of pathological growths in case of some particular systemic conditions.

  1. Emergent Start Peritoneal Dialysis for End-Stage Renal Disease: Outcomes and Advantages.

    Science.gov (United States)

    Nayak, K Shivanand; Subhramanyam, Sreepada V; Pavankumar, Navva; Antony, Sinoj; Sarfaraz Khan, M A

    2018-01-01

    Initiating renal replacement therapy in late referred patients with central venous catheter (CVC) hemodialysis (HD) causes serious complications. In urgent start peritoneal dialysis, initiating peritoneal dialysis (PD) within 14 days of catheter insertion still needs HD with CVC. We initiated Emergent start PD (ESPD) with Automated PD (APD) at our center within 48 h from the time of presentation. A prospective, case-controlled, intention-to-treat study with 56 patients was conducted between March 2016 and August 2017. Group A (24 patients) underwent conventional PD 14 days after catheter insertion. Group B (32 patients), underwent ESPD with APD. Exit site leak (ESL), catheter blockage, and peritonitis at 90 days were primary outcomes. Technique survival was secondary outcome. Baseline characteristics were similar with 3 episodes of ESLs (9.4%) in the study group and none in the control group (p = 0.123). Catheter blockage (16.7%-Group A, 25%-Group B) and peritonitis (none vs. 9.4% in study group) were similar in terms of statistical details just as technique survival (95%-Group A, 88.2%-Group B at 90 days). ESPD with APD in the unplanned patient is an appropriate approach. © 2018 S. Karger AG, Basel.

  2. Lessons from 30 years’ data of Korean end-stage renal disease registry, 1985–2015

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    Dong-Chan Jin

    2015-09-01

    Hemodialysis patients, especially diabetics and elderly patients have increased in number very rapidly during recent years in Korea. The Korean prevalence rate of ESRD patients was about 70% of the United States and about 50% of Japan according to the international comparisons in the annual data report of United States Renal Data System. The blood pressure control, anemia control, and dialysis adequacy have continuously improved year by year. The importance of calcium and phosphorus control has also been increasing because of the increase in long-term dialysis patients. In addition, chronic dialysis complications should be closely monitored and dialysis modifications, such as hemodiafiltration therapy, might be considered. Because of the increase of private clinics and nursing hospitals in dialysis practice, the role of dialysis specialists and continuing education are thought to be essential. For strict cost-effective dialysis control of increasing elderly, diabetic, and long-term dialysis patients, the KSN ESRD patient registration should be run by the KSN and health ministry in cooperation, in which the dialysis fee reimbursement should be accompanied.

  3. 'Known unknowns - examining the burden of neurocognitive impairment in the end-stage renal failure population'.

    Science.gov (United States)

    Wilson, Scott; Dhar, Arup; Tregaskis, Peter; Lambert, Gavin; Barton, David; Walker, Rowan

    2018-01-18

    The burden of neurocognitive impairment (NCI) in patients receiving maintenance dialysis represents a spectrum of deficits across multiple cognitive domains which are associated with hospitalisation, reduced quality-of-life, mortality and forced decision-making around dialysis withdrawal. Point prevalence data suggests that dialysis patients manifest NCI at rates 3-5 fold higher than the general population with executive function the most commonly affected cognitive domain. The unique physiology of the renal failure state and maintenance dialysis appears to drive an excess of vascular dementia subtype compared to the general population where classical Alzheimer's disease predominates. Despite the absence of evidence based cost-effective therapies for NCI, detecting it in this population creates opportunity to proactively personalise care through education, supported decision making and targeted communication strategies to cover specific areas of deficit and help define goals of care. This review discusses NCI in the dialysis setting, including developments in the definition of neurocognitive impairment, dialysis-specific epidemiology across modalities, screening strategies and opportunities for dialysis providers in this space. This article is protected by copyright. All rights reserved.

  4. Alterations of erythrocyte rheology and cellular susceptibility in end stage renal disease: Effects of peritoneal dialysis.

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    Nesrin Zeynep Ertan

    Full Text Available In this study, we investigated the effects of peritoneal dialysis on hemorheological and hematological parameters and their relations with oxidant and antioxidant status of uremic patients. Hemorheological parameters (erythrocyte deformability, erythrocyte aggregation, osmotic deformability, blood and plasma viscosity were measured in patients with renal insufficiency undergoing peritoneal dialysis (PD and volunteers. Erythrocyte deformability, osmotic deformability and aggregation in both autologous plasma and 3% dextran 70 were measured by laser diffraction ektacytometry. Enzyme activities of glutathione peroxidase, superoxide dismutase and catalase were studied in erythrocytes; lipid peroxidation was studied by measuring the amount of malondialdehyde in both erythrocytes and plasma samples. Blood viscosity at native hematocrit was significantly lower in PD patients at all measured shear rates compared to controls, but it was high in PD patients at corrected (45% hematocrit. Erythrocyte deformability did not show any difference between the two groups. Osmotic deformability was significantly lower in PD patients compared to controls. Aggregation index values were significantly high in PD patients in plasma Catalase and glutathione peroxidase activities in erythrocytes were decreased in PD patients whereas superoxide dismutase activity was increased compared to controls. Malondialdehyde was significantly increased in erythrocytes and plasma samples of PD patients which also shows correlations with aggregation parameters. It has been concluded that erythrocytes in PD patients are more prone to aggregation and this tendency could be influenced by lipid peroxidation activity in patient's plasma. These results imply that uremic conditions, loss of plasma proteins and an increased risk of oxidative stress because of decreasing levels of antioxidant enzymes affect erythrocyte rheology during peritoneal dialysis. This level of distortion may have

  5. Pesticide exposure and end-stage renal disease risk among wives of pesticide applicators in the Agricultural Health Study.

    Science.gov (United States)

    Lebov, Jill F; Engel, Lawrence S; Richardson, David; Hogan, Susan L; Sandler, Dale P; Hoppin, Jane A

    2015-11-01

    Pesticide exposure has been found to cause renal damage and dysfunction in experimental studies, but epidemiological research on the renal effects of chronic low-level pesticide exposure is limited. We investigated the relationships between end-stage renal disease (ESRD) among wives of licensed pesticide applicators (N=31,142) in the Agricultural Health Study (AHS) and (1) personal pesticide use, (2) exposure to the husband's pesticide use, and (3) other pesticide-associated farming and household activities. AHS participants reported pesticide exposure via self-administered questionnaires at enrollment (1993-1997). ESRD cases were identified via linkage to the United States Renal Data System. Associations between ESRD and pesticide exposures were estimated with Cox proportional hazard regression models controlling for age at enrollment. Models of associations with farming and household factors were additionally adjusted for personal use of pesticides. We identified 98 ESRD cases diagnosed between enrollment and 31 December 2011. Although women who ever applied pesticides (56% of cohort) were less likely than those who did not apply to develop ESRD (Hazard Ratio (HR): 0.42; 95% CI: 0.28, 0.64), among women who did apply pesticides, the rate of ESRD was significantly elevated among those who reported the highest (vs. lowest) cumulative general pesticide use (HR: 4.22; 95% CI: 1.26, 14.20). Among wives who never applied pesticides, ESRD was associated with husbands' ever use of paraquat (HR=1.99; 95% CI: 1.14, 3.47) and butylate (HR=1.71; 95% CI: 1.00, 2.95), with a positive exposure-response pattern for husband's cumulative use of these pesticides. ESRD may be associated with direct and/or indirect exposure to pesticides among farm women. Future studies should evaluate indirect exposure risk among other rural populations. Published by Elsevier Inc.

  6. Pesticide exposure and end-stage renal disease risk among wives of pesticide applicators in the Agricultural Health Study✩

    Science.gov (United States)

    Lebov, Jill F.; Engel, Lawrence S.; Richardson, David; Hogan, Susan L.; Sandler, Dale P.; Hoppin, Jane A.

    2015-01-01

    Background Pesticide exposure has been found to cause renal damage and dysfunction in experimental studies, but epidemiological research on the renal effects of chronic low-level pesticide exposure is limited. We investigated the relationships between end-stage renal disease (ESRD) among wives of licensed pesticide applicators (N = 31,142) in the Agricultural Health Study (AHS) and (1) personal pesticide use, (2) exposure to the husband's pesticide use, and (3) other pesticide-associated farming and household activities. Methods AHS participants reported pesticide exposure via self-administered questionnaires at enrollment (1993–1997). ESRD cases were identified via linkage to the United States Renal Data System. Associations between ESRD and pesticide exposures were estimated with Cox proportional hazard regression models controlling for age at enrollment. Models of associations with farming and household factors were additionally adjusted for personal use of pesticides. Results We identified 98 ESRD cases diagnosed between enrollment and 31 December 2011. Although women who ever applied pesticides (56% of cohort) were less likely than those who did not apply to develop ESRD (Hazard Ratio (HR): 0.42; 95% CI: 0.28, 0.64), among women who did apply pesticides, the rate of ESRD was significantly elevated among those who reported the highest (vs. lowest) cumulative general pesticide use (HR: 4.22; 95% CI: 1.26, 14.20). Among wives who never applied pesticides, ESRD was associated with husbands' ever use of paraquat (HR = 1.99; 95% CI: 1.14, 3.47) and butylate (HR = 1.71; 95% CI: 1.00, 2.95), with a positive exposure–response pattern for husband’s cumulative use of these pesticides. Conclusions ESRD may be associated with direct and/or indirect exposure to pesticides among farm women. Future studies should evaluate indirect exposure risk among other rural populations. PMID:26505650

  7. The role of sociodemographic factors in health - related quality of life of patients with end stage renal disease

    Directory of Open Access Journals (Sweden)

    Paraskevi Theofilou

    2011-01-01

    Full Text Available Background: Renal failure is a chronic disease that can have serious effects on patients’ quality of life (QoL.Objective: Gender, age, education and marital status were investigated in end-stage renal disease patients. Specifically, the relationship of QoL and mental health to sociodemographic variables was examined.Methodology: 144 patients in-centre haemodialysis (HD and continuous ambulatory peritoneal dialysis (CAPD were administered the World Health Organization QoL instrument (WHOQOLBREF, the General Health Questionnaire (GHQ-28, the depression CES-D scale, the State-TraitAnxiety Inventory (STAI and the Multidimensional Health Locus of Control scale (MHLC.Results: Female patients reported lower scores in the psychological and environmental QoL domains and higher scores in the Trait Anxiety measure. Elder patients reported higher scores in the GHQ-28 sub-scale of social dysfunction and in the CES-D depression scale, while less educated patients presented higher scores in the GHQ-28 sub-scales of anxiety/insomnia and severe depression. Divorced/widowed patients presented lower scores in the physical, social and environmental QoL domains and higher scores in the severe depression sub-scale. Regarding health locus of control, females and less educated patients reported higher scores in the attitudinal dimension of chance, while younger patients in the dimension of internal.Conclusions: Findings provide evidence that sociodemographic variables, like being female, older, less educated and divorced/widowed, relate to a more compromised QoL.

  8. Racial and ethnic differences in trends of end-stage renal disease: United States, 1995 to 2005.

    Science.gov (United States)

    Burrows, Nilka Ríos; Li, Yanfeng; Williams, Desmond E

    2008-04-01

    End-stage renal disease (ESRD) disproportionately affects racial/ethnic minority populations in the United States, whereas the prevalence of ESRD risk factors such as diabetes continues to increase. Using data from the US Renal Data System, we examined trends in ESRD incidence, including ESRD caused by diabetes or hypertension. We determined the total number of persons in the United States by race/ethnicity who began treatment during 1995 to 2005 for ESRD and for ESRD with diabetes or hypertension as the primary diagnosis. Incidence rates were calculated by using census data and age-adjusted based on the 2000 US standard population. Joinpoint regression was used to analyze trends. Overall, during 1995 to 2005, the age-adjusted ESRD incidence increased from 260.7 per million to 350.9 per million, but the rate of increase slowed from 1998 to 2005. In the 2000s, compared with the 1990s, the age-adjusted ESRD incidence has continued to increase but at a slower rate among whites and blacks and has decreased significantly among Native Americans, Asians, and Hispanics. The disparity gap in ESRD incidence between minority populations and whites narrowed during 1995 to 2005. Continued interventions to reduce the prevalence of ESRD risk factors are needed to decrease ESRD incidence.

  9. Genetic diversity through human leukocyte antigen typing in end-stage renal disease patients and prospective donors of North India

    Directory of Open Access Journals (Sweden)

    Mohit Chowdhry

    2016-01-01

    Full Text Available As the incidence of end-stage renal disease (ESRD is rapidly increasing, the demand for dialysis and transplantation has dramatically increased, which has led to concerns about the availability and equitable allocation of kidneys for transplantation. The distribution of HLA-A, B and DR alleles in 148 renal transplant recipients and 191 live related prospective donors from 2009 to 2010 were analyzed. Allele frequencies and haplotype frequencies were calculated in recipients and donors. The prospective donors were further analyzed on the basis of their relationship to the patients and according to the sex ratio. A significant female preponderance was noted in the prospective donor population, most of whom were either siblings or parents of the recipients. On the contrary, the recipient population predominantly comprised of males. The most frequent HLA-A, HLA-B, HLA-DRB1 alleles in renal transplant patients were HLA-AFNx0111, AFNx0102, AFNx0101, AFNx0124; HLA-BFNx0135, BFNx0140, BFNx0144, BFNx0115, BFNx0152, and HLA-DRB1FNx0115, DRB1FNx0107, DRB1FNx0113, DRB1FNx0111 respectively. The most frequent HLA-A, HLA-B, HLA-DRB1 alleles in prospective donors were HLA-AFNx0102, AFNx0111, AFNx0133, AFNx0124; HLA-BFNx0135, BFNx0144, BFNx0140, BFNx0115 and HLA-DRB1FNx0115, DRB1FNx0107, DRB1FNx0111, DRB1FNx0113 respectively. AFNx0111-BFNx0135, AFNx0102-DRB1FNx0115, BFNx0140-DRB1FNx0115 were the most common HLA A-B , HLA A-DR, HLA B-DR haplotypes respectively in renal transplant patients, whereas, AFNx0111-BFNx0135, AFNx0111-DRB1FNx0115, BFNx0144-DRB1FNx0107 were the most common haplotypes in renal donors. In three locus haplotype, HLA-AFNx0102-BFNx0140-DRB1FNx0115 was the most frequent haplotype in patients, whereas, in prospective renal donors HLA-AFNx0133-BFNx0144-DRB1FNx0107 was the most frequent haplotype.

  10. Pesticide use and risk of end-stage renal disease among licensed pesticide applicators in the Agricultural Health Study.

    Science.gov (United States)

    Lebov, Jill F; Engel, Lawrence S; Richardson, David; Hogan, Susan L; Hoppin, Jane A; Sandler, Dale P

    2016-01-01

    Experimental studies suggest a relationship between pesticide exposure and renal impairment, but epidemiological evidence is limited. We evaluated the association between exposure to 39 specific pesticides and end-stage renal disease (ESRD) incidence in the Agricultural Health Study, a prospective cohort study of licensed pesticide applicators in Iowa and North Carolina. Via linkage to the US Renal Data System, we identified 320 ESRD cases diagnosed between enrolment (1993-1997) and December 2011 among 55 580 male licensed pesticide applicators. Participants provided information on use of pesticides via self-administered questionnaires. Lifetime pesticide use was defined as the product of duration and frequency of use and then modified by an intensity factor to account for differences in pesticide application practices. Cox proportional hazards models, adjusted for age and state, were used to estimate associations between ESRD and: (1) ordinal categories of intensity-weighted lifetime use of 39 pesticides, (2) poisoning and high-level pesticide exposures and (3) pesticide exposure resulting in a medical visit or hospitalisation. Positive exposure-response trends were observed for the herbicides alachlor, atrazine, metolachlor, paraquat, and pendimethalin, and the insecticide permethrin. More than one medical visit due to pesticide use (HR=2.13; 95% CI 1.17 to 3.89) and hospitalisation due to pesticide use (HR=3.05; 95% CI 1.67 to 5.58) were significantly associated with ESRD. Our findings support an association between ESRD and chronic exposure to specific pesticides, and suggest pesticide exposures resulting in medical visits may increase the risk of ESRD. Clinicaltrials.gov NCT00352924. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  11. Association of tibia lead and blood lead with end-stage renal disease: A pilot study of African-Americans

    International Nuclear Information System (INIS)

    Muntner, Paul; Menke, Andy; Batuman, Vecihi; Rabito, Felicia A.; He Jiang; Todd, Andrew C.

    2007-01-01

    The association between body lead burden and kidney disease remains controversial. Fifty-five African-American end-stage renal disease (ESRD) cases and 53 age- and sex-matched African-American controls without known renal disease were recruited from Tulane University-affiliated dialysis clinics and out-patient clinics, respectively. Blood lead was measured via atomic absorption spectrophotometry and tibia lead (a measure of body lead) was measured via 109 Cd-based K shell X-ray fluorescence. Median blood lead levels were significantly higher among ESRD cases (6 μg/dL) compared to their control counterparts (3 μg/dL; P<0.001). Although no participants had overt lead poisoning (blood lead ≥25 μg/dL), seven cases but no controls had blood lead levels above 10 μg/dL (P=0.006). The median tibia lead level was 17 micrograms of lead per gram of bone mineral (μg/g) and 13 μg/g among ESRD cases and their control counterparts, respectively (P=0.134). Four ESRD cases (7%), but no controls, had a tibia lead level above 40 μg/g (P=0.115) while a similar proportion of cases and controls had tibia lead between 20 and 39 μg/g (33% and 32%, respectively; P=0.726). After adjustment for potential confounders, the odds ratios of ESRD associated with a tibia lead ≥20 μg/g and each four-fold higher tibia lead (e.g., 5-20 μg/g) were 1.55 (95% CI: 0.55, 4.41) and 1.88 (95% CI: 0.53, 6.68), respectively. These findings support the need for prospective cohort studies of body lead burden and renal disease progression

  12. Association between Low Serum Bicarbonate Concentrations and Cardiovascular Disease in Patients in the End-Stage of Renal Disease

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    Vaia D. Raikou

    2016-11-01

    Full Text Available Background: Metabolic acidosis, a common condition particularly in the end-stage of renal disease patients, results in malnutrition, inflammation and oxidative stress. In this study, we focused on the association between low serum bicarbonate and cardiovascular disease in patients on intermittent dialysis. Methods: We studied 52 on-line-pre-dilution hemodiafiltration (on-l HDF patients, 32 males and 20 females, with a mean age of 58.01 ± 15.4 years old. Metabolic acidosis was determined by serum bicarbonate concentrations less than 22 mmol/L. Residual renal function (RRF was defined by interdialytic urine volume. Kaplan–Meier curves and Cox regression models were performed to predict coronary artery disease (CAD, defined by ejection fraction <50%, or diastolic dysfunction congestive heart failure (CHF and peripheral vascular disease (PVD. Results: Kaplan–Meier analyses showed that a lower or higher than 22 mmol/L serum bicarbonate metabolic acidosis status was significantly associated with both PVD and diastolic dysfunction (log-rank = 5.07, p = 0.02 and log-rank = 5.84, p = 0.01, respectively. A similar prevalence of serum bicarbonate on CAD or CHF by low ejection fraction was not shown. The RRF was associated with PVD event and serum bicarbonate less than 22 mmol/L (log-rank = 5.49, p = 0.01 and log-rank = 3.9, p = 0.04, respectively. Cox regression analysis revealed that serum bicarbonate and RRF were significant risk factors for PVD after adjustment for confounders. Furthermore, RRF adjusted for covariates was shown to be a significant risk factor for diastolic dysfunction. Conclusion: Low serum bicarbonate was associated with peripheral vascular disease and diastolic dysfunction in intermittent dialysis. The residual renal function may impact patients’ outcomes through its relationship with metabolic acidosis status, particularly for peripheral vascular disease manifestation.

  13. End-stage renal disease after occupational lead exposure: 20 years of follow-up.

    Science.gov (United States)

    Evans, Marie; Discacciati, Andrea; Quershi, Abdul Rashid; Åkesson, Agneta; Elinder, Carl-Gustaf

    2017-06-01

    Whether low-level exposure to lead may give rise to chronic kidney disease or end-stage renal disease (ESRD) is debated. In this study, we aimed to specifically investigate if low-level occupational exposure to lead was associated with increased incidence of ESRD. The incidence of starting renal replacement therapy as a result of ESRD was examined in a cohort of10 303 lead-workers who had controlled blood lead concentrations due to a compulsory occupational health surveillance programme in Sweden during the time period 1977-1990. The ESRD incidence (obtained through register-linkage) among the lead-exposed workers was compared with the age, sex and calendar period-adjusted expected incidence based on data from the Swedish renal registry. Dose-response association was evaluated in external (general population) and internal (within the occupational cohort) comparisons by highest achieved blood lead level. There were 30 (0.29%) individuals in the cohort who developed ESRD during the median follow-up period of 26.3 years. The standardised incidence ratio (SIR) for ESRD incidence was 0.79 (95% CI 0.54 to 1.13). Among those who achieved the highest blood lead (>41.4 µg/dL), the SIR was 1.01 (0.44 to 1.99). There was no evidence of a dose-response relationship between the maximum achieved blood lead or the cumulative blood lead exposure and ESRD in external or internal comparisons. This study of workers with documented occupational lead exposures followed for 20 years shows no statistically significant association between lead exposure (following the current occupational recommendations for Sweden) and ESRD. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  14. Factors influencing general practitioner referral of patients developing end-stage renal failure: a standardised case-analysis study.

    LENUS (Irish Health Repository)

    Montgomery, Anthony J

    2006-01-01

    BACKGROUND: To understand why treatment referral rates for ESRF are lower in Ireland than in other European countries, an investigation of factors influencing general practitioner referral of patients developing ESRF was conducted. METHOD: Randomly selected general practitioners (N = 51) were interviewed using 32 standardised written patient scenarios to elicit referral strategies. Main outcome measures: General practitioner referral levels and thresholds for patients developing end-stage renal disease; referral routes (nephrologist vs other physicians); influence of patient age, marital status and co-morbidity on referral. RESULTS: Referral levels varied widely with the full range of cases (0-32; median = 15) referred by different doctors after consideration of first laboratory results. Less than half (44%) of cases were referred to a nephrologist. Patient age (40 vs 70 years), marital status, co-morbidity (none vs rheumatoid arthritis) and general practitioner prior specialist renal training (yes or no) did not influence referral rates. Many patients were not referred to a specialist at creatinine levels of 129 micromol\\/l (47% not referred) or 250 micromol\\/l (45%). While all patients were referred at higher levels (350 and 480 micromol\\/l), referral to a nephrologist decreased in likelihood as scenarios became more complex; 28% at 129 micromol\\/l creatinine; 28% at 250 micromol\\/l; 18% at 350 micromol\\/l and 14% at 480 micromol\\/l. Referral levels and routes were not influenced by general practitioner age, sex or practice location. Most general practitioners had little current contact with chronic renal patients (mean number in practice = 0.7, s.d. = 1.3). CONCLUSION: The very divergent management patterns identified highlight the need for guidance to general practitioners on appropriate management of this serious condition.

  15. Ten-years trends in renal replacement therapy for end-stage renal disease in mainland France: Lessons from the French Renal Epidemiology and Information Network (REIN) registry.

    Science.gov (United States)

    Vigneau, Cécile; Kolko, Anne; Stengel, Bénédicte; Jacquelinet, Christian; Landais, Paul; Rieu, Philippe; Bayat, Sahar; Couchoud, Cécile

    2017-06-01

    The incidence rate of renal replacement therapy (RRT) for end-stage renal disease (ESRD) is decreasing in several countries, but not in France. We studied the RRT trends in mainland France from 2005 to 2014 to understand the reasons for this discrepancy and determine the effects of ESRD management changes. Data were extracted from the French Renal Epidemiology and Information Network registry. Time trends of RRT incidence and prevalence rates, patients' clinical and treatment characteristics were analysed using the Joinpoint regression program and annual percentage changes. Survival within the first year of RRT was analysed using Kaplan-Meier estimates for 4 periods of time. The overall age- and gender-adjusted RRT incidence rate increased from 144 to 159 individuals per million inhabitants (pmi) (+0.8% per year; 95% CI: 0.5-1.2) and the prevalence from 903 to 1141 pmi (+2.4% per year; 95% CI: 2.2-2.7). This increase concerned exclusively ESRD associated with type 2 diabetes (+4.0%; 3.4-4.6) and mostly elderly men. Despite patient aging and increasing comorbidity burden and a persistent 30% rate of emergency dialysis start, the one-year survival rate slightly improved from 82.1% (81.4-82.8) to 83.8% (83.3-84.4). Pre-emptive wait listing for renal transplantation and the percentage of wait-listed patients within one year after dialysis start strongly increased (from 5.6% to 15.5% and from 29% to 39%, respectively). Kidney transplantation and survival significantly improved despite the heavier patient burden. However, the rise in type 2 diabetes-related ESRD and the stable high rate of emergency dialysis start remain major issues. Copyright © 2016 Association Société de néphrologie. Published by Elsevier Masson SAS. All rights reserved.

  16. Clinical characteristics and outcomes of end-stage renal disease patients with self-reported pruritus symptoms

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    Ramakrishnan K

    2013-12-01

    Full Text Available Karthik Ramakrishnan,1 T Christopher Bond,1 Ami Claxton,1 Vipan C Sood,2 Maria Kootsikas,2 Wendy Agnese,2 Scott Sibbel11DaVita Clinical Research, Minneapolis, MN, USA; 2Mitsubishi Tanabe Pharma Corporation, Jersey City, NJ, USAAbstract: One of the most common conditions affecting end-stage renal disease (ESRD patients undergoing hemodialysis (HD is pruritus. Studies report that itchy and dry skin, symptoms of pruritus, affect 40%–90% of ESRD patients. Yet, in clinical practice the condition is often underdiagnosed resulting in inadequate management and an underappreciated impact on patient outcomes. Two retrospective analyses were conducted: a preliminary analysis of ESRD patients with pruritus symptoms (n=73,124 undergoing HD or peritoneal dialysis at a large dialysis provider and a subsequent detailed analysis of a homogenous subset of patients undergoing in-center HD (n=38,315. The goal was to better understand the clinical burden of pruritus as it relates to patient characteristics, quality of life, medication use, and HD compliance. This population is commonly burdened by multiple comorbidities and related polypharmaceutical management; identifying the relationship of pruritus to these ailments can help guide future research and resource allocation. The detailed analysis confirmed trends observed in the preliminary analysis: 30% reported being "moderately" to "extremely bothered" by itchiness. The HD patient population with the highest severity of self-reported pruritus also had a consistent trend in overall increased resource utilization – higher monthly doses of erythropoietin-stimulating agents (53,397.1 to 63,405.4 units and intravenous (IV iron (237.2 to 247.6 units and higher use of IV antibiotics (14.1% to 20.7%, as well as poorer quality-of-life measures (25-point reductions in Burden of Disease Score and Effects on Daily Life subscales of the Kidney Disease Quality of Life-36 survey. These results highlight the need to better

  17. Imaging of Myocardial Fibrosis in Patients with End-Stage Renal Disease: Current Limitations and Future Possibilities

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    M. P. M. Graham-Brown

    2017-01-01

    Full Text Available Cardiovascular disease in patients with end-stage renal disease (ESRD is driven by a different set of processes than in the general population. These processes lead to pathological changes in cardiac structure and function that include the development of left ventricular hypertrophy and left ventricular dilatation and the development of myocardial fibrosis. Reduction in left ventricular hypertrophy has been the established goal of many interventional trials in patients with chronic kidney disease, but a recent systematic review has questioned whether reduction of left ventricular hypertrophy improves cardiovascular mortality as previously thought. The development of novel imaging biomarkers that link to cardiovascular outcomes and that are specific to the disease processes in ESRD is therefore required. Postmortem studies of patients with ESRD on hemodialysis have shown that the extent of myocardial fibrosis is strongly linked to cardiovascular death and accurate imaging of myocardial fibrosis would be an attractive target as an imaging biomarker. In this article we will discuss the current imaging methods available to measure myocardial fibrosis in patients with ESRD, the reliability of the techniques, specific challenges and important limitations in patients with ESRD, and how to further develop the techniques we have so they are sufficiently robust for use in future clinical trials.

  18. New and prevalent patients with end-stage renal disease in Canada. A portrait of the year 2000.

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    Desmeules, M; Schaubel, D; Fenton, S S; Mao, Y

    1995-01-01

    The number of patients initiating treatment for end-stage renal disease (ESRD) has increased dramatically in Canada and other countries. To assist healthcare planners, the prevalence of ESRD in Canada has been projected to the year 2000 using a Markov modelling technique. Significant increases in ESRD are expected in Canada during the next decade, particularly among the elderly and diabetic populations: estimated increases in prevalence rates of ESRD between 1992 and the year 2000 were 78% and 154% for non diabetic and diabetic populations respectively. These expected increases did not differ significantly between the treatment groups, except among patients with diabetes, in whom projected increases in the prevalence of functioning transplant was smaller than for hemodialysis or peritoneal dialysis. Because the current Canadian prevalence rates are lower than those of some other countries, such as the United States and Japan, these expected trends in prevalence appear reasonable, and illustrate the growing healthcare needs of the ESRD population in Canada during the next decade.

  19. Unplanned Start on Peritoneal Dialysis Right after PD Catheter Implantation for Older People with End-Stage Renal Disease.

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    Povlsen, Johan V; Sørensen, Anette Bagger; Ivarsen, Per

    2015-11-01

    Unplanned start on dialysis remains a major problem for the dialysis community worldwide. Late-referred patients with end-stage renal disease (ESRD) and urgent need for dialysis are overrepresented among older people. These patients are particularly likely to be started on in-center hemodialysis (HD), with a temporary vascular access known to be associated with excess mortality and increased risks of potentially lethal complications such as bacteremia and central venous thrombosis or stenosis.The present paper describes in detail our program for unplanned start on automated peritoneal dialysis (APD) right after PD catheter implantation and summarizes our experiences with the program so far. Compared with planned start on PD after at least 2 weeks of break-in between PD catheter implantation and initiation of dialysis, unplanned start may be associated with a slight increased risk of mechanical complications but apparently no detrimental effect on mortality, peritonitis-free survival, or PD technique survival.In our opinion and experience, the risk of serious complications associated with the implantation and immediate use of a PD catheter is less than the risk of complications associated with unplanned start on HD with a temporary central venous catheter (CVC). Unplanned start on APD is a gentle, safe, and feasible alternative to unplanned start on HD with a temporary CVC that is also valid for the late-referred older patient with ESRD and urgent need for dialysis. Copyright © 2015 International Society for Peritoneal Dialysis.

  20. Simultaneous pancreas and kidney transplantation as the standard surgical treatment for diabetes mellitus patients with end-stage renal disease.

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    Chan, C M; Chim, Thomas M Y; Leung, K C; Tong, C H; Wong, T F; Leung, Gilberto K K

    2016-02-01

    To review the outcome following simultaneous pancreas and kidney transplantation in patients with type 1 diabetes mellitus and end-stage renal disease, as well as those with type 2 diabetes mellitus, and to discuss the applicability of this treatment in this locality. A systematic literature review was performed by searching the PubMed and Elsevier databases. The search terms used were "simultaneous pancreas and kidney transplantation", "diabetes", "pancreas transplant" and "SPK". Original and major review articles related to simultaneous pancreas and kidney transplantation were reviewed. Papers published in English after 1985 were included. Clinical outcomes following transplantation were extracted for comparison between different treatment methods. Outcomes of simultaneous pancreas and kidney transplant and other transplantation methods were identified and categorised into patient survival, graft survival, diabetic complications, and quality of life. Patient survivals and graft survivals were also compared. Currently available clinical evidence shows good outcomes for type 1 diabetes mellitus in terms of patient survival, graft survival, diabetic complications, and quality of life. For type 2 diabetes mellitus, the efficacy and application of the procedure remain controversial but the outcomes are possibly comparable with those in type 1 diabetes mellitus. Simultaneous pancreas and kidney transplantation is a technically demanding procedure that is associated with significant complications, and it should be regarded as a 'last resort' treatment in patients whose diabetic complications have become life-threatening or severely burdensome despite best efforts in maintaining good diabetic control through lifestyle modifications and medications.

  1. Research cardiac magnetic resonance imaging in end stage renal disease - incidence, significance and implications of unexpected incidental findings

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    Rutherford, Elaine; Weir-McCall, Jonathan R.; Houston, J.G.; Struthers, Allan D. [Ninewells Hospital, Division of Cardiovascular and Diabetes Medicine, Dundee (United Kingdom); Patel, Rajan K.; Jardine, Alan G.; Mark, Patrick B. [Institute of Cardiovascular and Medical Sciences, Glasgow (United Kingdom); Roditi, Giles [NHS Greater Glasgow and Clyde, Department of Radiology, Glasgow Royal Infirmary, Glasgow (United Kingdom)

    2017-01-15

    Left ventricular mass (LVM) at cardiac magnetic resonance imaging (CMR) is a frequent end point in clinical trials in nephrology. Trial participants with end stage renal disease (ESRD) may have a greater frequency of incidental findings (IF). We retrospectively investigated prevalence of IF in previous research CMR and reviewed their subsequent impact on participants. Between 2002 and 2006, 161 ESRD patients underwent CMR in a transplant assessment study. Images were used to assess LV mass and function. In the current study a radiologist reviewed the scans for IF. Review of patient records determined the subsequent clinical significance of IF. There were 150 IF in 95 study participants. Eighty-four (56 %) were new diagnoses. One hundred and two were non-cardiac. Fifteen were suspicious of malignancy. There was a clinically significant IF for 14.9 % of the participants. In six cases earlier identification of an IF may have improved quality of life or survival. Without radiology support clinically important IF may be missed on CMR. Patients undergoing CMR in trials should be counselled about the frequency and implications of IF. Patients with ESRD have a higher prevalence of IF than reported in other populations. Nephrology studies require mechanisms for radiologist reporting and strategies for dealing with IF. (orig.)

  2. The social determinants of health for people with type 1 diabetes that progress to end-stage renal disease.

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    Hill, Kathleen E; Gleadle, Jonathan M; Pulvirenti, Mariastella; McNaughton, Darlene A

    2015-12-01

    Self-management of type 1 diabetes over a lifetime is complex and challenging even in the best of circumstances, and the social environment can be a powerful determinant of health behaviours and outcomes. The aim of this study was to identify how social determinants of health can impact on the capacity of young people to manage their glycaemic control. The findings emerged from a constructivist grounded theory approach through an in-depth examination of life course events that were recounted through qualitative interviews. The rich descriptive detail obtained from this enquiry locates common experiences and the context in which concordance with therapies occurs and health behaviours develop. This qualitative study of young people with type 1 diabetes who have developed end-stage renal disease demonstrates that there are many factors beyond individual control that can contribute to health outcomes. The social determinants of childhood environment, education, socio-economic status, gender and the culture of public health can contribute to disengagement from treatment regimens and the health-care system and to the development of microvascular complications at a comparatively young age. These findings challenge the assumptions of health-care practitioners about individual responsibility and highlight the importance of considering how social determinants can shape lives, behaviours and health. © 2014 John Wiley & Sons Ltd.

  3. Barriers to Advance Care Planning in End-Stage Renal Disease: Who is to Blame, and What Can be Done?

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    Kelley, Alan Taylor; Turner, Jeffrey; Doolittle, Benjamin

    2018-07-01

    Patients with end-stage renal disease experience significant mortality and morbidity, including cognitive decline. Advance care planning has been emphasized as a responsibility and priority of physicians caring for patients with chronic kidney disease in order to align with patient values before decision-making capacity is lost and to avoid suffering. This emphasis has proven ineffective, as illustrated in the case of a patient treated in our hospital. Is this ineffectiveness a consequence of failure in the courtroom or the clinic? Through our own experience we affirm what has been written before: that legal precedent favors intensive treatment in virtually all cases without 'clear and convincing evidence' of a patient's previously declared wishes to the contrary. Equally clear is that more than 20 years of support in the clinical literature suggesting advance care planning early in the course of disease can address challenges in the legal system for those lacking capacity. However, many physicians fail to recognize the need for advance care planning in a timely manner and lack the necessary training to provide it. The need for more training and new tools to recognize opportunities for advance care planning in daily practice remains unmet.

  4. Clinical Results of Arteriovenous Fistulas Constructed Using Autologous Vessels in End-Stage Renal Disease Patients on Hemodialysis

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    Ki Tae Kim

    2018-04-01

    Full Text Available Background: For hemodialysis patients with end-stage renal disease (ESRD, it is important to construct an efficient vascular access with a superior patency rate. This study investigated the factors influencing the efficiency of arteriovenous fistulas (AVFs constructed using an autologous vessel and evaluated the necessity of ultrasonography as a preoperative tool for AVF construction. Methods: A retrospective analysis was performed of 250 patients in whom an AVF was constructed using an autologous vessel due to ESRD at our institution from January 2009 to April 2016. Results: The 1-, 3-, and 5-year patency rates for all subjects were 87.6%, 85.6%, and 84.4%, respectively. The patients who underwent a preoperative evaluation of their vessels via ultrasonography had better patency rates than those who did not. Superior patency rates were found in patients under 65 years of age or with an anastomotic vein diameter of 3 mm or more. The 1-year patency rate and the diameter of the anastomotic vein showed a positive relationship. Conclusion: Ultrasonography is strongly recommended for AVF construction, and efforts should be made to increase the patency rate in patients over 65. Superior clinical results can be expected when an AVF is made using an autologous vessel with an anastomotic vein diameter of at least 3 mm.

  5. Spatial Disassociation of Disrupted Functional Connectivity for the Default Mode Network in Patients with End-Stage Renal Disease.

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    Xiaofen Ma

    Full Text Available To investigate the aberrant functional connectivity of the default mode network (DMN in patients with end-stage renal disease (ESRD and their clinical relevance.Resting-state functional MRI data were collected from 31 patients with ESRD (24 men, 24-61 years and 31 age- and gender-matched healthy controls (HCs, 21 men, 26-61years. A whole-brain seed-based functional connectivity analysis of these collected R-fMRI data was performed by locating the seeds in the posterior cingulate cortex (PCC and ventromedial prefrontal cortex (vmPFC to investigate the functional connectivity of the posterior and anterior DMN over the whole brain, respectively.Compared to the HCs, the patients exhibited significantly decreased functional connectivity with the PCC in the left middle temporal gyrus, the right anterior cingulate gyrus, and the bilateral medial superior frontal gyrus. For the vmPFC seed, only the right thalamus showed significantly decreased functional connectivity in the patients with ESRD compared to HCs. Interestingly, functional connectivity between the PCC and right medial superior frontal gyrus exhibited a significantly positive correlation with the hemoglobin level in the patients.Our findings suggest a spatially specific disruption of functional connectivity in the DMN in patients with ESRD, thereby providing novel insights into our understanding of the neurophysiology mechanism that underlies the disease.

  6. Associations of mitochondrial haplogroups and mitochondrial DNA copy numbers with end-stage renal disease in a Han population.

    Science.gov (United States)

    Zhang, Yuheng; Zhao, Ying; Wen, Shuzhen; Yan, Rengna; Yang, Qinglan; Chen, Huimei

    2017-09-01

    Mitochondrial DNA (mtDNA) is closely related to mitochondrion function, and variations have been suggested to be involved in pathogenesis of complex diseases. The present study sought to elucidate mitochondrial haplogroups and mtDNA copy number in end-stage renal disease (ESRD) in a Han population. First, the mitochondrial haplogroups of 37 ESRD patients were clustered into several haplogroups, and haplogroup A & D were taken as the candidate risk haplogroups for ESRD. Second, the frequencies of A and D were assessed in 344 ESRD patients and 438 healthy controls, respectively. Haplogroup D was found to be risk maker for ESRD in young subjects (numbers were evaluated with quantitative-PCR. The ESRD patients exhibited greater cell-free mtDNA contents than the healthy controls but less intracellular mtDNA. Haplogroup D exhibited a further increase in cell-free mtDNA content and a decrease in intracellular mtDNA content among the ESRDs patients. Our findings suggest that mtNDA haplogroup D may contributes to pathogenesis of early-onset ESRD through alterations of mtDNA copy numbers.

  7. An exploration of the relationship between fatigue and physical functioning in patients with end stage renal disease receiving haemodialysis.

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    O'Sullivan, Dawn; McCarthy, Geraldine

    2007-11-01

    To measure fatigue and physical functioning in patients with end stage renal disease (ESRD) receiving haemodialysis and to investigate the relationships between fatigue and physical functioning. Fatigue and reduced physical functioning are among the most bothersome symptoms experienced by individuals receiving haemodialysis for ESRD. Research has shown that increasing activity levels has resulted in decreased fatigue levels and improved physical functioning in individuals with cancer. Establishing whether or not a relationship exists between both concepts in haemodialysis patients is a preliminary step in identifying potential fatigue reducing strategies necessary for improved wellbeing. A quantitative exploratory correlational design was used with 46 individuals completing the Multi-dimensional Fatigue Inventory, the Medical Outcomes Study Short-Form 36-item questionnaire and a Demographic Questionnaire. Results indicated fatigue was prevalent with highest scores achieved for physical fatigue; reduced activity and general fatigue. Substantial limitations in physical functioning were found. A significant moderate negative relationship between general fatigue and physical functioning indicated that, as physical functioning levels increased, fatigue levels decreased. A significant difference was also found between general fatigue scores for males and females. Significant relationships were found between overall physical functioning, older age and employment status. The research indicates the prevalence of fatigue and limitations in physical functioning in individuals with ESRD. However, as physical functioning increased fatigue decreased; a finding relevant to clinical nursing. Understanding the levels of fatigue and the value of exercise is of relevance to clinical practice thus assessment of fatigue and physical functioning ability in the clinical setting is necessary.

  8. The effect of regular hemodialysis on the nutritional status of children with end-stage renal disease

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    Hala M Lotfy

    2015-01-01

    Full Text Available Growth failure is one of the most common and profound clinical manifestation of chronic kidney disease (CKD in infants, children and adolescents. The aim of this study was to assess the nutritional status of Egyptian children with end-stage renal disease (ESRD on regular hemodialysis (HD. The study included 50 Egyptian children with ESRD on regular HD, following-up at the Pediatric Nephrology unit, Cairo University. History, including dietary history, was taken for all patients and clinical examination was performed on all of them. Body weight, standing height, height or length SD score, the skin fold thickness, mid-arm circumference, mid-arm muscle circumference and mid-arm muscle circumference area were also assessed. The height of the patients was the most affected anthropometric parameter, as 78% of the patients were shorter (height SDS below -3. Body weight is less affected than height, as body weight SDS of 34% of patients was less than -3 SDS. In addition, the body mass index of 16% of the patients was 97 th percentile. Although most ESRD patients received adequate protein and caloric intake, their growth was markedly affected, especially with longer period on HD. We suggest that assessment of growth parameters should be performed at a minimum period of every six months in children with CKD stages 2-3. For children with more advanced CKD (stages 4-5 and 5D, more frequent evaluation may be warranted due to the greater risk of abnormalities.

  9. Identification of impeding factors for dry weight achievement in end-stage renal disease after appropriate kidney graft function.

    Science.gov (United States)

    Rivera-González, Sonia Catalina; Pérez-Grovas, Héctor; Madero, Magdalena; Mora-Bravo, Franklin; Saavedra, Nadia; López-Rodriguez, Javier; Lerma, Claudia

    2014-02-01

    The aim of this study was to evaluate the factors that prevent dry weight achievement in patients with end-stage renal disease (ESRD) in renal replacement therapy through the change in their body weight after kidney transplant (KT) compared with 1 week before KT. The study included 188 ESRD patients of diverse etiology who received living kidney transplantation with normal immediate graft function, 62.2% were male, age 29 ± 11 years old. All patients were on renal replacement therapy for at least 1 month before KT with either hemodiafiltration (N = 106), hemodialysis (N = 25), or peritoneal dialysis (N = 57). Based on body weight difference (after transplant-before transplant), patients with body weight difference ≤2 kg were considered as being close to their dry weight (Group 1, N = 112), whereas patients with body weight difference >2 kg were considered as being overhydrated (Group 2, N = 76). Clinical and biochemical characteristics were obtained from the medical records at three periods of time: time of ESRD initiation (baseline), 1 week before undergoing KT, and 1 week after KT. The mean time (± standard deviation) from renal replacement therapy initiation to the week before KT was 9.2 ± 5 months. Group 2 had a higher proportion of men, antihypertensive use, peritoneal dialysis, and higher urine output during all periods. Before KT, Group 2 had higher systolic and diastolic blood pressures than Group 1. After KT, both systolic and diastolic blood pressures decreased in Group 2, whereas no change occurred in Group 1. Before KT, Group 2 had higher levels of blood urea nitrogen, creatinine, uric acid, and phosphorous compared with Group 1. Compared with baseline, Group 1 had more optimal blood urea nitrogen, creatinine, and uric acid parameters before KT than Group 2. After KT, all parameters improved with respect to baseline in both groups. Hemoglobin, albumin, and sodium were similar between groups, except for higher

  10. Trends in incidence of end-stage renal disease among persons with diagnosed diabetes--Puerto Rico, 1996-2010.

    Science.gov (United States)

    Burrows, Nilka Rios; Hora, Israel; Williams, Desmond E; Geiss, Linda S

    2014-03-07

    During 2010, approximately 6,091 persons aged ≥18 years in Puerto Rico were living with end-stage renal disease (ESRD) (i.e., kidney failure that requires regular dialysis or kidney transplantation for survival). This included 1,462 persons who began treatment for ESRD in 2010. Diabetes is the leading cause of ESRD in Puerto Rico, accounting for 66% of new cases in adults, followed by hypertension, which accounts for 15% of the cases. Although the number of adults initiating ESRD treatment (i.e., dialysis or kidney transplantation) in Puerto Rico each year who have diabetes listed as a primary cause (ESRD-D) has increased since 1996, ESRD-D incidence among adults with diagnosed diabetes has not shown a consistent trend. To assess recent trends in ESRD-D incidence among adults aged ≥18 years in Puerto Rico with diagnosed diabetes and to further examine trends by age group and sex, CDC analyzed 1996-2010 data from the U.S. Renal Data System (USRDS) and the Behavioral Risk Factor Surveillance System (BRFSS). After increasing in the late 1990s, ESRD-D incidence decreased during the 2000s among adult men and among persons aged 18-44 years with diagnosed diabetes in Puerto Rico. Throughout the period, ESRD-D incidence among adult women and among persons aged 45-64 and ≥75 years with diagnosed diabetes did not show a consistent trend, and ESRD-D incidence among persons aged 65-74 years with diagnosed diabetes increased. Increased awareness of the risk factors for kidney disease and implementation of effective interventions to prevent or delay kidney disease among persons with diagnosed diabetes might decrease ESRD incidence in Puerto Rico, particularly among women and older persons.

  11. Pre-End-Stage Renal Disease Care and Early Survival among Incident Dialysis Patients in the US Military Health System.

    Science.gov (United States)

    Nee, Robert; Fisher, Evan; Yuan, Christina M; Agodoa, Lawrence Y; Abbott, Kevin C

    2017-01-01

    Previous reports showed an increased early mortality after chronic dialysis initiation among the end-stage renal disease (ESRD) population. We hypothesized that ESRD patients in the Military Health System (MHS) would have greater access to pre-ESRD care and hence better survival rates during this early high-risk period. In this retrospective cohort study, using the US Renal Data System database, we identified 1,256,640 patients initiated on chronic dialysis from January 2, 2004 through December 31, 2014, from which a bootstrap sample of 3,984 non-MHS incident dialysis patients were compared with 996 MHS patients. We assessed care by a nephrologist and dietitian, erythropoietin administration, and vascular access use at dialysis initiation as well as all-cause mortality as outcome variables. MHS patients were significantly more likely to have had pre-ESRD nephrology care (adjusted OR [aOR] 2.9; 95% CI 2.3-3.7) and arteriovenous fistula used at dialysis initiation (aOR 2.2; 95% CI 1.7-2.7). Crude mortality rates peaked between the 4th and the 8th week for both cohorts but were reduced among MHS patients. The baseline adjusted Cox model showed significantly lower death rates among MHS vs. non-MHS patients at 6, 9, and 12 months. This survival advantage among MHS patients was attenuated after further adjustment for pre-ESRD nephrology care and dialysis vascular access. MHS patients had improved survival within the first 12 months compared to the general ESRD population, which may be explained in part by differences in pre-ESRD nephrology care and vascular access types. © 2017 S. Karger AG, Basel.

  12. Effectiveness of a nutrition education program for the prevention and treatment of malnutrition in end-stage renal disease.

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    Hernández Morante, Juan José; Sánchez-Villazala, Almudena; Cutillas, Ruben Cañavate; Fuentes, Mari Carmen Conesa

    2014-01-01

    In end-stage renal disease (ESRD) patients, malnutrition is mainly addressed from a pharmacological but not educational point of view. Therefore, the objective of this study was to implement a nutritional education program (NEP) and to evaluate and compare its effectiveness in the treatment and prevention of malnutrition with oral supplementation (OS)-the standard treatment in these patients. This study was a longitudinal, 4-month prospective study. The study was conducted from January to May 2012 in the Hemodialysis Fresenius Medical Care Clinic of Murcia. One hundred twenty patients with ESRD undergoing hemodialysis were randomly assigned to a NEP or to OS. Patients assigned to the NEP group followed an educational program for 4 months that aimed to improve general nutritional knowledge and included culinary recommendations and an elaboration of balanced menus. The OS group received a nutritional supplement during the hemodialysis procedure. The main outcome measure was certain biochemical markers of nutritional and metabolic status. Nutrition knowledge was also evaluated. After 4 months of intervention, nutritional knowledge was increased in all patients (P values, and other biochemical parameters improved significantly in both groups (P < .050 in all cases), although other parameters such as C-reactive protein were impaired only in the NEP group. The NEP was at least as effective as OS for preventing and even treating malnutrition in patients with chronic renal failure on hemodialysis, improving their nutritional status, which may result in a long-term decrease in the mortality and morbidity of these patients. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  13. Association of CD30 transcripts with Th1 responses and proinflammatory cytokines in patients with end-stage renal disease.

    Science.gov (United States)

    Velásquez, Sonia Y; Opelz, Gerhard; Rojas, Mauricio; Süsal, Caner; Alvarez, Cristiam M

    2016-05-01

    High serum sCD30 levels are associated with inflammatory disorders and poor outcome in renal transplantation. The contribution to these phenomena of transcripts and proteins related to CD30-activation and -cleavage is unknown. We assessed in peripheral blood of end-stage renal disease patients (ESRDP) transcripts of CD30-activation proteins CD30 and CD30L, CD30-cleavage proteins ADAM10 and ADAM17, and Th1- and Th2-type immunity-related factors t-bet and GATA3. Additionally, we evaluated the same transcripts and release of sCD30 and 32 cytokines after allogeneic and polyclonal T-cell activation. In peripheral blood, ESRDP showed increased levels of t-bet and GATA3 transcripts compared to healthy controls (HC) (both PCD30, CD30L, ADAM10 and ADAM17 transcripts were similar. Polyclonal and allogeneic stimulation induced higher levels of CD30 transcripts in ESRDP than in HC (both PsCD30, the Th-1 cytokine IFN-γ, MIP-1α, RANTES, sIL-2Rα, MIP-1β, TNF-β, MDC, GM-CSF and IL-5, and another one consisting of CD30 and t-bet transcripts, IL-13 and proinflammatory proteins IP-10, IL-8, IL-1Rα and MCP-1. Reflecting an activated immune state, ESRDP exhibited after allostimulation upregulation of CD30 transcripts in T cells, which was associated with Th1 and proinflammatory responses. Copyright © 2016 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.

  14. Outcomes of rationing dialysis therapy in biopsy-proven end-stage renal disease in South Africa.

    Science.gov (United States)

    Okpechi, Ikechi G; Swanepoel, Charles R; Rayner, Brian L

    2012-01-01

    Due to poverty, many countries of sub-Saharan Africa suffer a severe burden of end-stage renal disease (ESRD), the cause of which is often unidentified. We sought to identify biopsy-proven causes of ESRD in Cape Town, South Africa, and to determine the outcome of these patients. Records of biopsies reported as ESRD over a 10-year period were selected for analysis. The demographic, clinical and biochemical characteristics of the patients at the time of biopsy were documented. The decision of the committee that assesses the eligibility of patients for long-term renal replacement therapy (RRT) was documented, and if a patient was not accepted the reasons for the rejection were noted. Chronic glomerulonephritis (CGN) was the most frequent cause of ESRD (31.2%); human immunodeficiency virus-associated nephropathy (HIVAN) accounted for 12.5% of ESRD cases. Sixty-six patients (45.8%) were never reviewed by the assessment committee for placement in the dialysis program. Of the remaining 78 patients (54.2%) reviewed for RRT, only 48/78 (61.5%) were selected. A higher frequency of patients with HIVAN were not accepted for RRT (17.7%) than patients with HIVAN who were accepted (2.1%) (p=0.008). Social factors such as lack of housing, alcohol abuse, illicit drug abuse, lack of transportation and lack of family/social support accounted for 56.7% of patients not being accepted for RRT. There needs to be a development of programs amongst Africans to provide effective solutions that tackle the burden of ESRD, especially related to the increasing prevalence of HIVAN.

  15. Quality of Life, Perceptions, and Health Satisfaction of Older Adults with End-Stage Renal Disease: A Systematic Review.

    Science.gov (United States)

    Balogun, Seki A; Balogun, Rasheed; Philbrick, John; Abdel-Rahman, Emaad

    2017-04-01

    To explore the quality of life (QOL), perceptions, and health satisfaction of older adults with end-stage renal disease (ESRD) undergoing renal replacement therapy (RRT). Systematic review of literature. Individuals with ESRD undergoing RRT aged 65 and older. Articles identified from PubMed database search from January 1994 to December 2014. The methodological quality of each of the selected articles was assessed using eight standards adapted from well-established research quality review criteria. Of the initial 1,401 articles identified, 23 met the inclusion criteria. The age range of study participants examined was 65 to 90. Seventy-eight percent of the studies met six or more of the methodological standards; 47% found overall health-related and mental component summary QOL scores in elderly adults with ESRD to be similar to or higher than those of age-matched controls or younger individuals, although the physical component summary QOL scores tended to be lower in older adults. Only six studies addressed health satisfaction and perceptions of elderly adults with ESRD, with widely variable findings. Few studies specifically examine QOL in elderly adults with ESRD undergoing RRT and even fewer address issues of perceptions and health satisfaction. However, the limited data from the QOL studies looks promising with a significant proportion showing similar or higher overall health-related and mental component summary QOL scores in elderly adults with ESRD. The very limited data on perceptions and health satisfaction of elderly adults with ESRD undergoing RRT makes it difficult to make any generalizable conclusions. Overall, more research is needed to examine these factors in elderly adults with ESRD. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  16. Prevalence of sleep apnea and excessive day time sleepiness in patients with end-stage renal disease on dialysis

    Directory of Open Access Journals (Sweden)

    Hamdan Al-Jahdali

    2012-01-01

    Full Text Available Sleep apnea (SA and excessive daytime sleepiness (EDS are common sleep disorders among patients with end-stage renal disease (ESRD. This cross-sectional study, carried out in two dialysis centers in Saudi Arabia, assessed the prevalence of sleep apnea and sleepiness in Saudi patients with ESRD who are on maintenance dialysis with either peritoneal or hemodialysis. We used questionnaires to assess the prevalence of SA and EDS. The association between sleep apnea, EDS, and other sleep disorders, the underlying causes of renal failure, and other demo-graphic data were also examined. Among 227 enrolled patients, the mean patient age was 55.7 years ΁ 17.2 years; 53.7% were male, and 46.3% were female. The overall prevalence of SA as defined by the Berlin questionnaire (BQ was 37% in males and 34% in females, which was not a statistically significant difference (P = 0.459. Sleep apnea was significantly associated with age, neck size, afternoon and evening hemodialysis shift, obesity, diabetes, and hypertension (P-values, 0.001, 0.029, < 0.0001, < 0.0001, < 0.008, 0.002, and < 0.001, respectively. Sleep apnea was also significantly associated with other sleep disorders such as restless leg syndrome, insomnia, habitual snoring, and EDS (P-values, < 0.001, < 0.001, < 0.001, and < 0.001, respectively. The prevalence of EDS was 44%, and EDS was significantly more prevalent in patients undergoing peritoneal dialysis (P < 0.001; it was also associated with older age, diabetes mellitus, and other sleep disorders. SA and EDS are common in dialysis patients and are significantly associated with other sleep disorders.

  17. Protein-energy wasting and nutritional supplementation in patients with end-stage renal disease on hemodialysis.

    Science.gov (United States)

    Sabatino, A; Regolisti, G; Karupaiah, T; Sahathevan, S; Sadu Singh, B K; Khor, B H; Salhab, N; Karavetian, M; Cupisti, A; Fiaccadori, E

    2017-06-01

    Protein-Energy Wasting (PEW) is the depletion of protein/energy stores observed in the most advanced stages of Chronic Kidney Disease (CKD). PEW is highly prevalent among patients on chronic dialysis, and is associated with adverse clinical outcomes, high morbidity/mortality rates and increased healthcare costs. This narrative review was aimed at exploring the pathophysiology of PEW in end-stage renal disease (ESRD) on hemodialysis. The main aspects of nutritional status evaluation, intervention and monitoring in this clinical setting were described, as well as the current approaches for the prevention and treatment of ESRD-related PEW. An exhaustive literature search was performed, in order to identify the relevant studies describing the epidemiology, pathogenesis, nutritional intervention and outcome of PEW in ESRD on hemodialysis. The pathogenesis of PEW is multifactorial. Loss of appetite, reduced intake of nutrients and altered lean body mass anabolism/catabolism play a key role. Nutritional approach to PEW should be based on a careful and periodic assessment of nutritional status and on timely dietary counseling. When protein and energy intakes are reduced, nutritional supplementation by means of specific oral formulations administered during the hemodialysis session may be the first-step intervention, and represents a valid nutritional approach to PEW prevention and treatment since it is easy, effective and safe. Omega-3 fatty acids and fibers, now included in commercially available preparations for renal patients, could lend relevant added value to macronutrient supplementation. When oral supplementation fails, intradialytic parenteral nutrition can be implemented in selected patients. Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  18. Etiology and management of dyslipidemia in children with chronic kidney disease and end-stage renal disease.

    Science.gov (United States)

    Khurana, Mona; Silverstein, Douglas M

    2015-12-01

    Lipids are essential components of cell membranes, contributing to cell fuel, myelin formation, subcellular organelle function, and steroid hormone synthesis. Children with chronic kidney disease (CKD) and end-stage renal disease (ESRD) exhibit various co-morbidities, including dyslipidemia. The prevalence of dyslipidemias in children with CKD and ESRD is high, being present in 39-65% of patients. Elevated lipid levels in children without renal disease are a risk factor for cardiovascular disease (CVD), while the risk for CVD in pediatric CKD/ESRD is unclear. The pathogenesis of dyslipidemia in CKD features various factors, including increased levels of triglycerides, triglyceride-rich lipoproteins, apolipoprotein C3 (ApoC-III), decreased levels of cholesterylester transfer protein and high-density lipoproteins, and aberrations in serum very low-density and intermediate-density lipoproteins. If initial risk assessment indicates that a child with advanced CKD has 2 or more co-morbidities for CVD, first-line treatment should consist of non-pharmacologic management such as therapeutic lifestyle changes and dietary counseling. Pharmacologic treatment of dyslipidemia may reduce the incidence of CVD in children with CKD/ESRD, but randomized trials are lacking. Statins are the only class of lipid-lowering drugs currently approved by the U.S. Food and Drug Administration (FDA) for use in the pediatric population. FDA-approved pediatric labeling for these drugs is based on results from placebo-controlled trial results, showing 30-50% reductions in baseline low-density lipoprotein cholesterol. Although statins are generally well tolerated in adults, a spectrum of adverse events has been reported with their use in both the clinical trial and post-marketing settings.

  19. End-Stage Renal Disease After Renal Surgery in Patients with Normal Preoperative Kidney Function: Balancing Surgical Strategy and Individual Disorders at Baseline.

    Science.gov (United States)

    Capitanio, Umberto; Larcher, Alessandro; Terrone, Carlo; Antonelli, Alessandro; Volpe, Alessandro; Fiori, Cristian; Furlan, Maria; Dehò, Federico; Minervini, Andrea; Serni, Sergio; Porpiglia, Francesco; Trevisani, Francesco; Salonia, Andrea; Carini, Marco; Simeone, Claudio; Montorsi, Francesco; Bertini, Roberto

    2016-10-01

    Although nephron-sparing surgery (NSS) has demonstrated benefit in terms of renal function preservation, it is unclear whether NSS might also decrease the risk of end-stage renal disease (ESRD) relative to radical nephrectomy (RN). In the current paper, we aimed to report the rate and the predictors of ESRD after surgery, accounting for detailed individual baseline characteristics and comorbidities. A multi-institutional collaboration among five European tertiary care centers allowed study of 2027 patients with normal preoperative renal function and a clinically localized T1abN0M0 renal mass. Cox regression analyses were used to predict the risk of ESRD (defined as the onset of a postoperative estimated glomerular filtration rate kidney disease. Univariable ESRD rates at 5 and 10 yr of follow-up were virtually equivalent for patients who underwent NSS (1.5% and 2.5%, respectively) versus RN (1.9% and 2.7%, respectively; hazard ratio [HR]: 0.8; 95% confidence interval [CI], 0.4-1.6). However, diabetes, smoking, uncontrolled hypertension, and other comorbidities were consistently more frequent in the NSS group relative to their RN counterparts. After adjusting for detailed baseline individual characteristics, NSS was shown to have an independent protective effect relative to RN (HR: 0.4; 95% CI, 0.2-0.8; p=0.02) at multivariable analyses. After accounting for individual baseline characteristics, such as age, diabetes, uncontrolled hypertension, or other comorbidities, partial nephrectomy independently protects against end-stage renal disease and the consequent need for dialysis relative to radical nephrectomy. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  20. Renal replacement therapy for diabetic end-stage renal disease: Data from 10 registries in Europe (1991-2000)

    NARCIS (Netherlands)

    van Dijk, Paul C. W.; Jager, Kitty J.; Stengel, Bénédicte; Grönhagen-Riska, Carola; Feest, Terry G.; Briggs, J. Douglas

    2005-01-01

    Background. There is concern about the rising prevalence of type 2 diabetes mellitus and of the resultant nephropathy. This study uses data from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry to provide information on the epidemiology and outcome of

  1. Early renin-angiotensin system intervention is more beneficial than late intervention in delaying end-stage renal disease in patients with type 2 diabetes

    DEFF Research Database (Denmark)

    Schievink, B; Kröpelin, T; Mulder, S

    2016-01-01

    AIMS: To develop and validate a model to simulate progression of diabetic kidney disease (DKD) from early onset until end-stage renal disease (ESRD), and to assess the effect of renin-angiotensin system (RAS) intervention in early, intermediate and advanced stages of DKD. METHODS: We used data from...

  2. Validity of the Hospital Anxiety and Depression Scale and the Beck Depression Inventory for use in end-stage renal disease patients

    NARCIS (Netherlands)

    Loosman, W.L.; Siegert, C.E.H.; Korzec, A.; Honig, A.

    2010-01-01

    Objective. To validate the Hospital Anxiety and Depression Scale (HADS) and the Beck Depression Inventory (BDI) for use in patients with end-stage renal disease (ESRD) and to compare the outcome of both screening measures with each other. Design. Cross-sectional and between-subjects design. The

  3. Effect of parathyroidectomy and cinacalcet on quality of life in patients with end-stage renal disease-related hyperparathyroidism : A systematic review

    NARCIS (Netherlands)

    van der Plas, Willemijn Y.; Dulfer, Roderick R.; Engelsman, Anton F.; Vogt, Liffert; de Borst, Martin H.; van Ginhoven, Tessa M.; Kruijff, Schelto

    2017-01-01

    Background. Patients with end-stage renal disease (ESRD) have a decreased quality of life (QoL), which is attributable in part to ESRD-related hyperparathyroidism (HPT). Both cinacalcet and parathyroidectomy (PTx) are treatments for advanced HPT, but their effects on QoL are unclear. We performed a

  4. Lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease. A collaborative meta-analysis of kidney disease population cohorts

    DEFF Research Database (Denmark)

    Astor, Brad C; Matsushita, Kunihiro; Gansevoort, Ron T

    2011-01-01

    We studied here the independent associations of estimated glomerular filtration rate (eGFR) and albuminuria with mortality and end-stage renal disease (ESRD) in individuals with chronic kidney disease (CKD). We performed a collaborative meta-analysis of 13 studies totaling 21,688 patients selected...

  5. Health-related quality of life in patients with pediatric onset of end-stage renal disease: state of the art and recommendations for clinical practice

    NARCIS (Netherlands)

    Tjaden, Lidwien A.; Grootenhuis, Martha A.; Noordzij, Marlies; Groothoff, Jaap W.

    2016-01-01

    Health-related quality of life (HRQoL) is increasingly recognized as a key outcome in both clinical and research settings in the pediatric population with end-stage renal disease (ESRD). This review aims to: (1) summarize the current knowledge on HRQoL and socioprofessional outcomes and (2) provide

  6. Effect of parathyroidectomy and cinacalcet on quality of life in patients with end-stage renal disease-related hyperparathyroidism: a systematic review

    NARCIS (Netherlands)

    van der Plas, Willemijn Y.; Dulfer, Roderick R.; Engelsman, Anton F.; Vogt, Liffert; de Borst, Martin H.; van Ginhoven, Tessa M.; Kruijff, Schelto

    2017-01-01

    Background. Patients with end-stage renal disease (ESRD) have a decreased quality of life (QoL), which is attributable in part to ESRD-related hyperparathyroidism (HPT). Both cinacalcet and parathyroidectomy (PTx) are treatments for advanced HPT, but their effects on QoL are unclear. We performed a

  7. Ego mechanisms of defense are associated with patients’ preference of treatment modality independent of psychological distress in end-stage renal disease

    OpenAIRE

    Thomas Hyphantis; Spiros Katsoudas; Sonia Voudiclari

    2010-01-01

    Thomas Hyphantis1, Spiros Katsoudas2, Sonia Voudiclari31Associate Professor of Psychiatry, Department of Psychiatry, Medical School, University of Ioannina, Ioannina, Greece; 2Nephrologist, Renal Clinic, Hippocration General Hospital, Athens, Greece; 3Department of Nephrology, University of Athens, GreeceAbstract: Several parameters mediate the selection of treatment modality in end-stage renal disease (ESRD). The nephrology community suggests that patient preference should be the prime deter...

  8. Mapping end-stage renal disease (ESRD: spatial variations on small area level in northern France, and association with deprivation.

    Directory of Open Access Journals (Sweden)

    Florent Occelli

    Full Text Available Strong geographic variations in the incidence of end-stage renal disease (ESRD are observed in developed countries. The reasons for these variations are unknown. They may reflect regional inequalities in the population's sociodemographic characteristics, related diseases, or medical practice patterns. In France, at the district level, the highest incidence rates have been found in the Nord-Pas-de-Calais region. This area, with a high population density and homogeneous healthcare provision, represents a geographic situation which is quite suitable for the study, over small areas, of spatial disparities in the incidence of ESRD, together with their correlation with a deprivation index and other risk factors.The Renal Epidemiology and Information Network is a national registry, which lists all ESRD patients in France. All cases included in the Nord-Pas-de-Calais registry between 2005 and 2011 were extracted. Adjusted and smoothed standardized incidence ratio (SIR was calculated for each of the 170 cantons, thanks to a hierarchical Bayesian model. The correlation between ESRD incidence and deprivation was assessed using the quintiles of Townsend index. Relative risk (RR and credible intervals (CI were estimated for each quintile.Significant spatial disparities in ESRD incidence were found within the Nord-Pas-de-Calais region. The sex- and age-adjusted, smoothed SIRs varied from 0.66 to 1.64. Although no correlation is found with diabetic or vascular nephropathy, the smoothed SIRs are correlated with the Townsend index (RR: 1.18, 95% CI [1.00-1.34] for Q2; 1.28, 95% CI [1.11-1.47] for Q3; 1.30, 95% CI [1.14-1.51] for Q4; 1.44, 95% CI [1.32-1.74] for Q5.For the first time at this aggregation level in France, this study reveals significant geographic differences in ESRD incidence. Unlike the time of renal replacement care, deprivation is certainly a determinant in this phenomenon. This association is probably independent of the patients' financial

  9. End-stage renal disease, dialysis, kidney transplantation and their impact on CD4+ -T-cell differentiation.

    Science.gov (United States)

    Schaier, Matthias; Leick, Angele; Uhlmann, Lorenz; Kälble, Florian; Morath, Christian; Eckstein, Volker; Ho, Anthony; Mueller-Tidow, Carsten; Meuer, Stefan; Mahnke, Karsten; Sommerer, Claudia; Zeier, Martin; Steinborn, Andrea

    2018-05-02

    Premature aging of both CD4 + -regulatory- (Tregs) and CD4 + -responder-T-cells (Tresps) in end-stage renal disease (ESRD) patients is expected to affect the success of later kidney transplantation. Both T-cell populations are released from the thymus as inducible co-stimulatory (ICOS + -) and ICOS - -recent thymic emigrant (RTE)-Tregs/Tresps, which differ primarily in their proliferative capacities. In this study, we analysed the effect of ESRD and subsequent renal replacement therapies on the differentiation of ICOS + - and ICOS - -RTE-Tregs/Tresps into ICOS + - or ICOS - -CD31 - -Memory-Tregs/Tresps and examined whether diverging pathways affected the suppressive activity of ICOS + - and ICOS - -Tregs in co-culture with autologous Tresps. Compared to healthy controls, we found an increased differentiation of ICOS + -RTE-Tregs/Tresps and ICOS - -RTE-Tregs via CD31 + -memory-Tregs/Tresps into CD31 - -memory-Tregs/Tresps in ESRD and dialysis patients. In contrast, ICOS - -RTE-Tresps showed an increased differentiation via ICOS - -mature naïve (MN)-Tresps into CD31 - -memory-Tresps. Thereby, the ratio of ICOS + -Tregs/ICOS + -Tresps was not changed, while that of ICOS - -Tregs/ICOS - -Tresps was significantly increased. This differentiation preserved the suppressive activity of both Treg populations in ESRD and partly in dialysis patients. After transplantation, the increased differentiation of ICOS + - and ICOS - -RTE-Tresps proceeded, while that of ICOS + -RTE-Tregs ceased and that of ICOS - -RTE-Tregs switched to an increased differentiation via ICOS - -MN-Tregs. Consequently, the ratios of ICOS + -Tregs/ICOS + -Tresps and of ICOS - -Tregs/ICOS - -Tresps decreased significantly, reducing the suppressive activity of Tregs markedly. Our data reveal that an increased tolerance-inducing differentiation of ICOS + - and ICOS - -Tregs preserves the functional activity of Tregs in ESRD patients, but this cannot be maintained during long-term renal replacement therapy

  10. Effects of hemodialysis on corneal and anterior chamber morphometry and intraocular pressure in patients with end-stage renal disease

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    Mehtap Caglayan

    Full Text Available ABSTRACT Purpose: To evaluate the effects of hemodialysis (HD on corneal and anterior chamber morphometry, as well as intraocular pressure (IOP in patients with end-stage renal disease. Methods: Fifty right eyes were examined 30 minutes before and after HD. IOP was measured with a Goldmann applanation tonometer, and Ehlers' formula was used to calculate the corrected IOP values. The central corneal thickness (CCT, corneal volume (CV, keratometric values, anterior chamber depth (ACD, aqueous depth (AQD, anterior chamber volume (ACV, and anterior chamber angle (ACA in the nasal and temporal quadrants were measured with a Sirius anterior segment analysis system. Blood urea nitrogen levels, body mass, and systolic and diastolic arterial pressure were also measured before and after HD. Results: The mean age was 60.80 ± 13.38 (range: 35-80 years. The mean uncorrected and corrected IOP values decreased from 18.06 ± 3.91 and 18.31 ± 4.83 mmHg to 16.94 ± 3.87 and 16.95 ± 4.74 mmHg after HD, respectively (p=0.011 and p=0.003, respectively. The mean CCT decreased from 536.38 ± 24.73 to 533.18 ± 27.25 µm (p=0.002, and the mean CV decreased from 57.52 ± 3.15 to 55.68 ± 3.55 mm³ (p0.05 for all values. There were no significant correlations between the ocular and systemic parameters (p>0.05 for all correlations. Conclusions: Uncorrected IOP, corrected IOP, CCT, and CV values decreased after HD, whereas the anterior chamber morphometry values remained similar between the measurements performed before and after HD.

  11. Prevalence and severity of pain in adult end-stage renal disease patients on chronic intermittent hemodialysis: a systematic review

    Directory of Open Access Journals (Sweden)

    Brkovic T

    2016-06-01

    Full Text Available Tonci Brkovic,1 Eliana Burilovic,2 Livia Puljak3 1Department of Internal Medicine, Division of Nephrology, 2Department of Psychiatry, University Hospital Split, 3Department of Anatomy, Histology and Embryology, Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia Objectives: Understanding the epidemiology of pain in patients on hemodialysis (HD is crucial for further improvement in managing pain. The aim of this study was to systematically review available evidence on the prevalence and severity of pain in adult end-stage renal disease patients on chronic intermittent HD. Materials and methods: We carried out a systematic review of the literature and developed a comprehensive search strategy based on search terms on pain and HD. We searched the databases MEDLINE, Scopus, PsycINFO, and CINAHL from the earliest date of each database to July 24, 2014. Manuscripts in all languages were taken into consideration. Two authors performed each step independently, and all disagreements were resolved after discussion with the third author. The quality of studies was estimated using the STROBE checklist and Cochrane risk-of-bias tool.Results: We included 52 studies with 6,917 participants. The prevalence of acute and chronic pain in HD patients was up to 82% and 92%, respectively. A considerable number of patients suffered from severe pain. Various locations and causes of pain were described, with most of the studies reporting pain in general, pain related to arteriovenous access, headache, and musculoskeletal pain.Conclusion: The findings of this systematic review indicate high prevalence of pain in HD patients and considerable gaps and limitations in the available evidence. Pain in this population should be recognized as a considerable health concern, and the nephrology community should promote pain management in HD patients as a clinical and research priority to improve patients’ quality of life and pain

  12. Serum hepcidin levels are associated with serum triglycerides and interleukin-6 concentrations in patients with end-stage renal disease.

    Science.gov (United States)

    Samouilidou, Elisabeth; Pantelias, Konstantinos; Petras, Dimitrios; Tsirpanlis, George; Bakirtzi, Joulia; Chatzivasileiou, George; Tzanatos, Helen; Grapsa, Eirini

    2014-06-01

    Hepcidin has emerged as a peptide with a key role in the regulation of iron homeostasis in patients with chronic kidney disease (CKD), having a strong dependence on inflammation. Recent studies reveal that hepcidin may be also associated with the progression of atherosclerosis. This study was performed to analyze the relation of hepcidin to markers of atherosclerosis and inflammation in patients on dialysis. A total of 90 individuals were enrolled. Sixty patients with end-stage renal disease, who were on hemodialysis (HD) (N = 30) and peritoneal dialysis (N = 30) were compared with 30 normal controls (NC). Age, body mass index, time on dialysis, serum lipids, C-reactive protein (CRP) and interleukin-6 (IL-6) were measured and analyzed in correlation with hepcidin concentration. It was found that patients on HD and peritoneal dialysis have significantly higher (P triglycerides (r = 0.401, P = 0.005), HDL-C (r = -0.268, P = 0.048), CRP (r = 0.436, P = 0.0007) and IL-6 (r = 0.569, P triglycerides (β = 0.402, P = 0.041) and IL-6 (β = 0.559, P = 0.006). Moreover, patients with high triglycerides in combination with high IL-6 levels have significantly increased concentrations of hepcidin than those with low triglycerides and low IL-6 levels (P triglycerides and high IL-6 serum concentrations. This probably suggests that hepcidin may play a role to the progression of atherosclerosis and inflammation, but this hypothesis should be further evaluated. © 2013 The Authors. Therapeutic Apheresis and Dialysis © 2013 International Society for Apheresis.

  13. A study of pulmonary function in end-stage renal disease patients on hemodialysis: a cross-sectional study

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    Ashima Sharma

    Full Text Available ABSTRACT BACKGROUND: The aim here was to study acute effects of hemodialysis among end-stage renal disease (ESRD patients. DESIGN AND SETTING: Prospective study in tertiary-level care center. METHODS: Fifty ESRD patients undergoing hemodialysis were studied. Spirometric pulmonary function tests were performed before and after four-hour hemodialysis sessions. RESULTS: The patients’ average age was 45.8 ± 10.0 years; 64% were males and 64% had normal body mass index. Anemia (94% and hypoalbuminemia (72% were common. Diabetes mellitus (68%, hypertension (34% and coronary artery disease (18% were major comorbidities. Forty-five patients (90% had been on hemodialysis for six months to three years. The patients’ pre-dialysis mean forced vital capacity (FVC and forced expiratory volume in 1 second (FEV1 were below normal: 45.8 ± 24.9% and 43.5 ± 25.9% of predicted, respectively. After hemodialysis, these increased significantly, to 51.1 ± 23.4% and 49.3 ± 25.5% of predicted, respectively (P 0.05. The pre-dialysis mean forced expiratory flow 25-75% was 50.1 ± 31% and increased significantly, to 56.3 ± 31.6% of predicted (P < 0.05. The mean peak expiratory flow was below normal (43.8 ± 30.7% and increased significantly, to 49.1 ± 29.9% of predicted (P < 0.05. Males and females showed similar directions of change after hemodialysis. CONCLUSIONS: Pulmonary function abnormalities are common among ESRD patients. Comparison of pre and post-hemodialysis parameters showed significant improvements, but normal predicted values were still not achieved.

  14. Progressive rise in red blood cell distribution width predicts mortality and cardiovascular events in end-stage renal disease patients.

    Science.gov (United States)

    Yoon, Hye Eun; Kim, Sung Jun; Hwang, Hyeon Seok; Chung, Sungjin; Yang, Chul Woo; Shin, Seok Joon

    2015-01-01

    Red blood cell distribution width (RDW) is a robust marker of adverse clinical outcomes in various populations. However, the clinical significance of a progressive rise in RDW is undetermined in end-stage renal disease (ESRD) patients. The purpose of this study was to determine the prognostic importance of a change in RDW in ESRD patients. Three hundred twenty-six incident dialysis patients were retrospectively analyzed. Temporal changes in RDW during 12 months after dialysis initiation were assessed by calculating the coefficients by linear regression. Patients were divided into two groups: an RDW-decreased group who had negative coefficient values (n = 177) and an RDW-increased group who had positive values (n = 149). The associations between rising RDW and mortality and cardiovascular (CV) events were investigated. During a median follow-up of 2.7 years (range, 1.0-7.7 years), 75 deaths (24.0%) and 60 non-fatal CV events (18.4%) occurred. The event-free survival rate for the composite of end-points was lower in the RDW-increased group (P = 0.004). After categorizing patients according to baseline RDW, the event-free survival rate was lowest in patients with a baseline RDW >14.9% and increased RDW, and highest in patients with a baseline RDW ≤14.9% and decreased RDW (P = 0.02). In multivariate analysis, rising RDW was independently associated with the composite of end-points (hazard ratio = 1.75, P = 0.007), whereas the baseline RDW was not. This study shows that a progressive rise in RDW independently predicted mortality and CV events in ESRD patients. Rising RDW could be an additive predictor for adverse CV outcomes ESRD patients.

  15. Interleukin‑1 gene cluster variants in hemodialysis patients with end stage renal disease: An association and meta‑analysis

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    G Tripathi

    2015-01-01

    Full Text Available We evaluated whether polymorphisms in interleukin (IL-1 gene cluster (IL-1 alpha [IL-1A], IL-1 beta [IL-1B], and IL-1 receptor antagonist [IL-1RN] are associated with end stage renal disease (ESRD. A total of 258 ESRD patients and 569 ethnicity matched controls were examined for IL-1 gene cluster. These were genotyped for five single-nucleotide gene polymorphisms in the IL-1A, IL-1B and IL-1RN genes and a variable number of tandem repeats (VNTR in the IL-1RN. The IL-1B − 3953 and IL-1RN + 8006 polymorphism frequencies were significantly different between the two groups. At IL-1B, the T allele of − 3953C/T was increased among ESRD (P = 0.0001. A logistic regression model demonstrated that two repeat (240 base pair [bp] of the IL-1Ra VNTR polymorphism was associated with ESRD (P = 0.0001. The C/C/C/C/C/1 haplotype was more prevalent in ESRD = 0.007. No linkage disequilibrium (LD was observed between six loci of IL-1 gene. We further conducted a meta-analysis of existing studies and found that there is a strong association of IL-1 RN VNTR 86 bp repeat polymorphism with susceptibility to ESRD (odds ratio = 2.04, 95% confidence interval = 1.48-2.82; P = 0.000. IL-1B − 5887, +8006 and the IL-1RN VNTR polymorphisms have been implicated as potential risk factors for ESRD. The meta-analysis showed a strong association of IL-1RN 86 bp VNTR polymorphism with susceptibility to ESRD.

  16. Health-related Quality of Life and Existential Concerns Among Patients with End-stage Renal Disease.

    Science.gov (United States)

    Bele, Samir; Bodhare, Trupti N; Mudgalkar, Nikhil; Saraf, Abhay; Valsangkar, Sameer

    2012-05-01

    Health-Related Quality Of Life (HRQOL) among patients with End-Stage Renal Disease (ESRD) is significantly impacted by virtue of varied disease or treatment-related factors, and its evaluation along with existential concerns is required for providing comprehensive care to the patient. The aim of this study was to describe the various dimensions of HRQOL and existential concerns and to examine the relationship between the two among patients with ESRD. A cross-sectional descriptive study was conducted among 54 patients with ESRD undergoing maintenance hemodialysis in a teaching hospital. A semi-structured questionnaire was used to assess socio-demographic characteristics and existential concerns of the respondents. The HRQOL was evaluated using a standardized scale of Kidney Disease Quality of Life-Short Form (KDQOL-SF™) questionnaire. Data were presented as frequencies, mean ± Standard Deviation (SD) for baseline characteristics and scores. Pearson correlation was used to study the association between various domains of quality of life and existential concerns. Among HRQOL, the worst results obtained were in the domain of burden of kidney disease (33.45 ± 13.53), work status (49.07 ± 24.75), quality of social interaction (62.22 ±11.80), general health (43.06 ± 13.01), and physical functioning (47.50 ± 18.88). Disrupted personal integrity (12.80 ± 2.81) and loss of continuity (5.37 ± 1.17) were most bothersome existential concerns. A co-relational model behaves distinctly eliciting weak to strong association among various domains of HRQOL and existential concerns. Patients with ESRD reported impaired HRQOL in most of the domains. Existential concerns are distinguished as important dimensions of HRQOL. Association between HRQOL and existential concerns showed that these dimensions are distinct, and there is a need for assessing and attending these entities through a multidisciplinary approach to alleviate the suffering and achieving a sense of overall

  17. A comparison of center-based vs. home-based daily hemodialysis for patients with end-stage renal disease.

    Science.gov (United States)

    Kraus, Michael; Burkart, John; Hegeman, Rebecca; Solomon, Richard; Coplon, Norman; Moran, John

    2007-10-01

    Home hemodialysis has been a therapeutic option for almost 4 decades. The complexity of dialysis equipment has been a factor-limiting adoption of this modality. We performed a feasibility study to demonstrate the safety of center-based vs. home-based daily hemodialysis with the NxStage System One portable hemodialysis device. We also performed a retrospective analysis to determine if clinical effects previously associated with short-daily dialysis were also seen using this novel device. We conducted a prospective, 2-treatment, 2-period, open-label, crossover study of in-center hemodialysis vs. home hemodialysis in 32 patients treated at 6 U.S. centers. The 8-week In-Center Phase (6 days/week) was followed by a 2-week transition period and then followed by the 8-week Home Phase (6 days/week). We retrospectively collected data on hemodialysis treatment parameters immediately preceding the study in a subset of patients. Twenty-six out of 32 patients (81%) successfully completed the study. Successful delivery of at least 90% of prescribed fluid volume (primary endpoint) was achieved in 98.5% of treatments in-center and 97.3% at home. Total effluent volume as a percentage of prescribed volume was between 94% and 100% for all study weeks. The composite rate of intradialytic and interdialytic adverse events per 100 treatments was significantly higher for the In-Center Phase (5.30) compared with the Home Phase (2.10; p=0.007). Compared with the period immediately preceding the study, there were reductions in blood pressure, antihypertensive medications, and interdialytic weight gain. Daily home hemodialysis with a small, easy-to-use hemodialysis device is a viable dialysis option for end-stage renal disease patients capable of self/partner-administered dialysis.

  18. Validating a Patient-Reported Comorbidity Measure with Respect to Quality of Life in End-Stage Renal Disease.

    Directory of Open Access Journals (Sweden)

    Maxi Robinski

    Full Text Available Medical record-derived comorbidity measures such as the Charlson Comorbidity Index (CCI do not predict functional limitations or quality of life (QoL in the chronically ill. Although these shortcomings are known since the 1980s, they have been largely ignored by the international literature. Recently, QoL has received growing interest as an end-point of interventional trials in Nephrology. The aim of this study is to compare a patient-reported comorbidity measure and the CCI with respect to its validity regarding QoL.The German Self-Administered Comorbidity Questionnaire (SCQ-G was completed by 780 adult end-stage renal disease-patients recruited from 55 dialysis units throughout Germany. Acceptance was evaluated via response rates. Content validity was examined by comparing the typical comorbidity pattern in dialysis patients and the pattern retrieved from our data. Convergent validity was assessed via kappa statistics. Data was compared to the CCI. Linear associations with QoL were examined (criterion validity.The SCQ-G was very well accepted by dialysis patients of all ages (response rate: 99%. Content validity can be interpreted as high (corresponding comorbidity items: 73.7%. Convergent validity was rather weak (.27≤ρ≤.29 but increased when comparing only concordant items (.39≤ρ≤.43. With respect to criterion validity, the SCQ-G performed better than the CCI regarding the correlation with QoL (e.g., SF-12-physical: SCQ-G total score: ρ = -.49 vs. CCI: ρ = -.36.The patient-reported measure proved to be more valid than the external assessment when aiming at insights on QoL. Due to the inclusion of subjective limitations, the SCQ-G is more substantial with respect to patient-centered outcomes and might be used as additional measure in clinical trials.

  19. Therapeutic Approach to Patients with Heart Failure with Reduced Ejection Fraction and End-stage Renal Disease.

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    Inampudi, Chakradhari; Alvarez, Paulino; Asleh, Rabea; Briasoulis, Alexandros

    2018-03-14

    Several risk factors including Ischemic heart disease, uncontrolled hypertension, high output Heart Failure (HF) from shunting through vascular hemodialysis access, and anemia, contribute to development of HF in patients with End-Stage Renal Disease (ESRD). Guidelinedirected medical and device therapy for Heart Failure with Reduced Ejection Fraction (HFrEF) has not been extensively studied and may have limited safety and efficacy in patients with ESRD. Maintenance of interdialytic and intradialytic euvolemia is a key component of HF management in these patients but often difficult to achieve. Beta-blockers, especially carvedilol which is poorly dialyzed is associated with cardiovascular benefit in this population. Despite paucity of data, Angiotensin-converting Enzyme Inhibitors (ACEI) or Angiotensin II Receptor Blockers (ARBs) when appropriately adjusted by dose and with close monitoring of serum potassium can also be administered to these patients who tolerate beta-blockers. Mineralocorticoid receptors in patients with HFrEF and ESRD have been shown to reduce mortality in a large randomized controlled trial without any significantly increased risk of hyperkalemia. Implantable Cardiac-defibrillators (ICDs) should be considered for primary prevention of sudden cardiac death in patients with HFrEF and ESRD who meet the implant indications. Furthermore in anemic iron-deficient patients, intravenous iron infusion may improve functional status. Finally, mechanical circulatory support with leftventricular assist devices may be related to increased mortality risk and the presence of ESRD poses a relative contraindication to further evaluation of these devices. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  20. Bloodstream infection in patients with end-stage renal disease in a teaching hospital in central-western Brazil

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    Tamara Trelha Gauna

    2013-08-01

    Full Text Available Introduction Vascular access in patients undergoing hemodialysis is considered a critical determinant of bloodstream infection (BSI and is associated with high morbidity and mortality. The purpose of this study was to investigate the occurrence of BSI in patients with end-stage renal disease using central venous catheters for hemodialysis. Methods A cohort study was conducted in a public teaching hospital in central-western Brazil from April 2010 to December 2011. For every patient, we noted the presence of hyperemia/exudation upon catheter insertion, as well as fever, shivering, and chills during hemodialysis. Results Fifty-nine patients were evaluated. Thirty-five (59.3% patients started dialysis due to urgency, 37 (62.7% had BSI, and 12 (20% died. Hyperemia at the catheter insertion site (64.9% was a significant clinical manifestation in patients with BSI. Statistical analysis revealed 1.7 times more cases of BSI in patients with hypoalbuminemia compared with patients with normal albumin levels. The principal infective agents identified in blood cultures and catheter-tip cultures were Staphylococcus species (24 cases, non-fermentative Gram-negative bacilli (7 cases of Stenotrophomonas maltophilia and 5 cases of Chryseobacterium indologenes, and Candida species (6. Among the Staphylococci identified, 77.7% were methicillin-resistant, coagulase-negative Staphylococci. Of the bacteria isolated, the most resistant were Chryseobacterium indologenes and Acinetobacter baumannii. Conclusions Blood culture was demonstrated to be an important diagnostic test and identified over 50% of positive BSI cases. The high frequency of BSI and the isolation of multiresistant bacteria were disturbing findings. Staphylococcus aureus was the most frequently isolated microorganism, although Gram-negative bacteria predominated overall. These results highlight the importance of infection prevention and control measures in dialysis units.

  1. Heparin induces an accumulation of atherogenic lipoproteins during hemodialysis in normolipidemic end-stage renal disease patients.

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    Barbagallo, Carlo M; Noto, Davide; Cefalù, Angelo B; Ganci, Antonia; Giammarresi, Carlo; Panno, Donata; Cusumano, Gaspare; Greco, Massimiliano; Di Gaudio, Francesca; Averna, Maurizio R

    2015-07-01

    Dyslipidemias may account for the excess of cardiovascular mortality in end-stage renal disease (ESRD). Lipoprotein studies in ESRD patients are usually relative to prehemodialysis samples even if significative changes may occur after dialysis. In this study, we aimed to investigate the effects of ESRD on triglyceride-rich lipoproteins (TRL) subpopulations distribution and acute change following hemodialytic procedures, including the relative contribution of heparin administration. We selected a group of normolipidemic male middle-aged ESRD patients free of any concomitant disease affecting lipoprotein remnant metabolism compared with controls. We separated TRL subfractions according to density and apoE content and evaluated the changes of these particles after hemodialytic procedures with or without heparin. ESRD subjects had higher TRL subfractions, with the exception of apoE-rich particles, lower high-density lipoprotein (HDL) largest subclasses, and a smaller low-density lipoprotein peak particle size than controls. After a hemodialytic standard procedure with heparin, we demonstrated a significant reduction of triglyceride, an increase of HDL-cholesterol levels, and a raise of small very-low-density lipoprotein, intermediate-density lipoproteins (IDL), apoE-rich particles, and non-HDL-cholesterol levels. When hemodialysis was performed without heparin, no significant changes were observed. In the absence of concomitant hyperlipidemic triggers, ESRD patients show significant lipoprotein abnormalities before dialysis, but without any increased remnant particles concentrations. We speculate that hemodialysis, in particular heparin administration during this procedure, leads to a massive atherogenic TRLs production because of the acute stimulation of the dysfunctional lipolytic system not followed by an efficient removal, determining a recurrent lipoprotein remnant accumulation. © 2014 International Society for Hemodialysis.

  2. Assessment of resource use and costs associated with parathyroidectomy for secondary hyperparathyroidism in end stage renal disease in the UK.

    Science.gov (United States)

    Pockett, Rhys D; Cevro, Emir; Chamberlain, George; Scott-Coombes, David; Baboolal, Kesh

    2014-03-01

    Secondary hyperparathyroidism (SHPT) is a major complication of end stage renal disease (ESRD). For the National Health Service (NHS) to make appropriate choices between medical and surgical management, it needs to understand the cost implications of each. A recent pilot study suggested that the current NHS healthcare resource group tariff for parathyroidectomy (PTX) (£2071 and £1859 in patients with and without complications, respectively) is not representative of the true costs of surgery in patients with SHPT. This study aims to provide an estimate of healthcare resources used to manage patients and estimate the cost of PTX in a UK tertiary care centre. Resource use was identified by combining data from the Proton renal database and routine hospital data for adults undergoing PTX for SHPT at the University Hospital of Wales, Cardiff, from 2000-2008. Data were supplemented by a questionnaire, completed by clinicians in six centres across the UK. Costs were obtained from NHS reference costs, British National Formulary and published literature. Costs were applied for the pre-surgical, surgical, peri-surgical, and post-surgical periods so as to calculate the total cost associated with PTX. One hundred and twenty-four patients (mean age=51.0 years) were identified in the database and 79 from the questionnaires. The main costs identified in the database were the surgical stay (mean=£4066, SD=£,130), the first month post-discharge (£465, SD=£176), and 3 months prior to surgery (£399, SD=£188); the average total cost was £4932 (SD=£4129). From the questionnaires the total cost was £5459 (SD=£943). It is possible that the study was limited due to missing data within the database, as well as the possibility of recall bias associated with the clinicians completing the questionnaires. This analysis suggests that the costs associated with PTX in SHPT exceed the current NHS tariffs for PTX. The cost implications associated with PTX need to be considered in the

  3. Manifestações cutâneas na doença renal terminal Cutaneous manifestations in end-stage renal disease

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    Omar Lupi

    2011-04-01

    Full Text Available A prevalência da doença renal crônica aumentou nos últimos anos. Os efeitos dessa doença são complexos e podem levar à disfunção de múltiplos órgãos, entre eles, a pele. A maioria dos pacientes apresenta pelo menos uma alteração dermatológica. Algumas vezes, esses sintomas podem ser o primeiro sinal evidente de doença renal. Este artigo aborda as manifestações cutâneas relacionadas a disfunção renal grave ou doença renal terminal, divididas em não específicas e específicas, revisando quadro clínico, etiopatogenia e opções terapêuticas dessas dermatoses. Seu reconhecimento e trata mento precoces diminuem a morbidade, melhorando a qualidade de vida desses doentes.The prevalence of chronic kidney disease has increased over the last years. The effects of this disease are complex and may lead to dysfunction of multiple organs, including the skin, with most patients presenting with at least one dermatologic alteration. Sometimes these symptoms can be the first clear sign of kidney disease. This article discusses the skin manifestations related to severe renal impairment or end-stage renal disease (ESRD, which are divided into nonspecific and specific, and reviews the clinical features, etiopathogenesis and therapeutic options for these dermatoses. Early recognition and treatment reduce morbidity and improve these patients' quality of life.

  4. Relative risks of Chronic Kidney Disease for mortality and End Stage Renal Disease across races is similar

    Science.gov (United States)

    Wen, Chi-Pang; Matsushita, Kunihiro; Coresh, Josef; Iseki, Kunitoshi; Islam, Muhammad; Katz, Ronit; McClellan, William; Peralta, Carmen A; Wang, HaiYan; de Zeeuw, Dick; Astor, Brad C; Gansevoort, Ron T; Levey, Andrew S; Levin, Adeera

    2014-01-01

    Some suggest race-specific cutpoints for kidney measures to define and stage chronic kidney disease (CKD), but evidence for race-specific clinical impact is limited. To address this issue, we compared hazard ratios of estimated glomerular filtration rates (eGFR) and albuminuria across races using meta-regression in 1.1 million adults (75% Asians, 21% whites, and 4% blacks) from 45 cohorts. Results came mainly from 25 general population cohorts comprising 0.9 million individuals. The associations of lower eGFR and higher albuminuria with mortality and end-stage renal disease (ESRD) were largely similar across races. For example, in Asians, whites, and blacks, the adjusted hazard ratios (95% confidence interval) for eGFR 45–59 vs. 90–104 ml/min/1.73m2 were 1.3 (1.2–1.3), 1.1 (1.0–1.2) and 1.3 (1.1–1.7) for all-cause mortality, 1.6 (1.5–1.8), 1.4 (1.2–1.7), and 1.4 (0.7–2.9) for cardiovascular mortality, and 27.6 (11.1–68.7), 11.2 (6.0–20.9), and 4.1 (2.2–7.5) for ESRD, respectively. The corresponding hazard ratios for urine albumin-to-creatinine ratio 30–299 mg/g or dipstick 1-positive vs. an albumin-to-creatinine ratio under 10 or dipstick negative were 1.6 (1.4–1.8), 1.7 (1.5–1.9) and 1.8 (1.7–2.1) for all-cause mortality, 1.7 (1.4–2.0), 1.8 (1.5–2.1), and 2.8 (2.2–3.6) for cardiovascular mortality, and 7.4 (2.0–27.6), 4.0 (2.8–5.9), and 5.6 (3.4–9.2) for ESRD, respectively. Thus, the relative mortality or ESRD risks of lower eGFR and higher albuminuria were largely similar among three major races, supporting similar clinical approach to CKD definition and staging, across races. PMID:24522492

  5. Regional homogeneity changes in hemodialysis patients with end stage renal disease: in vivo resting-state functional MRI study.

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    Cheng Li

    Full Text Available OBJECTIVE: To prospectively investigate and detect early cerebral regional homogeneity (ReHo changes in neurologically asymptomatic patients with end stage renal disease (ESRD using in vivo resting-state functional MR imaging (Rs-fMRI. METHODS: We enrolled 20 patients (15 men, 5 women; meanage, 37.1 years; range, 19-49 years with ESRD and 20 healthy controls (15 men, 5 women; mean age, 38.3 years; range, 28-49 years. The mean duration of hemodialysis for the patient group was 10.7±6.4 monthes. There was no significant sex or age difference between the ESRD and control groups. Rs-fMRI was performed using a gradient-echo echo-planar imaging sequence. ReHo was calculated using software (DPARSF. Voxel-based analysis of the ReHo maps between ESRD and control groups was performed with a two-samples t test. Statistical maps were set at P value less than 0.05 and were corrected for multiple comparisons. The Mini-Mental State Examination (MMSE was administered to all participants at imaging. RESULTS: ReHo values were increased in the bilateral superior temporal gyrus and left medial frontal gyrus in the ERSD group compared with controls, but a significantly decreased ReHo value was found in the right middle temporal gyrus. There was no significant correlation between ReHo values and the duration of hemodialysis in the ESRD group. Both the patients and control subjects had normal MMSE scores (≥28. CONCLUSIONS: Our finding revealed that abnormal brain activity was distributed mainly in the memory and cognition related cotices in patients with ESRD. The abnormal spontaneous neuronal activity in those areas provide information on the neural mechanisms underlying cognitive impairment in patients with ESRD, and demonstrate that Rs-fMRI with ReHo analysis is a useful non-invasive imaging tool for the detection of early cerebral ReHo changes in hemodialysis patients with ESRD.

  6. Serum Vascular Adhesion Protein-1 Predicts End-Stage Renal Disease in Patients with Type 2 Diabetes.

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    Hung-Yuan Li

    Full Text Available Diabetes is the leading cause of end-stage renal disease (ESRD worldwide. Vascular adhesion protein-1 (VAP-1 participates in inflammation and catalyzes the deamination of primary amines into aldehydes, hydrogen peroxide, and ammonia, both of which are involved in the pathogenesis of diabetic complications. We have shown that serum VAP-1 is higher in patients with diabetes and in patients with chronic kidney disease (CKD, and can predict cardiovascular mortality in subjects with diabetes. In this study, we investigated if serum VAP-1 can predict ESRD in diabetic subjects.In this prospective cohort study, a total of 604 type 2 diabetic subjects were enrolled between 1996 to 2003 at National Taiwan University Hospital, Taiwan, and were followed for a median of 12.36 years. The development of ESRD was ascertained by linking our database with the nationally comprehensive Taiwan Society Nephrology registry. Serum VAP-1 concentrations at enrollment were measured by time-resolved immunofluorometric assay.Subjects with serum VAP-1 in the highest tertile had the highest incidence of ESRD (p<0.001. Every 1-SD increase in serum VAP-1 was associated with a hazard ratio of 1.55 (95%CI 1.12-2.14, p<0.01 for the risk of ESRD, adjusted for smoking, history of cardiovascular disease, body mass index, hypertension, HbA1c, duration of diabetes, total cholesterol, use of statins, ankle-brachial index, estimated GFR, and proteinuria. We developed a risk score comprising serum VAP-1, HbA1c, estimated GFR, and proteinuria, which could predict ESRD with good performance (area under the ROC curve = 0.9406, 95%CI 0.8871-0.9941, sensitivity = 77.3%, and specificity = 92.8%. We also developed an algorithm based on the stage of CKD and a risk score including serum VAP-1, which can stratify these subjects into 3 categories with an ESRD risk of 0.101%/year, 0.131%/year, and 2.427%/year, respectively.In conclusion, serum VAP-1 can predict ESRD and is a useful biomarker to

  7. The impact of intervention strategies that target arterial stiffness in end-stage renal disease: a systematic review protocol.

    Science.gov (United States)

    Rodriguez, Rosendo A; Shea, Beverley; Hae, Richard; Burns, Kevin D

    2016-07-19

    Vascular damage contributes to the high cardiovascular morbidity and mortality in end-stage renal disease (ESRD). Increased aortic stiffness measured by carotid-femoral pulse wave velocity (cf-PWV) is a strong and independent predictor of the cardiovascular risk in ESRD patients. Recently, there has been considerable interest in developing strategies to lessen the progression of arterial stiffness in ESRD patients using cf-PWV as a tool to monitor therapeutic responses, but their benefit on the long-term cardiovascular risk is not known. Appraisal of the effects of existing stiffness-based interventions on the cf-PWV would facilitate selecting optimal therapies to be tested in randomized clinical trials. The aim of this systematic review will be to evaluate the impact of arterial stiffness-based interventions on the cf-PWV in ESRD patients. Secondarily, for each intervention, we will determine the minimal duration needed to achieve a significant reduction of cf-PWV, the minimal cf-PWV reduction threshold or effect size, and adverse events. This review will be conducted using MEDLINE, EMBASE, and EBM Reviews. We will select clinical trials and observational studies (cohort, case-control, and before/after studies and case series) that evaluated pharmacologic or non-pharmacologic interventions in which the primary effect is to improve structural and/or dynamic components of arterial stiffness in adults with stage 5 chronic kidney disease. The primary outcome of interest will be cf-PWV. Study selection and data collection will be performed by two reviewers. Validated tools will be used to assess the methodological quality and risk of bias among different study designs. We will describe all included citations according to study characteristics, methodological quality, and outcomes. Suitability for meta-analysis will be determined by the degree of clinical and statistical heterogeneity between studies. If appropriate, we will calculate effect estimates by obtaining the

  8. Health-related quality of life and existential concerns among patients with end-stage renal disease

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    Samir Bele

    2012-01-01

    Full Text Available Background : Health-Related Quality Of Life (HRQOL among patients with End-Stage Renal Disease (ESRD is significantly impacted by virtue of varied disease or treatment-related factors, and its evaluation along with existential concerns is required for providing comprehensive care to the patient. Aim : The aim of this study was to describe the various dimensions of HRQOL and existential concerns and to examine the relationship between the two among patients with ESRD. Materials and Methods : A cross-sectional descriptive study was conducted among 54 patients with ESRD undergoing maintenance hemodialysis in a teaching hospital. A semi-structured questionnaire was used to assess socio-demographic characteristics and existential concerns of the respondents. The HRQOL was evaluated using a standardized scale of Kidney Disease Quality of Life-Short Form (KDQOL-SF™ questionnaire. Data were presented as frequencies, mean ± Standard Deviation (SD for baseline characteristics and scores. Pearson correlation was used to study the association between various domains of quality of life and existential concerns. Results : Among HRQOL, the worst results obtained were in the domain of burden of kidney disease (33.45 ± 13.53, work status (49.07 ± 24.75, quality of social interaction (62.22 ±11.80, general health (43.06 ± 13.01, and physical functioning (47.50 ± 18.88. Disrupted personal integrity (12.80 ± 2.81 and loss of continuity (5.37 ± 1.17 were most bothersome existential concerns. A co-relational model behaves distinctly eliciting weak to strong association among various domains of HRQOL and existential concerns. Conclusion : Patients with ESRD reported impaired HRQOL in most of the domains. Existential concerns are distinguished as important dimensions of HRQOL. Association between HRQOL and existential concerns showed that these dimensions are distinct, and there is a need for assessing and attending these entities through a multidisciplinary

  9. Clinical pharmacy activities in chronic kidney disease and end-stage renal disease patients: a systematic literature review

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    Stemer Gunar

    2011-07-01

    Full Text Available Abstract Background Chronic kidney disease (CKD and end-stage renal disease (ESRD represent worldwide health problems with an epidemic extent. Therefore, attention must be given to the optimisation of patient care, as gaps in the care of CKD and ESRD patients are well documented. As part of a multidisciplinary patient care strategy, clinical pharmacy services have led to improvements in patient care. The purpose of this study was to summarise the available evidence regarding the role and impact of clinical pharmacy services for these patient populations. Methods A literature search was conducted using the Medline, Embase and International Pharmaceutical Abstracts databases to identify relevant studies on the impact of clinical pharmacists on CKD and ESRD patients, regarding disease-oriented and patient-oriented outcomes, and clinical pharmacist interventions on drug-related problems. Results Among a total of 21 studies, only four (19% were controlled trials. The majority of studies were descriptive (67% and before-after studies (14%. Interventions comprised general clinical pharmacy services with a focus on detecting, resolving and preventing drug-related problems, clinical pharmacy services with a focus on disease management, or clinical pharmacy services with a focus on patient education in order to increase medication knowledge. Anaemia was the most common comorbidity managed by clinical pharmacists, and their involvement led to significant improvement in investigated disease-oriented outcomes, for example, haemoglobin levels. Only four of the studies (including three controlled trials presented data on patient-oriented outcomes, for example, quality of life and length of hospitalisation. Studies investigating the number and type of clinical pharmacist interventions and physician acceptance rates reported a mean acceptance rate of 79%. The most common reported drug-related problems were incorrect dosing, the need for additional

  10. End-Stage Renal Disease Outcomes among the Kaiser Permanente Southern California Creatinine Safety Program (Creatinine SureNet): Opportunities to Reflect and Improve.

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    Sim, John J; Batech, Michael; Danforth, Kim N; Rutkowski, Mark P; Jacobsen, Steven J; Kanter, Michael H

    2017-01-01

    The Kaiser Permanente Southern California (KPSC) creatinine safety program (Creatinine SureNet) identifies and outreaches to thousands of people annually who may have had a missed diagnosis for chronic kidney disease (CKD). We sought to determine the value of this outpatient program and evaluate opportunities for improvement. Longitudinal cohort study (February 2010 through December 2015) of KPSC members captured into the creatinine safety program who were characterized using demographics, laboratory results, and different estimations of glomerular filtration rate. Age- and sex-adjusted rates of end-stage renal disease (ESRD) were compared with those in the overall KPSC population. Among 12,394 individuals, 83 (0.7%) reached ESRD. The age- and sex-adjusted relative risk of ESRD was 2.7 times higher compared with the KPSC general population during the same period (94.7 vs 35.4 per 100,000 person-years; p creatinine measurements, only 13% had a urine study performed (32% among patients with confirmed CKD). Our study found a higher incidence of ESRD among individuals captured into the KPSC creatinine safety program. If the Chronic Kidney Disease Epidemiology Collaboration equation were used, fewer people would have been captured while improving the accuracy for diagnosing CKD. Urine testing was low even among patients with confirmed CKD. Our findings demonstrate the importance of a creatinine safety net program in an integrated health system but also suggest opportunities to improve CKD care and screening.

  11. The End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ): testing the psychometric properties in patients receiving in-center hemodialysis.

    OpenAIRE

    Kim, Y; Evangelista, LS; Phillips, LR; Pavlish, C; Kopple, JD

    2010-01-01

    Reported treatment adherence rates of patients with end stage renal disease (ESRD) have been extremely varied due to lack of reliable and valid measurement tools. This study was conducted to develop and test an instrument to measure treatment adherence to hemodialysis (HD) attendance, medications, fluid restrictions, and diet prescription among patients with ESRD. This article describes the methodological approach used to develop and test the psychometric properties (such as reliability and v...

  12. Analysis of Human Bradykinin Receptor Gene and Endothelial Nitric Oxide Synthase Gene Polymorphisms in End-Stage Renal Disease Among Malaysians

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    R. Vasudevan

    2014-06-01

    Full Text Available The aim of this study was to determine the association of the c.894G>T; p.Glu298Asp polymorphism and the variable number tandem repeat (VNTR polymorphism of the endothelial nitric oxide synthase (eNOS gene and c.181C>T polymorphism of the bradykinin type 2 receptor gene (B2R in Malaysian end-stage renal disease (ESRD subjects.

  13. Ego mechanisms of defense are associated with patients? preference of treatment modality independent of psychological distress in end-stage renal disease

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    Hyphantis, Thomas; Katsoudas, Spiros; Voudiclari, Sonia

    2010-01-01

    Several parameters mediate the selection of treatment modality in end-stage renal disease (ESRD). The nephrology community suggests that patient preference should be the prime determinant of modality choice. We aimed to test whether ego mechanisms of defense are associated with patients? treatment modality preferences, independent of psychological distress. In 58 eligible ESRD patients who had themselves chosen their treatment modality, we administered the Symptom Distress Checklist-90-R and ...

  14. Lower Incidence of End-Stage Renal Disease but Suboptimal Pre-Dialysis Renal Care in Schizophrenia: A 14-Year Nationwide Cohort Study.

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    Yueh-Han Hsu

    Full Text Available Schizophrenia is closely associated with cardiovascular risk factors which are consequently attributable to the development of chronic kidney disease and end-stage renal disease (ESRD. However, no study has been conducted to examine ESRD-related epidemiology and quality of care before starting dialysis for patients with schizophrenia. By using nationwide health insurance databases, we identified 54,361 ESRD-free patients with schizophrenia and their age-/gender-matched subjects without schizophrenia for this retrospective cohort study (the schizophrenia cohort. We also identified a cohort of 1,244 adult dialysis patients with and without schizophrenia (1:3 to compare quality of renal care before dialysis and outcomes (the dialysis cohort. Cox proportional hazard models were used to estimate the hazard ratio (HR for dialysis and death. Odds ratio (OR derived from logistic regression models were used to delineate quality of pre-dialysis renal care. Compared to general population, patients with schizophrenia were less likely to develop ESRD (HR = 0.6; 95% CI 0.4-0.8, but had a higher risk for death (HR = 1.2; 95% CI, 1.1-1.3. Patients with schizophrenia at the pre-ESRD stage received suboptimal pre-dialysis renal care; for example, they were less likely to visit nephrologists (OR = 0.6; 95% CI, 0.4-0.8 and received fewer erythropoietin prescriptions (OR = 0.7; 95% CI, 0.6-0.9. But they had a higher risk of hospitalization in the first year after starting dialysis (OR = 1.4; 95% CI, 1.0-1.8, P < .05. Patients with schizophrenia undertaking dialysis had higher risk for mortality than the general ESRD patients. A closer collaboration between psychiatrists and nephrologists or internists to minimize the gaps in quality of general care is recommended.

  15. Thallium stress testing does not predict cardiovascular risk in diabetic patients with end-stage renal disease undergoing cadaveric renal transplantation

    International Nuclear Information System (INIS)

    Holley, J.L.; Fenton, R.A.; Arthur, R.S.

    1991-01-01

    This study assessed the usefulness of thallium stress testing as a predictor of perioperative cardiovascular risk in diabetic patients with end-stage renal disease undergoing cadaveric renal transplantation. Demographic factors influencing the exercise performance in these patients were also examined. The medical records of 189 consecutive patients with diabetic nephropathy who were evaluated for cadaveric renal transplantation were reviewed. Thallium stress testing was the initial examination of cardiovascular status in 141 patients. An adequate examination was one in which at least 70% of maximum heart rate was achieved. A thallium stress test was normal if there were no ST segment depressions on the electrocardiogram and no perfusion abnormalities on the thallium scan. Forty-four patients underwent cardiac catheterization as the initial evaluation (Group C) and four patients underwent transplantation without a formal cardiovascular evaluation (Group D). Sixty-four of the 141 patients undergoing thallium stress testing had an adequate and normal examination (Group A). The incidence of perioperative cardiac events in this group was 2%. Seventy-seven patients (Group B) had an abnormal (n = 41) or an inadequate (n = 36) thallium stress test and most (n = 61) then underwent coronary angiography. The use of beta-blockers was the only predictor of an abnormal or inadequate thallium stress test. Forty-three percent of patients with inadequate or abnormal thallium stress tests had significant coronary artery disease on cardiac catheterization. The perioperative risk of cardiac events was not different in Group A versus Groups B, C, and D combined. Survival of Group A and B patients was not different but was significantly longer than that of Group C patients

  16. Fatal acute pancreatitis associated with reactive AA amyloidosis in rheumatoid arthritis with end-stage renal disease: a report of three cases.

    Science.gov (United States)

    Kuroda, Takeshi; Sato, Hiroe; Hasegawa, Hisashi; Wada, Yoko; Murakami, Shuichi; Saeki, Takako; Nakano, Masaaki; Narita, Ichiei

    2011-01-01

    We report three cases of fatal pancreatitis associated with systemic AA amyloidosis in rheumatoid arthritis (RA). All of the patients showed end-stage renal failure, and hemodialysis was introduced during the course of treatment. Autopsy was performed on two of the three patients, and this revealed amyloid deposition on the vascular walls in the pancreas. It was strongly suggested that the acute pancreatitis in all three patients was attributable to deposition of amyloid in vascular and pancreatic tissues. Acute pancreatitis is considered to be a rare complication of end-stage amyloidosis associated with RA, and is frequently fatal. It is important to treat RA patients intensively to avoid such deposition of amyloid.

  17. Ethnic disparities in risk of cardiovascular disease, end-stage renal disease and all-cause mortality: a prospective study among Asian people with Type 2 diabetes.

    Science.gov (United States)

    Liu, J J; Lim, S C; Yeoh, L Y; Su, C; Tai, B C; Low, S; Fun, S; Tavintharan, S; Chia, K S; Tai, E S; Sum, C F

    2016-03-01

    To study prospectively the ethnic-specific risks of cardiovascular disease, end-stage renal disease and all-cause mortality in patients with Type 2 diabetes mellitus among native Asian subpopulations. A total of 2337 subjects with Type 2 diabetes (70% Chinese, 17% Malay and 13% Asian Indian) were followed for a median of 4.0 years. Time-to-event analysis was used to study the association of ethnicity with adverse outcomes. Age- and gender-adjusted hazard ratios for cardiovascular disease in ethnic Malay and Asian Indian subjects were 2.01 (1.40-2.88; PChinese subjects. Adjustment for conventional cardiovascular disease risk factors, including HbA1c , blood pressure and lipid profile, slightly attenuated the hazards in Malay (1.82, 1.23-2.71; P=0.003) and Asian Indian subjects (1.47, 0.95-2.30; P=0.086); However, further adjustment for baseline renal function (estimated GFR) and albuminuria weakened the cardiovascular disease risks in Malay (1.48, 0.98-2.26; P=0.065) but strengthened that in Asian Indian subjects (1.81, 1.14-2.87; P=0.012). Competing-risk regression showed that the age- and gender-adjusted sub-distribution hazard ratio for end-stage renal disease was 1.87 (1.27-2.73; P=0.001) in Malay and 0.39 (0.18-0.83; P=0.015) in Asian Indian subjects. Notably, the difference in end-stage renal disease risk among the three ethnic groups was abolished after further adjustment for baseline estimated GFR and albuminuria. There was no significant difference in risk of all-cause mortality among the three ethnic groups. Risks of cardiovascular and end-stage renal diseases in native Asian subjects with Type 2 diabetes vary substantially among different ethnic groups. Differences in prevalence of diabetic kidney disease may partially explain the ethnic disparities. © 2015 The Authors. Diabetic Medicine © 2015 Diabetes UK.

  18. Symptom Prevalence and the Negative Emotional States in End-Stage Renal Disease Patients with or without Renal Replacement Therapy: A Cross-Sectional Analysis.

    Science.gov (United States)

    Wan Zukiman, Wan Zul Haikal; Yaakup, Hayati; Zakaria, Nor Fadhlina; Shah, Shamsul Azhar Bin

    2017-10-01

    Limited comparative data are available on the symptom severity and burden of dialyzed versus nondialyzed end-stage renal disease (ESRD) patients and their association with negative emotional states. To investigate the prevalence of symptom burden and severity of ESRD patients and correlate the findings with their psychological status. This was a cross-sectional study of dialyzed (N = 87) and nondialyzed (N = 100) patients. The symptom burden and severity were determined using the Dialysis Symptom Index (DSI) and the psychological assessment using Depression Anxiety Stress Scale 21 (DASS-21). Symptom severity evaluated using the DSI was comparable in both groups with fatigue as the most common symptom (n = 141, 75.4%), followed by sleep-related, sexual dysfunction, and dry skin problems. The symptom burden for worrying, dry skin and mouth, decreased appetite, numbness, and leg swelling were significant in not dialyzed group (p symptom burden regardless of their treatment options (p symptom burden and severity, irrespective of the type of treatment. Psychological disturbances were associated with higher symptom burden and severity and, therefore, should be screened thoroughly to achieve optimal ESRD management.

  19. Porphyria Cutanea Tarda in a Patient with End-Stage Renal Disease: A Case of Successful Treatment with Deferoxamine and Ferric Carboxymaltose

    Directory of Open Access Journals (Sweden)

    Natacha Rodrigues

    2017-01-01

    Full Text Available Porphyria cutanea tarda (PCT is a rare disease, with a strong association with hepatitis C virus. PCT is particularly problematic in end-stage renal disease patients as they have no renal excretion of porphyrins and these are poorly dialyzed. Also, conventional treatment of PCT is compromised in these patients as hydroxychloroquine is contraindicated, phlebotomies with the stipulated frequency are poorly tolerated in already anaemia-prone patients, and iron-chelating agents are less efficient in removing iron and contribute to worsening anaemia. The authors report a patient on haemodialysis, with hepatitis C infection, that is diagnosed with PCT. Despite the good clinical results with deferoxamine, she became dependent on blood transfusions because of her ferropenic state. Every time oxide iron was started, the patient developed clinical features of the disease, resolving after the suspension of the drug. A decision was made to start the patient on ferric carboxymaltose, which was well tolerated without disease symptoms and need of further blood transfusions. This case suggests that deferoxamine is efficient in treatment of porphyria cutanea tarda. Also, ferric carboxymaltose may be a valuable option for refractory anaemia in patients with this disease and end-stage renal disease, as it seems to provide iron without clinical relapse of the disease.

  20. Prognostic value of the six-minute walk test in end-stage renal disease life expectancy: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Leandro de Moraes Kohl

    2012-01-01

    Full Text Available OBJECTIVES: The six-minute walk test has been widely used to evaluate functional capacity and predict mortality in several populations. Thus, the aim of this study was to evaluate the prognostic value of the six-minute walk test for the life expectancy of end-stage renal disease patients. METHODS: Patients over 18 years old who underwent hemodialysis for at least six months were included. Patients with hemodynamic instability, smoking, chronic obstructive pulmonary disease, physical incapacity and acute myocardial stroke in the preceding three months were excluded. RESULTS: Fifty-two patients (54% males; 36+11 years old were followed for 144 months. The distance walked in the six-minute walk test was a survival predictor for end-stage renal disease patients. In the multivariate analysis, for each 100 meters walked with a 100-meter increment, the hazard ratio was 0.53, with a 95% confidence interval of 0.37-0.74. There was a positive correlation between the distance walked in the six-minute walk test and peak oxygen consumption (r = 0.508. In the multivariate analysis, each year of dialysis treatment represented a 10% increase in death probability; in the severity index analysis, each point on the scale represented an 11% increase in the death risk. CONCLUSIONS: We observed that survival increased approximately 5% for every 100 meters walked in the six-minute walk test, demonstrating that the test is a viable option for evaluating the functional capacity in patients with end-stage renal disease.

  1. 76 FR 18930 - Medicare Programs: Changes to the End-Stage Renal Disease Prospective Payment System Transition...

    Science.gov (United States)

    2011-04-06

    ... Payment System Transition Budget-Neutrality Adjustment AGENCY: Centers for Medicare & Medicaid Services... in the CY 2011 ESRD Prospective Payment System (PPS) final rule for renal dialysis services provided...-Stage Renal Disease Prospective Payment System'', hereinafter, referred to as the CY 2011 ESRD PPS final...

  2. Increased risk of dialysis and end-stage renal disease among HIV patients in Denmark compared with the background population

    DEFF Research Database (Denmark)

    Rasch, Magnus G; Helleberg, Marie; Feldt-Rasmussen, Bo

    2014-01-01

    BACKGROUND: HIV patients have increased risk of impaired renal function. We aimed to estimate the incidence of any renal replacement therapy (aRRT) and start of chronic renal replacement therapy (cRRT) among HIV patients compared with population controls. METHODS: In a nationwide, population......-based cohort study we analysed incidence rates (IR), incidence rate ratios (IRR) and risk factors for aRRT and cRRT among HIV patients compared with an age- and gender-matched population control cohort using Poisson regression. RESULTS: We identified 5300 HIV patients and 53 000 population controls. The IRs...

  3. Renal Function and Outcomes With Use of Left Ventricular Assist Device Implantation and Inotropes in End-Stage Heart Failure: A Retrospective Single Center Study.

    Science.gov (United States)

    Verma, Sean; Bassily, Emmanuel; Leighton, Shane; Mhaskar, Rahul; Sunjic, Igor; Martin, Angel; Rihana, Nancy; Jarmi, Tambi; Bassil, Claude

    2017-07-01

    Left ventricular assist device (LVAD) and inotrope therapy serve as a bridge to transplant (BTT) or as destination therapy in patients who are not heart transplant candidates. End-stage heart failure patients often have impaired renal function, and renal outcomes after LVAD therapy versus inotrope therapy have not been evaluated. In this study, 169 patients with continuous flow LVAD therapy and 20 patients with continuous intravenous inotrope therapy were analyzed. The two groups were evaluated at baseline and at 3 and 6 months after LVAD or inotrope therapy was started. The incidence of acute kidney injury (AKI), need for renal replacement therapy (RRT), BTT rate, and mortality for 6 months following LVAD or inotrope therapy were studied. Results between the groups were compared using Mann-Whitney U test and Chi-square with continuity correction or Fischer's exact at the significance level of 0.05. Mean glomerular filtration rate (GFR) was not statistically different between the two groups, with P = 0.471, 0.429, and 0.847 at baseline, 3 and 6 months, respectively. The incidence of AKI, RRT, and BTT was not statistically different. Mortality was less in the inotrope group (P < 0.001). Intravenous inotrope therapy in end-stage heart failure patients is non-inferior for mortality, incidence of AKI, need for RRT, and renal function for 6-month follow-up when compared to LVAD therapy. Further studies are needed to compare the effectiveness of inotropes versus LVAD implantation on renal function and outcomes over a longer time period.

  4. Use of Erythropoietin-Stimulating Agents (ESA) in Patients With End-Stage Renal Failure Decided to Forego Dialysis: Palliative Perspective.

    Science.gov (United States)

    Cheng, Hon Wai Benjamin; Chan, Kwok Ying; Lau, Hoi To; Man, Ching Wah; Cheng, Suk Ching; Lam, Carman

    2017-05-01

    Normochromic normocytic anemia is a common complication in chronic kidney disease (CKD) and is associated with many adverse clinical consequences. Erythropoiesis-stimulating agents (ESAs) act to replace endogenous erythropoietin for patients with end-stage renal disease having anemia. Today, ESAs remain the main tool for treating anemia associated with CKD. In current practice, the use of ESA is not limited to the patients on renal replacement therapy but has extended to nondialysis patients under palliative care (PC). Current evidence on ESA usage in patients with CKD decided to forego dialysis often have to take reference from studies conducted in other groups of patients with CKD, including pre-dialysis patients and those on renal replacement therapy. There is paucity of studies targeting use of ESAs in renal PC patients. Small-scale retrospective study in renal PC patients had suggested clinical advantage of ESAs in terms of hemoglobin improvement, reduction in fatigue, and hospitalization rate. With the expected growth in elderly patients with CKD decided to forego dialysis and manage conservatively, there remains an urgent need to call for large-scale prospective trial in exploring efficacy of ESAs in this population, targeting on quality of life and symptoms improvement outcome. This article also reviews the mechanism of action, pharmacology, adverse effects, and clinical trial evidence for ESA in patients with CKD under renal PC.

  5. Reduced clearance of rocuronium and sugammadex in patients with severe to end-stage renal failure: a pharmacokinetic study.

    NARCIS (Netherlands)

    Staals, L.M.; Snoeck, M.M.J.; Driessen, J.J.; Hamersvelt, H.W. van; Flockton, E.A.; Heuvel, M.W. van den; Hunter, J.M.

    2010-01-01

    BACKGROUND: Sugammadex is a selective relaxant binding agent designed to encapsulate the neuromuscular blocking agent, rocuronium. The sugammadex-rocuronium complex is eliminated by the kidneys. This trial investigated the pharmacokinetics (PKs) of sugammadex and rocuronium in patients with renal

  6. Impact of ventricular assist device placement on longitudinal renal function in children with end-stage heart failure.

    Science.gov (United States)

    May, Lindsay J; Montez-Rath, Maria E; Yeh, Justin; Axelrod, David M; Chen, Sharon; Maeda, Katsuhide; Almond, Christopher S D; Rosenthal, David N; Hollander, Seth A; Sutherland, Scott M

    2016-04-01

    Although ventricular assist devices (VADs) restore hemodynamics in those with heart failure, reversibility of end-organ dysfunction with VAD support is not well characterized. Renal function often improves in adults after VAD placement, but this has not been comprehensively explored in children. Sixty-three children on VAD support were studied. Acute kidney injury (AKI) was defined by Kidney Disease: Improving Global Outcomes criteria. Estimated glomerular filtration rate (eGFR) was determined by the Schwartz method. Generalized linear mixed-effects models compared the pre-VAD and post-VAD eGFR for the cohort and sub-groups with and without pre-VAD renal dysfunction (pre-VAD eGFR renal dysfunction. AKI affected 60.3% (38 of 63), with similar rates in those with and without pre-existing renal dysfunction. Within the cohort, the nadir eGFR occurred 1 day post-operatively (62.9 ml/min/1.73 m(2); IQR, 51.2-88.9 ml/min/1.73 m(2); p renal dysfunction experienced the greatest improvement in the eGFR (β = 0.0051 vs β = 0.0013, p Renal dysfunction is prevalent in children with heart failure undergoing VAD placement. Although peri-operative AKI is common, renal function improves substantially in the first post-operative week and for months thereafter. This is particularly pronounced in those with pre-VAD renal impairment, suggesting that VADs may facilitate recovery and maintenance of kidney function in children with advanced heart failure. Copyright © 2016 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  7. Nutrition and hydration status improve with exercise training using stationary cycling during hemodialysis (HD) in patients with end-stage renal disease (ESRD).

    Science.gov (United States)

    Załuska, Alicja; Załuska, Wojciech T; Bednarek-Skublewska, Anna; Ksiazek, Andrzej

    2002-01-01

    Patients with end-stage renal disease (ESRD) undergoing hemodialysis and peritoneal dialysis are functionally limited as a consequence of their physical, emotional, and social problems. Exercise intolerance is a major problem in chronic renal failure. Stationary cycle training during hemodialysis is recommended as safe, effective, and practical in ESRD patients treated on hemodialysis. The aim of the present study was to evaluate the effect of cycling exercises in 10 HD patients during 6-month period (including each of dialysis sessions) on nutrition, dialysis adequacy, and fluid parameters as measured by biochemical, and bioimpedance parameters. A significant increase in serum albumin concentration, Kt/V, and nPCR, and decrease in serum CRP have been observed after 6 months of regular stationary cycling during hemodialysis. Relative changes (pre-post HD) in extracellular water compartment and ECW/TBW ratio have significantly increased after 6 months of observation period.

  8. End-stage renal disease inthe course ofurinary tract defects inWolf–Hirschhorn syndrome – case report

    Directory of Open Access Journals (Sweden)

    Katarzyna Jungiewicz

    2014-09-01

    Full Text Available Wolf–Hirschhorn syndrome is a complex development disorder containing facial dysmorphy, development retardation, growth impairment, muscular hypotonia and occurrence of paroxysmal disorders. Characteristic dysmorphic features are hypertelorism, oblique eyelids, prominent high forehead, wide nose, short philtrum, micrognathia, low set dysplastic ears and gothic palate, in some cases cleft palate. Those features are described as “Greek warrior helmet”. Dysmorphia can be accompanied by various congenital defects, such as growth impairment, heart defects, coloboma, urogenital and skeletal abnormalities, deafness, and in 20% of patients kidney defects, which could lead in some cases to end of stage renal disease. Observed disorders are resulting from deletion of short arm of 4th chromosome and their severity, clinical outcome and intensity of  development retardation depend on deletion size. In our article we present a  boy with severe case of Wolf–Hirschhorn syndrome accompanied by renal dysplasia of his only kidney, which lead to end of stage renal disease during his infancy. He has been treated with peritoneal dialysis since then. In our patient’s case variety of congenital defects and severe development retardation cause bad clinical outcome and serious prognosis. Patient like that requires multidisciplinary medical care. Decision about initiation of renal replacement therapy in such a patient is still an important ethical dilemma.

  9. Characteristics and outcomes of end-stage renal disease patients with active tuberculosis followed in intensive care units

    International Nuclear Information System (INIS)

    Ulasli, Sevinc Sarinc; Ulubay, Gaye; Arslan, Nevra Gullu; Akcay, Sule; Eyuboglu, Fusun Oner; Sezer, Siren; Haberal, Mehmet

    2009-01-01

    Tuberculosis (TB) remains a common problem in patients with chronic renal failure. In intensive care units, misdiagnosis or delayed diagnosis of TB is common. Therefore, a description of characteristics of active TB in patients with renal failure followed in intensive care units is important to reduce mortality and transmission of the disease. This study was performed to describe the characteristics of patients with renal failure admitted to the intensive care units and having active TB and evaluate predictive factors for in hospital mortality. The hospital records of 24 patients (11 women, 13 men) having ESRD and TB between 2001-2006 were reviewed. Clinical, radiological, and laboratory data on admission were recorded. Possible parameters contributing to in-hospital mortality were obtained from the medical records. In-hospital mortality rate was 66.6%. Factors associated with mortality were decreased partial pressure of oxygen and malnutrition. Fever was reported in 8 patients and hemoptysis was reported in 3 patients. Eight patients had consolidation on chest radiograph, while 4 had normal findings Seventeen patients had pulmonary involvement, and 11 had extra pulmonary involvement. The mortality rate in TB patients followed in intensive care units is high, with 3 factors contributing to in-hospital mortality. Clinicians should consider active TB in renal failure patients being followed in the intensive care unit, even when results of a chest radiograph are normal especially in patients with unexplained poor general health or respiratory failure. (author)

  10. Effect of LDL cholesterol and treatment with losartan on end-stage renal disease in the RENAAL study

    DEFF Research Database (Denmark)

    Tershakovec, A.M.; Keane, W.F.; Zhang, Z.

    2008-01-01

    Renal pathology and dyslipidemia commonly coexist. Treatments that lower albuminuria/proteinuria may lower lipids, but it is not known whether lipid lowering independent of lessening albuminuria/proteinuria slows progression of kidney disease. We examined the association between LDL cholesterol...

  11. End-stage renal disease and its treatment in Latin America in the twenty-first century.

    Science.gov (United States)

    Cusumano, Ana; Garcia-Garcia, Guillermo; Di Gioia, Cristina; Hermida, Osvaldo; Lavorato, Carlos; Carreño, Cesar Agost; Torrico, Maria Placida Garron; Batista, Paulo Benigno Pena; Romão, João Egídio; Badal, Hugo Poblete; Miranda, Susana Elgueta; Gomez, Rafael; Calderon, Manuel Cerdas; Sanchez, Sergio Herra; Lopez, Miguel Almaguer; Moscoso, Julio; Merino, Ricardo Leiva; Polo, Jose Vicente Sánchez; Lopez, Alirio; Romero, Norman Jiron; Garcia, Ramiro; Acosta, Blanca V Franco; Lopez, Augusto Saavedra; Delpin, Eduardo Santiago; Mena, Emilio; González, Carlota; Milanés, Carmen Luisa; Acchiardo, Sergio

    2006-01-01

    The Latin American Society of Nephrology and Arterial Hypertension's Dialysis and Transplant Registry was chartered in 1991. It collects information on ESRD and its treatment in 20 countries of the region. The prevalence of patients on renal replacement therapy (RRT) increased from 129 pmp in 1992 to 447 pmp in 2004; in 2004, 56% of the patients were on hemodialysis, 23% on peritoneal dialysis, and 21% had a functioning kidney graft. The highest rates of prevalence were reported in Puerto Rico (1027 pmp), Chile (686 pmp), and Uruguay (683 pmp). Hemodialysis was widely used, except in El Salvador, Mexico, Guatemala, Nicaragua, and the Dominican Republic, where peritoneal dialysis predominated. Incidence rate increased from 27.8 pmp to 147 pmp in the same period of observation; the lowest rate was reported in Guatemala (11.4 pmp) and the highest in Puerto Rico (337.4 pmp). Diabetes mellitus was the leading cause of renal failure in incident patients; the highest rates were reported in Puerto Rico (62.2%) and Mexico (60%). Forty-four percent of the incident population were older than 65 years. Access to renal replacement therapy was universal in Argentina, Brazil, Chile, Cuba, Puerto Rico, Uruguay, and Venezuela, while was restricted in other countries. Main causes of death in dialysis were cardiovascular (44%) and infectious disease (26%). The rate of renal transplantation increased from 3.7 pmp in 1987 to 14.5 in 2004; fifty-three percent of the organs came from cadavers. Overall, donation rate was 5.9 pmp. In conclusion, the prevalence and incidence rates have increased over the years, and diabetes mellitus has emerged as the leading cause of kidney disease in the region. Although the rate of kidney transplantation has increased, the number remains insufficient to match the growing demand. The implementation of renal health programs in the region is urgently needed.

  12. Functional genomic analysis identifies indoxyl sulfate as a major, poorly dialyzable uremic toxin in end-stage renal disease.

    Directory of Open Access Journals (Sweden)

    Sachin Jhawar

    Full Text Available Chronic renal failure is characterized by progressive renal scarring and accelerated arteriosclerotic cardiovascular disease despite what is considered to be adequate hemodialysis or peritoneal dialysis. In rodents with reduced renal mass, renal scarring has been attributed to poorly filtered, small protein-bound molecules. The best studied of these is indoxyl sulfate (IS.We have attempted to establish whether there are uremic toxins that are not effectively removed by hemodialysis. We examined plasma from patients undergoing hemodialysis, employing global gene expression in normal human renal cortical cells incubated in pre- and post- dialysis plasma as a reporter system. Responses in cells incubated with pre- and post-dialysis uremic plasma (n = 10 were compared with responses elicited by plasma from control subjects (n = 5. The effects of adding IS to control plasma and of adding probenecid to uremic plasma were examined. Plasma concentrations of IS were measured by HPLC (high pressure liquid chromatography.Gene expression in our reporter system revealed dysregulation of 1912 genes in cells incubated with pre-dialysis uremic plasma. In cells incubated in post-dialysis plasma, the expression of 537 of those genes returned to baseline but the majority of them (1375 remained dysregulated. IS concentration was markedly elevated in pre- and post-dialysis plasma. Addition of IS to control plasma simulated more than 80% of the effects of uremic plasma on gene expression; the addition of probenecid, an organic anion transport (OAT inhibitor, to uremic plasma reversed the changes in gene expression.These findings provide evidence that hemodialysis fails to effectively clear one or more solutes that effect gene expression, in our reporter system, from the plasma of patients with uremia. The finding that gene dysregulation was simulated by the addition of IS to control plasma and inhibited by addition of an OAT inhibitor to uremic plasma identifies IS

  13. Adherence to treatment, emotional state and quality of life in patients with end-stage renal disease undergoing dialysis

    OpenAIRE

    García-Llana, Helena; Remor, Eduardo; Selgas, Rafael

    2013-01-01

    A low rate of adherence to treatment is a widespread problem of great clinical relevance among dialysis patients. The objective of the present study is to determine the relationship between adherence, emotional state (depression, anxiety, and perceived stress), and healthrelated quality of life (HRQOL) in renal patients undergoing dialysis. Method: Two patient groups (30 in hemodialysis and 31 in peritoneal dialysis) participated in this study. We evaluated aspects of adhere...

  14. A survey of views and practice patterns of dialysis medical directors toward end-of-life decision making for patients with end-stage renal disease.

    Science.gov (United States)

    Fung, Enrica; Slesnick, Nate; Kurella Tamura, Manjula; Schiller, Brigitte

    2016-07-01

    Patients with end-stage renal disease report infrequent end-of-life discussions, and nephrology trainees report feeling unprepared for end-of-life decision making, but the views of dialysis medical directors have not been studied. Our objective is to understand dialysis medical directors' views and practice patterns on end-of-life decision making for patients with ESRD. We administered questionnaires to dialysis medical directors during medical director meetings of three different dialysis organizations in 2013. Survey questions corresponded to recommendations from the Renal Physicians Association clinical practice guidelines on initiation and withdrawal of dialysis. There were 121 medical director respondents from 28 states. The majority of respondents felt "very prepared" (66%) or "somewhat prepared" (29%) to participate in end-of-life decisions and most (80%) endorsed a model of shared decision making. If asked to do so, 70% of the respondents provided prognostic information "often" or "nearly always." For patients with a poor prognosis, 36% of respondents would offer a time-limited trial of dialysis "often" or "nearly always", while 56% of respondents would suggest withdrawal from dialysis "often" or "nearly always" for those with a poor prognosis currently receiving dialysis therapy. Patient resistance and fear of taking away hope were the most commonly cited barriers to end-of-life discussions. Views and reported practice patterns of medical directors are consistent with clinical practice guidelines for end-of-life decision making for patients with end-stage renal disease but inconsistent with patient perceptions. © The Author(s) 2016.

  15. Relationship between serum uric acid and mortality among hemodialysis patients: Retrospective analysis of Korean end-stage renal disease registry data

    Science.gov (United States)

    Kim, Chang Seong; Jin, Dong-Chan; Yun, Young Cheol; Bae, Eun Hui; Ma, Seong Kwon; Kim, Soo Wan

    2017-01-01

    Background It is thought that hyperuricemia might lower the risk of mortality among hemodialysis patients, unlike in the general population, but the evidence is controversial. The aim of the current study was to evaluate the impact of serum uric acid level on the long-term clinical outcomes of hemodialysis patients in Korea. Methods Retrospective analysis was performed on data from the End-Stage Renal Disease Registry of the Korean Society of Nephrology. This included data for 7,333 patients (mean age, 61 ± 14 years; 61% male) who received hemodialysis from January 2001 through April 2015. Initial laboratory data were used in the analysis. Results The mean serum uric acid level in this study was 7.1 ± 1.7 mg/dL. Body mass index, normalized protein catabolic rate, albumin, and cholesterol were positively correlated with serum uric acid level after controlling for age and sex. After controlling for demographic data, comorbidities, and residual renal function, a higher uric acid level was independently associated with a significantly lower all-cause mortality (hazard ratio [HR], 0.90 per 1 mg/dL increase in uric acid level; 95% confidence interval [CI], 0.83–0.97; P = 0.008), but not cardiovascular mortality (HR, 0.90; 95% CI, 0.80–1.01; P = 0.078). Comparing uric acid levels in the highest and lowest quintiles, the HR for all-cause mortality was 0.65 (95% CI, 0.42–0.99; P = 0.046). Conclusion Hyperuricemia was strongly associated with a lower risk of all-cause mortality, but there seems to be no significant association between serum uric acid level and cardiovascular mortality among Korean hemodialysis patients with end-stage renal disease. PMID:29285429

  16. Ego mechanisms of defense are associated with patients’ preference of treatment modality independent of psychological distress in end-stage renal disease

    Directory of Open Access Journals (Sweden)

    Thomas Hyphantis

    2010-02-01

    Full Text Available Thomas Hyphantis1, Spiros Katsoudas2, Sonia Voudiclari31Associate Professor of Psychiatry, Department of Psychiatry, Medical School, University of Ioannina, Ioannina, Greece; 2Nephrologist, Renal Clinic, Hippocration General Hospital, Athens, Greece; 3Department of Nephrology, University of Athens, GreeceAbstract: Several parameters mediate the selection of treatment modality in end-stage renal disease (ESRD. The nephrology community suggests that patient preference should be the prime determinant of modality choice. We aimed to test whether ego mechanisms of defense are associated with patients’ treatment modality preferences, independent of psychological distress. In 58 eligible ESRD patients who had themselves chosen their treatment modality, we administered the Symptom Distress Checklist-90-R and the Defense Style Questionnaire. Thirtyseven patients (53.4% had chosen hemodialysis and 21 (46.6% peritoneal dialysis. Patients who preferred peritoneal dialysis were younger (odds ratio [OR], 0.89; 95% confidence interval [CI]: 0.804–0.988, had received more education (OR, 8.84; 95% CI: 1.301–60.161, and were twice as likely to adopt an adaptive defense style as compared to patients who preferred hemodialysis (57.1% vs 27.0%, respectively; P < 0.033. On the contrary, the latter were more likely to adopt an image-distorting defense style (35.1% vs 14.3%; P = 0.038 and passive–aggressive defenses (OR, 0.73: 95% CI: 0.504–1.006. These results were independent of psychological distress. Our findings indicate that the patient’s personality should be taken into account, if we are to better define which modalities are best suited to which patients. Also, physicians should bear in mind passive–aggressive behaviors that warrant attention and intervention in patients who preferred hemodialysis.Keywords: end-stage renal disease, hemodialysis, peritoneal dialysis, ego mechanisms of defense, DSQ, psychopathology

  17. Health related quality of life in rheumatoid arthritis, osteoarthritis, diabetes mellitus, end stage renal disease and geriatric subjects. Experience from a General Hospital in Mexico.

    Science.gov (United States)

    Ambriz Murillo, Yesenia; Menor Almagro, Raul; Campos-González, Israel David; Cardiel, Mario H

    2015-01-01

    Chronic diseases have a great impact in the morbidity and mortality and in the health-related quality of life (HRQoL) of patients around the world. The impact of rheumatic diseases has not been fully recognized. We conducted a comparative study to evaluate the HRQoL in different chronic diseases. The aim of the present study was to assess the HRQoL and identify specific areas affected in patients with rheumatoid arthritis (RA), osteoarthritis (OA), diabetes mellitus, end-stage renal disease, geriatric subjects and a control group. We conducted a cross-sectional study, in a General Hospital in Morelia, Mexico. All patients met classification criteria for RA, OA, diabetes mellitus, end-stage renal disease; the geriatric subjects group was≥65 years, and the control group≥30 years. Demographic characteristics were recorded, different instruments were applied: SF-36, visual analogue scale for pain, patient's and physician's global assessments, Beck Depression Inventory and specific instruments (DAS-28, HAQ-Di, WOMAC, Diabetes Quality of Life [DQOL] and Kidney Disease Questionnaire of Life [KDQOL]). Biochemical measures: erythrocyte sedimentation rate, blood count, glucose, HbA1C, serum creatinine and urea. We evaluated 290 subjects (control group: 100; geriatric subjects: 30 and 160 for the rest of groups). Differences were detected in baseline characteristics (Prenal disease group (±SD: 48.06±18.84 x/SD). The general health was the principal affected area in RA. The pain was higher in rheumatic diseases: OA (5.2±2.4) and RA (5.1±3). HAQ was higher in OA compared to RA (1.12±0.76 vs 0.82±0.82, respectively; P=.001). Forty five percent of all subjects had depression. The HRQoL in RA patients is poor and comparable to other chronic diseases (end-stage renal disease and diabetes mellitus). Rheumatic diseases should be considered high impact diseases and therefore should receive more attention. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  18. Caliceal clubbing and adjacent parenchymal scarring (always reflux nephropathy) as a cause of end-stage renal failure

    International Nuclear Information System (INIS)

    Thomsen, H.S.; Dorph, S.; Copenhagen Univ., Herlev

    1986-01-01

    Various clinical and laboratory aspects in 15 kidney transplanted patients with urographic evidence of caliceal clubbing and adjacent parenchymal scarring in their native kidneys are reported. These lesions were found in 16 per cent of our series of kidney transplantations; below 35 years of age it was the second most frequent disease. In 9 of these patients severe vesicoureteral reflux had been demonstrated. In the remaining 6 patients reflux nephropathy was only a tentative diagnosis based on a striking similarity in the radiographs and in several clinical findings. Nine patients had symptoms (mainly related to urinary tract infection) from 1 to 17 years before diagnosis/urography, in 5 as early as the first year of life. Recurrent urinary tract infection and renal impairment were the most frequent disorders leading to the diagnosis. Replacement therapy was initiated at an average age of 32.7 years. Following renal transplantation urinary tract infection was documented in 37 per cent of patients whether the patient had been bilaterally nephrectomized or not. (orig)

  19. Is CAPD a viable option among ADPKD with end stage renal disease population in India? Its outcomes and economics.

    Science.gov (United States)

    Kaul, Anupma; Dharshan, R; Bhadhuaria, Dharmendra; Prasad, Narayan; Gupta, Amit; Sharma, R K

    2015-09-01

    Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited renal disease, with 50-75% of these patients requiring renal replacement therapy (RRT). The outcome of peritoneal dialysis (PD) in ADPKD with end-disease renal disease (ESRD) is not clearly defined, more so in developing countries. We conducted a retrospective analysis of the outcomes and economics of PD in these ESRD patients and compared them with other causes of ESRD on PD. Data were reviewed of all the PD patients who were followed-up at our institute from January 2007 to December 2011. The inclusion criteria were ADPKD patients who chose PD as the dialysis modality (Group 1), while age and gender-matched ESRD (other than ADPKD) patients who were started on PD during the same period were considered as the other group (Group 2). A total of 26 ADPKD patients underwent PD with an average size of kidneys among ADPKD ESRD patients of 15.2 + 2.1 cm. The overall peritonitis rates were similar among the compared groups. The median survival for the first peritonitis episodes were 1.2 and 1.8 years (95% confidence interval 0.82-1.91) for the control and ADPKD groups, respectively. The overall patient survival was 22 among PKD while five patients died among the control group. Among PKD, one patient died due to intra-cerebral bleed while one patient had severe cyst hemorrhage and infection, while three others had peritonitis and sepsis. Hernia was observed in four ADPKD patients, once on PD that was surgically corrected and PD was resumed in all. Two patients lost the catheter due to peritonitis while one patient had membrane failure while one underwent surgical exploration due to diverticulosis. PD treatment was not prevented by voluminous kidneys in any of these patients and no patient ceased PD treatment due to insufficient peritoneal space. Besides this, the cost on PD was much less as compared with that on hemodialysis (HD). PD is a reasonable mode of RRT among ADPKD, where HD is not

  20. Changes in causes of death and risk of cancer in Danish patients with autosomal dominant polycystic kidney didease and end-stage renal disease

    DEFF Research Database (Denmark)

    Ørskov, Bjarne; Feldt-Rasmussen, Bo Friis; Strandgaard, Svend Valdemar

    2012-01-01

    Abstract Background. With the improved prognosis in patients with autosomal dominant polycystic kidney disease (ADPKD), causes of death and the risk of cancer might have changed. This was investigated in a Danish population with ADPKD and end-stage renal disease (ESRD) between 1 January 1993 and 31...... December 2008. Methods. Data were retrieved from three Danish national registries and a total of 823 patients were identified of which 431 had died during the study period. The 16 years were divided into two 8-year periods and the causes of death were divided into six categories: cancer, cardiovascular......, cerebrovascular, infection, other and unknown. Results. Cardiovascular disease was the major cause of death. A multivariate competing risk model comparing the two 8-year periods, adjusted for age at ESRD, gender and treatment modality, showed that deaths from cardiovascular disease decreased by 35% [hazard ratios...

  1. The End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ): testing the psychometric properties in patients receiving in-center hemodialysis.

    Science.gov (United States)

    Kim, Youngmee; Evangelista, Lorraine S; Phillips, Linda R; Pavlish, Carol; Kopple, Joel D

    2010-01-01

    Reported treatment adherence rates of patients with end stage renal disease (ESRD) have been extremely varied due to lack of reliable and valid measurement tools. This study was conducted to develop and test an instrument to measure treatment adherence to hemodialysis (HD) attendance, medications, fluid restrictions, and diet prescription among patients with ESRD. This article describes the methodological approach used to develop and test the psychometric properties (such as reliability and validity) of the 46-item ESRD-Adherence Questionnaire (ESRD-AQ) in a cohort of patients receiving maintenance HD at dialysis centers in Los Angeles County. The ESRD-AQ is the first self-report instrument to address all components of adherence behaviors of patients with ESRD. The findings support that the instrument is reliable and valid and is easy to administer. Future studies are needed in a larger sample to determine whether additional modifications are needed.

  2. Changes in causes of death and risk of cancer in Danish patients with autosomal dominant polycystic kidney didease and end-stage renal disease

    DEFF Research Database (Denmark)

    Ørskov, Bjarne; Sørensen, Vibeke Rømming; Feldt-Rasmussen, Bo Friis

    2012-01-01

    Abstract Background. With the improved prognosis in patients with autosomal dominant polycystic kidney disease (ADPKD), causes of death and the risk of cancer might have changed. This was investigated in a Danish population with ADPKD and end-stage renal disease (ESRD) between 1 January 1993 and 31...... December 2008. Methods. Data were retrieved from three Danish national registries and a total of 823 patients were identified of which 431 had died during the study period. The 16 years were divided into two 8-year periods and the causes of death were divided into six categories: cancer, cardiovascular...... (HR) 0.65, P = 0.008] and deaths from cerebrovascular disease decreased by 69% (HR 0.31, P = 0.0003) from the first to the second time period. There were no significant changes between the time periods in death from cancer, infection, other or unknown. From the first to the second 8-year interval...

  3. Serum adiponectin predicts all-cause mortality and end stage renal disease in patients with type I diabetes and diabetic nephropathy

    DEFF Research Database (Denmark)

    Jorsal, A.; Tarnow, L.; Frystyk, J.

    2008-01-01

    Adiponectin levels are increased in patients with type I diabetes especially in the presence of microangiopathy. Here we determined the predictive value of serum adiponectin levels and 8 adiponectin gene polymorphisms for mortality, cardiovascular events and end-stage renal disease in type I...... diabetic patients. This prospective, observational follow-up study of type I diabetics consisted of 438 patients with overt diabetic nephropathy that were compared to 440 type I patients with normal albumin excretion. These two groups were followed an average of 8 years and generally matched for gender......, age and duration of diabetes. Cox regression analysis of 373 patients showed a covariate-adjusted hazard ratio for all-cause mortality of 1.46 for a change of one standard deviation in log10 of serum adiponectin. There was no association with cardiovascular events; however, serum adiponectin levels...

  4. Rationale and design of A Trial of Sertraline vs. Cognitive Behavioral Therapy for End-stage Renal Disease Patients with Depression (ASCEND).

    Science.gov (United States)

    Hedayati, S Susan; Daniel, Divya M; Cohen, Scott; Comstock, Bryan; Cukor, Daniel; Diaz-Linhart, Yaminette; Dember, Laura M; Dubovsky, Amelia; Greene, Tom; Grote, Nancy; Heagerty, Patrick; Katon, Wayne; Kimmel, Paul L; Kutner, Nancy; Linke, Lori; Quinn, Davin; Rue, Tessa; Trivedi, Madhukar H; Unruh, Mark; Weisbord, Steven; Young, Bessie A; Mehrotra, Rajnish

    2016-03-01

    Major Depressive Disorder (MDD) is highly prevalent in patients with End Stage Renal Disease (ESRD) treated with maintenance hemodialysis (HD). Despite the high prevalence and robust data demonstrating an independent association between depression and poor clinical and patient-reported outcomes, MDD is under-treated when identified in such patients. This may in part be due to the paucity of evidence confirming the safety and efficacy of treatments for depression in this population. It is also unclear whether HD patients are interested in receiving treatment for depression. ASCEND (Clinical Trials Identifier Number NCT02358343), A Trial of Sertraline vs. Cognitive Behavioral Therapy (CBT) for End-stage Renal Disease Patients with Depression, was designed as a multi-center, 12-week, open-label, randomized, controlled trial of prevalent HD patients with comorbid MDD or dysthymia. It will compare (1) a single Engagement Interview vs. a control visit for the probability of initiating treatment for comorbid depression in up to 400 patients; and (2) individual chair-side CBT vs. flexible-dose treatment with a selective serotonin reuptake inhibitor, sertraline, for improvement of depressive symptoms in 180 of the up to 400 patients. The evolution of depressive symptoms will also be examined in a prospective longitudinal cohort of 90 HD patients who choose not to be treated for depression. We discuss the rationale and design of ASCEND, the first large-scale randomized controlled trial evaluating efficacy of non-pharmacologic vs. pharmacologic treatment of depression in HD patients for patient-centered outcomes. Published by Elsevier Inc.

  5. Rationale and Design of A Trial of Sertraline vs. Cognitive Behavioral Therapy for End-stage Renal Disease Patients with Depression (ASCEND)

    Science.gov (United States)

    Hedayati, S. Susan; Daniel, Divya M.; Cohen, Scott; Comstock, Bryan; Cukor, Daniel; Diaz-Linhart, Yaminette; Dember, Laura M.; Dubovsky, Amelia; Greene, Tom; Grote, Nancy; Heagerty, Patrick; Katon, Wayne; Kimmel, Paul L.; Kutner, Nancy; Linke, Lori; Quinn, Davin; Rue, Tessa; Trivedi, Madhukar H.; Unruh, Mark; Weisbord, Steven; Young, Bessie A.; Mehrotra, Rajnish

    2015-01-01

    Major Depressive Disorder (MDD) is highly prevalent in patients with End Stage Renal Disease (ESRD) treated with maintenance hemodialysis (HD). Despite the high prevalence and robust data demonstrating an independent association between depression and poor clinical and patient-reported outcomes, MDD is under-treated when identified in such patients. This may in part be due to the paucity of evidence confirming the safety and efficacy of treatments for depression in this population. It is also unclear whether HD patients are interested in receiving treatment for depression. ASCEND (Clinical Trials Identifier Number NCT02358343), A Trial of Sertraline vs. Cognitive Behavioral Therapy (CBT) for End-stage Renal Disease Patients with Depression, was designed as a multi-center, 12-week, open-label, randomized, controlled trial of prevalent HD patients with comorbid MDD or dysthymia. It will compare (1) a single Engagement Interview vs. a control visit for the probability of initiating treatment for comorbid depression in up to 400 patients; and (2) individual chair-side CBT vs. flexible-dose treatment with a selective serotonin reuptake inhibitor, sertraline, for improvement of depressive symptoms in 180 of the up to 400 patients. The evolution of depressive symptoms will also be examined in a prospective longitudinal cohort of 90 HD patients who choose not to be treated for depression. We discuss the rationale and design of ASCEND, the first large-scale randomized controlled trial evaluating efficacy of non-pharmacologic vs. pharmacologic treatment of depression in HD patients for patient-centered outcomes. PMID:26621218

  6. Circulating FGF21 levels are progressively increased from the early to end stages of chronic kidney diseases and are associated with renal function in Chinese.

    Directory of Open Access Journals (Sweden)

    Zhuofeng Lin

    Full Text Available BACKGROUND: Fibroblast growth factor 21 (FGF21 is a hepatic hormone involved in the regulation of lipid and carbohydrate metabolism. This study aims to test the hypothesis that elevated FGF21 concentrations are associated with the change of renal function and the presence of left ventricular hypertrophy (LVH in the different stages of chronic kidney disease (CKD progression. METHODOLOGY/PRINCIPAL FINDINGS: 240 subjects including 200 CKD patients (146 outpatients and 54 long-term hemodialytic patients and 40 healthy control subjects were recruited. All CKD subjects underwent echocardiograms to assess left ventricular mass index. Plasma FGF21 levels and other clinical and biochemical parameters in all subjects were obtained based on standard clinical examination methods. Plasma FGF21 levels were significantly increased with the development of CKD from early- and end-stage (P<0.001 for trend, and significantly higher in CKD subjects than those in healthy subjects (P<0.001. Plasma FGF21 levels in CKD patients with LVH were higher than those in patients without LVH (P = 0.001. Furthermore, plasma FGF21 level correlated positively with creatinine, blood urea nitrogen (BUN, β2 microglobulin, systolic pressure, adiponectin, phosphate, proteinuria, CRP and triglyceride, but negatively with creatinine clearance rate (CCR, estimated glomerular filtrate rate (eGFR, HDL-c, LDL-c, albumin and LVH after adjusting for BMI, gender, age and the presence of diabetes mellitus. Multiple stepwise regression analyses indicated that FGF21 was independently associated with BUN, Phosphate, LVMI and β2 microglobulin (all P<0.05. CONCLUSION: Plasma FGF21 levels are significantly increased with the development of early- to end-stage CKD and are independently associated with renal function and adverse lipid profiles in Chinese population. Understanding whether increased FGF21 is associated with myocardial hypertrophy in CKD requires further study.

  7. Managing oral phosphate binder medication expenditures within the Medicare bundled end-stage renal disease prospective payment system: economic implications for large U.S. dialysis organizations.

    Science.gov (United States)

    Park, Haesuk; Rascati, Karen L; Keith, Michael S

    2015-06-01

    From January 2016, payment for oral-only renal medications (including phosphate binders and cinacalcet) was expected to be included in the new Medicare bundled end-stage renal disease (ESRD) prospective payment system (PPS). The implementation of the ESRD PPS has generated concern within the nephrology community because of the potential for inadequate funding and the impact on patient quality of care. To estimate the potential economic impact of the new Medicare bundled ESRD PPS reimbursement from the perspective of a large dialysis organization in the United States. We developed an interactive budget impact model to evaluate the potential economic implications of Medicare payment changes to large dialysis organizations treating patients with ESRD who are receiving phosphate binders. In this analysis, we focused on the budget impact of the intended 2016 integration of oral renal drugs, specifically oral phosphate binders, into the PPS. We also utilized the model to explore the budgetary impact of a variety of potential shifts in phosphate binder market shares under the bundled PPS from 2013 to 2016. The base model predicts that phosphate binder costs will increase to $34.48 per dialysis session in 2016, with estimated U.S. total costs for phosphate binders of over $682 million. Based on these estimates, a projected Medicare PPS $33.44 reimbursement rate for coverage of all oral-only renal medications (i.e., phosphate binders and cinacalcet) would be insufficient to cover these costs. A potential renal drugs and services budget shortfall for large dialysis organizations of almost $346 million was projected. Our findings suggest that large dialysis organizations will be challenged to manage phosphate binder expenditures within the planned Medicare bundled rate structure. As a result, large dialysis organizations may have to make treatment choices in light of potential inadequate funding, which could have important implications for the quality of care for patients

  8. Levels of cholesteryl esters and other lipids in the plasma of patientswith end-stage renal failure

    International Nuclear Information System (INIS)

    Gillett, Michael P.T.; Obineche, Enyioma N.; Lakhani, Mohammad S.; Abdulle, Abdishakur M.; Amirlak, I.; Al-Rukhaimi, M.; Suleiman, Mustafa N.

    2001-01-01

    The importance of plasma lipid abnormalities in chronic renal failure(CRF) is well recognized, but surprisingly little attention has been given tothe study of some plasma lipid fractions, including cholesteryl esters (CE)and phospholipids, which might be expected to be important factors in thepathogenesis of disease. Fasting blood samples were taken from 25 controlsubjects and 53 CRF patients (29 predialysis and 24 on Hemodialysis). Sampleswere analyzed for urea nitrogen, creatinine, triacyglycerols, total andindividuals phospholipids, total and free cholesterol, as well as cholesterolbound to be very low-, and high- density lipoproteins (VDL, LDL and HDL).Plasma CE was calculated and expressed as a percentage of total cholesterol.Over half of the patients had CE levels more than two standard deviationsbelow the control value. In this subgroup of low CE patients, total LDL- andHDL-cholesterol levels were also significantly lower than for controls, whilelevels of phosphatidylcholine and lysophosphatidylcholine were decreased andincreased, respectively. In patients with high CE, no significant lipidabnormalities were observed. In this study, CE was an excellent marker forlipid disturbances-if CE was high, then the other lipid fractions wereabnormal. The changes noted appear to be consequences of or related todeficiency of the plasma enzyme lecithin-cholesterol acyltransferase. (author)

  9. Adherence to treatment, emotional state and quality of life in patients with end-stage renal disease undergoing dialysis.

    Science.gov (United States)

    García-Llana, Helena; Remor, Eduardo; Selgas, Rafael

    2013-02-01

    A low rate of adherence to treatment is a widespread problem of great clinical relevance among dialysis patients. The objective of the present study is to determine the relationship between adherence, emotional state (depression, anxiety, and perceived stress), and health-related quality of life (HRQOL) in renal patients undergoing dialysis. Two patient groups (30 in hemodialysis and 31 in peritoneal dialysis) participated in this study. We evaluated aspects of adherence, depression, anxiety, perceived stress, and HRQOL with self-report and standardized instruments. Peritoneal dialysis patients reported significantly higher levels of adherence to treatment and better HRQOL in Physical Function and Bodily Pain domains. Depression level is associated with HRQOL indicators. We did not find any differences regarding specific adherence to antihypertensive and phosphate binder drugs or in psychological variables depending on the modality of dialysis. Patients with adherence to antihypertensive drugs show better physical HRQOL. The predictors of HRQOL in dialysis patients were: work, gender and depression. Our results suggest that the modality of dialysis does not differentially affect the emotional state or specific adherence to drugs, but it is nevertheless related to their overall adherence to treatment and to their HRQOL.

  10. Neurotoxicity following the Ingestion of Bilimbi Fruit (Averrhoa bilimbi) in an End-Stage Renal Disease Patient on Hemodialysis.

    Science.gov (United States)

    Caetano, Camille Pereira; de Sá, Cinara Barros; Faleiros, Bruno Antônio Paixão; Gomes, Marcelo Fonseca Coutinho Fernandes; Pereira, Edna Regina Silva

    2017-01-01

    The toxic effects of the ingestion of star fruit (Averrhoa carambola) in chronic kidney disease patients are well described in the literature. Recently, the compound caramboxin has been isolated, explaining the mechanisms of its neurotoxicity. Bilimbi fruit belongs to the family Oxalidaceae, Averrhoa bilimbi species, and exhibits similar biochemical characteristics to star fruit. To report the case of a patient with chronic kidney disease who developed a seizure disorder after the ingestion of bilimbi fruit. A 69-year-old man with chronic kidney disease on hemodialysis therapy had intractable hiccups, myoclonus, and generalized tonic-clonic seizures after the consumption of a moderate amount of bilimbi fruit. The electroencephalogram showed a pattern of seizure disorder despite the use of anticonvulsant drugs. Renal replacement therapy was maintained during the whole period and prescribed according to the patient's hemodynamic status. Despite showing clinical resolution of the seizure disorder, the patient died on the 27th day of hospitalization for infectious complications. The neurologic status without any other known cause and with clear temporal association with the ingestion of the fruit suggests the diagnosis of neurotoxicity. We propose the hypothesis that the bilimbi fruit has neurotoxic effects similar to those exhibited by the star fruit.

  11. Efficacy and safety of sugammadex in the reversal of deep neuromuscular blockade induced by rocuronium in patients with end-stage renal disease: A comparative prospective clinical trial.

    Science.gov (United States)

    de Souza, Camila M; Tardelli, Maria A; Tedesco, Helio; Garcia, Natalia N; Caparros, Mario P; Alvarez-Gomez, Jose A; de Oliveira Junior, Itamar S

    2015-10-01

    Renal failure affects the pharmacology of nondepolarizing neuromuscular blockers making recovery of neuromuscular function unpredictable. Sugammadex antagonises rocuronium-induced neuromuscular blockade by encapsulating rocuronium, creating a stable complex molecule that is mainly excreted by the kidneys. Previous studies suggest that sugammadex is effective in reversing moderate neuromuscular block in the presence of renal failure, but no data are available regarding reversal of profound neuromuscular block in patients with renal failure. The objective of this study is to compare the efficacy and safety of sugammadex in reversing profound neuromuscular block induced by rocuronium in patients with end-stage renal disease and those with normal renal function. A prospective clinical trial. Two university hospitals, from 1 October 2011 to 31 January 2012. Forty patients undergoing kidney transplant: 20 with renal failure [creatinine clearance (ClCr) 90 ml min). Neuromuscular monitoring was performed by acceleromyography and train-of-four (TOF) stimulation. Profound neuromuscular block (posttetanic count, one to three responses) was maintained during surgery. Sugammadex 4 mg kg was administered on completion of skin closure. Recovery of the TOF ratio to 0.9 was recorded. Monitoring of neuromuscular function continued in the postanesthesia care unit for a further 2 h. The efficacy of sugammadex was evaluated by the time taken for the TOF ratio to recover to 0.9. The safety of sugammadex was assessed by monitoring for recurrence of neuromuscular block every 15 min for 2 h. Secondary variables were time to recovery of TOF ratio to 0.7 and 0.8. After sugammadex administration, the mean time for recovery of the TOF ratio to 0.9 was prolonged in the renal failure group (5.6 ± 3.6 min) compared with the control group (2.7 ± 1.3 min, P = 0.003). No adverse events or evidence of recurrence of neuromuscular block were observed. In patients with

  12. End-stage renal disease treated in Provence-Alpes Côte d'Azur: 12-years follow-up and forecast to the year 2030.

    Science.gov (United States)

    Durand, Anne-Claire; Jouve, Elisabeth; Delarozière, Jean-Christophe; Boucekine, Mohamed; Izaaryene, Ghizlane; Crémades, Adeline; Mazoué, Franck; Devictor, Bénédicte; Kakar, Asmatullah; Sambuc, Roland; Brunet, Philippe; Gentile, Stéphanie

    2018-06-15

    This study describes the time trend of renal replacement therapy for end-stage renal disease (ESRD) in the Provence-Alpes Côte d'Azur region (PACA) between 2004 and 2015, and forecasts up to 2030. A longitudinal study was conducted on all ESRD patients treated in PACA and recorded in the French Renal Epidemiology and Information Network (REIN) during this period. Time trends and forecasts to 2030 were analyzed using Poisson regression models. Since 2004, the number of new patients has steadily increased by 3.4% per year (95% CI, 2.8-3.9, p < 0.001) and the number of patients receiving RRT has increased by 3.7% per year (RR 1.037, 95% CI: 1.034-1.039, p < 0.001). If these trends continue, the PACA region will be face with 7371 patients on dialysis and 3891 with a functional renal transplant who will need to be managed in 2030. The two most significant growth rates were the percentage of obese people (RR 1.140, 95% CI: 1.131-1.149, p < 0.001) and those with diabetes (RR 1.070, 95% CI; 1.064-1.075, p < 0.001). This study highlights the increase in the number of ESRD patients over 12 years, with no prospect of stabilization. These findings allow us to anticipate the quality and quantity of care offered and to propose more preventive measures to combat obesity and diabetes.

  13. Incidence of End-Stage Renal Disease Attributed to Diabetes Among Persons with Diagnosed Diabetes - United States and Puerto Rico, 2000-2014.

    Science.gov (United States)

    Burrows, Nilka Rios; Hora, Israel; Geiss, Linda S; Gregg, Edward W; Albright, Ann

    2017-11-03

    During 2014, 120,000 persons in the United States and Puerto Rico began treatment for end-stage renal disease (ESRD) (i.e., kidney failure requiring dialysis or transplantation) (1). Among these persons, 44% (approximately 53,000 persons) had diabetes listed as the primary cause of ESRD (ESRD-D) (1). Although the number of persons initiating ESRD-D treatment each year has increased since 1980 (1,2), the ESRD-D incidence rate among persons with diagnosed diabetes has declined since the mid-1990s (2,3). To determine whether ESRD-D incidence has continued to decline in the United States overall and in each state, the District of Columbia (DC), and Puerto Rico, CDC analyzed 2000-2014 data from the U.S. Renal Data System and the Behavioral Risk Factor Surveillance System. During that period, the age-standardized ESRD-D incidence among persons with diagnosed diabetes declined from 260.2 to 173.9 per 100,000 diabetic population (33%), and declined significantly in most states, DC, and Puerto Rico. No state experienced an increase in ESRD-D incidence rates. Continued awareness of risk factors for kidney failure and interventions to improve diabetes care might sustain and improve these trends.

  14. Incidence of end-stage renal disease attributed to diabetes among persons with diagnosed diabetes --- United States and Puerto Rico, 1996-2007.

    Science.gov (United States)

    2010-10-29

    During 2007, approximately 110,000 persons in the United States and Puerto Rico began treatment for end-stage renal disease (ESRD) (i.e., kidney failure requiring dialysis or transplantation). Diabetes is the leading cause of ESRD in the United States, accounting for 44% of new cases in 2007. Although the number of persons initiating treatment for kidney failure each year who have diabetes listed as a primary cause (ESRD-D) has increased since 1996, ESRD-D incidence among persons with diagnosed diabetes has declined since 1996. To determine whether this decline occurred in every U.S. region and in every state, CDC analyzed 1996-2007 data from the U.S. Renal Data System (USRDS) and the Behavioral Risk Factor Surveillance System (BRFSS). During the period, the age-adjusted rate of ESRD-D among persons with diagnosed diabetes declined 35% overall, from 304.5 to 199.1 per 100,000 persons with diagnosed diabetes, and declined in all U.S. regions and in most states. No state showed a significant increase in the age-adjusted ESRD-D rate. Continued awareness of risk factors for kidney failure and interventions to improve diabetes care are needed to sustain and improve these trends.

  15. The relation between dual energy X-ray absorptiometry measurements of body fat composition and plasma ghrelin in patients with end-stage renal disease

    International Nuclear Information System (INIS)

    Elsayed, Naglaa M.; Hamed, Soha T.; El-Khatib, Mohamed M.; El-Shehaby, Amal M.

    2009-01-01

    Objective was to clarify the role of ghrelin in malnutrition in uremia and its relationship to fat composition using dual x-ray absorptiometry (DXA). This is a cohort study including Group I: 60 patients with end stage renal disease (30 on hemodialysis [group IA] and 30 pre-dialysis [group IB]) and Group II: 20 controls. This study was carried out in Cairo University Hospital, Kasr Al-Aini, Cairo, Egypt in 2007. Body fat composition (total, differential and lean body mass) was assessed using DXA and plasma ghrelin was measured. Ghrelin was significantly higher in hemodialysis and pre-dialysis groups compared to the control group and higher in hemodialysis group compared to the pre-dialysis group. In hemodialysis, ghrelin was negatively correlated with weight, body mass index (BMI), and truncal fat mass, and positively correlated with serum creatinine, lean body mass. In control, plasma ghrelin showed negative correlation with weight, BMI, truncal fat mass and positive correlation with lean body mass. Ghrelin was markedly elevated in renal failure due to its decrease in excretion. Negative correlation between ghrelin and fat mass composition was detected in dialysis patients. Serial evaluation of body fat mass composition using DXA is recommended for assessment of nutritional status of those patients. (author)

  16. MTHFR and HFE, but not preproghrelin and LBP, polymorphisms as risk factors for all-cause end-stage renal disease development.

    Science.gov (United States)

    Bloudíčková, S; Kuthanová, L; Hubáček, J A

    2014-01-01

    End-stage renal disease (ESRD) is a serious health problem worldwide. The high prevalence of cardiovascular diseases and chronic inflammation remains a major cause of morbidity and mortality in haemodialysed patients. Beside some external factors, genetic predisposition both to renal failure and poor prognosis has been assumed. We have collected a total of 1,014 haemodialysed patients and 2,559 unrelated healthy Caucasians. Single-nucleotide polymorphisms (SNPs) in genes for preproghrelin (GHRL), lipopolysaccharide-binding protein (LBP), HFE and MTHFR were genotyped. In the group of patients, significantly more carriers presented the MTHFR T667T (P = 0.002) and HFE Asp63Asp (P = 0.001) and Cys282Cys (P = 0.01) genotypes. The frequencies of individual SNPs within GHRL and LBP genes did not differ between the patients and controls. The trends in genotype frequencies did not differ between the subgroups of patients with different time on haemodialysis. Common variants in MTHFR and HFE could be a risk factor for all-cause ESRD development, but are not predictors for the survival on haemodialysis.

  17. Hemodialysis Decreases the Etiologically-Related Early Vascular Aging Observed in End-Stage Renal Disease: A 5-Year Follow-Up Study.

    Science.gov (United States)

    Bia, Daniel; Galli, Cintia; Zócalo, Yanina; Valtuille, Rodolfo; Wray, Sandra; Armentano, Ricardo; Cabrera-Fischer, Edmundo

    2017-01-01

    To analyze the early vascular aging (EVA) in end-stage renal disease (ESRD) patients, attempting to determine a potential association between EVA and the etiology of ESRD, and to investigate the association of hemodialysis and EVA in ESRD patients during a 5-year follow-up period. Carotid-femoral pulse wave velocity (cfPWV) was obtained in 151 chronically hemodialyzed patients (CHP) and 283 control subjects, and in 25 CHP, who were followed-up after a 5-year lapse. cfPWV increased in ESRD patients compared to control subjects. The cfPWV-age relationship was found to have a steeper increase in ESRD patients. The highest cfPWV and EVA values were observed in patients with diabetic nephropathy. Regression analysis demonstrated a significant reduction of the EVA in HD patients on a 5-year follow-up. Patients in ESRD showed higher levels of EVA. cfPWV and EVA differed in ESRD patients depending on their renal failure etiology. CHP showed an EVA reduction after a 5-year follow-up period. © 2016 S. Karger AG, Basel.

  18. Arteriovenous renal replacement therapy in end-stage left-sided heart failure patients has a detrimental effect on patients with impaired right ventricular function.

    Science.gov (United States)

    Repasos, Evangelos; Kaldara, Elisabeth; Pantsios, Christos; Kapelios, Chris; Nana, Emmeleia; Vernadakis, Spiridon; Melexopoulou, Christina; Malliaras, Konstantinos; Boletis, John; Nanas, John N

    Chronic intermittent renal replacement therapy(RRT) is an alternate method of decongestion for patients presenting with diuretic-resistant, end-stage heart failure(HF) and cardiorenal syndrome. The optimal method of vascular access has not been confirmed. This study investigated the 6-month outcomes of patients with end-stage HF after the creation of arteriovenous communications (AVC) compared with other means of RRT. We treated 40 patients with chronic, intermittent, ambulatory RRT, of whom 15 (37.5%; Group A) underwent creation of AVC, and 25 (62.5%; Group B) received intraperitoneal (n=6) or internal jugular catheters (n=19) with the goal of achieving body weight stabilization and relief from congestion. The characteristics of the two groups were similar. According to Cox regression analysis, the 6-month rate of death or re-hospitalization for HF was significantly higher in Group A (73%) than in Group B (44%); hazard ratio (HR): 2.58; 95% confidence interval (CI) 1.2-6.2; P=0.02. Over a 6-month follow-up, the cumulative survival was significantly shorter (P=0.03) in Group A (13.8±10 weeks) than in Group B (20.7±7 weeks). In the 15 patients who received AVC, the only independent predictor of adverse outcome at 6 months was serum total bilirubin concentration (HR 2.5; 95% CI 1.1-5.7, p=0.02), whereas in the 25 patients who underwent other means of RRT, pulmonary vascular resistance (PVR) was identified as a risk factor for hospitalization or death at 1-year follow-up (HR 1.26; 95% CI 1.1-1.57, p=0.04). In patients with end-stage HF, the creation of AVC for intermittent RRT was followed by a significant increase in morbidity and mortality in comparison to the safe and effective placement of permanent central venous catheters. Patients with elevated PVR seem to comprise a group at high risk for adverse outcomes after central catheter insertion. Copyright © 2016 Hellenic Society of Cardiology. Published by Elsevier B.V. All rights reserved.

  19. Incidence and outcome of patients starting renal replacement therapy for end-stage renal disease due to multiple myeloma or light-chain deposit disease: an ERA-EDTA Registry study

    DEFF Research Database (Denmark)

    Tsakiris, D.J.; Stel, V.S.; Finne, P.

    2010-01-01

    Background. Information on demographics and survival of patients starting renal replacement therapy (RRT) for end-stage renal disease (ESRD) due to multiple myeloma (MM) or light-chain deposit disease (LCDD) is scarce. The aim of this study was to describe the incidence, characteristics, causes...... causes (non-MM) was observed overtime. Patient survival on RRT was examined, unadjusted and adjusted for age and gender. Results. Of the 159 637 patients on RRT, 2453 (1.54%) had MM or LCDD. The incidence of RRT for ESRD due to MM or LCDD, adjusted for age and gender, increased from 0.70 pmp in 1986...

  20. Stroke and Risks of Development and Progression of Kidney Diseases and End-Stage Renal Disease: A Nationwide Population-Based Cohort Study.

    Directory of Open Access Journals (Sweden)

    Chia-Lin Wu

    Full Text Available There is little information about the association between stroke and kidney diseases. We aimed to investigate the impact of stroke on long-term renal outcomes.In this large population-based retrospective cohort study, we identified 100,353 subjects registered in the National Health Insurance Research Database of Taiwan from January 1, 2000, through December 31, 2012, including 33,451 stroke patients and 66,902 age-, sex- and Charlson's comorbidity index score-matched controls.The incidence rate of chronic kidney disease (CKD was higher in the stroke than in the control cohort (17.5 vs. 9.06 per 1000 person-years. After multivariate adjustment, the risk of developing CKD was significantly higher in patients with stroke (adjusted hazard ratio [aHR] 1.43, 95% confidence interval [CI] 1.36-1.50, P<0.001. Subgroup analysis showed that stroke patients <50 years (aHR 1.61, P<0.001 and those with concomitant diabetes mellitus (aHR 2.12, P<0.001, hyperlipidemia (aHR 1.53, P<0.001 or gout (aHR 1.84, P<0.001 were at higher risk of incident CKD. Additionally, the risks of progression to advanced CKD and end-stage renal disease (ESRD were significantly higher for stroke patients (aHRs, 1.22 and 1.30; P = 0.04 and P = 0.008, respectively, independent of age, sex, comorbidities and long-term medications.Stroke is associated with higher risks for incident CKD, decline in renal function and ESRD. Younger stroke patients, as well as those with concomitant diabetes mellitus, hyperlipidemia or gout are at greater risk for kidney diseases.

  1. Determination of the optimal case definition for the diagnosis of end-stage renal disease from administrative claims data in Manitoba, Canada.

    Science.gov (United States)

    Komenda, Paul; Yu, Nancy; Leung, Stella; Bernstein, Keevin; Blanchard, James; Sood, Manish; Rigatto, Claudio; Tangri, Navdeep

    2015-01-01

    End-stage renal disease (ESRD) is a major public health problem with increasing prevalence and costs. An understanding of the long-term trends in dialysis rates and outcomes can help inform health policy. We determined the optimal case definition for the diagnosis of ESRD using administrative claims data in the province of Manitoba over a 7-year period. We determined the sensitivity, specificity, predictive value and overall accuracy of 4 administrative case definitions for the diagnosis of ESRD requiring chronic dialysis over different time horizons from Jan. 1, 2004, to Mar. 31, 2011. The Manitoba Renal Program Database served as the gold standard for confirming dialysis status. During the study period, 2562 patients were registered as recipients of chronic dialysis in the Manitoba Renal Program Database. Over a 1-year period (2010), the optimal case definition was any 2 claims for outpatient dialysis, and it was 74.6% sensitive (95% confidence interval [CI] 72.3%-76.9%) and 94.4% specific (95% CI 93.6%-95.2%) for the diagnosis of ESRD. In contrast, a case definition of at least 2 claims for dialysis treatment more than 90 days apart was 64.8% sensitive (95% CI 62.2%-67.3%) and 97.1% specific (95% CI 96.5%-97.7%). Extending the period to 5 years greatly improved sensitivity for all case definitions, with minimal change to specificity; for example, for the optimal case definition of any 2 claims for dialysis treatment, sensitivity increased to 86.0% (95% CI 84.7%-87.4%) at 5 years. Accurate case definitions for the diagnosis of ESRD requiring dialysis can be derived from administrative claims data. The optimal definition required any 2 claims for outpatient dialysis. Extending the claims period to 5 years greatly improved sensitivity with minimal effects on specificity for all case definitions.

  2. Mortality risk disparities in children receiving chronic renal replacement therapy for the treatment of end-stage renal disease across Europe

    DEFF Research Database (Denmark)

    Chesnaye, Nicholas C; Schaefer, Franz; Bonthuis, Marjolein

    2017-01-01

    HR) and the explained variation were modelled for patient-level and country-level factors with multilevel Cox regression. The primary outcome studied was all-cause mortality while on renal replacement therapy. FINDINGS: Between Jan 1, 2000, and Dec 31, 2013, the overall 5 year renal replacement therapy mortality rate......BACKGROUND: We explored the variation in country mortality rates in the paediatric population receiving renal replacement therapy across Europe, and estimated how much of this variation could be explained by patient-level and country-level factors. METHODS: In this registry analysis, we extracted...... patient data from the European Society for Paediatric Nephrology/European Renal Association-European Dialysis and Transplant Association (ESPN/ERA-EDTA) Registry for 32 European countries. We included incident patients younger than 19 years receiving renal replacement therapy. Adjusted hazard ratios (a...

  3. Increased platelet expression of FcGammaRIIa and its potential impact on platelet reactivity in patients with end stage renal disease

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    Sobel Burton E

    2007-06-01

    Full Text Available Abstract Background Increased platelet reactivity has been implicated in cardiovascular disease – the major cause of death in patients with end stage renal disease (ESRD. FcGammaRIIA is a component of glycoprotein VI and Ib-IX-V that mediate activation of platelets by collagen and von Willebrand factor. To determine whether expression of FcGammaRIIA impacts platelet reactivity we quantified its expression and platelet reactivity in 33 patients with ESRD who were undergoing hemodialysis. Methods Blood samples were obtained from patients immediately before hemodialysis and before administration of heparin. Platelet expression of FcGammaRIIA and the activation of platelets in response to low concentrations of convulxin (1 ng/ml, selected to mimic effects of collagen, thrombin (1 nM, adenosine diphosphate (ADP, 0.2 uM, or platelet activating factor (PAF, 1 nM were determined with the use of flow cytometry in samples of whole blood anticoagulated with corn trypsin inhibitor (a specific inhibitor of Factor XIIa. Results Patients were stratified with respect to the median expression of FcGammaRIIA. Patients with high platelet expression of FcGammaRIIA exhibited 3-fold greater platelet reactivity compared with that in those with low expression in response to convulxin (p Conclusion Increased platelet reactivity in response to low concentrations of diverse agonists is associated with high expression of FcGammaRIIA and may contribute to an increased risk of thrombosis in patients with ESRD.

  4. An XML schema for automated data integration in a Multi-Source Information System dedicated to end-stage renal disease.

    Science.gov (United States)

    Dufour, Eric; Ben Saïd, Mohamed; Jais, Jean Philippe; Le Mignot, Loic; Richard, Jean-Baptiste; Landais, Paul

    2009-01-01

    Data exchange and interoperability between clinical information systems represent a crucial issue in the context of patient record data collection. An XML representation schema adapted to end-stage renal disease (ESRD) patients was developed and successfully tested against patient data in the dedicated Multi-Source Information System (MSIS) active file (more than 16,000 patient records). The ESRD-XML-Schema is organized into Schema subsets respecting the coherence of the clinical information and enriched with coherent data types. Tests are realized against XML-data files generated in conformity with the ESRD-XML Schema. Manual tests allowed the XML schema validation of the data format and content. Programmatic tests allowed the design of generic XML parsing routines, a portable object data model representation and the implementation of automatic data-exchange flows with the MSIS database system. The ESRD-XML-Schema represents a valid framework for data exchange and supports interoperability. Its modular design offers opportunity to simplify physicians' multiple tasks in order to privilege their clinical work.

  5. Changes in causes of death and risk of cancer in Danish patients with autosomal dominant polycystic kidney disease and end-stage renal disease.

    Science.gov (United States)

    Orskov, Bjarne; Sørensen, Vibeke Rømming; Feldt-Rasmussen, Bo; Strandgaard, Svend

    2012-04-01

    With the improved prognosis in patients with autosomal dominant polycystic kidney disease (ADPKD), causes of death and the risk of cancer might have changed. This was investigated in a Danish population with ADPKD and end-stage renal disease (ESRD) between 1 January 1993 and 31 December 2008. Data were retrieved from three Danish national registries and a total of 823 patients were identified of which 431 had died during the study period. The 16 years were divided into two 8-year periods and the causes of death were divided into six categories: cancer, cardiovascular, cerebrovascular, infection, other and unknown. Cardiovascular disease was the major cause of death. A multivariate competing risk model comparing the two 8-year periods, adjusted for age at ESRD, gender and treatment modality, showed that deaths from cardiovascular disease decreased by 35% [hazard ratios (HR) 0.65, P=0.008] and deaths from cerebrovascular disease decreased by 69% (HR 0.31, P=0.0003) from the first to the second time period. There were no significant changes between the time periods in death from cancer, infection, other or unknown. From the first to the second 8-year interval, the prevalence of cancer increased by 35% (P=0.0002) while the cancer incidence was stable. In Danish patients with ADPKD and ESRD, there was a significant reduction in cardiovascular and cerebrovascular deaths from 1993 to 2008. The prevalence of cancer increased without significant change in cancer incidence or deaths from cancer.

  6. Conservative management and health-related quality of life in end-stage renal disease: a systematic review.

    Science.gov (United States)

    Tsai, Hung-Bin; Chao, Chia-Ter; Chang, Ray-E; Hung, Kuan-Yu; COGENT Study Group

    2017-06-26

    Few studies have addressed health-related quality of life (QoL) in patients who chose conservative management over dialysis. This systematic review aims to better define the role of conservative management in improving health-related QoL in patients with end-stage renal disease (ESRD). Medline, Cochrane and EMBASE were searched for prospective or retrospective studies published until June 30, 2016, that examined QoL of ESRD patients. The primary outcome was health-related QoL. Four studies were included (405 patients received dialysis and 332 received conservative management). Two studies that used the Short Form-36 Survey (SF-36) showed that the dialysis group had higher physical component scores, but the conservative management group had similar, or better, mental component scores at the end of intervention. Another study using the SF-36 showed that the physical and mental component scores of the dialysis group did not significantly change after intervention. In the conservative management group, the physical component scores did not change, but the mental component scores increased significantly over time (0.12 ± 0.32, p management group. Although there are only a limited number of published articles, ESRD patients who receive conservative management may have improved mental health-related QoL when compared with those who receive dialysis.

  7. Effect of restricted protein diet supplemented with keto analogues in end-stage renal disease: a systematic review and meta-analysis.

    Science.gov (United States)

    Jiang, Zheng; Tang, Yi; Yang, Lichuan; Mi, Xuhua; Qin, Wei

    2018-04-01

    To evaluate the efficacy and safety of the restricted protein diet supplemented with keto analogues when applied in end-stage renal disease (ESRD). The Cochrane Library, PubMed, Embase, CBM and CENTRAL databases were searched and reviewed up to January 2017. Clinical trials were analyzed using RevMan 5.3 software. Five randomized controlled trials were selected and included in this study according to our inclusion and exclusion criteria. Changes in serum albumin, PTH, triglyceride, cholesterol, calcium, phosphorus, hemoglobin, Kt/v and CRP before and after treatment were analyzed. Meta-analysis results indicated that, compared with normal protein diet, low-protein diet (LPD) supplemented with keto analogues (sLPD) could improve serum albumin (P diet supplemented with keto analogues (sLPD) may improve nutritional status and prevent hyperparathyroidism in ESRD patients. The current data were mainly obtained from short-term, single-center trails with small sample sizes and limited nutritional status indexes, indicating a need for further study.

  8. Replacing Phosphorus-Containing Food Additives With Foods Without Additives Reduces Phosphatemia in End-Stage Renal Disease Patients: A Randomized Clinical Trial.

    Science.gov (United States)

    de Fornasari, Margareth Lage Leite; Dos Santos Sens, Yvoty Alves

    2017-03-01

    The purpose of the study was to verify the effects of replacing phosphorus-containing food additives with foods without additives on phosphatemia in end-stage renal disease (ESRD) patients. Randomized clinical trial. Adult patients on hemodialysis for ≥6 months at a single center. A total of 134 patients with phosphorus levels of >5.5 mg/dL were included and were randomized into an intervention group (n = 67) and a control group (n = 67). The IG received individual orientation to replace processed foods that have phosphorus additives with foods of similar nutritional value without these additives. The CG received only the nutritional orientation given before the study. Clinical laboratory data, nutritional status, energy and protein intake, and normalized protein nitrogen appearance (nPNA) were evaluated at the beginning of the study and after 90 days. There was no initial difference between the groups in terms of serum phosphorus levels, nutritional status, and energy intake. After 3 months, there was a decline in phosphorus levels in the IG (from 7.2 ± 1.4 to 5.0 ± 1.3 mg/dL, P food additives with foods without additives reduced serum phosphorus without interfering in the nutritional status of ESRD patients. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  9. "It's hard to ask": examining the factors influencing decision-making among end-stage renal disease patients considering approaching family and friends for a kidney.

    Science.gov (United States)

    Jones, Merryn A; Cornwall, Jon

    2018-05-04

    People needing kidney transplants in New Zealand can receive organs from deceased donors or from a living kidney donor. This project explored issues surrounding donor recruitment, examining the lived experience of end-stage renal disease (ESRD) patients in order to facilitate improved donor recruitment for ESRD patients. A qualitative study comprising interviews of ESRD patients in Hawke's Bay, focusing on the factors surrounding approaching family and friends for a kidney. Purposeful sampling and thematic analysis of data was utilised. Fifteen participants were interviewed (Five female; mean age 49.8yrs). Most stated it was hard to ask for a kidney; almost half had never approached anyone. For many, approaching potential donors was a barrier. Many Māori had limited recruitment opportunities due to comorbidities within extended whanau, making the decision of who to approach difficult. Other barriers included concern for donor health, poor health literacy and poor self-efficacy. Recipients desired more support to facilitate approaching donors, with cultural differences observed between Māori and non-Māori in recruitment expectations. Tailored support could be enabled with development of a screening tool to assess willingness and motivation to accept donation, cultural needs, self-efficacy, communication skills and health literacy. Psychosocial support could help address barriers such as reciprocity concerns.

  10. End Stage Renal Disease: Not a Contraindication for Minor Oral Surgery-Protocol for the Management of Oral Surgery patients with ESRD on Hemodialysis.

    Science.gov (United States)

    Pendem, Sneha; Lakshmi Narayana, G; Ravi, Poornima

    2017-06-01

    To describe a safe and effective protocol for the management of patients with end stage renal disease (ESRD) undergoing minor oral surgery. A prospective cohort study was conducted on all patients with ESRD who were referred for dental consultation. A definite protocol was designed in consultation with the nephrologist to minimize the risk of bleeding and wound healing complications during and after the minor surgical procedures. 36 patients consented for the protocol to be followed while 4 patients did not comply with the protocol and in 2 cases the protocol could be followed. The intra operative, post operative bleeding, and the wound healing were assessed in these patients. 36 patients had uneventful extractions as the blood pressure was brought down to pre hypertensive stage following the protocol. 4 patients who did not comply with the protocol had episodes of bleeding in the post operative period. There were two special scenarios where additional precautions had to be taken have been discussed. The wound healing was satisfactory in all these patients. The protocol discussed in this article helps us provide safe minor oral surgical treatment in patients with ESRD.

  11. Cost calculations during "dire straits": a cost-of-illness analysis of regular hemodialysis for end-stage renal disease in Greece.

    Science.gov (United States)

    Naoum, Panagiota; Topkaroglou, Ioannis; Kitsonis, Dimitrios; Skroumpelos, Anastasios; Athanasakis, Kostas; Iatrou, Christos; Boletis, John; Kyriopoulos, John

    2016-02-01

    More than 3 million people worldwide suffer from end-stage renal disease (ESRD). Even though regular hemodialysis is considered very costly, it is still the most commonly used method of treatment in Greece. The aim of this study is to provide a current estimate of the annual patient cost for ESRD-related regular hemodialysis, especially during a period of economic instability for Greece. Data was collected from 113 anonymous patient files from 3 dialysis units. The cost analysis includes the following parameters: hospitalization, disposable supplies, medication, meals, contaminants, human resources and equipment depreciation/utilization. The cost of a regular hemodialysis session was estimated at €177.12. Human resources account for 43.53% of the hemodialysis cost, while expendable supplies and medication account for 24.79% and 21.16%, respectively. The total annual cost of ESRD per patient was calculated at €34,012.31, which breaks down into €27,630.72 (81.24%) for hemodialysis, €4,800.64 (14.11%) for hospitalization, €1,454.84 (4.28%) for laboratory tests and €126.11 (0.37%) for microsurgery. ESRD entails a significant economic burden for the Greek health care system. In a current context of ongoing austerity measures, which severely pressure the health care budget, further research should be performed in order to identify possible ways to reduce costs and improve management of the disease.

  12. Understanding the relationship between trust in health care and attitudes toward living donor transplant among African Americans with end-stage renal disease.

    Science.gov (United States)

    McDonald, Evangeline L; Powell, C Lamonte; Perryman, Jennie P; Thompson, Nancy J; Arriola, Kimberly R Jacob

    2013-01-01

    Transplantation is the favored therapy for patients with end-stage renal disease (ESRD). Unfortunately, demand for available organs far outpaces the supply. African Americans are disproportionately affected by the ever-widening gap between organ supply and demand. Additionally, structural, biological, and social factors contribute to feelings of unease some African Americans may feel regarding living donor transplant (LDT). The present research examines the relationship between trust in health care and attitudes toward LDT among African American ESRD patients. We hypothesized that lower trust in health care would be significantly associated with negative attitudes toward LDT, and that this relationship would be moderated by patient attitudes toward dialysis. Data were collected from August 2011 to April 2012 as part of a larger study. Measures included trust (of doctors, racial equity of treatment, and hospitals) and attitudes toward both LDT and dialysis. Bivariate analysis revealed that trust in one's doctor, hospital, and in racial equity in health care was significantly correlated with attitudes toward LDT (r = 0.265; r = 0.131; and r = 0.202, respectively). Additionally, attitudes toward dialysis moderated the relationships between Trust in Doctors/Attitudes toward LDT and Trust in Racial equity of treatment/Attitudes toward LDT. Findings suggest a strong relationship between trust in health care and attitudes toward LDT. These findings also shed light on how dialysis experiences are related to the relationship between trust in health care and attitudes toward LDT. © 2013 John Wiley & Sons A/S.

  13. Marine n-3 polyunsaturated fatty acids in patients with end-stage renal failure and in subjects without kidney disease: a comparative study.

    Science.gov (United States)

    Madsen, Trine; Christensen, Jeppe H; Svensson, My; Witt, Petra M; Toft, Egon; Schmidt, Erik B

    2011-03-01

    Patients with end-stage renal disease treated with chronic hemodialysis (HD) are reported to have low levels of marine n-3 polyunsaturated fatty acids (PUFA) in plasma and cell membranes compared with healthy subjects. The aim of this study was to investigate whether n-3 PUFA levels in plasma and cells are lower in HD patients as compared with subjects without kidney disease. A comparative study was carried out. This study was carried out at the Departments of Nephrology and Cardiology, Aalborg Hospital, Aarhus University Hospital, Denmark. This study consisted of 2 study populations comprising HD patients and 5 study populations comprising subjects without kidney disease. The fatty acid distribution in plasma phospholipids and platelet phospholipids was measured using gas chromatography. Eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and arachidonic acid (AA) levels in plasma or serum phospholipids and platelet phospholipids in HD patients were compared with n-3 PUFA levels in subjects without kidney disease. EPA and DHA were lower and AA/EPA was higher in plasma/serum phospholipids in HD patients than in subjects without kidney disease. Similarly, higher AA and AA/EPA and lower EPA and DHA levels were found in platelet phospholipids of HD patients. Adjustment for gender, age, and habitual intake of fish and fish oil supplements did not change these results. HD patients have lower n-3 PUFA levels in plasma and cells compared with subjects without kidney disease. Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  14. Evaluation of plasma concentrations of homocysteine, IL-6, TNF-alpha, hs-CRP, and total antioxidant capacity in patients with end-stage renal failure.

    Directory of Open Access Journals (Sweden)

    Mahin Babaei

    2014-12-01

    Full Text Available It has been proved that hyperhomocysteinemia has a high prevalence in patients with end-stage renal disease (ESRD, which may contribute to the high cardiovascular risk in these patients. Cardiovascular disease is the first cause of high mortality rate in ESRD patients. The aim of the present study was to assess five important factors in patients with ESRD (the amount of homocysteine, IL-6, TNF-alpha, hs-CRP, and Total Antioxidant Capacity. These factors were surveyed in ESRD patients to compare with healthy subjects. In a cross-sectional study, we enrolled 80 patients on maintenance hemodialysis and measured the inflammatory and oxidative stress indicators. The plasma samples were assayed for five above mentioned variables using standard protocols. Two-hour post hemodialysis plasma samples were also assayed for TAC. Plasma levels of inflammation markers, IL-6 and hs-CRP, homocysteine were significantly increased in ESRD group versus control group. This increase was also found in TNF-α levels as compared to the controls, but the differences were not statistically significant. Also, the post dialysis samples had significantly lower levels of TAC as compared to predialysis ones.

  15. Contemporary Management of Coronary Artery Disease and Acute Coronary Syndrome in Patients with Chronic Kidney Disease and End-Stage Renal Disease

    Science.gov (United States)

    Huang, Chin-Chou; Chen, Jaw-Wen

    2013-01-01

    Chronic kidney disease (CKD) and end-stage renal disease (ESRD) have emerged as a worldwide public health problem. Due to the remarkably higher incidence and prevalence of this chronic disease in Taiwan than in other countries, CKD/ESRD has contributed to a significant health burden in Taiwan. Patients with CKD/ESRD have an increased risk of coronary artery disease (CAD) and acute coronary syndrome (ACS) compared to the normal population. Patients with ACS alone can present differently than patients with ACS and CKD/ESRD. Also, due to the lower prevalence of chest pain and ST-segment elevation, CKD/ESRD patients were more difficult to diagnose than other patients. Furthermore, whether advances in ACS management with medical therapy and an early invasive approach could improve patient outcomes with CKD/ESRD is not known. The use of antiplatelets such as aspirin and other antithrombotic agents might reduce the incidence of ACS or stroke in CKD patients. However, such use could also increase bleeding risk and even increase the likelihood of mortality, especially in dialysis patients. While recent clinical data suggest the potential benefit of aggressive management with coronary intervention for CAD and ACS in this category of patients, further clinical studies are still indicated for the proper medical strategy and revascularization therapy to improve the outcomes of CAD and ACS in CKD/ESRD patients, both in Taiwan and worldwide. PMID:27122697

  16. Ego mechanisms of defense are associated with patients' preference of treatment modality independent of psychological distress in end-stage renal disease.

    Science.gov (United States)

    Hyphantis, Thomas; Katsoudas, Spiros; Voudiclari, Sonia

    2010-03-24

    Several parameters mediate the selection of treatment modality in end-stage renal disease (ESRD). The nephrology community suggests that patient preference should be the prime determinant of modality choice. We aimed to test whether ego mechanisms of defense are associated with patients' treatment modality preferences, independent of psychological distress. In 58 eligible ESRD patients who had themselves chosen their treatment modality, we administered the Symptom Distress Checklist-90-R and the Defense Style Questionnaire. Thirty-seven patients (53.4%) had chosen hemodialysis and 21 (46.6%) peritoneal dialysis. Patients who preferred peritoneal dialysis were younger (odds ratio [OR], 0.89; 95% confidence interval [CI]: 0.804-0.988), had received more education (OR, 8.84; 95% CI: 1.301-60.161), and were twice as likely to adopt an adaptive defense style as compared to patients who preferred hemodialysis (57.1% vs 27.0%, respectively; P psychological distress. Our findings indicate that the patient's personality should be taken into account, if we are to better define which modalities are best suited to which patients. Also, physicians should bear in mind passive-aggressive behaviors that warrant attention and intervention in patients who preferred hemodialysis.

  17. Role of regional anesthesia for placement of peritoneal dialysis catheter under ultrasound guidance: Our experience with 52 end-stage renal disease patients

    Directory of Open Access Journals (Sweden)

    Smaranjit Chatterjee

    2015-01-01

    Full Text Available Aim: The number of patients with end-stage renal disease (ESRD has shown a consistent rise in India in recent years. Continuous ambulatory peritoneal dialysis (CAPD remains one of the safe and effective forms of treatment. In this study, we have tried to assess the effectiveness of field block technique for analgesia during catheter placement surgery until 24 h postoperatively, also, if it can obviate the need for general anesthesia in these high-risk patients. Materials and Methods: We studied 52 ESRD patients from 2010 to 2012 who were posted for CAPD catheterization in the Department of Urology, Care Hospital, Hyderabad, India. Under ultrasound guidance, "unilateral posterior" and "unilateral subcostal" transversus abdominis plane block anesthesia were given for the placement of CAPD catheter. Patient′s intra-operative pain and post-operative pain were recorded with visual analog scores (VAS and analyzed. Results: All patients in our study belonged to American Society of Anesthesiologists category 2 or 3 with multiple co-morbidities. 41 out of 52 patients required no supplemental analgesia during the procedure; 8 patients needed additional infiltration of local anesthetic during skin incisions. Three patients required supplemental analgesia and were considered as failure. A VAS of two was noted in 30 patients and 1 in 19 Patients. No Patient had significant pain 24 h post operatively. No local complication was noted in any patient. Conclusion: CAPD Catheterization under regional field block remains safe and effective options for ESRD patients.

  18. Association of urinary KIM-1, L-FABP, NAG and NGAL with incident end-stage renal disease and mortality in American Indians with type 2 diabetes mellitus.

    Science.gov (United States)

    Fufaa, Gudeta D; Weil, E Jennifer; Nelson, Robert G; Hanson, Robert L; Bonventre, Joseph V; Sabbisetti, Venkata; Waikar, Sushrut S; Mifflin, Theodore E; Zhang, Xiaoming; Xie, Dawei; Hsu, Chi-Yuan; Feldman, Harold I; Coresh, Josef; Vasan, Ramachandran S; Kimmel, Paul L; Liu, Kathleen D

    2015-01-01

    Kidney injury molecule 1 (KIM-1), liver fatty acid-binding protein (L-FABP), N-acetyl-β-D-glucosaminidase (NAG) and neutrophil gelatinase-associated lipocalin (NGAL) are urinary biomarkers of renal tubular injury. We examined their association with incident end-stage renal disease (ESRD) and all-cause mortality in American Indians with type 2 diabetes. Biomarker concentrations were measured in baseline urine samples in 260 Pima Indians who were followed for a median of 14 years. HRs were reported per SD of creatinine (Cr)-normalised log-transformed KIM-1, NAG and NGAL, and for three categories of L-FABP. During follow-up, 74 participants developed ESRD and 101 died. Median concentrations of KIM-1/Cr, NAG/Cr and NGAL/Cr and the proportion of detectable L-FABP were highest in those with macroalbuminuria (p associated with ESRD (HR 1.59, 95% CI 1.20, 2.11) and mortality (HR 1.39, 95% CI 1.06, 1.82); L-FABP/Cr was inversely associated with ESRD (HR [for highest vs lowest tertile] 0.40, 95% CI 0.19, 0.83). Addition of NGAL/Cr to models that included albuminuria and glomerular filtration rate increased the c-statistic for predicting ESRD from 0.828 to 0.833 (p = 0.001) and for death from 0.710 to 0.722 (p = 0.018). Addition of L-FABP/Cr increased the c-statistic for ESRD from 0.828 to 0.832 (p = 0.042). In Pima Indians with type 2 diabetes, urinary concentrations of NGAL and L-FABP are associated with important health outcomes, but they are unlikely to add to risk prediction with standard markers in a clinically meaningful way given the small increase in the c-statistic.

  19. Early home-based group education to support informed decision-making among patients with end-stage renal disease: a multi-centre randomized controlled trial.

    Science.gov (United States)

    Massey, Emma K; Gregoor, Peter J H Smak; Nette, Robert W; van den Dorpel, Marinus A; van Kooij, Anthony; Zietse, Robert; Zuidema, Willij C; Timman, Reinier; Busschbach, Jan J; Weimar, Willem

    2016-05-01

    The aim was to test the effectiveness of early home-based group education on knowledge and communication about renal replacement therapy (RRT). We conducted a randomized controlled trial using a cross-over design among 80 end-stage renal disease (ESRD) patients. Between T0 and T1 (weeks 1-4) Group 1 received the intervention and Group 2 received standard care. Between T1 and T2 (weeks 5-8) Group 1 received standard care and Group 2 received the intervention. The intervention was a group education session on RRT options held in the patient's home given by social workers. Patients invited members from their social network to attend. Self-report questionnaires were used at T0, T1 and T2 to measure patients' knowledge and communication, and concepts from the Theory of Planned Behaviour such as attitude. Comparable questionnaires were completed pre-post intervention by 229 attendees. Primary RRT was registered up to 2 years post-intervention. Multilevel linear modelling was used to analyse patient data and paired t-tests for attendee data. Statistically significant increases in the primary targets knowledge and communication were found among patients and attendees after receiving the intervention. The intervention also had a significant effect in increasing positive attitude toward living donation and haemodialysis. Of the 80 participants, 49 underwent RRT during follow-up. Of these, 34 underwent a living donor kidney transplant, of which 22 were pre-emptive. Early home-based group education supports informed decision-making regarding primary RRT for ESRD patients and their social networks and may remove barriers to pre-emptive transplantation. © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

  20. Superficial temporal artery calcification in patients with end-stage renal disease: Association with vascular risk factors and ischemic cerebrovascular disease

    International Nuclear Information System (INIS)

    Anwar, Zeeshan; Zan, Elcin; Carone, Marco; Ozturk, Arzu; Sozio, Stephen M; Yousem, David M

    2011-01-01

    Extracranial superficial temporal artery (STA) calcification is an unusual finding seen in patients with chronic kidney disease and has unknown ramifications with respect to intracranial ischemic disease. We sought to determine the association between the risk factors for vascular calcification and this rare phenomenon, in patients with chronic renal failure, and to assess the coexistence of cerebral ischemia. Medical records and laboratory data on risk factors for vascular calcification were retrospectively retrieved for 453 patients with a discharge diagnosis of end-stage renal disease (ESRD). CT head examinations were reviewed to identify and associate STA calcification with 1) risk factors for the vascular calcification, 2) intracranial artery calcification, and 3) cerebral ischemia (white matter and/or cortical ischemic changes). STA calcification was present in 9.9% (45/453) of the studied cohort. The prevalence of cerebral ischemia was 24.4% (11/45) in patients with STA calcification and 9.3% (38/408) in patients without it. Diabetes mellitus (OR: 2.56, 95% CI: 1.059-6.208; P=0.037) was independently associated with the risk of STA calcification. The risk of cerebral ischemia, however, was not related to STA calcification (P=0.221). The presence of diabetes mellitus is important in describing the risk of STA calcification in patients with ESRD, whereas age, gender, hypertension, serum calcium, serum phosphate, or serum hemoglobin levels are not. The risk of cerebral ischemia is not related to STA calcification but has the strongest association with diabetes mellitus

  1. Continuity of care with physicians and risk of subsequent hospitalization and end-stage renal disease in newly diagnosed type 2 diabetes mellitus patients.

    Science.gov (United States)

    Chang, Po-Ya; Chien, Li-Nien; Bai, Chyi-Huey; Lin, Yuh-Feng; Chiou, Hung-Yi

    2018-01-01

    Effective management for type 2 diabetes mellitus (DM) can slow the progression of kidney outcomes and reduce hospital admissions. Better continuity of care (COC) was found to improve patients' adherence and self-management. This study examined the associations between COC, hospitalization, and end-stage renal disease (ESRD) in DM patients. In the cohort study, data from 1996 to 2012 were retrieved from the Longitudinal Health Insurance Database, using inverse probability weighted analysis. A total of 26,063 patients with newly diagnosed type 2 DM who had been treated with antihyperglycemic agents were included. COC is to assess the extent to which a DM patient visited the same physician during the study period. This study categorized COC into 3 groups - low, intermediate, and high, - according to the distribution of scores in our sample. The number of ESRD patients in the high, intermediate, and low COC groups were 92 (22.33%), 130 (31.55%), and 190 (46.12%), respectively, and the mean follow-up periods for the 3 groups were 7.13, 7.12, and 7.27 years, respectively. After using inverse probability weighting, the intermediate and low COC groups were significantly associated with an increased risk of ESRD compared with the high COC group (adjusted hazard ratio (aHR) 1.36 [95% CI, 1.03-1.80] and aHR 1.76 [95% CI, 1.35-2.30], respectively). The intermediate and low COC groups were also significantly associated with the subsequent hospitalization compared with the high COC group (aHR 1.15 [95% CI, 0.99-1.33] and aHR 1.72 [95% CI, 1.50-1.97], respectively). COC is related to ESRD onset and subsequent hospitalization among patients with DM. This study suggested that when DM patients keep visiting the same physician for managing their diseases, the progression of renal disease can be prevented.

  2. Rationale and design of a patient-centered medical home intervention for patients with end-stage renal disease on hemodialysis.

    Science.gov (United States)

    Porter, Anna C; Fitzgibbon, Marian L; Fischer, Michael J; Gallardo, Rani; Berbaum, Michael L; Lash, James P; Castillo, Sheila; Schiffer, Linda; Sharp, Lisa K; Tulley, John; Arruda, Jose A; Hynes, Denise M

    2015-05-01

    In the U.S., more than 400,000 individuals with end-stage renal disease (ESRD) require hemodialysis (HD) for renal replacement therapy. ESRD patients experience a high burden of morbidity, mortality, resource utilization, and poor quality of life (QOL). Under current care models, ESRD patients receive fragmented care from multiple providers at multiple locations. The Patient-Centered Medical Home (PCMH) is a team approach, providing coordinated care across the healthcare continuum. While this model has shown some early benefits for complex chronic diseases such as diabetes, it has not been applied to HD patients. This study is a non-randomized quasi-experimental intervention trial implementing a Patient-Centered Medical Home for Kidney Disease (PCMH-KD). The PCMH-KD extends the existing dialysis care team (comprised of a nephrologist, dialysis nurse, dialysis technician, social worker, and dietitian) by adding a general internist, pharmacist, nurse coordinator, and a community health worker, all of whom will see the patients together, and separately, as needed. The primary goal is to implement a comprehensive, multidisciplinary care team to improve care coordination, quality of life, and healthcare use for HD patients. Approximately 240 patients will be recruited from two sites; a non-profit university-affiliated dialysis center and an independent for-profit dialysis center. Outcomes include (i) patient-reported outcomes, including QOL and satisfaction; (ii) clinical outcomes, including blood pressure and diet; (iii) healthcare use, including emergency room visits and hospitalizations; and (iv) staff perceptions. Given the significant burden that patients with ESRD on HD experience, enhanced care coordination provides an opportunity to reduce this burden and improve QOL. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Multicentre, parallel-group, comparative trial evaluating the efficacy and safety of sugammadex in patients with end-stage renal failure or normal renal function.

    NARCIS (Netherlands)

    Staals, L.M.; Snoeck, M.M.J.; Driessen, J.J.; Flockton, E.A.; Heeringa, M.; Hunter, J.M.

    2008-01-01

    BACKGROUND: Sugammadex, a modified gamma-cyclodextrin, is the first selective relaxant binding agent that specifically encapsulates the steroidal neuromuscular blocking agent, rocuronium. The action of rocuronium is prolonged in patients with renal failure. As sugammadex is primarily cleared

  4. Amiloidose e insuficiência renal crônica terminal associada à hanseníase Amyloidosis and end-stage renal disease associated with leprosy

    Directory of Open Access Journals (Sweden)

    Geraldo Bezerra da Silva Júnior

    2010-08-01

    Full Text Available O envolvimento renal na hanseníase é diverso, incluindo glomerulonefrites, amiloidose e nefrite túbulo-intersticial. Um homem de 58 anos foi admitido com edema de membros inferiores e dispnéia. Na admissão, havia retenção de escórias nitrogenadas, anemia, hipercalemia e acidose metabólica, com necessidade de hemodiálise. Referia história de hanseníase virchoviana. Foi realizada biopsia renal, compatível com amiloidose. O paciente evoluiu estável, sem recuperação da função renal, permanecendo em tratamento hemodialítico. A hanseníase deve ser investigada em todo paciente com perda de função renal, sobretudo naqueles que apresentam lesões cutâneas ou outras manifestações sugestivas de hanseníase.Renal involvement in leprosy includes glomerulonephritis, amyloidosis and tubulointerstitial nephritis. A 58-year-old man was admitted with complaints of lower limb edema and dyspnea. At admission, nitrogen retention, anemia, hyperkalemia and metabolic acidosis were observed, requiring hemodialysis. The patient had a history of lepromatous leprosy. A renal biopsy was performed that was compatible with amyloidosis. The patient had a stable outcome, but without renal function recovery and remained on regular hemodialysis. Leprosy should be investigated in every patient with renal function loss, particularly in those with cutaneous lesions or other manifestations suggestive of leprosy.

  5. Children of non-Western origin with end-stage renal disease in the Netherlands, Belgium and a part of Germany have impaired health-related quality of life compared with Western children

    NARCIS (Netherlands)

    Schoenmaker, Nikki J.; Haverman, Lotte; Tromp, Wilma F.; van der Lee, Johanna H.; Offringa, Martin; Adams, Brigitte; Bouts, Antonia H. M.; Collard, Laure; Cransberg, Karlien; van Dyck, Maria; Godefroid, Nathalie; van Hoeck, Koenraad; Koster-Kamphuis, Linda; Lilien, Marc R.; Raes, Ann; Taylan, Christina; Grootenhuis, Martha A.; Groothoff, Jaap W.

    2014-01-01

    Many children with end-stage renal disease (ESRD) living in Western Europe are of non-Western European origin. They have unfavourable somatic outcomes compared with ESRD children of Western origin. In this study, we compared the Health-related Quality of Life (HRQoL) of both groups. All children

  6. Children of non-Western origin with end-stage renal disease in the Netherlands, Belgium and a part of Germany have impaired health-related quality of life compared with Western children

    NARCIS (Netherlands)

    Schoenmaker, N.J.; Haverman, L.; Tromp, W.F.; Lee, J.H. van der; Offringa, M.; Adams, B.; Bouts, A.H.M.; Collard, L.; Cransberg, K.; Dyck, M. van; Godefroid, N.; Hoeck, K. van; Koster-Kamphuis, L.; Lilien, M.R.; Raes, A.; Taylan, C.; Grootenhuis, M.A.; Groothoff, J.W.

    2014-01-01

    BACKGROUND: Many children with end-stage renal disease (ESRD) living in Western Europe are of non-Western European origin. They have unfavourable somatic outcomes compared with ESRD children of Western origin. In this study, we compared the Health-related Quality of Life (HRQoL) of both groups.

  7. Mortality risk disparities in children receiving chronic renal replacement therapy for the treatment of end-stage renal disease across Europe: an ESPN-ERA/EDTA registry analysis.

    Science.gov (United States)

    Chesnaye, Nicholas C; Schaefer, Franz; Bonthuis, Marjolein; Holman, Rebecca; Baiko, Sergey; Baskın, Esra; Bjerre, Anna; Cloarec, Sylvie; Cornelissen, Elisabeth A M; Espinosa, Laura; Heaf, James; Stone, Rosário; Shtiza, Diamant; Zagozdzon, Ilona; Harambat, Jérôme; Jager, Kitty J; Groothoff, Jaap W; van Stralen, Karlijn J

    2017-05-27

    We explored the variation in country mortality rates in the paediatric population receiving renal replacement therapy across Europe, and estimated how much of this variation could be explained by patient-level and country-level factors. In this registry analysis, we extracted patient data from the European Society for Paediatric Nephrology/European Renal Association-European Dialysis and Transplant Association (ESPN/ERA-EDTA) Registry for 32 European countries. We included incident patients younger than 19 years receiving renal replacement therapy. Adjusted hazard ratios (aHR) and the explained variation were modelled for patient-level and country-level factors with multilevel Cox regression. The primary outcome studied was all-cause mortality while on renal replacement therapy. Between Jan 1, 2000, and Dec 31, 2013, the overall 5 year renal replacement therapy mortality rate was 15·8 deaths per 1000 patient-years (IQR 6·4-16·4). France had a mortality rate (9·2) of more than 3 SDs better, and Russia (35·2), Poland (39·9), Romania (47·4), and Bulgaria (68·6) had mortality rates more than 3 SDs worse than the European average. Public health expenditure was inversely associated with mortality risk (per SD increase, aHR 0·69, 95% CI 0·52-0·91) and explained 67% of the variation in renal replacement therapy mortality rates between countries. Child mortality rates showed a significant association with renal replacement therapy mortality, albeit mediated by macroeconomics (eg, neonatal mortality reduced from 1·31 [95% CI 1·13-1·53], p=0·0005, to 1·21 [0·97-1·51], p=0·10). After accounting for country distributions of patient age, the variation in renal replacement therapy mortality rates between countries increased by 21%. Substantial international variation exists in paediatric renal replacement therapy mortality rates across Europe, most of which was explained by disparities in public health expenditure, which seems to limit the availability and

  8. Health-Related Quality of Life Impacts Mortality but Not Progression to End-Stage Renal Disease in Pre-Dialysis Chronic Kidney Disease: A Prospective Observational Study.

    Science.gov (United States)

    Jesky, Mark D; Dutton, Mary; Dasgupta, Indranil; Yadav, Punit; Ng, Khai Ping; Fenton, Anthony; Kyte, Derek; Ferro, Charles J; Calvert, Melanie; Cockwell, Paul; Stringer, Stephanie J

    2016-01-01

    Chronic kidney disease (CKD) is associated with reduced health-related quality of life (HRQL). However, the relationship between pre-dialysis CKD, HRQL and clinical outcomes, including mortality and progression to end-stage renal disease (ESRD) is unclear. All 745 participants recruited into the Renal Impairment In Secondary Care study to end March 2014 were included. Demographic, clinical and laboratory data were collected at baseline including an assessment of HRQL using the Euroqol EQ-5D-3L. Health states were converted into an EQ-5Dindex score using a set of weighted preferences specific to the UK population. Multivariable Cox proportional hazards regression and competing risk analyses were undertaken to evaluate the association of HRQL with progression to ESRD or all-cause mortality. Regression analyses were then performed to identify variables associated with the significant HRQL components. Median eGFR was 25.8 ml/min/1.73 m2 (IQR 19.6-33.7ml/min) and median ACR was 33 mg/mmol (IQR 6.6-130.3 mg/mmol). Five hundred and fifty five participants (75.7%) reported problems with one or more EQ-5D domains. When adjusted for age, gender, comorbidity, eGFR and ACR, both reported problems with self-care [hazard ratio 2.542, 95% confidence interval 1.222-5.286, p = 0.013] and reduced EQ-5Dindex score [hazard ratio 0.283, 95% confidence interval 0.099-0.810, p = 0.019] were significantly associated with an increase in all-cause mortality. Similar findings were observed for competing risk analyses. Reduced HRQL was not a risk factor for progression to ESRD in multivariable analyses. Impaired HRQL is common in the pre-dialysis CKD population. Reduced HRQL, as demonstrated by problems with self-care or a lower EQ-5Dindex score, is associated with a higher risk for death but not ESRD. Multiple factors influence these aspects of HRQL but renal function, as measured by eGFR and ACR, are not among them.

  9. Elevated global cerebral blood flow, oxygen extraction fraction and unchanged metabolic rate of oxygen in young adults with end-stage renal disease: an MRI study

    Energy Technology Data Exchange (ETDEWEB)

    Zheng, Gang; Lou, Yaxian; Pan, Zhiying; Liu, Ya [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Nanjing University of Aeronautics and Astronautics, College of Aivil Aviation, Nanjing, Jiangsu (China); Wen, Jiqiu; Li, Xue; Zhang, Zhe [Medical School of Nanjing University, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing, Jiangsu (China); Lu, Hanzhang [University of Texas Southwestern Medical Center, Advanced Imaging Research Center, Dallas, TX (United States); Liu, Wei [Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, Guangdong (China); Liu, Hui [Siemens MR NEA Collaboration, Siemens Ltd., Shanghai (China); Chen, Huijuan; Kong, Xiang; Luo, Song; Jiang, Xiaolu; Zhang, Zongjun; Zhang, Long Jiang; Lu, Guang Ming [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China)

    2016-06-15

    To noninvasively assess global cerebral blood flow (CBF), oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO{sub 2}) in young adults with end-stage renal disease (ESRD). Thirty-six patients and 38 healthy volunteers were included and took part in MR examinations, blood and neuropsychological tests. CBF and OEF were measured by phase-contrast and T2-relaxation-under-spin-tagging MRI techniques, respectively. CMRO{sub 2} was computed from CBF, OEF and hematocrit according to Fick's principle. Correlations were performed between MR measurements, blood biochemistry measurements and neuropsychological test scores. Compared with controls, ESRD patients had elevated CBF (72.9 ± 12.5 vs. 63.8 ± 8.5 ml min{sup -1} 100 g{sup -1}, P < 0.001), elevated OEF (47.2 ± 10.2 vs. 35.8 ± 5.4 %, P < 0.001), but unaffected CMRO{sub 2} (199.5 ± 36.4 vs. 193.8 ± 28.6 μmol O{sub 2} min{sup -1} 100 g{sup -1}, P = 0.879). Hematocrit negatively correlated with CBF (r = -0.640, P < 0.001) and OEF (r = -0.701, P < 0.001), but not with CMRO{sub 2}. Altered neuropsychological test scores of ESRD patients were associated with OEF and CBF, but not with CMRO{sub 2}. There were weak relationships between eGFR and hematocrit (r = 0.308, P = 0.068) or CBF (r = 0.318, P = 0.059). Our findings suggested that anaemic young adults with ESRD may afford higher CBF and OEF to maintain a normal CMRO{sub 2}. Despite this compensatory process, however, cognitive function was still impaired and its severity was correlated with their CBF and OEF abnormality. (orig.)

  10. Feasibility of Urgent-Start Peritoneal Dialysis in Older Patients with End-Stage Renal Disease: A Single-Center Experience.

    Science.gov (United States)

    Jin, Haijiao; Ni, Zhaohui; Mou, Shan; Lu, Renhua; Fang, Wei; Huang, Jiaying; Hu, Chunhua; Zhang, Haifen; Yan, Hao; Li, Zhenyuan; Yu, Zanzhe

    2018-01-01

    Patients with end-stage renal disease (ESRD) frequently require urgent-start dialysis. Recent evidence suggests that peritoneal dialysis (PD) might be a feasible alternative to hemodialysis (HD) in these patients, including in older patients. This retrospective study enrolled patients aged > 65 years with ESRD who underwent urgent dialysis without functional vascular access or PD catheter at a single center, from January 2011 to December 2014. Patients were grouped based on their dialysis modality (PD or HD). Patients unable to tolerate PD catheter insertion or wait for PD were excluded. Each patient was followed for at least 30 days after catheter insertion. Short-term (30-day) dialysis-related complications and patient survival were compared between the 2 groups. A total of 94 patients were enrolled, including 53 (56.4%) who underwent PD. The incidence of dialysis-related complications during the first 30 days was significantly lower in PD compared with HD patients (3 [5.7%] vs 10 [24.4%], p = 0.009). Logistic regression identified urgent-start HD as an independent risk factor for dialysis-related complications compared with urgent-start PD (odds ratio 4.760 [1.183 - 19.147], p = 0.028). The 6-, 12-, 24-, and 36-month survival rates in the PD and HD groups were 92.3% vs 94.6%, 82.4% vs 81.3%, 75.7% vs 74.2%, and 69.5% vs 60.6%, respectively, with no significant differences between the groups (log-rank = 0.011, p = 0.915). Urgent-start PD was associated with fewer short-term dialysis-related complications and similar survival to urgent-start HD in older patients with ESRD. Peritoneal dialysis may thus be a safe and effective dialysis modality for older ESRD patients requiring urgent dialysis. Copyright © 2018 International Society for Peritoneal Dialysis.

  11. Klotho G-395A gene polymorphism: impact on progression of end-stage renal disease and development of cardiovascular complications in children on dialysis.

    Science.gov (United States)

    Elghoroury, Eman A; Fadel, Fatina I; Elshamaa, Manal F; Kandil, Dina; Salah, Doaa M; El-Sonbaty, Marwa M; Farouk, Hebatallah; Raafat, Mona; Nasr, Soha

    2018-06-01

    Klotho G-395-A gene polymorphism may impact children with end-stage renal disease (ESRD). We investigated the relevance of Klotho G-395-A on ESRD development and progression, and its relationship with evolution of cardiovascular complications in pediatric dialysis patients. Fifty-five children with chronic kidney disease (CKD) and seventy healthy children were genotyped for Klotho G-395A. Incidence of GA/AA genotypes and A allele were higher in ESRD patients compared with controls (54.5 vs. 7.1%, P < 0.001; 30.9 vs. 13.6%, P = 0.001, respectively). Also, children with GA/AA genotypes were 15.6 times more likely to develop ESRD than with GG genotype (95% CI 5.4-44.7, P < 0.001). A allele carriers have 2.8 times higher risk of developing ESRD than those with G allele (95% CI 1.5-5.35, P = 0.001). Also, the A allele could be considered a predictor of cardiovascular disease (CVD), as carriers have 161 times higher risk of cardiovascular complications than non-carriers (95% CI 21-1233, P < 0.001). All ESRD patients with CVD presented with left ventricular hypertrophy (LVH) and the frequency of A allele was significantly higher among ESRD children with LVH, whereas G allele frequency was significantly higher among ESRD children without LVH. The A allele of the G-395A Klotho gene polymorphism shows a significantly higher frequency among children with CKD and those with CVD and LVH. This mutant allele could be used as a risk marker for the development of ESRD as well as a predictor of CVD in these children.

  12. Sign and magnitude scaling properties of heart rate variability in patients with end-stage renal failure: Are these properties useful to identify pathophysiological adaptations?

    Science.gov (United States)

    Lerma, Claudia; Echeverría, Juan C.; Infante, Oscar; Pérez-Grovas, Héctor; González-Gómez, Hortensia

    2017-09-01

    The scaling properties of heart rate variability data are reliable dynamical features to predict mortality and for the assessment of cardiovascular risk. The aim of this manuscript was to determine if the scaling properties, as provided by the sign and magnitude analysis, can be used to differentiate between pathological changes and those adaptations basically introduced by modifications of the mean heart rate in distinct manoeuvres (active standing or hemodialysis treatment, HD), as well as clinical conditions (end stage renal disease, ESRD). We found that in response to active standing, the short-term scaling index (α1) increased in healthy subjects and in ESRD patients only after HD. The sign short-term scaling exponent (α1sign) increased in healthy subjects and ESRD patients, showing a less anticorrelated behavior in active standing. Both α1 and α1sign did show covariance with the mean heart rate in healthy subjects, while in ESRD patients, this covariance was observed only after HD. A reliable estimation of the magnitude short-term scaling exponent (α1magn) required the analysis of time series with a large number of samples (>3000 data points). This exponent was similar for both groups and conditions and did not show covariance with the mean heart rate. A surrogate analysis confirmed the presence of multifractal properties (α1magn > 0.5) in the time series of healthy subjects and ESDR patients. In conclusion, α1 and α1sign provided insights into the physiological adaptations during active standing, which revealed a transitory impairment before HD in ESRD patients. The presence of multifractal properties indicated that a reduced short-term variability does not necessarily imply a declined regulatory complexity in these patients.

  13. Opting out of dialysis – Exploring patients' decisions to forego dialysis in favour of conservative non-dialytic management for end-stage renal disease.

    Science.gov (United States)

    Seah, Angeline S T; Tan, Fiona; Srinivas, Subramaniam; Wu, Huei Yei; Griva, Konstadina

    2015-10-01

    Dialysis prolongs the life of people with end-stage renal disease (ESRD), but for patients who are elderly and suffer multiple comorbid illnesses the benefits of dialysis may be outweighed by its negative consequences. Non-dialytic conservative management has therefore become an alternative treatment route, yet little is known on patients' experience with choosing end-of-life treatment. To gain insight into the decision-making process leading to opting out of dialysis and the experience with conservative non-dialytic management from the patients' perspective. Qualitative study using semi-structured interviews. Interpretative phenomenological analysis was undertaken as the framework for data analysis. N = 9 ESRD participants who have taken the decision to forego dialysis were recruited from the advanced care programme under the National Healthcare Group, Singapore. Participants discussed life since ESRD diagnosis, and the personal and contextual factors that led them to choose conservative management. The perceived physical and financial burden of dialysis both for the individual but most importantly for their family, uncertainty over likely gains over risks which were fuelled by communication of negative dialysis stories of others, coupled with sense of life completion and achievement led them to refuse dialysis. All participants took ownership of their decision despite contrary advice by doctors and were content with their decision and current management. Study highlights the factors driving patients' decisions for conservative non-dialytic management over dialysis to allow medical professionals to offer appropriate support to patients through their decision-making process and in caring them for the rest of their lives. © 2013 John Wiley & Sons Ltd.

  14. Adropin and irisin levels in relation to nutrition, body composition, and insulin resistance in patients with end-stage renal disease on chronic hemodialysis and peritoneal dialysis.

    Science.gov (United States)

    Kałużna, Małgorzata; Hoppe, Krzysztof; Schwermer, Krzysztof; Ibrahim, Aisha Y; Pawlaczyk, Krzysztof; Ziemnicka, Katarzyna

    2016-07-25

    INTRODUCTION    Newly discovered myokines, adropin, and irisin, are regulators of energy homeostasis and metabolism in humans. In end-stage renal disease (ESRD), the significance and role of irisin and adropin as metabolism regulators are still unclear. OBJECTIVES    The aim of this study was to evaluate serum adropin and irisin levels and establish their relation to insulin resistance, nutritional status, and hydration status in patients on chronic hemodialysis (HD) and on peritoneal dialysis (PD). PATIENTS AND METHODS    The study consisted of 71 subjects, including 48 patients (18 women, 30 men; median age, 56.5 years; range, 26-84 years) either on HD (n = 41) or PD (n = 7) and 36 healthy controls matched for age and sex. We measured the serum levels of adropin, irisin, creatinine, albumin, glucose, and insulin, as well as the plasma levels of lipids. The bioimpedance method was used to evaluate the body composition and overhydration in patients with ESRD. RESULTS    Irisin levels were significantly lower in patients with ESRD compared with controls, but there were no differences in adropin levels between both study groups. Adropin levels were inversely correlated with body mass, lean tissue mass, total, intracellular, and extracellular water, and albumin concentrations in patients with ESRD. Irisin levels were positively correlated with glucose levels and homeostasis model assessment of insulin resistance. No significant correlations were observed between adropin and irisin concentrations and overhydration. CONCLUSIONS    Adropin may be considered as a new marker of nutritional status in patients with ESRD. The significance and cause of low irisin levels characteristic for these patients are still unclear. Adropin and irisin should be further investigated as possible markers of cachexia and insulin resistance in patients with ESRD.

  15. Elevated global cerebral blood flow, oxygen extraction fraction and unchanged metabolic rate of oxygen in young adults with end-stage renal disease: an MRI study

    International Nuclear Information System (INIS)

    Zheng, Gang; Lou, Yaxian; Pan, Zhiying; Liu, Ya; Wen, Jiqiu; Li, Xue; Zhang, Zhe; Lu, Hanzhang; Liu, Wei; Liu, Hui; Chen, Huijuan; Kong, Xiang; Luo, Song; Jiang, Xiaolu; Zhang, Zongjun; Zhang, Long Jiang; Lu, Guang Ming

    2016-01-01

    To noninvasively assess global cerebral blood flow (CBF), oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO 2 ) in young adults with end-stage renal disease (ESRD). Thirty-six patients and 38 healthy volunteers were included and took part in MR examinations, blood and neuropsychological tests. CBF and OEF were measured by phase-contrast and T2-relaxation-under-spin-tagging MRI techniques, respectively. CMRO 2 was computed from CBF, OEF and hematocrit according to Fick's principle. Correlations were performed between MR measurements, blood biochemistry measurements and neuropsychological test scores. Compared with controls, ESRD patients had elevated CBF (72.9 ± 12.5 vs. 63.8 ± 8.5 ml min -1 100 g -1 , P < 0.001), elevated OEF (47.2 ± 10.2 vs. 35.8 ± 5.4 %, P < 0.001), but unaffected CMRO 2 (199.5 ± 36.4 vs. 193.8 ± 28.6 μmol O 2 min -1 100 g -1 , P = 0.879). Hematocrit negatively correlated with CBF (r = -0.640, P < 0.001) and OEF (r = -0.701, P < 0.001), but not with CMRO 2 . Altered neuropsychological test scores of ESRD patients were associated with OEF and CBF, but not with CMRO 2 . There were weak relationships between eGFR and hematocrit (r = 0.308, P = 0.068) or CBF (r = 0.318, P = 0.059). Our findings suggested that anaemic young adults with ESRD may afford higher CBF and OEF to maintain a normal CMRO 2 . Despite this compensatory process, however, cognitive function was still impaired and its severity was correlated with their CBF and OEF abnormality. (orig.)

  16. Association Between Early Helicobacter pylori Eradication and a Lower Risk of Recurrent Complicated Peptic Ulcers in End-Stage Renal Disease Patients

    Science.gov (United States)

    Chang, Shen-Shong; Hu, Hsiao-Yun

    2015-01-01

    Abstract End-stage renal disease (ESRD) patients exhibit an increased incidence of peptic ulcer disease. Helicobacter pylori plays a central role in the development of peptic ulcers. The effect of early H pylori eradication on the recurrence of complicated peptic ulcer disease in ESRD patients remains unclear. The aim of the present study was to explore whether early H pylori eradication therapy in ESRD patients can reduce the risk of recurrent complicated peptic ulcers. We conducted a population-based cohort study and recruited patients with ESRD who had developed peptic ulcers. We categorized patients into early (time lag ≦120 days after peptic ulcer diagnosis) and late H pylori eradication therapy groups. The Cox proportional hazards model was used. The endpoint was based on hospitalization for complicated recurrent peptic ulcers. The early and late H pylori eradication therapy groups consisted of 2406 and 1356 ESRD patients, respectively, in a time lag of 120 days. After adjusting for possible confounders, the early eradication group exhibited a lower rate of complicated recurrent peptic ulcer disease (hazard ratio [HR] = 0.76, 95% confidence interval [CI] = 0.64–0.91, P = 0.003) in a time lag of ≦120 days, but a similar rate of complicated recurrent peptic ulcer disease in time lags of ≦1 year (HR = 0.97, 95% CI 0.79–1.19, P = 0.758) and 2 years (HR = 1.11, 95% CI 0.86–1.44, P = 0.433) compared with the late eradication group. We recommend administering H pylori eradication within 120 days after peptic ulcer diagnosis to H pylori infected ESRD patients who have developed peptic ulcers. PMID:25569660

  17. Clinical Impact of Education Provision on Determining Advance Care Planning Decisions among End Stage Renal Disease Patients Receiving Regular Hemodialysis in University Malaya Medical Centre.

    Science.gov (United States)

    Hing Wong, Albert; Chin, Loh Ee; Ping, Tan Li; Peng, Ng Kok; Kun, Lim Soo

    2016-01-01

    Advance care planning (ACP) is a process of shared decision-making about future health-care plans between patients, health care providers, and family members, should patients becomes incapable of participating in medical treatment decisions. ACP discussions enhance patient's autonomy, focus on patient's values and treatment preferences, and promote patient-centered care. ACP is integrated as part of clinical practice in Singapore and the United States. To assess the clinical impact of education provision on determining ACP decisions among end-stage renal disease patients on regular hemodialysis at University Malaya Medical Centre (UMMC). To study the knowledge and attitude of patients toward ACP and end-of-life issues. Fifty-six patients were recruited from UMMC. About 43 questions pretest survey adapted from Lyon's ACP survey and Moss's cardiopulmonary resuscitation (CPR) attitude survey was given to patients to answer. An educational brochure is then introduced to these patients, and a posttest survey carried out after that. The results were analyzed using SPSS version 22.0. Opinion on ACP, including CPR decisions, showed an upward trend on the importance percentage after the educational brochure exposure, but this was statistically not significant. Seventy-five percent of participants had never heard of ACP before, and only 3.6% had actually prepared a written advanced directive. The ACP educational brochure clinically impacts patients' preferences and decisions toward end-of-life care; however, this is statistically not significant. Majority of patients have poor knowledge on ACP. This study lays the foundation for execution of future larger scale clinical trials, and ultimately, the incorporation of ACP into clinical practice in Malaysia.

  18. [Analysis of the clinical course of disease and subsequent dialysis therapy in a group of patients with rheumatoid arthritis and end-stage renal disease].

    Science.gov (United States)

    Majdan, Maria; Stepniak, Cezary; Piotrowicz, Sebastian; Broniek, Karina; Blajer, Beata; Bednarek-Skublewska, Anna

    2005-04-01

    The chronic nephropathy is often present in pts with rheumatoid arthritis (RA). In the study the authors retrospectively analyzed the clinical course of the disease and outcomes of subsequent dialysotherapy in a group of pts with RA and end-stage renal disease ESRD. During last 5 years ESRD connected with RA was found in 10 (8 F, 2 M) pts out of 325 chronically dialyzed pts (peritoneal dialysis and hemodialysis) representing 3,1% of pts. The mean age at the initiation of dialysotherapy in these pts was 62,8 +/- 10,2 (range 46-76) years. Mean time from the diagnosis of RA to the start of dialysotherapy was 18,8 +/- 11,6 (range 5-40) years. Earlier the patients were treated with many disease modifying antirheumatic drugs (DMARDS) also with glucocorticosteroids and many nonsteroidal anti-inflammatory drugs. It means that they had rather aggressive type of RA. Amyloidosis was histological confirmed in 6 pts (4 F, 2 M). Peritoneal dialysis (PD) was the first choice therapy in 8 pts (2 on APD, 6 on CAPD). The main complication was increased incidence of peritonitis. 3 pts died on PD after 5, 9, 24 months (respectively) of CAPD treatment. 3 pts were transferred to HD after 5, 15, 18 (respectively) months of CAPD because of recurrent peritonitis. 2 pts up to date continue PD (one 12 months, the second 46 months on CAPD). In 5 pts who needed hemodialysis treatment there have been very serious problems with permanent vascular access formation. All used permanent indwelling catheters (Permcath). We concluded that: occurrence of ESRD in pts with RA was connected with aggressive type of disease. Pts with RA represent a dialysis group that is particularly prone to complications of PD (enteric peritonitis) and HD (vascular access problems). It seems to be connected with secondary vasculitis often found in pts with aggressive type of RA.

  19. The NT-ProBNP Test in Subjects with End-Stage Renal Disease on Hemodialysis Presenting with Acute Dyspnea: Is Knowing Worth the Cost?

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    Shaffer R. S. Mok

    2013-01-01

    Full Text Available Background. The NT-ProBNP/BNP test has been validated as a marker for determining the etiology of acute dyspnea. In the setting of end-stage renal disease on hemodialysis (ESRD on HD, the utility of the NT-ProBNP/BNP test has not been validated. This study examines the clinical utility of the NT-ProBNP test in the setting of ESRD on HD patients presenting with acute dyspnea. Methods. A retrospective case series of 250 subjects were admitted to Cooper University Hospital, 07/2010-03/2011, with ESRD and HD presenting with dyspnea. The incidences of echocardiography, cardiology consultation, and NT-ProBNP elevated and normal were examined. Correlation coefficients were calculated for NT-ProBNP with age (years, estimated dry weight (kg, amount of fluid removed (L, and ejection fraction (EF in % among other echocardiography parameters. Results. Of the total sample 235 patients had NT-ProBNP levels performed. Cardiology consults were placed in 68.8% and 58% who underwent echocardiography. Of those for whom an echocardiography was performed estimated mean EFs of 54.6%, 50.8%, and 61.7% were observed among the NT-ProBNP elevated group, normal group, and no NT-ProBNP group, respectively. No differences were detected in all other echocardiography measurements. No correlation was observed between NT-ProBNP and age (, baseline EDW (, amount of fluid removed (, or EF (. Conclusion. In the setting of ESRD on HD, the NT-ProBNP test has no clinical utility in determining the etiology of acute dyspnea. This can be demonstrated through echocardiographic and therapeutic parameters measured in this study.

  20. The influence of serum 25-hydroxy vitamin D levels on Helicobacter Pylori infections in patients with end-stage renal failure on regular hemodialysis

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    Nasri, H.; Baradaran, A.

    2007-01-01

    This study was designed to determine whether the serum levels of 25-OH vitamin D influence the occurrence of infection with Helicobacter Pylori (H.Pylori) in patients on maintenance hemodialysis (HD). The study subjects were patients with end-stage renal disease who were undergoing maintenance dialysis at the hemodialysis section, Hajar Medical, Educational and Therapeutic Center, Shahrekord, Iran. The serum 25-OH vitamin D level and serum H. Pylori specific antibody titers were measured using an enzyme linked immunosorbent assay (ELISA) method. A total of 36 patients were studied including 21 males and 15 females. The mean age of study group was 47(+ 1 7) years. The mean level of serum 25-OH vitamin D was 0.5+-18.7 nmol/L (median: 3.5) while the mean value of serum H.Pylori specific IgG antibody titer was 7.7 (+-9.9) u/ml (median: 2 u/ml). Thus, a significant positive correlation was found between the levels of serum 25-OH vitamin D and serum H.Pylori specific IgG antibody titers (data adjusted for age, urea reduction rate, duration and dose of dialysis) (r=0.36, p=0.043). Our study suggests that vitamin D may positively affect the chronic inflammatory status of dialysis patients and may potentiate the immune response in such patients. Because of this immuno-modulatory effect, vitamin D analogs may offer new means to control the inflammatory status in patients on maintenance dialysis. (author)

  1. Comparison of plasma and erythrocyte membrane fatty acid compositions in patients with end-stage renal disease and type 2 diabetes mellitus.

    Science.gov (United States)

    Sertoglu, Erdim; Kurt, Ismail; Tapan, Serkan; Uyanik, Metin; Serdar, Muhittin A; Kayadibi, Huseyin; El-Fawaeir, Saad

    2014-02-01

    In this study, we aimed to compare the serum lipid profile and fatty acid (FA) compositions of erythrocyte membrane (EM) and plasma in three different patient groups (group 1: type 2 diabetes mellitus (T2DM)+end-stage renal disease (ESRD), group 2: ESRD, group 4: T2DM) and healthy controls (group 3) simultaneously. 40 ESRD patients treated with hemodialysis (HD) in Gulhane School of Medicine (20 with T2DM) and 32 controls (17 with T2DM, 15 healthy controls) were included in the study. Plasma and EM FA concentrations were measured by gas chromatography-flame ionization detector (GC-FID). Plasma and EM palmitic acid (PA) and stearic acid (SA) levels were significantly higher in T2DM patients compared to controls (p=0.040 and p=0.002 for plasma, p=0.001 and p=0.010 for EM, respectively). EM docosahexaenoic acid (DHA) levels were also significantly lower in patients with ESRD+T2DM and ESRD compared to controls (p=0.004 and p=0.037, respectively). Patients with insulin resistance display a pattern of high long chain saturated FAs (PA, SA and arachidic acids). However, while there are no recognized standards for normal EM DHA content, decreased levels of EM DHA in ESRD patient groups (groups 1 and 2) suggest that there may be reduced endogenous synthesis of DHA in HD subjects, due to the decreased functionality of desaturase and elongase enzymes. Because membrane PUFA content affects membrane fluidity and cell signaling, these findings are worthy of further investigation. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  2. Assessment of Liver Fibrosis by Transient Elastography Should Be Done After Hemodialysis in End Stage Renal Disease Patients with Liver Disease.

    Science.gov (United States)

    Taneja, Sunil; Borkakoty, Amritangsu; Rathi, Sahaj; Kumar, Vivek; Duseja, Ajay; Dhiman, Radha K; Gupta, Krishan L; Chawla, Yogesh

    2017-11-01

    The patients with end stage renal disease (ESRD) are at greater risk of acquiring chronic hepatitis B or C and subsequently development of liver disease. The aim of the study was to assess liver fibrosis by transient elastography (TE) and look for factors associated with change in liver stiffness measurement (LSM) with one session of hemodialysis (HD). Consecutive ESRD patients on maintenance hemodialysis (MHD) with suspected liver disease were enrolled. They underwent LSM by TE before and after one session of HD. Bioelectric impedance analysis was done to evaluate the volume status at the time of TE. Sixty-eight patients with mean age of 40 ± 14 years were included. There was a significant reduction in LSM after HD (18.5 [95% CI 14.8-23.1] vs. 11.2 [95% CI 8.8-13.7] kPa, p  or  2.5 L (8.6 [95% CI 5.7-11.5] vs. 5.1 [95% CI 2.9-7.5], p = 0.05). In 18 patients who underwent liver biopsy, LSM after HD performed better at detecting significant fibrosis, with area under receiver operating characteristics curve 0.71 [95% CI 0.46-0.97], versus 0.64 [95% CI 0.38-0.90], respectively. An LSM value of 12.2 kPa after HD was 71% sensitive and 74% specific for detection of significant fibrosis (≥ F2), while values less than 9 kPa ruled out significant fibrosis with a sensitivity and specificity of 37 and 100%, respectively. LSM by TE decreases significantly after HD in patients with ESRD on long-term MHD. Hence, TE should be done after HD for accurate assessment of liver fibrosis.

  3. Exit site and tunnel infections in children on chronic peritoneal dialysis: findings from the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative.

    Science.gov (United States)

    Swartz, Sarah J; Neu, Alicia; Skversky Mason, Amy; Richardson, Troy; Rodean, Jonathan; Lawlor, John; Warady, Bradley; Somers, Michael J G

    2018-06-01

    The Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative is a quality improvement initiative to reduce dialysis-associated infections. The frequency of peritoneal dialysis (PD) catheter exit site infection (ESI) and variables influencing its development and end result are unclear. We sought to determine ESI rates, to elucidate the epidemiology, risk factors, and outcomes for ESI, and to assess for association between provider compliance with care bundles and ESI risk. We reviewed demographic, dialysis and ESI data, and care bundle adherence and outcomes for SCOPE enrollees from October 2011 to September 2014. ESI involved only the exit site, only the subcutaneous catheter tunnel, or both. A total of 857 catheter insertions occurred in 734 children over 10,110 cumulative months of PD provided to these children. During this period 207 ESIs arose in 124 children or 0.25 ESIs per dialysis year. Median time to ESI was 392 days, with 69% of ESIs involving exit site only, 23% involving the tunnel only, and 8% involving both sites. Peritonitis developed in 6%. ESI incidence was associated with age (p = 0.003), being the lowest in children aged  0 at prior month's visit (p treatment, 24% required hospitalization, and 9% required catheter removal, generally secondary to tunnel infection. Exit site infections occur at an annualized rate of 0.25, typically well into the dialysis course. Younger patient age and documented review of site care are associated with lower ESI rates. Although most ESIs resolve, hospitalization is frequent, and tunnel involvement/catheter loss complicate outcomes.

  4. Importance of glomerular filtration rate change as surrogate endpoint for the future incidence of end-stage renal disease in general Japanese population: community-based cohort study.

    Science.gov (United States)

    Kanda, Eiichiro; Usui, Tomoko; Kashihara, Naoki; Iseki, Chiho; Iseki, Kunitoshi; Nangaku, Masaomi

    2018-04-01

    Because of the necessity for extended period and large costs until the event occurs, surrogate endpoints are indispensable for implementation of clinical studies to improve chronic kidney disease (CKD) patients' prognosis. Subjects with serum creatinine level for a baseline period over 1-3 years were enrolled (n = 69,238) in this community-based prospective cohort study in Okinawa, Japan, and followed up for 15 years. The endpoint was end-stage renal disease (ESRD). The percent of estimated glomerular filtration rate (%eGFR) change was calculated on the basis of the baseline period. Subjects had a mean ± SD age, 55.59 ± 14.69 years; eGFR, 80.15 ± 21.15 ml/min/1.73 m 2 . Among the subjects recruited, 15.81% had a low eGFR (<60 ml/min/1.73 m 2 ) and 36.1/100,000 person years developed ESRD. Cox proportional hazards models adjusted for baseline characteristics showed that the risk of ESRD tended to be high with high rates of decrease in %eGFR changes over 2 or 3 years in the high- and low-eGFR groups. The specificities and positive predictive values for ESRD based on a cutoff value of %eGFR change of less than -30% over 2 or 3 years were high in the high- and low-eGFR groups. %eGFR change tends to be associated with the risk of ESRD. %eGFR change of less than -30% over 2 or 3 years can be a candidate surrogate endpoint for ESRD in the general Japanese population.

  5. Effect of fluid loading on left ventricular volume and stroke volume variability in patients with end-stage renal disease: a pilot study

    Science.gov (United States)

    Kanda, Hirotsugu; Hirasaki, Yuji; Iida, Takafumi; Kanao-Kanda, Megumi; Toyama, Yuki; Kunisawa, Takayuki; Iwasaki, Hiroshi

    2015-01-01

    Purpose The aim of this study was to investigate fluid loading-induced changes in left ventricular end-diastolic volume (LVEDV) and stroke volume variability (SVV) in patients with end-stage renal disease (ESRD) using real-time three-dimensional transesophageal echocardiography and the Vigileo-FloTrac system. Patients and methods After obtaining ethics committee approval and informed consent, 28 patients undergoing peripheral vascular procedures were studied. Fourteen patients with ESRD on hemodialysis (HD) were assigned to the HD group and 14 patients without ESRD were assigned to the control group. Institutional standardized general anesthesia was provided in both groups. SVV was measured using the Vigileo-FloTrac system. Simultaneously, a full-volume three-dimensional transesophageal echocardiography dataset was acquired to measure LVEDV, left ventricular end-systolic volume, and left ventricular ejection fraction. Measurements were obtained before and after loading 500 mL hydroxyethyl starch over 30 minutes in both groups. Results In the control group, intravenous colloid infusion was associated with a significant decrease in SVV (13.8%±2.6% to 6.5%±2.6%, P<0.001) and a significant increase in LVEDV (83.6±23.4 mL to 96.1±28.8 mL, P<0.001). While SVV significantly decreased after infusion in the HD group (16.2%±6.0% to 6.2%±2.8%, P<0.001), there was no significant change in LVEDV. Conclusion Our preliminary data suggest that fluid responsiveness can be assessed not by LVEDV but also by SVV due to underlying cardiovascular pathophysiology in patients with ESRD. PMID:26527879

  6. Intensive procedure preferences at the end of life (EOL) in older Latino adults with end stage renal disease (ESRD) on dialysis.

    Science.gov (United States)

    Gonzalez, Karla; Ulloa, Jesus G; Moreno, Gerardo; Echeverría, Oscar; Norris, Keith; Talamantes, Efrain

    2017-10-23

    Latinos in the U.S. are almost twice as likely to progress to End Stage Renal disease (ESRD) compared to non-Latino whites. Patients with ESRD on dialysis experience high morbidity, pre-mature mortality and receive intensive procedures at the end of life (EOL). This study explores intensive procedure preferences at the EOL in older Latino adults. Seventy-three community-dwelling Spanish- and English-Speaking Latinos over the age of 60 with and without ESRD participated in this study. Those without ESRD (n = 47) participated in one of five focus group sessions, and those with ESRD on dialysis (n = 26) participated in one-on-one semi-structured interviews. Focus group and individual participants answered questions regarding intensive procedures at the EOL. Recurring themes were identified using standard qualitative content-analysis methods. Participants also completed a brief survey that included demographics, language preference, health insurance coverage, co-morbidities, Emergency Department visits and functional limitations. The majority of participants were of Mexican origin with mean age of 70, and there were more female participants in the non-ESRD group, compared to the ESRD dialysis dependent group. The dialysis group reported a higher number of co-morbidities and functional limitations. Nearly 69% of those in the dialysis group reported one or more emergency department visits in the past year, compared to 38% in the non-ESRD group. Primary themes centered on 1) The acceptability of a "natural" versus "invasive" procedure 2) Cultural traditions and family involvement 3) Level of trust in physicians and autonomy in decision-making. Our results highlight the need for improved patient- and family-centered approaches to better understand intensive procedure preferences at the EOL in this underserved population of older adults.

  7. Relationship of associated secondary hyperparathyroidism to serum fibroblast growth factor-23 in end stage renal disease: A case-control study

    Science.gov (United States)

    Sliem, Hamdy; Tawfik, Gamal; Moustafa, Fadia; Zaki, Heba

    2011-01-01

    Introduction: Secondary hyperparathyroidism (SHPT) is an insidious disease that develops early in the course of chronic kidney disease (CKD) and increases in severity as the glomerular filtration rate deteriorates. Recent studies have identified fibroblast growth factor-23 (FGF23) as a new protein with phosphaturic activity. It is mainly secreted by osteoblasts and is now considered the most important factor for regulation of phosphorus homeostasis. It is not yet proven if there is any direct relation between parathyroid hormone (PTH) and FGF23. The present study aims to evaluate the relation between serum FGF23, phosphorus, and PTH in end-stage renal disease in patients with SHPT on regular hemodialysis. Materials and Methods: Forty-six consecutive CKD adult patients (case group) and 20 healthy adults (control group) were included in the study. All patients had SHPT and were on regular hemodialysis. Both groups were subjected to full medical history, clinical examination and biochemical studies. Serum phosphorus, calcium, ferritin, hemoglobin level, blood urea, creatinine, PTH, and FGF23 were analyzed. Results: Levels of FGF23 were significantly higher in the case group in comparison with those in the control group, viz., 4-fold, and positively correlated with PTH. Phosphorus levels in the case group were significantly high in spite of the increasing levels of FGF23. Both PTH and FGF23 were positively correlated with phosphorus and negatively with hemoglobin levels. Conclusion: SHPT and FGF23 may have a partial role in the development of anemia in patients with CKD. FGF23 could be a central factor in the pathogenesis of SHPT. Its role in controlling hyperphosphatemia in CKD is vague. PMID:21731867

  8. The Incidence of End-Stage Renal Disease in the Diabetic (Compared to the Non-Diabetic) Population: A Systematic Review

    Science.gov (United States)

    Narres, Maria; Claessen, Heiner; Droste, Sigrid; Kvitkina, Tatjana; Koch, Michael; Kuss, Oliver; Icks, Andrea

    2016-01-01

    End-stage renal disease (ESRD) in diabetes is a life threatening complication resulting in a poor prognosis for patients as well as high medical costs. The aims of this systematic review were (1) to evaluate the incidence of ESRD due to all causes and due to diabetic nephropathy in the diabetic population and differences between incidences of ESRD with respect to sex, ethnicity, age and regions, (2) to compare incidence rates in the diabetic and non-diabetic population, and (3) to investigate time trends. The systematic review was conducted according to the PRISMA group guidelines by performing systematic literature searches in the biomedical databases until January 3rd 2015; thirty-two studies were included. Among patients with incident type 1 diabetes the 30-year cumulative incidence ranged from 3.3% to 7.8%. Among patients with prevalent diabetes, incidence rates of ESRD due to all causes ranged from 132.0 to 167.0 per 100,000 person-years, whereas incidence rates of ESRD due to diabetic nephropathy varied from 38.4 to 804.0 per 100,000 person-years. The incidence of ESRD in the diabetic population was higher compared to the non-diabetic population, and relative risks varied from 6.2 in the white population to 62.0 among Native Americans. The results regarding time trends were inconsistent. The review conducted demonstrates the considerable variation of incidences of ESRD among the diabetic population. Consistent findings included an excess risk when comparing the diabetic to the non-diabetic population and ethnic differences. We recommend that newly designed studies should use standardized methods for the determination of ESRD and population at risk. PMID:26812415

  9. Relationship of associated secondary hyperparathyroidism to serum fibroblast growth factor-23 in end stage renal disease: A case-control study

    Directory of Open Access Journals (Sweden)

    Hamdy Sliem

    2011-01-01

    Full Text Available Introduction: Secondary hyperparathyroidism (SHPT is an insidious disease that develops early in the course of chronic kidney disease (CKD and increases in severity as the glomerular filtration rate deteriorates. Recent studies have identified fibroblast growth factor-23 (FGF23 as a new protein with phosphaturic activity. It is mainly secreted by osteoblasts and is now considered the most important factor for regulation of phosphorus homeostasis. It is not yet proven if there is any direct relation between parathyroid hormone (PTH and FGF23. The present study aims to evaluate the relation between serum FGF23, phosphorus, and PTH in end-stage renal disease in patients with SHPT on regular hemodialysis. Materials and Methods: Forty-six consecutive CKD adult patients (case group and 20 healthy adults (control group were included in the study. All patients had SHPT and were on regular hemodialysis. Both groups were subjected to full medical history, clinical examination and biochemical studies. Serum phosphorus, calcium, ferritin, hemoglobin level, blood urea, creatinine, PTH, and FGF23 were analyzed. Results: Levels of FGF23 were significantly higher in the case group in comparison with those in the control group, viz., 4-fold, and positively correlated with PTH. Phosphorus levels in the case group were significantly high in spite of the increasing levels of FGF23. Both PTH and FGF23 were positively correlated with phosphorus and negatively with hemoglobin levels. Conclusion: SHPT and FGF23 may have a partial role in the development of anemia in patients with CKD. FGF23 could be a central factor in the pathogenesis of SHPT. Its role in controlling hyperphosphatemia in CKD is vague.

  10. Blunted cyclic variation of heart rate predicts mortality risk in post-myocardial infarction, end-stage renal disease, and chronic heart failure patients

    Science.gov (United States)

    Hayano, Junichiro; Yasuma, Fumihiko; Watanabe, Eiichi; Carney, Robert M.; Stein, Phyllis K.; Blumenthal, James A.; Arsenos, Petros; Gatzoulis, Konstantinos A.; Takahashi, Hiroshi; Ishii, Hideki; Kiyono, Ken; Yamamoto, Yoshiharu; Yoshida, Yutaka; Yuda, Emi; Kodama, Itsuo

    2017-01-01

    Abstract Aims Cyclic variation of heart rate (CVHR) associated with sleep-disordered breathing is thought to reflect cardiac autonomic responses to apnoeic/hypoxic stress. We examined whether blunted CVHR observed in ambulatory ECG could predict the mortality risk. Methods and results CVHR in night-time Holter ECG was detected by an automated algorithm, and the prognostic relationships of the frequency (FCV) and amplitude (ACV) of CVHR were examined in 717 patients after myocardial infarction (post-MI 1, 6% mortality, median follow-up 25 months). The predictive power was prospectively validated in three independent cohorts: a second group of 220 post-MI patients (post-MI 2, 25.5% mortality, follow-up 45 months); 299 patients with end-stage renal disease on chronic haemodialysis (ESRD, 28.1% mortality, follow-up 85 months); and 100 patients with chronic heart failure (CHF, 35% mortality, follow-up 38 months). Although CVHR was observed in ≥96% of the patients in all cohorts, FCV did not predict mortality in any cohort. In contrast, decreased ACV was a powerful predictor of mortality in the post-MI 1 cohort (hazard ratio [95% CI] per 1 ln [ms] decrement, 2.9 [2.2–3.7], P < 0.001). This prognostic relationship was validated in the post-MI 2 (1.8 [1.4–2.2], P < 0.001), ESRD (1.5 [1.3–1.8], P < 0.001), and CHF (1.4 [1.1–1.8], P = 0.02) cohorts. The prognostic value of ACV was independent of age, gender, diabetes, β-blocker therapy, left ventricular ejection fraction, sleep-time mean R-R interval, and FCV. Conclusion Blunted CVHR detected by decreased ACV in a night-time Holter ECG predicts increased mortality risk in post-MI, ESRD, and CHF patients. PMID:27789562

  11. Blunted cyclic variation of heart rate predicts mortality risk in post-myocardial infarction, end-stage renal disease, and chronic heart failure patients.

    Science.gov (United States)

    Hayano, Junichiro; Yasuma, Fumihiko; Watanabe, Eiichi; Carney, Robert M; Stein, Phyllis K; Blumenthal, James A; Arsenos, Petros; Gatzoulis, Konstantinos A; Takahashi, Hiroshi; Ishii, Hideki; Kiyono, Ken; Yamamoto, Yoshiharu; Yoshida, Yutaka; Yuda, Emi; Kodama, Itsuo

    2017-08-01

    Cyclic variation of heart rate (CVHR) associated with sleep-disordered breathing is thought to reflect cardiac autonomic responses to apnoeic/hypoxic stress. We examined whether blunted CVHR observed in ambulatory ECG could predict the mortality risk. CVHR in night-time Holter ECG was detected by an automated algorithm, and the prognostic relationships of the frequency (FCV) and amplitude (ACV) of CVHR were examined in 717 patients after myocardial infarction (post-MI 1, 6% mortality, median follow-up 25 months). The predictive power was prospectively validated in three independent cohorts: a second group of 220 post-MI patients (post-MI 2, 25.5% mortality, follow-up 45 months); 299 patients with end-stage renal disease on chronic haemodialysis (ESRD, 28.1% mortality, follow-up 85 months); and 100 patients with chronic heart failure (CHF, 35% mortality, follow-up 38 months). Although CVHR was observed in ≥96% of the patients in all cohorts, FCV did not predict mortality in any cohort. In contrast, decreased ACV was a powerful predictor of mortality in the post-MI 1 cohort (hazard ratio [95% CI] per 1 ln [ms] decrement, 2.9 [2.2-3.7], P < 0.001). This prognostic relationship was validated in the post-MI 2 (1.8 [1.4-2.2], P < 0.001), ESRD (1.5 [1.3-1.8], P < 0.001), and CHF (1.4 [1.1-1.8], P = 0.02) cohorts. The prognostic value of ACV was independent of age, gender, diabetes, β-blocker therapy, left ventricular ejection fraction, sleep-time mean R-R interval, and FCV. Blunted CVHR detected by decreased ACV in a night-time Holter ECG predicts increased mortality risk in post-MI, ESRD, and CHF patients. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology.

  12. Prediction of new onset of end stage renal disease in Chinese patients with type 2 diabetes mellitus - a population-based retrospective cohort study.

    Science.gov (United States)

    Wan, Eric Yuk Fai; Fong, Daniel Yee Tak; Fung, Colman Siu Cheung; Yu, Esther Yee Tak; Chin, Weng Yee; Chan, Anca Ka Chun; Lam, Cindy Lo Kuen

    2017-08-01

    Since diabetes mellitus (DM) is the leading cause of end stage renal disease (ESRD), this study aimed to develop a 5-year ESRD risk prediction model among Chinese patients with Type 2 DM (T2DM) in primary care. A retrospective cohort study was conducted on 149,333 Chinese adult T2DM primary care patients without ESRD in 2010. Using the derivation cohort over a median of 5 years follow-up, the gender-specific models including the interaction effect between predictors and age were derived using Cox regression with a forward stepwise approach. Harrell's C-statistic and calibration plot were applied to the validation cohort to assess discrimination and calibration of the models. Prediction models showed better discrimination with Harrell's C-statistics of 0.866 (males) and 0.862 (females) and calibration power from the plots than other established models. The predictors included age, usages of anti-hypertensive drugs, anti-glucose drugs, and Hemogloblin A1c, blood pressure, urine albumin/creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR). Specific predictors for male were smoking and presence of sight threatening diabetic retinopathy while additional predictors for female included longer duration of diabetes and quadratic effect of body mass index. Interaction factors with age showed a greater weighting of insulin and urine ACR in younger males, and eGFR in younger females. Our newly developed gender-specific models provide a more accurate 5-year ESRD risk predictions for Chinese diabetic primary care patients than other existing models. The models included several modifiable risk factors that clinicians can use to counsel patients, and to target at in the delivery of care to patients.

  13. Hemodialysis versus Peritoneal Dialysis: A Comparison of Survival Outcomes in South-East Asian Patients with End-Stage Renal Disease.

    Directory of Open Access Journals (Sweden)

    Fan Yang

    Full Text Available Studies comparing patient survival of hemodialysis (HD and peritoneal dialysis (PD have yielded conflicting results and no such study was from South-East Asia. This study aimed to compare the survival outcomes of patients with end-stage renal disease (ESRD who started dialysis with HD and PD in Singapore.Survival data for a maximum of 5 years from a single-center cohort of 871 ESRD patients starting dialysis with HD (n = 641 or PD (n = 230 from 2005-2010 was analyzed using the flexible Royston-Parmar (RP model. The model was also applied to a subsample of 225 propensity-score-matched patient pairs and subgroups defined by age, diabetes mellitus, and cardiovascular disease.After adjusting for the effect of socio-demographic and clinical characteristics, the risk of death was higher in patients initiating dialysis with PD than those initiating dialysis with HD (hazard ratio [HR]: 2.08; 95% confidence interval [CI]: 1.67-2.59; p<0.001, although there was no significant difference in mortality between the two modalities in the first 12 months of treatment. Consistently, in the matched subsample, patients starting PD had a higher risk of death than those starting HD (HR: 1.73, 95% CI: 1.30-2.28, p<0.001. Subgroup analysis showed that PD may be similar to or better than HD in survival outcomes among young patients (≤65 years old without diabetes or cardiovascular disease.ESRD patients who initiated dialysis with HD experienced better survival outcomes than those who initiated dialysis with PD in Singapore, although survival outcomes may not differ between the two dialysis modalities in young and healthier patients. These findings are potentially confounded by selection bias, as patients were not randomized to the two dialysis modalities in this cohort study.

  14. Social disparities in the prevalence of diabetes in Australia and in the development of end stage renal disease due to diabetes for Aboriginal and Torres Strait Islanders in Australia and Maori and Pacific Islanders in New Zealand

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    Kathleen Hill

    2017-10-01

    Full Text Available Abstract Background Disparities in health status occur between people with differing socioeconomic status and disadvantaged groups usually have the highest risk exposure and the worst health outcome. We sought to examine the social disparities in the population prevalence of diabetes and in the development of treated end stage renal disease due to type 1 diabetes which has not previously been studied in Australia and New Zealand in isolation from type 2 diabetes. Methods This observational study examined the population prevalence of diabetes in a sample of the Australian population (7,434,492 using data from the National Diabetes Services Scheme and of treated end stage renal disease due to diabetes using data from the Australian and New Zealand Dialysis and Transplant Registry. The data were then correlated with the Australian Bureau of Statistics Socioeconomic Indexes for Areas for an examination of socioeconomic disparities. Results There is a social gradient in the prevalence of diabetes in Australia with disease incidence decreasing incrementally with increasing affluence (Spearman’s rho = .765 p < 0.001. There is a higher risk of developing end stage renal disease due to type 1 diabetes for males with low socioeconomic status (RR 1.20; CI 1.002–1.459 in comparison to females with low socioeconomic status. In Australia and New Zealand Aboriginal and Torres Strait Islanders, Maori and Pacific Islanders appear to have a low risk of end stage renal disease due to type 1 diabetes but continue to carry a vastly disproportionate burden of end stage renal disease due to type 2 diabetes (RR 6.57 CI 6.04–7.14 & 6.48 CI 6.02–6.97 respectively p < 0.001 in comparison to other Australian and New Zealanders. Conclusion Whilst low socioeconomic status is associated with a higher prevalence of diabetes the inverse social gradient seen in this study has not previously been reported. The social disparity seen in relation to treated end stage

  15. Social disparities in the prevalence of diabetes in Australia and in the development of end stage renal disease due to diabetes for Aboriginal and Torres Strait Islanders in Australia and Maori and Pacific Islanders in New Zealand.

    Science.gov (United States)

    Hill, Kathleen; Ward, Paul; Grace, Blair S; Gleadle, Jonathan

    2017-10-11

    Disparities in health status occur between people with differing socioeconomic status and disadvantaged groups usually have the highest risk exposure and the worst health outcome. We sought to examine the social disparities in the population prevalence of diabetes and in the development of treated end stage renal disease due to type 1 diabetes which has not previously been studied in Australia and New Zealand in isolation from type 2 diabetes. This observational study examined the population prevalence of diabetes in a sample of the Australian population (7,434,492) using data from the National Diabetes Services Scheme and of treated end stage renal disease due to diabetes using data from the Australian and New Zealand Dialysis and Transplant Registry. The data were then correlated with the Australian Bureau of Statistics Socioeconomic Indexes for Areas for an examination of socioeconomic disparities. There is a social gradient in the prevalence of diabetes in Australia with disease incidence decreasing incrementally with increasing affluence (Spearman's rho = .765 p < 0.001). There is a higher risk of developing end stage renal disease due to type 1 diabetes for males with low socioeconomic status (RR 1.20; CI 1.002-1.459) in comparison to females with low socioeconomic status. In Australia and New Zealand Aboriginal and Torres Strait Islanders, Maori and Pacific Islanders appear to have a low risk of end stage renal disease due to type 1 diabetes but continue to carry a vastly disproportionate burden of end stage renal disease due to type 2 diabetes (RR 6.57 CI 6.04-7.14 & 6.48 CI 6.02-6.97 respectively p < 0.001) in comparison to other Australian and New Zealanders. Whilst low socioeconomic status is associated with a higher prevalence of diabetes the inverse social gradient seen in this study has not previously been reported. The social disparity seen in relation to treated end stage renal disease due to type 2 diabetes for Aboriginal and Torres Strait

  16. Elevated global cerebral blood flow, oxygen extraction fraction and unchanged metabolic rate of oxygen in young adults with end-stage renal disease: an MRI study.

    Science.gov (United States)

    Zheng, Gang; Wen, Jiqiu; Lu, Hanzhang; Lou, Yaxian; Pan, Zhiying; Liu, Wei; Liu, Hui; Li, Xue; Zhang, Zhe; Chen, Huijuan; Kong, Xiang; Luo, Song; Jiang, Xiaolu; Liu, Ya; Zhang, Zongjun; Zhang, Long Jiang; Lu, Guang Ming

    2016-06-01

    To noninvasively assess global cerebral blood flow (CBF), oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO2) in young adults with end-stage renal disease (ESRD). Thirty-six patients and 38 healthy volunteers were included and took part in MR examinations, blood and neuropsychological tests. CBF and OEF were measured by phase-contrast and T2-relaxation-under-spin-tagging MRI techniques, respectively. CMRO2 was computed from CBF, OEF and hematocrit according to Fick's principle. Correlations were performed between MR measurements, blood biochemistry measurements and neuropsychological test scores. Compared with controls, ESRD patients had elevated CBF (72.9 ± 12.5 vs. 63.8 ± 8.5 ml min(-1) 100 g(-1), P < 0.001), elevated OEF (47.2 ± 10.2 vs. 35.8 ± 5.4 %, P < 0.001), but unaffected CMRO2 (199.5 ± 36.4 vs. 193.8 ± 28.6 μmol O2 min(-1) 100 g(-1), P = 0.879). Hematocrit negatively correlated with CBF (r = -0.640, P < 0.001) and OEF (r = -0.701, P < 0.001), but not with CMRO2. Altered neuropsychological test scores of ESRD patients were associated with OEF and CBF, but not with CMRO2. There were weak relationships between eGFR and hematocrit (r = 0.308, P = 0.068) or CBF (r = 0.318, P = 0.059). Our findings suggested that anaemic young adults with ESRD may afford higher CBF and OEF to maintain a normal CMRO2. Despite this compensatory process, however, cognitive function was still impaired and its severity was correlated with their CBF and OEF abnormality. • Anaemic young adults with ESRD may afford higher CBF and OEF. • Anaemic young adults with ESRD maintain a normal CMRO 2 . • Cognitive function was still impaired in young ESRD adults. • The severity of cognitive dysfunction correlated with CBF and OEF changes.

  17. Altered pattern of spontaneous brain activity in the patients with end-stage renal disease: a resting-state functional MRI study with regional homogeneity analysis.

    Directory of Open Access Journals (Sweden)

    Xue Liang

    Full Text Available PURPOSE: To investigate the pattern of spontaneous neural activity in patients with end-stage renal disease (ESRD with and without neurocognitive dysfunction using resting-state functional magnetic resonance imaging (rs-fMRI with a regional homogeneity (ReHo algorithm. MATERIALS AND METHODS: rs-fMRI data were acquired in 36 ESRD patients (minimal nephro-encephalopathy [MNE], n = 19, 13 male, 37±12.07 years; non-nephro-encephalopathy [non-NE], n = 17, 11 male, 38±12.13 years and 20 healthy controls (13 male, 7 female, 36±10.27 years. Neuropsychological (number connection test type A [NCT-A], digit symbol test [DST] and laboratory tests were performed in all patients. The Kendall's coefficient of concordance (KCC was used to measure the regional homogeneity for each subject. The regional homogeneity maps were compared using ANOVA tests among MNE, non-NE, and healthy control groups and post hoc t -tests between each pair in a voxel-wise way. A multiple regression analysis was performed to evaluate the relationships between ReHo index and NCT-A, DST scores, serum creatinine and urea levels, disease and dialysis duration. RESULTS: Compared with healthy controls, both MNE and non-NE patients showed decreased ReHo in the multiple areas of bilateral frontal, parietal and temporal lobes. Compared with the non-NE, MNE patients showed decreased ReHo in the right inferior parietal lobe (IPL, medial frontal cortex (MFC and left precuneus (PCu. The NCT-A scores and serum urea levels of ESRD patients negatively correlated with ReHo values in the frontal and parietal lobes, while DST scores positively correlated with ReHo values in the bilateral PCC/precuneus, MFC and inferior parietal lobe (IPL (all P0.05, AlphaSim corrected. CONCLUSION: Diffused decreased ReHo values were found in both MNE and non-NE patients. The progressively decreased ReHo in the default mode network (DMN, frontal and parietal lobes might be trait-related in MNE. The Re

  18. Studying psychosocial adaptation to end-stage renal disease: the proximal-distal model of health-related outcomes as a base model.

    Science.gov (United States)

    Chan, Ramony; Brooks, Robert; Erlich, Jonathan; Gallagher, Martin; Snelling, Paul; Chow, Josephine; Suranyi, Michael

    2011-05-01

    Studying psychosocial adaptation in end-stage renal disease (ESRD) is increasingly important, as it may explain the variability in health outcomes unaccounted for by clinical factors. The Brenner et al. proximal-distal model of health-related outcomes provides a theoretical foundation for understanding psychosocial adaptation and integrating health outcomes, clinical, and psychosocial factors (Brenner MH, Curbow B, Legro MW. The proximal-distal continuum of multiple health outcome measures: the case of cataract surgery. Med Care. 1995;33(4 Suppl):AS236-44). This study aims to empirically validate the proximal-distal model in the dialysis population and examine the impact of psychosocial factors on the model. A cross-sectional observational study was conducted with a sample of long-term dialysis patients (n=201). Eleven factors: quality of life (QoL), depression, positive affect, comorbidity, symptoms, physical functioning, disease accommodation, loss, self-efficacy, illness acceptance, and social support were measured by standardized psychometric scales. A three-month average of hemoglobin was used. Latent composite structural equation modeling was used to examine the models. The proximal-distal model with slight modification was supported by fit statistics [χ(2)=16.04, df=13, P=.25, root mean square error of approximation (RMSEA)=0.024], indicating that the impact of clinical factors on QoL is mediated through a range of functional and psychological factors, except for hemoglobin which impacts directly on QoL. The model with additional psychosocial factors was also supported by fit statistics (χ(2)=43.59, df=41, P=.36, RMSEA=0.018). These additional factors mainly impact on symptom status, psychological states, and QoL components of the model. The present study supported the proximal-distal model in the dialysis population and demonstrated the considerable impact of psychosocial factors on the model. The proximal-distal model plus psychosocial factors as a

  19. Effective peer-to-peer support for young people with end-stage renal disease: a mixed methods evaluation of Camp COOL

    Science.gov (United States)

    2013-01-01

    Background The Camp COOL programme aims to help young Dutch people with end-stage renal disease (ESRD) develop self-management skills. Fellow patients already treated in adult care (hereafter referred to as ‘buddies’) organise the day-to-day program, run the camp, counsel the attendees, and also participate in the activities. The attendees are young people who still have to transfer to adult care. This study aimed to explore the effects of this specific form of peer-to-peer support on the self-management of young people (16–25 years) with ESRD who participated in Camp COOL (CC) (hereafter referred to as ‘participants’). Methods A mixed methods research design was employed. Semi-structured interviews (n = 19) with initiators/staff, participants, and healthcare professionals were conducted. These were combined with retrospective and pre-post surveys among participants (n = 62), and observations during two camp weeks. Results Self-reported effects of participants were: increased self-confidence, more disease-related knowledge, feeling capable of being more responsible and open towards others, and daring to stand up for yourself. According to participants, being a buddy or having one positively affected them. Self-efficacy of attendees and independence of buddies increased, while attendees’ sense of social inclusion decreased (measured as domains of health-related quality of life). The buddy role was a pro-active combination of being supervisor, advisor, and leader. Conclusions Camp COOL allowed young people to support each other in adjusting to everyday life with ESRD. Participating in the camp positively influenced self-management in this group. Peer-to-peer support through buddies was much appreciated. Support from young adults was not only beneficial for adolescent attendees, but also for young adult buddies. Paediatric nephrologists are encouraged to refer patients to CC and to facilitate such initiatives. Together with nephrologists in adult

  20. Use of complementary and alternative medicine by patients with end-stage renal disease on haemodialysis in Trinidad: A descriptive study.

    Science.gov (United States)

    Bahall, Mandreker

    2017-05-04

    Despite the paucity of scientific evidence, complementary and alternative medicine (CAM) is widely used for the prevention and treatment of illness, holistic care, and counteracting the adverse effects of conventional medicine (CM). This study investigates the use of CAM by patients with end-stage renal disease (ESRD) on haemodialysis. This quantitative study was conducted from November 1, 2014 to December 31, 2014 in the haemodialysis unit at San Fernando General Hospital (San Fernando, Trinidad). Face-to-face questionnaire-based interviews were held with101of 125 eligible patients (response rate, 80.5%) at the chairside during haemodialysis. The completed questionnaires were entered into a secure computer database. Data analysis included descriptive analysis, χ 2 tests, and binary logistic regression analysis. A minority of the patients were CAM users (n = 19; 18.8%). All 19 CAM users took medicinal herbs, 78.9% (n = 15) used spiritual therapy, and 10.5% (n = 2) used alternative systems. Medicinal tea (n = 15; 78.9%), garlic (Allium sativum) (n = 17; 73.7%), and ginger (Zingiber officinale roscoe) (n = 13; 68.4%) were the most commonly used medicinal herbs. Seven (36.8%) patients used Chinese herbal medicines and 3 (15.8%) patients used Aloe vera. All CAM users were willing to use CAM without supervision or monitoring by their doctors while receiving CM. The use of CAM could not be predicted by age, sex, ethnicity, education, religion, marital status, or employment. Nearly all (98%) patients were satisfied with CAM. More than one-third (36.8%) of patients did not disclose their use of CAM to their doctors, who were generally indifferent to such therapy. The use of CAM by patients with ESRD was relatively infrequent. All patients used medicinal herbs, most patients used spiritual therapy, and a minority of patients used alternative systems. Complementary and alternative medicine was primarily used for spiritual reasons and the likelihood of its use

  1. Cluster analysis and its application to healthcare claims data: a study of end-stage renal disease patients who initiated hemodialysis.

    Science.gov (United States)

    Liao, Minlei; Li, Yunfeng; Kianifard, Farid; Obi, Engels; Arcona, Stephen

    2016-03-02

    Cluster analysis (CA) is a frequently used applied statistical technique that helps to reveal hidden structures and "clusters" found in large data sets. However, this method has not been widely used in large healthcare claims databases where the distribution of expenditure data is commonly severely skewed. The purpose of this study was to identify cost change patterns of patients with end-stage renal disease (ESRD) who initiated hemodialysis (HD) by applying different clustering methods. A retrospective, cross-sectional, observational study was conducted using the Truven Health MarketScan® Research Databases. Patients aged ≥18 years with ≥2 ESRD diagnoses who initiated HD between 2008 and 2010 were included. The K-means CA method and hierarchical CA with various linkage methods were applied to all-cause costs within baseline (12-months pre-HD) and follow-up periods (12-months post-HD) to identify clusters. Demographic, clinical, and cost information was extracted from both periods, and then examined by cluster. A total of 18,380 patients were identified. Meaningful all-cause cost clusters were generated using K-means CA and hierarchical CA with either flexible beta or Ward's methods. Based on cluster sample sizes and change of cost patterns, the K-means CA method and 4 clusters were selected: Cluster 1: Average to High (n = 113); Cluster 2: Very High to High (n = 89); Cluster 3: Average to Average (n = 16,624); or Cluster 4: Increasing Costs, High at Both Points (n = 1554). Median cost changes in the 12-month pre-HD and post-HD periods increased from $185,070 to $884,605 for Cluster 1 (Average to High), decreased from $910,930 to $157,997 for Cluster 2 (Very High to High), were relatively stable and remained low from $15,168 to $13,026 for Cluster 3 (Average to Average), and increased from $57,909 to $193,140 for Cluster 4 (Increasing Costs, High at Both Points). Relatively stable costs after starting HD were associated with more stable scores

  2. Arteriovenous renal replacement therapy in end-stage left-sided heart failure patients has a detrimental effect on patients with impaired right ventricular function

    Directory of Open Access Journals (Sweden)

    Evangelos Repasos, MD

    2017-07-01

    Conclusion: In patients with end-stage HF, the creation of AVC for intermittent RRT was followed by a significant increase in morbidity and mortality in comparison to the safe and effective placement of permanent central venous catheters. Patients with elevated PVR seem to comprise a group at high risk for adverse outcomes after central catheter insertion.

  3. Color Doppler Indices of Orbital Arterial Flow in End-Stage Renal Disease Patients; Are the Changes Related to Chronic Hemodialysis or Chronic Renal Failure?

    International Nuclear Information System (INIS)

    Rokni Yazdi, Hadi; Faraji, Safoura; Ahmadi, Farokhlegha; Shahmirzae, Reza

    2012-01-01

    Endothelial injury is a well-known complication in chronic kidney disease (CKD) and hemodialysis. One of the sites in which early vascular changes may be detected is the retina. Of course, these flow changes may not be detected in ophthalmologic exams, but it seems that color Doppler sonography of retinal arteries may be helpful in these cases. In previous studies on CKD patients who underwent chronic hemodialysis,hemodynamic changes were noted in retinal arteries, but no study has been performed to determine which of the two processes (CKD or chronic hemodialysis) can produce these changes. In this study, we tried to answer this question. Doppler ultrasonography of the orbital vasculature including the ophthalmic artery and the central retinal artery was carried out in 17 patients (34 eyes) with chronic renal failure (CRF) who underwent hemodialysis, 17 patients (34 eyes)with CRF without a history of hemodialysis and 17 normal patients (34 eyes). The peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance index were measured excluding hypertensive, diabetic patients and patients with cardiovascular disease. The mean PSV and EDV were lower only in the ophthalmic artery of CRF patients irrespective of the history of hemodialysis (PSV was 35.2 in hemodialysis, 38.8 in CRF and 51.6 in normal patients, P value = 0.001 and EDV was 7.4, 9.4, 11.8, respectively, P value =0.001) with no significant difference in the resistance index of the ophthalmic artery and other parameters [EDV, PSV, Resistance Index (RI)] in the central retinal artery. The mean PSV and DSV in the ophthalmic artery were lower only in the ophthalmic artery of CRF patients regardless of the history of hemodialysis. No significant difference in the resistance index of the ophthalmic artery and other parameters (EDV, PSV) of the central retinal artery were noted between different groups. These findings suggest that microvascular disease and endothelial cell dysfunction of the orbital

  4. Imaging of inflamed carotid artery atherosclerotic plaques with the use of {sup 99m}Tc-HYNIC-IL-2 scintigraphy in end-stage renal disease patients

    Energy Technology Data Exchange (ETDEWEB)

    Opalinska, Marta; Pach, Dorota; Sowa-Staszczak, Anna; Glowa, Boguslaw; Hubalewska-Dydejczyk, Alicja [Jagiellonian University Medical School, Nuclear Medicine Unit, Department of Endocrinology, Cracow (Poland); Stompor, Tomasz [University of Warmia and Mazury in Olsztyn, Department of Nephrology, Hypertensiology and Internal Medicine, Faculty of Medicine, Olsztyn (Poland); Mikolajczak, Renata; Garnuszek, Piotr; Maurin, Michal; Karczmarczyk, Urszula [National Centre for Nuclear Research Radioisotope Centre POLATOM, Otwock (Poland); Fedak, Danuta [Jagiellonian University Medical School, Clinical Biochemistry, Cracow (Poland); Krzanowski, Marcin; Sulowicz, Wladyslaw [Jagiellonian University Medical School, Department of Nephrology, Cracow (Poland); Rakowski, Tomasz [Jagiellonian University Medical School, 2nd Department of Cardiology, Institute of Cardiology, Cracow (Poland)

    2012-04-15

    Identification of vulnerable plaques remains crucial for better cardiovascular risk assessment. At least 20% of inflammatory cells within unstable (vulnerable) plaques comprise T lymphocytes, which contain receptors for interleukin-2 (IL-2); those receptors can be identified by scintigraphy with radiolabelled IL-2.The aim of this study was to identify the ''inflamed'' (vulnerable) plaques by scintigraphy using IL-2 labelled with {sup 99m}Tc in the selected, high cardiovascular risk group of end-stage renal disease (ESRD) patients. A total of 28 patients (18 men, 10 women, aged 55.2 {+-} 9.6 years, 17 on peritoneal dialysis, 11 on haemodialysis) underwent common carotid artery (CCA) scintigraphy with the use of {sup 99m}Tc-hydrazinonicotinamide (HYNIC)-IL-2. In all cases, ultrasound examination of the CCA was performed and levels of selected proinflammatory factors, atherogenic markers and calcium-phosphate balance parameters were measured. Finally, the target to non-target (T/nT) ratio of IL-2 uptake in atherosclerotic plaques with intima-media thickness (IMT), classic cardiovascular risk factors and concentrations of the measured factors were compared. Increased {sup 99m}Tc-HYNIC-IL-2 uptake in atherosclerotic plaques in 38/41 (91%) cases was detected. The median T/nT ratio of focal {sup 99m}Tc-HYNIC-IL-2 uptake in atherosclerotic plaques was 2.35 (range 1.23-3.63). The mean IMT value on the side of plaques assessed by scintigraphy was 0.79 {+-} 0.18 mm (median 0.8, range 0.5-1.275). Correlations between T/nT ratio and homocysteine (R = 0.22, p = 0.037), apolipoprotein B (apoB) (R = 0.31, p = 0.008), apoB to apoA-I ratio (R = 0.29, p = 0.012) and triglyceride concentration (R = 0.26, p = 0.021) were detected. A lower T/nT ratio in patients with better parameters of nutritional status (haemoglobin, albumin, adiponectin) in comparison with patients with worse nutritional parameters (3.20 {+-} 0.5 vs 2.16 {+-} 0.68, p = 0.025) was revealed as well

  5. The real-world dose-relativity of sevelamer hydrochloride and lanthanum carbonate monotherapy in patients with end-stage renal disease.

    Science.gov (United States)

    Wilson, Rosamund J; Keith, Michael S; Preston, Peter; Copley, J Brian

    2013-12-01

    Sevelamer hydrochloride (SH) and lanthanum carbonate (LC) are calcium-free phosphate binders used for the management of hyperphosphatemia in patients with end-stage renal disease (ESRD). The objective of this analysis was to evaluate the real-world dose-relativity between SH and LC monotherapy in US patients with ESRD. This was a post hoc analysis of a 16-week, real-world study (Vemuri et al. in BMC Nephrol 12:49, 2011) of the efficacy of conversion to LC monotherapy from other phosphate binders. The SH:LC dose-relativity ratio, based on the mean daily dose, was calculated in the subset of patients from the Vemuri study who converted from SH to LC monotherapy and had available SH and LC dose data. A total of 950 patients converted from SH to LC monotherapy and had recorded dose data. The post hoc analysis population comprised 691 patients with available dose data for both SH at baseline and LC at week 16. The mean (SD) serum phosphate level at baseline was 5.91 (1.66) mg/dL. After conversion to LC monotherapy for 16 weeks, the mean (SD) serum phosphate level was 5.93 (1.85) mg/dL. The mean (SD) daily baseline SH dose was 7,703 (3,642) mg and the mean (SD) daily LC dose at week 16 was 2,800 (939) mg (9.6 versus 2.8 tablets, respectively; P relativity ratio of 2.8. The median individual patient SH:LC dose-relativity ratio was 2.6 (95% CI 2.6-2.8). Across baseline SH dose subgroups (2,400-4,800, >4,800-7,200, >7,200-9,600, and >9,600 mg/day), the mean daily SH dose was 4,051, 7,047, 9,253, and 13,150 mg, respectively. In comparison, the mean daily LC dose was 2,445-3,156 mg. Thus, patients requiring baseline SH doses >7,200 mg/day (41% of the analysis population) had higher SH:LC dose-relativity ratios of 3.1-4.2 (median individual patient ratios 3.1-4.0). In this post hoc analysis of real-world dose-relativity, the overall SH:LC dose-relativity ratio was 2.8 (median individual patient ratio 2.6 (95% CI 2.6-2.8). These findings are consistent with the World Health

  6. Integrating emotional and psychological support into the end-stage renal disease pathway: a protocol for mixed methods research to identify patients' lower-level support needs and how these can most effectively be addressed.

    Science.gov (United States)

    Taylor, Francesca; Taylor, Celia; Baharani, Jyoti; Nicholas, Johann; Combes, Gill

    2016-08-02

    As a result of difficulties related to their illness, diagnosis and treatment, patients with end-stage renal disease experience significant emotional and psychological problems, which untreated can have considerable negative impact on their health and wellbeing. Despite evidence that patients desire improved support, management of their psychosocial problems, particularly at the lower-level, remains sub-optimal. There is limited understanding of the specific support that patients need and want, from whom, and when, and also a lack of data on what helps and hinders renal staff in identifying and responding to their patients' support needs, and how barriers to doing so might be overcome. Through this research we therefore seek to determine what, when, and how, support for patients with lower-level emotional and psychological problems should be integrated into the end-stage renal disease pathway. The research will involve two linked, multicentre studies, designed to identify and consider the perspectives of patients at five different stages of the end-stage renal disease pathway (Study 1), and renal staff working with them (Study 2). A convergent, parallel mixed methods design will be employed for both studies, with quantitative and qualitative data collected separately. For each study, the data sets will be analysed separately and the results then compared or combined using interpretive analysis. A further stage of synthesis will employ data-driven thematic analysis to identify: triangulation and frequency of themes across pathway stages; patterns and plausible explanations of effects. There is an important need for this research given the high frequency of lower-level distress experienced by end-stage renal disease patients and lack of progress to date in integrating support for their lower-level psychosocial needs into the care pathway. Use of a mixed methods design across the two studies will generate a holistic patient and healthcare professional perspective that

  7. Safety and Efficacy of PDpoetin for Management of Anemia in Patients with end Stage Renal Disease on Maintenance Hemodialysis: Results from a Phase IV Clinical Trial.

    Science.gov (United States)

    Javidan, Abbas Norouzi; Shahbazian, Heshmatollah; Emami, Amirhossein; Yekaninejad, Mir Saeed; Emami-Razavi, Hassan; Farhadkhani, Masoumeh; Ahmadzadeh, Ahmad; Gorjipour, Fazel

    2014-08-26

    Recombinant human erythropoietin (rHuEPO) is available for correcting anemia. PDpoetin, a new brand of rHuEPO, has been certified by Food and Drug Department of Ministry of Health and Medical Education of Iran for clinical use in patients with chronic kidney disease. We conducted this post-marketing survey to further evaluate the safety and efficacy of PDpoetin for management of anemia in patients on maintenance hemodialysis. Patients from 4 centers in Iran were enrolled for this multicenter, open-label, uncontrolled phase IV clinical trial. Changes in blood chemistry, hemoglobin and hematocrit levels, renal function, and other characteristics of the patients were recorded for 4 months; 501 of the patients recruited, completed this study. Mean age of the patients was 50.9 (±16.2) years. 48.7% of patients were female. Mean of the hemoglobin value in all of the 4 centers was 9.29 (±1.43) g/dL at beginning of the study and reached 10.96 (±2.23) g/dL after 4 months and showed significant increase overall (Pcase of immunological reactions to PDpoetin was observed. Our study, therefore, showed that PDpoetin has significantly raised the level of hemoglobin in the hemodialysis patients (about 1.7±0.6 g/dL). Anemia were successfully corrected in 49% of patients under study. Use of this biosimilar was shown to be safe and effective for the maintenance of hemoglobin in patients on maintenance hemodialysis.

  8. Safety and efficacy of PDpoetin for management of anemia in patients with end stage renal disease on maintenance hemodialysis: results from a phase IV clinical trial

    Directory of Open Access Journals (Sweden)

    Abbas Norouzi Javidan

    2014-09-01

    Full Text Available Recombinant human erythropoietin (rHuEPO is available for correcting anemia. PDpoetin, a new brand of rHuEPO, has been certified by Food and Drug Department of Ministry of Health and Medical Education of Iran for clinical use in patients with chronic kidney disease. We conducted this post-marketing survey to further evaluate the safety and efficacy of PDpoetin for management of anemia in patients on maintenance hemodialysis. Patients from 4 centers in Iran were enrolled for this multicenter, open-label, uncontrolled phase IV clinical trial. Changes in blood chemistry, hemoglobin and hematocrit levels, renal function, and other characteristics of the patients were recorded for 4 months; 501 of the patients recruited, completed this study. Mean age of the patients was 50.9 (±16.2 years. 48.7% of patients were female. Mean of the hemoglobin value in all of the 4 centers was 9.29 (±1.43 g/dL at beginning of the study and reached 10.96 (±2.23 g/dL after 4 months and showed significant increase overall (P<0.001. PDpoetin dose was stable at 50-100 U/kg thrice weekly. Hemorheologic disturbancesand changes in blood electrolytes was not observed. No case of immunological reactions to PDpoetin was observed. Our study, therefore, showed that PDpoetin has significantly raised the level of hemoglobin in the hemodialysis patients (about 1.7±0.6 g/dL. Anemia were successfully corrected in 49% of patients under study. Use of this biosimilar was shown to be safe and effective for the maintenance of hemoglobin in patients on maintenance hemodialysis.

  9. Incremental value of a combination of cardiac troponin T, N-terminal pro-brain natriuretic peptide and C-reactive protein for prediction of mortality in end-stage renal disease

    DEFF Research Database (Denmark)

    Hallén, Jonas; Madsen, Lene Helleskov; Ladefoged, Søren

    2011-01-01

    Abstract Objective. To determine the relative prognostic merits of C-reactive protein (CRP), cardiac troponin T (cTnT) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) for prediction of all-cause death in patients with end-stage renal disease (ESRD) receiving haemodialysis. Material...... and methods. This prospective, controlled cohort study included 109 patients. Biomarkers were sampled at inclusion and considered as categorical and continuous variables in Cox proportional hazard models. Results. Mean follow-up ± SD was 926 ± 385 days, during which 52 patients (48%) died. All three markers...

  10. Medicare Program; End-Stage Renal Disease Prospective Payment System, Coverage and Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program Bid Surety Bonds, State Licensure and Appeals Process for Breach of Contract Actions, Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program and Fee Schedule Adjustments, Access to Care Issues for Durable Medical Equipment; and the Comprehensive End-Stage Renal Disease Care Model. Final rule.

    Science.gov (United States)

    2016-11-04

    This rule updates and makes revisions to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year 2017. It also finalizes policies for coverage and payment for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury. This rule also sets forth requirements for the ESRD Quality Incentive Program, including the inclusion of new quality measures beginning with payment year (PY) 2020 and provides updates to programmatic policies for the PY 2018 and PY 2019 ESRD QIP. This rule also implements statutory requirements for bid surety bonds and state licensure for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP). This rule also expands suppliers' appeal rights in the event of a breach of contract action taken by CMS, by revising the appeals regulation to extend the appeals process to all types of actions taken by CMS for a supplier's breach of contract, rather than limit an appeal for the termination of a competitive bidding contract. The rule also finalizes changes to the methodologies for adjusting fee schedule amounts for DMEPOS using information from CBPs and for submitting bids and establishing single payment amounts under the CBPs for certain groupings of similar items with different features to address price inversions. Final changes also are made to the method for establishing bid limits for items under the DMEPOS CBPs. In addition, this rule summarizes comments on the impacts of coordinating Medicare and Medicaid Durable Medical Equipment for dually eligible beneficiaries. Finally, this rule also summarizes comments received in response to a request for information related to the Comprehensive ESRD Care Model and future payment models affecting renal care.

  11. Aortic-Radial Pulse Wave Velocity Ratio in End-stage Renal Disease Patients: Association with Age, Body Tissue Hydration Status, Renal Failure Etiology and Five Years of Hemodialysis.

    Science.gov (United States)

    Bia, Daniel; Valtuille, Rodolfo; Galli, Cintia; Wray, Sandra; Armentano, Ricardo; Zócalo, Yanina; Cabrera-Fischer, Edmundo

    2017-03-01

    The etiology of the end-stage renal disease (ESRD) and the hydration status may be involved in the arterial stiffening process observed in hemodialyzed patients. The ratio between carotid-femoral and carotid-radial pulse wave velocity (PWV ratio) was recently proposed to characterize the patient-specific stiffening process. to analyze: (1) the PWV-ratio in healthy and hemodialyzed subjects, analyzing potential changes associated to etiologies of the ESRD, (2) the PWV-ratio and hydration status using multiple-frequency bioimpedance and, (3) the effects of hemodialysis on PWV-ratio in a 5-year follow-up. PWV-ratio was evaluated in 151 patients differentiated by the pathology determining their ESRD. Total body fluid (TBF), intra and extra cellular fluid (ICF, ECF) were measured in 65 of these patients using bioelectrical-impedance. The association between arterial, hemodynamic or fluid parameters was analyzed. PWV-ratio was evaluated in a group of patients (n = 25) 5 years later (follow-up study). PWV-ratio increased in the ESRD cohort with respect to the control group (1.03 ± 0.23 vs. 1.31 ± 0.37; p hydration status, but not with the blood pressure. PWV-ratio could be considered a blood pressure-independent parameter, associated with the age and hydration status of the patient.

  12. Permanent vascular access in patients with end-stage renal disease, Brazil Acceso vascular permanente en pacientes renales crónicos terminales en Brasil Acesso vascular permanente em pacientes renais crônicos terminais no Brasil

    Directory of Open Access Journals (Sweden)

    Gisele Macedo da Silva

    2011-04-01

    Full Text Available OBJECTIVE: To assess factors associated with the establishment of permanent vascular access for patients with end-stage renal disease. METHODS: Cross-sectional study conducted in a nationally representative sample of Brazilian end-stage renal disease patients in dialysis and transplant centers during 2007. The sample comprised only patients who received hemodialysis as a primary therapy modality and reported the type of vascular access for their primary hemodialysis treatment (N=2,276. Data were from the TRS Project - "Economic and Epidemiologic Evaluation of Modalities of Renal Replacement Therapy in Brazil". Multiple logistic regression analysis was used to assess factors associated with the establishment of permanent vascular access in these patients. RESULTS: About 30% of the patients studied had an arteriovenous vascular access. The following factors were associated with a lower likelihood of having an arteriovenous vascular access as a primary type of access: time of hemodialysis start since the diagnosis of chronic renal failure OBJETIVO: Analizar factores asociados a la provisión de acceso vascular arteriovenoso en Brasil. MÉTODOS: Estudio transversal, nacionalmente representativo, con pacientes con enfermedad renal crónica terminal acompañados en servicios de diálisis o en centros transplantadores en el año de 2007. La muestra incluyó pacientes que tuvieron la hemodiálisis como primera modalidad de tratamiento y que sabían con que tipo de acceso vascular habían iniciado el tratamiento (N=2.276. Los datos son oriundos del Proyecto TRS - "Evaluación económica-epidemiológica de las modalidades de Terapia renal Sustitutiva en Brasil". Fue utilizada la regresión logística múltiple. RESULTADOS: Aproximadamente 30% de los pacientes tenían acceso vascular arteriovenoso. Los factores asociados a la baja probabilidad de tener acceso vascular arteriovenoso como primer tipo de acceso fueron: tiempo de diagnóstico de enfermedad

  13. Shared decision-making in end-stage renal disease: a protocol for a multi-center study of a communication intervention to improve end-of-life care for dialysis patients.

    Science.gov (United States)

    Eneanya, Nwamaka D; Goff, Sarah L; Martinez, Talaya; Gutierrez, Natalie; Klingensmith, Jamie; Griffith, John L; Garvey, Casey; Kitsen, Jenny; Germain, Michael J; Marr, Lisa; Berzoff, Joan; Unruh, Mark; Cohen, Lewis M

    2015-06-12

    End-stage renal disease carries a prognosis similar to cancer yet only 20 % of end-stage renal disease patients are referred to hospice. Furthermore, conversations between dialysis team members and patients about end-of-life planning are uncommon. Lack of provider training about how to communicate prognostic data may contribute to the limited number of end-of-life care discussions that take place with this chronically ill population. In this study, we will test the Shared Decision-Making Renal Supportive Care communication intervention to systematically elicit patient and caretaker preferences for end-of-life care so that care concordant with patients' goals can be provided. This multi-center study will deploy an intervention to improve end-of-life communication for hemodialysis patients who are at high risk of death in the ensuing six months. The intervention will be carried out as a prospective cohort with a retrospective cohort serving as the comparison group. Patients will be recruited from 16 dialysis units associated with two large academic centers in Springfield, Massachusetts and Albuquerque, New Mexico. Critical input from patient advisory boards, a stakeholder panel, and initial qualitative analysis of patient and caretaker experiences with advance care planning have informed the communication intervention. Rigorous communication training for hemodialysis social workers and providers will ensure that standardized study procedures are performed at each dialysis unit. Nephrologists and social workers will communicate prognosis and provide advance care planning in face-to-face encounters with patients and families using a social work-centered algorithm. Study outcomes including frequency and timing of hospice referrals, patient and caretaker satisfaction, quality of end-of-life discussions, and quality of death will be assessed over an 18 month period. The Shared Decision-Making Renal Supportive Care Communication intervention intends to improve discussions

  14. End-stage kidney disease

    Science.gov (United States)

    ... stage; Kidney failure - end stage; ESRD; ESKD Images Kidney anatomy References Fogarty DG, Taal MW. A stepped care approach to the management of chronic kidney disease. In: Skorecki K, Chertow GM, Marsden PA, ...

  15. Treatment-resistant hypertension and the incidence of cardiovascular disease and end-stage renal disease: results from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).

    Science.gov (United States)

    Muntner, Paul; Davis, Barry R; Cushman, William C; Bangalore, Sripal; Calhoun, David A; Pressel, Sara L; Black, Henry R; Kostis, John B; Probstfield, Jeffrey L; Whelton, Paul K; Rahman, Mahboob

    2014-11-01

    Apparent treatment-resistant hypertension (aTRH) is defined as uncontrolled hypertension despite the use of ≥3 antihypertensive medication classes or controlled hypertension while treated with ≥4 antihypertensive medication classes. Although a high prevalence of aTRH has been reported, few data are available on its association with cardiovascular and renal outcomes. We analyzed data on 14 684 Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants to determine the association between aTRH (n=1870) with coronary heart disease, stroke, all-cause mortality, heart failure, peripheral artery disease, and end-stage renal disease. We defined aTRH as blood pressure not at goal (systolic/diastolic blood pressure ≥140/90 mm Hg) while taking ≥3 classes of antihypertensive medication or taking ≥4 classes of antihypertensive medication with blood pressure at goal during the year 2 ALLHAT study visit (1996-2000). Use of a diuretic was not required to meet the definition of aTRH. Follow-up occurred through 2002. The multivariable adjusted hazard ratios (95% confidence intervals) comparing participants with versus without aTRH were as follows: coronary heart disease (1.44 [1.18-1.76]), stroke (1.57 [1.18-2.08]), all-cause mortality (1.30 [1.11-1.52]), heart failure (1.88 [1.52-2.34]), peripheral artery disease (1.23 [0.85-1.79]), and end-stage renal disease (1.95 [1.11-3.41]). aTRH was also associated with the pooled outcomes of combined coronary heart disease (hazard ratio, 1.47; 95% confidence interval, 1.26-1.71) and combined cardiovascular disease (hazard ratio, 1.46; 95% confidence interval, 1.29-1.64). These results demonstrate that aTRH increases the risk for cardiovascular disease and end-stage renal disease. Studies are needed to identify approaches to prevent aTRH and reduce risk for adverse outcomes among individuals with aTRH. © 2014 American Heart Association, Inc.

  16. Disparities in treatment rates of paediatric end-stage renal disease across Europe: insights from the ESPN/ERA-EDTA registry.

    Science.gov (United States)

    Chesnaye, Nicholas C; Schaefer, Franz; Groothoff, Jaap W; Caskey, Fergus J; Heaf, James G; Kushnirenko, Stella; Lewis, Malcolm; Mauel, Reiner; Maurer, Elisabeth; Merenmies, Jussi; Shtiza, Diamant; Topaloglu, Rezan; Zaicova, Natalia; Zampetoglou, Argyroula; Jager, Kitty J; van Stralen, Karlijn J

    2015-08-01

    Considerable disparities exist in the provision of paediatric renal replacement therapy (RRT) across Europe. This study aims to determine whether these disparities arise from geographical differences in the occurrence of renal disease, or whether country-level access-to-care factors may be responsible. Incidence was defined as the number of new patients aged 0-14 years starting RRT per year, between 2007 and 2011, per million children (pmc), and was extracted from the ESPN/ERA-EDTA registry database for 35 European countries. Country-level indicators on macroeconomics, perinatal care and physical access to treatment were collected through an online survey and from the World Bank database. The estimated effect is presented per 1SD increase for each indicator. The incidence of paediatric RRT in Europe was 5.4 cases pmc. Incidence decreased from Western to Eastern Europe (-1.91 pmc/1321 km, P macroeconomics, which limit the provision of treatment particularly in the youngest patients. This poses a challenge for healthcare policy makers in their aim to ensure universal and equal access to high-quality healthcare services across Europe. © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

  17. Latin American Dialysis and Transplant Registry: 2008 prevalence and incidence of end-stage renal disease and correlation with socioeconomic indexes.

    Science.gov (United States)

    Cusumano, Ana M; Garcia-Garcia, Guillermo; Gonzalez-Bedat, Maria C; Marinovich, Sergio; Lugon, Jocemir; Poblete-Badal, Hugo; Elgueta, Susana; Gomez, Rafael; Hernandez-Fonseca, Fabio; Almaguer, Miguel; Rodriguez-Manzano, Sandra; Freire, Nelly; Luna-Guerra, Jorge; Rodriguez, Gaspar; Bochicchio, Tommaso; Cuero, Cesar; Cuevas, Dario; Pereda, Carlos; Carlini, Raul

    2013-05-01

    In 2008, 563,294,000 people were living in Latin America (LA), of which 6.6% were older than 65. The region is going through a fast demographic and epidemiologic transition process, in the context of an improvement in socio-economic indices. The Latin American Dialysis and Renal Transplant Registry has collected data since 1991, through an annual survey completed by 20 affiliated National Societies. Renal replacement treatment (RRT) prevalence and incidence showed an increase year by year. The prevalence rate (in all modalities) correlated with the World Bank country classification by income and the epidemiologic transition stage the countries were experiencing. RRT prevalence and kidney transplantation rates correlated significantly with gross national income (GNI), health expenditure in constant dollars (HeExp), % older than 65, life expectancy at birth, and % of the population living in urban settings. Kidney transplantation increased also, year by year, with more than 50% of transplants performed using kidneys from deceased donors. Double transplants were performed in six countries. RRT prevalence and incidence increased in LA, and are associated with indexes reflecting higher and more evenly distributed national wealth (GNI and HeExp), and the stage of demographic and epidemiological transition.

  18. Comparison of oral and intravenous routes of administration of dipyridamole for thallium imaging of type I diabetics with end-stage renal disease

    International Nuclear Information System (INIS)

    Boudreau, R.J.; Stony, J.T.; du Cret, R.P.; Kuni, C.C.; Wang, Y.; Wilson, R.F.; Schwartz, J.F.; Castaneda-Zuniga, W.R.

    1989-01-01

    The authors have frequently seen myocardial infarction after renal transplantation in patient with type I diabetes, and treadmill T1-201 testing in these patients have been inadequate. The authors evaluated dipyridamole (DP) as a substitute for treadmill stress. Because intravenous DP was not approved in the United States at the time of the study, the oral formulation wax used for some patients. The authors have prospectively evaluated 80 uremic diabetics (40 received oral T1-201; 40 received intravenous T1-201). Angiogram and scan observers were blinded. There was not difference in the accuracy of the two routes of administration. Pooling the data gave a sensitivity of 86% and a specificity of 79%. However, their disease prevalence was high (52%), which precluded the use of any screening test. The authors now have recommended angiography for these patients

  19. Uremic restless legs syndrome (RLS) and sleep quality in patients with end-stage renal disease on hemodialysis: potential role of homocysteine and parathyroid hormone.

    Science.gov (United States)

    Gade, Katrin; Blaschke, Sabine; Rodenbeck, Andrea; Becker, Andreas; Anderson-Schmidt, Heike; Cohrs, Stefan

    2013-01-01

    The aetiology of uremic restless legs syndrome (RLS) remains unclear. Our research investigated whether an elevated plasma concentration of the excitatory amino acid homocysteine might be associated with RLS occurrence in patients with chronic renal insufficiency on hemodialysis. Total plasma homocysteine as well as creatinine, urea, folate, parathyroid hormone, hemoglobin, iron, ferritin, phosphate, calcium, magnesium, and albumin levels were compared between 26 RLS-affected (RLSpos) and 26 non-affected (RLSneg) patients on chronic hemodialysis. We further compared subjective sleep quality between RLSpos and RLSneg patients using the Pittsburgh-Sleep-Quality-Index and investigated possible relationships between laboratory parameters and sleep quality. Taking individual albumin concentrations into account, a significant positive correlation between total plasma homocysteine and RLS occurrence was observed (r= 0.246; p=0.045). Sleep quality was significantly more reduced in RLSpos compared to RLSneg patients and RLS severity correlated positively with impairment of sleep quality. Bad sleep quality in all patients was associated with higher concentrations of parathyroid hormone. Our results suggest a possible aetiological role of homocysteine in uremic RLS. They confirm that uremic RLS is an important factor causing sleep impairment in patients on hemodialysis. Higher parathyroid hormone levels might also be associated with bad sleep quality in these patients. © 2013 S. Karger AG, Basel.

  20. Percutaneous coronary intervention versus coronary artery bypass grafting in patients with end-stage renal disease requiring dialysis (5-year outcomes of the CREDO-Kyoto PCI/CABG Registry Cohort-2).

    Science.gov (United States)

    Marui, Akira; Kimura, Takeshi; Nishiwaki, Noboru; Mitsudo, Kazuaki; Komiya, Tatsuhiko; Hanyu, Michiya; Shiomi, Hiroki; Tanaka, Shiro; Sakata, Ryuzo

    2014-08-15

    Ischemic heart disease is a major risk factor for morbidity and mortality in patients with end-stage renal disease. However, long-term benefits of percutaneous coronary intervention (PCI) relative to coronary artery bypass grafting (CABG) in those patients is still unclear in the drug-eluting stent era. We identified 388 patients with multivessel and/or left main disease with end-stage renal disease requiring dialysis among 15,939 patients undergoing first coronary revascularization enrolled in the Coronary REvascularization Demonstrating Outcome Study in Kyoto PCI/CABG Registry Cohort-2 (PCI: 258 patients and CABG: 130 patients). The CABG group included more patients with 3-vessel (38% vs 57%, p PCI group (23.5 ± 8.7 vs 29.4 ± 11.0, p PCI and 5.4% for CABG. Cumulative 5-year all-cause mortality was 52.3% for PCI and 49.9% for CABG. Propensity score-adjusted all-cause mortality was not different between PCI and CABG (hazard ratio [HR] 1.33, 95% confidence interval [CI] 0.85 to 2.09, p = 0.219). However, the excess risk of PCI relative to CABG for cardiac death was significant (HR 2.10, 95% CI 1.11 to 3.96, p = 0.02). The risk of sudden death was also higher after PCI (HR 4.83, 95% CI 1.01 to 23.08, p = 0.049). The risk of myocardial infarction after PCI tended to be higher than after CABG (HR 3.30, 95% CI 0.72 to 15.09, p = 0.12). The risk of any coronary revascularization after PCI was markedly higher after CABG (HR 3.78, 95% CI 1.91 to 7.50, p PCI reduced the risk of cardiac death, sudden death, myocardial infarction, and any revascularization. However, the risk of all-cause death was not different between PCI and CABG. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Prognostic significance of repeat biopsy in lupus nephritis: Histopathologic worsening and a short time between biopsies is associated with significantly increased risk for end stage renal disease and death.

    Science.gov (United States)

    Arriens, Cristina; Chen, Sixia; Karp, David R; Saxena, Ramesh; Sambandam, Kamalanathan; Chakravarty, Eliza; James, Judith A; Merrill, Joan T

    2017-12-01

    Approximately half of patients with systemic lupus erythematosus (SLE) develop lupus nephritis (LN), a major cause of morbidity and early mortality in that disease. Prolonged renal inflammation is associated with irreversible kidney damage which confers a 30% risk of end stage renal disease (ESRD), making early, aggressive treatment mandatory. Failure to achieve therapeutic response or recurrence of renal flare often prompts repeat biopsy. However, the role of repeat biopsy in determining long-term renal prognosis remains controversial. For this reason repeat biopsies are usually not utilized unless clinical evidence of refractory or recurrent disease is already present, despite known mismatches between clinical and biopsy findings. The current study quantifies the degree to which histopathologic worsening between first and second biopsies and duration between them predicts ESRD and death. Medical records of 141 LN patients with more than one biopsy were obtained from a single large urban medical center. Cases were attained using billing codes for diagnosis and procedures from 1/1999-1/2015. Biopsy worsening was defined as unfavorable histopathologic classification transitions and/or increased chronicity; if neither were present, the patient was defined as non-worsening. We used Cox proportional hazard models to study the relationship between ESRD and survival adjusting for covariates which included age at first biopsy, gender, race, initial biopsy class, and initial induction therapy. Of 630 patients screened, 141 had more than one biopsy. Advancing chronicity was detected in 48 (34.0%) and a renal class switch to worse grade of pathology was found in 54 (38.3%). At least one of these adverse second biopsy features was reported in 79 (56.0%) patients. Five years following initial biopsy, 28 (35.4%) of those with worsening histopathology on second biopsy developed ESRD, compared to 6 (9.7%) of non-worsening patients and 10 (12.7%) of patients with worsening

  2. Case Report: Calciphylaxis Causing Digital, Gangrene in End Stage ...

    African Journals Online (AJOL)

    It is more frequently reported in whites than in blacks and commonly accompanies hyperphosphataemia, elevated calcium-phosphate product and marked secondary hyperparathyroidism. We report a rare case of CUA that complicated end stage renal disease secondary to obstructive uropathy in a 68 year old Nigerian.

  3. The effects of extreme low frequency pulsed electromagnetic field on bone mineral density and incidence of fractures in patients with end - stage renal disease on dialysis - three year follow up study

    Directory of Open Access Journals (Sweden)

    Rakočević-Hrnjak Aleksandra

    2018-01-01

    Full Text Available Background/Aim. A variety of physical therapy options has been developed for the treatment of musculoskeletal disorders including those characterized with low bone mineral density (BMD. Extreme low frequency pulsed electromagnetic field (ELF-PEMF can accelerate bone formation. Patients with end stage of renal disease (ESRD are predisposed to high incidence of fractures due to bone disorder with multifactorial pathogenesis. Vitamin D, calcium supplements, antiresorptive and anabolic drugs in those patients have changed pharmacodynamics and pharmacokinetics and have minimal or limited effects. The aim of this study was to assess the effectiveness of long-term ELF-PEMF therapy applied in concordance with physical exercise on bone mass, incidence of new bone fractures and parathyroid hormone concentrations in ESRD patients on dialysis. Methods. In this 3-year prospective clinical trial, 151 patients with ESRD on dialysis program were subjected to treatment with ELF-PEMF (18 Hz, 2 mT applied during 40 min after 10 consecutive dialysis procedures, 4 times through one year (120 treatments in total during three years together with kinesitherapy (study group or only with kinesitherapy (control group on the voluntary basis. Results. Total of 124 patients have completed the study. In the study group (n = 54, regardless of sex, significant improvements of BMD, T-score and Z-score on both lumbar spine and femoral neck were achieved after 3-year treatment with ELF-PEMF. In the control group (n = 70, significant decreases of BMD, T-score and Z-score as well as the higher incidence of new bone fractures were recorded. Conclusion. ELF-PEMF could be a convenient and safe non-pharmacological therapeutic strategy for fracture prevention in nephrology practices.

  4. Historical clinical and economic consequences of anemia management in patients with end-stage renal disease on dialysis using erythropoietin stimulating agents versus routine blood transfusions: a retrospective cost-effectiveness analysis.

    Science.gov (United States)

    Naci, Huseyin; de Lissovoy, Gregory; Hollenbeak, Christopher; Custer, Brian; Hofmann, Axel; McClellan, William; Gitlin, Matthew

    2012-01-01

    To determine whether Medicare's decision to cover routine administration of erythropoietin stimulating agents (ESAs) to treat anemia of end-stage renal disease (ESRD) has been a cost-effective policy relative to standard of care at the time. The authors used summary statistics from the actual cohort of ESRD patients receiving ESAs between 1995 and 2004 to create a simulated patient cohort, which was compared with a comparable simulated cohort assumed to rely solely on blood transfusions. Outcomes modeled from the Medicare perspective included estimated treatment costs, life-years gained, and quality-adjusted life-years (QALYs). Incremental cost-effectiveness ratio (ICER) was calculated relative to the hypothetical reference case of no ESA use in the transfusion cohort. Sensitivity of the results to model assumptions was tested using one-way and probabilistic sensitivity analyses. Estimated total costs incurred by the ESRD population were $155.47B for the cohort receiving ESAs and $155.22B for the cohort receiving routine blood transfusions. Estimated QALYs were 2.56M and 2.29M, respectively, for the two groups. The ICER of ESAs compared to routine blood transfusions was estimated as $873 per QALY gained. The model was sensitive to a number of parameters according to one-way and probabilistic sensitivity analyses. This model was counter-factual as the actual comparison group, whose anemia was managed via transfusion and iron supplements, rapidly disappeared following introduction of ESAs. In addition, a large number of model parameters were obtained from observational studies due to the lack of randomized trial evidence in the literature. This study indicates that Medicare's coverage of ESAs appears to have been cost effective based on commonly accepted levels of willingness-to-pay. The ESRD population achieved substantial clinical benefit at a reasonable cost to society.

  5. Children of non-Western origin with end-stage renal disease in the Netherlands, Belgium and a part of Germany have impaired health-related quality of life compared with Western children.

    Science.gov (United States)

    Schoenmaker, Nikki J; Haverman, Lotte; Tromp, Wilma F; van der Lee, Johanna H; Offringa, Martin; Adams, Brigitte; Bouts, Antonia H M; Collard, Laure; Cransberg, Karlien; van Dyck, Maria; Godefroid, Nathalie; van Hoeck, Koenraad; Koster-Kamphuis, Linda; Lilien, Marc R; Raes, Ann; Taylan, Christina; Grootenhuis, Martha A; Groothoff, Jaap W

    2014-02-01

    Many children with end-stage renal disease (ESRD) living in Western Europe are of non-Western European origin. They have unfavourable somatic outcomes compared with ESRD children of Western origin. In this study, we compared the Health-related Quality of Life (HRQoL) of both groups. All children (5-18 years) with ESRD included in the RICH-Q project (Renal Insufficiency therapy in Children-Quality assessment and improvement) or their parents were asked to complete the generic version of the Paediatric Quality-of-Life Inventory 4.0 (PedsQL). RICH-Q comprises the Netherlands, Belgium and a part of Germany. Children were considered to be of non-Western origin if they or at least one parent was born outside Western-European countries. Impaired HRQoL for children with ESRD of Western or non-Western origin was defined as a PedsQL score less than fifth percentile for healthy Dutch children of Western or non-Western origin, respectively. Of the 259 eligible children, 230 agreed to participate. One hundred and seventy-four children responded (response rate 67%) and 55 (32%) were of non-Western origin. Overall, 31 (56%) of the ESRD children of non-Western origin, and 58 (49%) of Western origin had an impaired total HRQoL score. Total HRQoL scores of children with ESRD of Western origin and non-Western origin were comparable, but scores on emotional functioning and school functioning were lower in non-Western origin (P=0.004 and 0.01, respectively). The adjusted odds ratios (95% confidence interval) for ESRD children of non-Western origin to have impaired emotional functioning and school functioning, compared with Western origin, were 3.3(1.5-7.1) and 2.2(1.1-4.2), respectively. Children with ESRD of non-Western origin in three Western countries were found to be at risk for impaired HRQoL on emotional and school functioning. These children warrant special attention.

  6. Epidemiological Transition of End-Stage Kidney Disease in Oman.

    Science.gov (United States)

    Al Ismaili, Faisal; Al Salmi, Issa; Al Maimani, Yaqoub; Metry, Abdul Massiah; Al Marhoobi, Humood; Hola, Alan; Pisoni, Ronald L

    2017-01-01

    The number of persons receiving renal replacement therapy (RRT) is estimated at more than 2.5 million worldwide, and is growing by 8% annually. Registries in the developing world are not up to standards compared to the United States Renal Data System (USRDS). Herein we examine the causes, progression, and magnitude of end-stage kidney disease (ESKD) over 3 decades in Oman. We examined ESKD data from 1983 to 2013. Data from 1998 to 2013 were obtained through an Information Management System. Data before 2008 were collected from patients' files. A questionnaire based on USRDS form 2728 was completed by nephrologists once a citizen reached ESKD. A total of 4066 forms were completed, with a response rate of 90% (52% male). The mean (SD) age was 50.1 (14.0) years. By 31 December 2013, there were 2386 patients alive on RRT, of whom 1206 were on hemodialysis (50.5%), 1080 were living with a functioning kidney transplant (45.3%), and 100 were receiving peritoneal dialysis (4.2%). The incidence of ESKD on RRT was 21, 75, and 120 per million population in 1983, 2001, and 2013, respectively. Similarly, the prevalence of ESKD was 49, 916, and 2386 in 1983, 2001, and 2013 respectively. Among patients with ESKD on RRT, a progressive rise was seen in diabetic nephropathy, with 5.8%, 32.1%, and 46% in 1983, 2001, and 2013 respectively. The incidence and prevalence of ESKD has increased progressively over last 30 years. This is anticipated to continue at an even higher rate in view of the progressive rise in noncommunicable diseases. Continuous improvement in registries is required to improve capturing of ESKD patients for providing accurate data to health authorities, and enhancing public awareness of the magnitude, future trends, treatments, and outcomes regarding ESKD.

  7. The microorganisms in chronically infected end-stage and non-end-stage cystic fibrosis patients

    DEFF Research Database (Denmark)

    Rudkjøbing, Vibeke B; Thomsen, Trine R; Alhede, Morten

    2011-01-01

    Patients suffering from cystic fibrosis (CF) develop chronic lung infections because of highly viscous mucus, where bacteria can form biofilms. In this study, we investigated the microorganisms present in the lungs of end-stage and non-end-stage patients using standard culturing techniques and mo...

  8. Estudo epidemiológico da doença renal crônica terminal no oeste do Paraná: uma experiência de 878 casos atendidos em 25 anos Epidemiological study of end-stage kidney disease in western Paraná: an experience of 878 cases in 25 years

    Directory of Open Access Journals (Sweden)

    Luis Alberto Batista Peres

    2010-03-01

    Full Text Available INTRODUÇÃO: A incidência e prevalência dos pacientes em fase final da doença renal crônica (DRC continuam a crescer em todo o mundo. O transplante renal continua tendo preferência na terapia renal substitutiva, mas, dada a limitada oferta de doadores de órgãos, terapias dialíticas são as modalidades mais realizadas. OBJETIVOS: Avaliar um registro de pacientes admitidos para terapia renal substitutiva no período de 1984 a 2009, em um único Centro. MÉTODOS: Este é um estudo epidemiológico retrospectivo. Foram analisadas as características demográficas e clínicas, incidência, principal doença renal de base, modalidades dialíticas, mortalidade e causas de óbitos. Para comparar as variáveis, foram utilizados o teste do qui-quadrado, teste t de Student, ANOVA e teste de Tukey. Curvas de Kaplan-Meier foram utilizadas para estimar a sobrevida dos pacientes. Um valor de p INTRODUCTION: The incidence and prevalence of treated end-stage chronic kidney disease (CKD patients continue to grow throughout the world. Renal transplantation remains the preferred form of renal substitutive therapy, but given the limited number of donors, dialytic therapies are the most common modalities. OBJECTIVES: To assess a registry of patients admitted for renal substitutive therapy at a single centre from 1984 to 2009. METHODS: This is a retrospective epidemiological study. The following were analyzed: demographic and clinical characteristics; incidence of CKD; underlying kidney disease; dialysis modalities; mortality; and causes of death. The variables were compared by using the chi-square test, Student t test, ANOVA, and Tukey test. Kaplan-Meier curves were used to estimate patient's survival. A p value < 0.05 was considered statistically significant. RESULTS: In the period studied, 878 patients were admitted to dialysis. Their mean age was 47.0 ± 16.2 years, 549 (62.5% were males, and 712 (81.1% were white. The major cause of CKD was hypertension

  9. Esophageal Resection for End-Stage Achalasia.

    Science.gov (United States)

    Aiolfi, Alberto; Asti, Emanuele; Bonitta, Gianluca; Siboni, Stefano; Bonavina, Luigi

    2018-04-01

    Achalasia is a rare disease characterized by impaired lower esophageal sphincter relaxation loss and of peristalsis in the esophageal body. Endoscopic balloon dilation and laparoscopic surgical myotomy have been established as initial treatment modalities. Indications and outcomes of esophagectomy in the management of end-stage achalasia are less defined. A literature search was conducted to identify all reports on esophagectomy for end-stage achalasia between 1987 and 2017. MEDLINE, Embase, and Cochrane databases were consulted matching the terms "achalasia," "end-stage achalasia," "esophagectomy," and "esophageal resection." Seventeen articles met the inclusion criteria and 1422 patients were included in this narrative review. Most of the patients had previous multiple endoscopic and/or surgical treatments. Esophagectomy was performed through a transthoracic (74%) or a transhiatal (26%) approach. A thoracoscopic approach was used in a minority of patients and seemed to be safe and effective. In 95 per cent of patients, the stomach was used as an esophageal substitute. The mean postoperative morbidity rate was 27.1 per cent and the mortality rate 2.1 per cent. Symptom resolution was reported in 75 to 100 per cent of patients over a mean follow-up of 43 months. Only five series including 195 patients assessed the long-term follow-up (>5 years) after reconstruction with gastric or colon conduits, and the results seem similar. Esophagectomy for end-stage achalasia is safe and effective in tertiary referral centers. A thoracoscopic approach is a feasible and safe alternative to thoracotomy and may replace the transhiatal route in the future.

  10. The effect of low serum bicarbonate values on the onset of action of local anesthesia with vertical infraclavicular brachial plexus block in patients with End-stage renal failure

    Directory of Open Access Journals (Sweden)

    Al-mustafa Mahmoud

    2010-01-01

    Full Text Available Vertical infraclavicular brachial plexus block is utilized in patients with chronic renal failure at the time of creation of an arterio-venous fistula (AVF. The aim of this study is to test the effect of impaired renal function, with the resulting deranged serum electrolytes and blood gases, on the success rate and the onset of action of the local anesthetics used. In this prospective clinical study, we investigated the effect of the serum levels of sodium, potassium, urea, crea-tinine, pH, and bicarbonate on the onset of action of a mixture of lidocaine and bupivacaine administered to create infraclavicular brachial plexus block. A total of 31 patients were studied. The success rate of the block was 93.5 % (29 patients. The mean onset time for impaired or re-duced sensation was found to be 8.9 ± 4.7 mins and for complete loss of sensation, was 21.2 ± 6.7 mins. There was no significant association with serum sodium, potassium, urea, creatinine or the blood pH level (P> 0.05. The bivariate correlation between serum bicarbonate level and the partial and complete sensory loss was -0.714 and -0.433 respectively, with significant correlation (P= 0.00, 0.019. Our study suggests that infraclavicular block in patients with chronic renal failure carries a high success rate; the onset of the block is delayed in patients with low serum bicarbonate levels.

  11. Qualidade de vida e severidade da doença em idosos renais crônicos Calidad de vida y severidad de la enfermedad en ancianos con Insuficiencia Renal Crónica Terminal Quality of life and measure of disease in elderly people with end-stage renal disease

    Directory of Open Access Journals (Sweden)

    Fabiana Ferreira de Souza

    2005-10-01

    Full Text Available O objetivo da pesquisa foi verificar, em uma população de idosos com Insuficiência Renal Crônica Terminal (IRCT em hemodiálise ambulatorial, a relação entre uma medida genérica de qualidade de vida (WHOQOL-breve e a medida de severidade da IRCT (ESRD-SI Índice de Severidade da IRCT. Trata-se de um estudo correlacional de corte transversal, realizado em duas clínicas de terapia renal substitutiva, com 100 idosos portadores de IRCT, em tratamento hemodialítico há pelo menos seis meses. A análise mostrou que os domínios do WHOQOL-breve correlacionaram-se negativamente com a severidade da ICRT, exceto os domínios psicológico e meio ambiente. Além disso, todos os domínios do WHOQOL-breve mostraram poder de discriminar os sujeitos em relação à severidade da doença.El objetivo de la investigación fue verificar en una población de ancianos con Insuficiencia Renal Crónica Terminal (IRCT en hemodiálisis en seguimiento ambulatorio la relación entre una medida genérica de cualidad de vida (WHOQOL breve y la medida de la severidad de la IRCT (ESRD-SI Índice de la Severidad de la IRCT. Es un estudio que establece correlaciones y de cohorte transversal que fue desarrollado en dos clínicas de terapia renal substitutiva, con 100 ancianos portadores de IRCT, en programa de hemodiálisis en periodo superior a seis meses. El WHOQOL breve estableció una correlación negativa con la severidad de la IRCT (ESRD-SI y permitió distinguir los ancianos con relación a la severidad de la IRCT.The purpose of this research was to identify, in an elderly population with end-stage renal disease (ESRD undergoing ambulatory hemodialysis, the correlation between a generic index of quality of life (WHOQOL-BREF and the severity index of the ESRD-SI. The work consisted of a correlational cross-section study conducted at two clinics providing replacement of renal therapy and involved 100 elderly patients suffering from ESRD, who had already been in

  12. Cardiovascular risk and mortality in end-stage renal disease patients undergoing dialysis: sleep study, pulmonary function, respiratory mechanics, upper airway collapsibility, autonomic nervous activity, depression, anxiety, stress and quality of life: a prospective, double blind, randomized controlled clinical trial.

    Science.gov (United States)

    dos Reis Santos, Israel; Danaga, Aline Roberta; de Carvalho Aguiar, Isabella; Oliveira, Ezequiel Fernandes; Dias, Ismael Souza; Urbano, Jessica Julioti; Martins, Aline Almeida; Ferraz, Leonardo Macario; Fonsêca, Nina Teixeira; Fernandes, Virgilio; Fernandes, Vinicius Alves Thomaz; Lopes, Viviane Cristina Delgado; Leitão Filho, Fernando Sérgio Studart; Nacif, Sérgio Roberto; de Carvalho, Paulo de Tarso Camillo; Sampaio, Luciana Maria Malosá; Giannasi, Lílian Christiane; Romano, Salvatore; Insalaco, Giuseppe; Araujo, Ana Karina Fachini; Dellê, Humberto; Souza, Nadia Karina Guimarães; Giannella-Neto, Daniel; Oliveira, Luis Vicente Franco

    2013-10-08

    Chronic kidney disease (CKD) is one of the most serious public health problems. The increasing prevalence of CKD in developed and developing countries has led to a global epidemic. The hypothesis proposed is that patients undergoing dialysis would experience a marked negative influence on physiological variables of sleep and autonomic nervous system activity, compromising quality of life. A prospective, consecutive, double blind, randomized controlled clinical trial is proposed to address the effect of dialysis on sleep, pulmonary function, respiratory mechanics, upper airway collapsibility, autonomic nervous activity, depression, anxiety, stress and quality of life in patients with CKD. The measurement protocol will include body weight (kg); height (cm); body mass index calculated as weight/height(2); circumferences (cm) of the neck, waist, and hip; heart and respiratory rates; blood pressures; Mallampati index; tonsil index; heart rate variability; maximum ventilatory pressures; negative expiratory pressure test, and polysomnography (sleep study), as well as the administration of specific questionnaires addressing sleep apnea, excessive daytime sleepiness, depression, anxiety, stress, and quality of life. CKD is a major public health problem worldwide, and its incidence has increased in part by the increased life expectancy and increasing number of cases of diabetes mellitus and hypertension. Sleep disorders are common in patients with renal insufficiency. Our hypothesis is that the weather weight gain due to volume overload observed during interdialytic period will influence the degree of collapsibility of the upper airway due to narrowing and predispose to upper airway occlusion during sleep, and to investigate the negative influences of haemodialysis in the physiological variables of sleep, and autonomic nervous system, and respiratory mechanics and thereby compromise the quality of life of patients. The protocol for this study is registered with the Brazilian

  13. New Targets for End-Stage Chronic Kidney Disease Therapy

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    Prakoura Niki

    2015-05-01

    Full Text Available Severe forms of chronic kidney disease can lead to a critical, end-stage condition, requiring renal replacement therapy, which may involve a form of dialysis or renal transplantation. Identification and characterization of novel markers and/or targets of therapy that could be applied in these critically ill patients remains the focus of the current research in the field of critical care medicine and has been the objective of our studies for some years past. To this end, we used models of renal vascular disease, Ang II, L-NAME or mice overexpressing renin, treated with AT1 antagonists at different stages of progression, to create cohorts of animals during progression, reversal or escape from therapy. Transcriptomic analysis and comparisons were performed and genes were selected according to the following criteria: a not previously described in the kidney, b highly upregulated during progression and returning to the normal levels during reversal, and c producing proteins that are either circulating or membrane receptors.

  14. Prevalência estimada da doença renal crônica terminal em crianças no estado de São Paulo Estimated prevalence of childhood end-stage renal disease in the state of São Paulo

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    Paulo Cesar Koch Nogueira

    2011-08-01

    Full Text Available OBJETIVO: Estimar a prevalência da doença renal crônica terminal (DRCT pediátrica e avaliar os dados demográficos e as características nefrológicas dessa doença no Estado de São Paulo no ano de 2008. MÉTODOS: Estudo observacional, descritivo e transversal com base em amostra da população de indivíduos < 18 anos. A coleta de casos ocorreu de três formas: 1. Questionário para as unidades de diálise; 2. Consulta junto à Central de Transplantes para determinar o número e as características de pacientes que estiveram em fila de transplante renal; 3. Consulta ao banco de dados dos pacientes registrados no Estudo Colaborativo do Registro Latino-Americano de Transplantes Renais Pediátricos. RESULTADOS: Dados de 301 pacientes, com idade de 9,0±5,8 anos, sendo 140 meninas (46,5%, resultando em estimativa de prevalência de 23,4 casos por milhão da população com idade compatível (pmpic. A faixa etária mais representada foi a dos 10 a 15 anos (32,2%, e as malformações do trato urinário representaram a etiologia conhecida mais comum (24,9%. A maioria das crianças recebeu transplante renal (62,1%, e entre os indivíduos em diálise predominou a hemodiálise (71,2%. O SUS foi o financiador mais importante dos tratamentos. CONCLUSÃO: A prevalência de 23,4 casos pmpic que encontramos é inferior à reportada no mundo ocidental. Acreditamos que haja subestimativa de dados em nosso estudo, pois poucas unidades de diálise responderam o questionário. Tal viés não invalida o caráter exploratório dos resultados. É imperativo mecanismos de captação de dados sobre a DRC pediátrica de maneira prospectiva e nos estágios mais precoces da doença para dimensionarmos esse grave problema de saúde em nosso meio.OBJECTIVE: To estimate the prevalence of pediatric end-stage renal disease and evaluate demographics and renal disease characteristics in state of São Paulo over the year 2008. METHODS: Observational, descriptive, and cross

  15. Ectopic and extranumerary parathyroid glands location in patients with hyperparathyroidism secondary to end stage renal disease Localização de paratireóides ectópicas e extranumerárias em pacientes com hiperparatireoidismo secundário à insuficiência renal crônica

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    Elaine Maria Santos Gomes

    2007-04-01

    Full Text Available Supranumerary or ectopic parathyroid glands are the main cause of persistent hyperparathyroidism (HPT in patients with end stage renal disease (ESRD submitted to parathyroidectomy (PTx. PURPOSE: To evaluate the prevalence and location of parathyroid glands in these patients. METHODS: Thirty-five patients with ESRD and severe secondary hyperparathyroidism (HPT2 had been submitted to total PTx at HUCFF from December 2001 to July 2005. Surgery was always performed by the same surgeon, who described in details the location of the glands. RESULTS: Sixteen patients (45.7% had ectopic glands, which were also extranumerary in five of them (14.3%. The most common locations were the thyroid parenchyma (33.3%, thyroid-thymus conduit (18.5%, and thymus (14.8%. Before PTx, the sensibility of ultrasonography and scintigraphy with technetium-99m Sestamibi was low (48.3% and 35.3%, respectively. Moreover, 51.4% of the nodules found at US were thyroid nodules. However, 99mTc-Sestamibi was useful to identify ectopic glands in those two patients with persistent HPT after PTx. CONCLUSION: The presence of extranumerary and ectopic parathyroid glands in HPT2 is sufficiently important to justify their exhaustive search. As the preoperative image exams present low sensibility to locate them, it is necessary to develop an exploratory routine embracing the most common sites of location.A principal causa cirúrgica de persistência da doença após paratireoidectomia no hiperparatireoidismo secundário à insuficiência renal crônica (HPT2 é a existência de paratireóides supranumerárias e/ou ectópicas. OBJETIVO: Avaliar o número, prevalência de ectopia e localizações mais comuns das paratireóides nestes pacientes. MÉTODOS: Acompanhamos prospectivamente pacientes com HPT2, submetidos à paratireoidectomia no HUCFF, entre dezembro/2001 e julho/2005. Todos foram operados pelo mesmo cirurgião, que descreveu detalhadamente a localização das paratire

  16. Characteristics of type 2 diabetics presenting with end stage renal ...

    African Journals Online (AJOL)

    Introduction: Diabète pancréatique est une cause de plus en plus courante de la ... fournir des informations de base pour l'élaboration de la politique de gestion. ... en charge de ces patients devrait tenir compte du contrôle d'hypertension et ...

  17. Hypertension, end-stage renal disease and mesangiocapillary ...

    African Journals Online (AJOL)

    Background: Methamphetamine abuse has risen dramatically in South Africa. The chronic effects of abuse on the kidneys and blood pressure have not been documented. This study reviewed patients referred for evaluation of kidney disease and/or hypertension, who had been abusing methamphetamines. Methods: The ...

  18. Characteristics of type 2 diabetics presenting with end stage renal ...

    African Journals Online (AJOL)

    The mean fasting blood glucose was 6.0 ± 2.7 mmol/L. Hypertriglyceridemia was the most common dyslipidemia seen in 38.1% of the patients, followed by reduced high- density lipoprotein (HDL) cholesterol in 33.3% and hypercholesterolemia in 23.8%. Common electrocardiographic abnormalities included myocardial ...

  19. Criteria for and Appropriateness of Renal Transplantation in Elderly Patients With End-Stage Renal Disease: A Literature Review and Position Statement on Behalf of the European Renal Association-European Dialysis and Transplant Association Descartes Working Group and European Renal Best Practice.

    Science.gov (United States)

    Segall, Liviu; Nistor, Ionuţ; Pascual, Julio; Mucsi, Istvan; Guirado, Lluis; Higgins, Robert; Van Laecke, Steven; Oberbauer, Rainer; Van Biesen, Wim; Abramowicz, Daniel; Gavrilovici, Cristina; Farrington, Ken; Covic, Adrian

    2016-10-01

    During the last 20 years, waiting lists for renal transplantation (RT) have grown significantly older. However, elderly patients (ie ≥65 years of age) are still more rarely referred or accepted to waiting lists and, if enlisted, have less chances of actually receiving a kidney allograft, than younger counterparts. In this review, we looked at evidence for the benefits and risks of RT in the elderly trying to answer the following questions: Should RT be advocated for elderly patients? What should be the criteria to accept elderly patients on the waiting list for RT? What strategies might be used to increase the rate of RT in waitlisted elderly candidates? For selected elderly patients, RT was shown to be superior to dialysis in terms of patient survival. Virtually all guidelines recommend that patients should not be deemed ineligible for RT based on age alone, although a short life expectancy generally might preclude RT. Concerning the assessment of comorbidities in the elderly, special attention should be paid to cardiac evaluation and screening for malignancy. Comorbidity scores and frailty assessment scales might help the decision making on eligibility. Psychosocial issues should also be evaluated. To overcome the scarcity of organ donors, elderly RT candidates should be encouraged to consider expanded criteria donors and living donors, as alternatives to deceased standard criteria donors. It has been demonstrated that expanded criteria donor RT in patients 60 years or older is associated with higher survival rates than remaining on dialysis, whereas living donor RT is superior to all other options.

  20. Albumin for End-Stage Liver Disease

    Science.gov (United States)

    2012-01-01

    Albumin has been widely used in patients with cirrhosis in an attempt to improve circulatory and renal functions. The benefits of albumin infusions in preventing the deterioration in renal function associated with large-volume paracentesis, spontaneous bacterial peritonitis, and established hepatorenal syndrome in conjunction with a vasoconstrictor are well established. While some of these indications are supported by the results of randomized studies, others are based only on clinical experience and have not been proved in prospective studies. The paucity of well-designed trials, the high cost of albumin, the lack of a clear-cut survival benefit, and fear of transmitting unknown infections make the use of albumin controversial. The recent development of the molecular adsorbent recirculating system, an albumin dialysis, is an example of the capacity of albumin to act by mechanisms other than its oncotic effect. Efforts should be made to define the indications for albumin use, the dose required, and predictors of response, so that patients gain the maximum benefit from its administration. PMID:22403494

  1. Cardiovascular Disease and Chronic Inflammation in End Stage Kidney Disease

    Directory of Open Access Journals (Sweden)

    Sofia Zyga

    2013-01-01

    Full Text Available Background: Chronic Kidney Disease (CKD is one of the most severe diseases worldwide. In patients affected by CKD, a progressive destruction of the nephrons is observed not only in structuralbut also in functional level. Atherosclerosis is a progressive disease of large and medium-sized arteries. It is characterized by the deposition of lipids and fibrous elements and is a common complication of the uremic syndrome because of the coexistence of a wide range of risk factors. High blood pressure, anaemia, insulin resistance, inflammation, high oxidative stress are some of the most common factors that cause cardiovascular disease and atherogenesis in patients suffering from End Stage Kidney Disease (ESRD. At the same time, the inflammatory process constitutes a common element in the apparition and development of CKD. A wide range of possible causes can justify the development of inflammation under uremic conditions. Such causes are oxidative stress, oxidation, coexistentpathological conditions as well as factors that are due to renal clearance techniques. Patients in ESRD and coronary disease usually show increased acute phase products. Pre-inflammatory cytokines, such as IL-6 and TNF-a, and acute phase reactants, such as CRP and fibrinogen, are closely related. The treatment of chronic inflammation in CKD is of high importance for the development ofthe disease as well as for the treatment of cardiovascular morbidity.Conclusions: The treatment factors focus on the use of renin-angiotensic system inhibitors, acetylsalicylic acid, statins and anti-oxidant treatment in order to prevent the action of inflammatorycytokines that have the ability to activate the mechanisms of inflammation.

  2. Costo-utilidad del trasplante renal frente a la hemodiálisis en el tratamiento de la insuficiencia renal crónica terminal en un hospital peruano Cost utility of renal transplant vs. hemodialysis in the treatment of end stage chronic kidney failure in a peruvian hospital

    Directory of Open Access Journals (Sweden)

    Ricardo E. Loza-Concha

    2011-09-01

    Full Text Available Objetivos. Determinar y comparar las razones de costo-utilidad de los trasplantes renales con donante cadavérico (TRDC practicados en el Hospital Nacional Guillermo Almenara Irigoyen los años 2000-2001, frente a hemodiálisis (HD, cinco años después del inicio del tratamiento. Material y métodos. Se realizó un estudio de costo utilidad, estudiando a todos los pacientes continuadores cinco años post TRDC, a quienes se asignó como controles, dos pacientes con cinco años de HD pareados por edad, sexo y tiempo de enfermedad. Se evaluaron los costos de cada procedimiento, los años de vida ajustados a la calidad (AVAC utilizando el cuestionario SF-36v2TM y se calcularon las razones de costo utilidad (CU y costo utilidad incremental (CUI. Resultados. Se realizaron 58 TRDC los años 2000-2001. Cinco años después, 17 (29 % pacientes fallecieron y 27 (47 % continuaron con su tratamiento post-TRDC. Treinta y uno (53 % TRDC fracasaron; 26 % por rechazo al trasplante, 55 % por complicación y 19 % por tratamiento irregular. Los puntajes SF-36v2TM promedio obtenidos por los TRDC y HD fueron 95±13 y 87±18 puntos respectivamente. En ambos años, los AVAC obtenidos por los TRDC y HD fueron de 251 y 229 puntos respectivamente; las razones de CU para los TRDC y los HD fueron de USD 11 984 y USD 9243, y la razón de CUI fue de USD 40 669. Conclusiones. Los TRDC realizados los años 2000-2001, cinco años después resultaron menos costo útiles que las HD; y los TRDC realizados el 2000 tuvieron una menor razón de costo utilidad incremental que los efectuados el 2001, probablemente por su mayor razón de tratamientos irregulares.Objectives. To assess and compare the cost utility of the cadaveric donor renal transplant (CDRT at the Hospital Nacional Guillermo Almenara Irigoyen between 2000 to 2001, against haemodialysis (HD, 5 years after treatment initiation. Materials and Methods. A cost utility study design was used, which evaluated every patient

  3. Surgical approach to end-stage heart failure.

    Science.gov (United States)

    Klotz, Stefan; Scheld, Hans H

    2011-02-01

    End-stage heart failure is a challenging disease with growing incidence. With decreasing heart transplant rates worldwide organ preserving therapies become, again, of interest. The purpose of the present review is to examine the potential challenges of surgical therapies in patients with end-stage heart failure. The gold-standard for end-stage heart failure is and will be cardiac transplantation. However, due to organ shortage this therapy is limited to a few patients. Therefore implantation of ventricular assist devices (VADs) or long-term minimal-invasive partial support devices will increase. Improvements in device design with smaller devices, easier implantation techniques, and modified anticoagulation outcome and long-term success will likely improve. In addition, good quality of life as destination therapy is almost available. Organ conservation surgery (coronary artery bypass grafting and surgical ventricular restoration or surgical repair of mitral valve regurgitation) in end-stage heart failure patients could not prove the expected results. Transcatheter or minimal-invasive approaches of these therapies might become routine in the near future. Due to the overwhelming outcome rates, cardiac transplantation is the most established surgical therapy for end-stage heart failure. VAD therapy is increasing and minimized VADs might further open the market for destination therapy/permanent support.

  4. Design and Optimization of Multi-bit Front-end Stage and Scaled Back-end Stages of Pipelined ADCs

    NARCIS (Netherlands)

    Quinn, P.J.; Roermund, van A.H.M.

    2005-01-01

    In this paper, an error analysis is presented to aid the design of a pipeline multi-bit front-end stage. It is demonstrated and quantified how the capacitor matching requirement can be reduced in high-resolution pipeline ADCs. The paper continues by analyzing the optimal design for low power of the

  5. The Effect of Renal Transplantation on Respiratory Muscle Strength in Patients with End Stage Renal Disease

    OpenAIRE

    Tavana, Sasan; Mirzaei, Samaneh

    2016-01-01

    Background: There is evidence of musculoskeletal and respiratory involvement in patients with chronic kidney disease (CKD). This is attributed to protein calorie imbalance that is caused by the disease process, and hemodialysis and is generally referred to as uremic myopathy. This results in calcification of respiratory muscles such as diaphragm and intercostal muscles. There are limited data about respiratory muscle strength in patients with CKD. We intended to evaluate the effect of kidney ...

  6. Artificial muscle for end-stage heart failure.

    Science.gov (United States)

    Tozzi, Piergiorgio; Michalis, Alexandre; Hayoz, Daniel; Locca, Didier; von Segesser, Ludwig K

    2012-01-01

    We describe a device made of artificial muscle for the treatment of end-stage heart failure as an alternative to current heart assist devices. The key component is a matrix of nitinol wires and aramidic fibers called Biometal muscle (BM). When heated electrically, it produces a motorless, smooth, and lifelike motion. The BM is connected to a carbon fiber scaffold, tightening the heart and providing simultaneous assistance to the left and right ventricles. A pacemaker-like microprocessor drives the contraction of the BM. We tested the device in a dedicated bench model of diseased heart. It generated a systolic pressure of 75 mm Hg and ejected a maximum of 330 ml/min, with an ejection fraction of 12%. The device required a power supply of 6 V, 250 mA. This could be the beginning of an era in which BMs integrate or replace the mechanical function of natural muscles.

  7. End-stage head and neck cancer coping mechanisms

    Directory of Open Access Journals (Sweden)

    Bogdan Popescu

    2017-10-01

    Full Text Available Coping mechanisms are patients’ means of adapting to stressful situations and involve psychological and physical changes in behavior. Patients adapt to head and neck cancer in a variety of ways. Head and neck cancers are extremely debilitating, especially in advanced stages of the disease or in end-of-life situations. While an oncology team needs to address the needs of all oncology patients, the advanced terminal patients require special attention. Most of these patients do not cope well with their situation and have a tendency to cease social interactions. Pain is the most frequentlyexperienced medical disability in patients having an end-stage illness experience, and thus an important medical endeavor is to afford dignity to the dying patient facingan incurable disease. In such cases, the medical community should never refuse therapy or to assist a dying patient.In some instances, the patient and family may derive benefit from their religious beliefs.

  8. End-stage kidney disease due to haemolytic uraemic syndrome – outcomes in 241 consecutive ANZDATA registry cases

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    Tang Wen

    2012-12-01

    Full Text Available Abstract Background The aim of this study was to investigate the characteristics and outcomes of patients receiving renal replacement therapy for end-stage kidney disease (ESKD secondary to haemolytic uraemic syndrome (HUS. Methods The study included all patients with ESKD who commenced renal replacement therapy in Australia and New Zealand between 15/5/1963 and 31/12/2010, using data from the ANZDATA Registry. HUS ESKD patients were compared with matched controls with an alternative primary renal disease using propensity scores based on age, gender and treatment era. Results Of the 58422 patients included in the study, 241 (0.4% had ESKD secondary to HUS. HUS ESKD was independently associated with younger age, female gender and European race. Compared with matched controls, HUS ESKD was not associated with mortality on renal replacement therapy (adjusted hazard ratio [HR] 1.14, 95% CI 0.87-1.50, p = 0.34 or dialysis (HR 1.34, 95% CI 0.93-1.93, p = 0.12, but did independently predict recovery of renal function (HR 54.01, 95% CI 1.45-11.1, p = 0.008. 130 (54% HUS patients received 166 renal allografts. Overall renal allograft survival rates were significantly lower for patients with HUS ESKD at 1 year (73% vs 91%, 5 years (62% vs 85% and 10 years (49% vs 73%. HUS ESKD was an independent predictor of renal allograft failure (HR 2.59, 95% CI 1.70-3.95, p  Conclusions HUS is an uncommon cause of ESKD, which is associated with comparable patient survival on dialysis, an increased probability of renal function recovery, comparable patient survival post-renal transplant and a heightened risk of renal transplant graft failure compared with matched ESKD controls.

  9. Osseous and Nonosseous Bone Scan Findings in Liver Transplant Candidates with end-stage Chronic Liver Disease

    Directory of Open Access Journals (Sweden)

    Seval Erhamamcı

    2013-08-01

    Full Text Available Objective: End-stage chronic liver disease (CLD adversely affects the function of multiple organ systems including the skeletal system. The aim of this study was to assess osseous and nonosseous bone scintigraphy (BS findings in liver transplant (LT candidates with end-stage CLD. Methods: We retrospectively evaluated BS findings in 50 consecutive patients with end-stage CLD who were undergoing preoperative assessment for LT from January 2006 to December 2011. All the patients were analyzed with respect to clinical and laboratory parameters, and BS findings. Scintigrams were visually assessed for the presence of osseous and nonosseous abnormalities. Osseous abnormalities were classified as those indicating bone metabolism changes or metastatic bone disease. Typical scintigraphic findings denoting to changes in bone metabolism were the presence of decreased osseous uptake, increased periarticular uptake, asymmetrical or unusual uptake patterns. Nonosseous findings were classified according to the degree of soft-tissue uptake as mild and severe. Results: The group consisted of 46 adult and 4 adolescent patients. All adolescent patients had normal skeletal accumulation with growth plate uptake and one had mildly increased renal cortical activity. A total of 46 adult patients had one or more of the following osseous findings: generalized decrease in osseous uptake (n=4, 8.7%; bilateral decrease in lower extremity uptake (n=26, 56.5%; symmetrically increased periarticular uptake (n=26, 56.5%; bilateral cortical/periosteal increased uptake in the lower extremity indicating hepatic hypertrophic osteoarthropathy (HOA (n=8, 17.4%; bilateral increased sacroiliac activity (n=16, 34.8%; sacral activity (n=10, 21.7%, coccygeal activity (n=2, 4.3%, focally increased uptake suggestive of metastases (n=5, 10.9%. Three rib metastases appeared to be linear. Nonosseous findings observed in adult patients were mild diffuse liver uptake (n=4, 8.7% and bilateral

  10. Psychosocial Factors in End-Stage Kidney Disease Patients at a Tertiary Hospital in Australia

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    Charan Bale

    2016-01-01

    Full Text Available Aim. This study seeks to review the psychosocial factors affecting patients with end-stage kidney disease (ESKD from a tertiary hospital in Australia. Methods. We audited patients with ESKD, referred to social work services from January 2012 to December 2014. All patients underwent psychosocial assessments by one, full-time renal social worker. Patient demographics, cumulative social issues, and subsequent interventions were recorded directly into a database. Results. Of the 244 patients referred, the majority were >60 years (58.6%, male (60.7%, born in Australia (62.3%, on haemodialysis (51.6%, and reliant on government financial assistance (88%. Adjustment issues (41%, financial concerns (38.5%, domestic assistance (35.2%, and treatment nonadherence (21.3% were the predominant reasons for social work consultation. Younger age, referral prior to start of dialysis, and unemployment were significant independent predictors of increased risk of adjustment issues (p=0.004, <0.001, and =0.018, resp.. Independent risk factors for treatment nonadherence included age and financial and employment status (p=0.041, 0.052, and 0.008, resp.. Conclusion. Psychosocial and demographic factors were associated with treatment nonadherence and adjustment difficulties. Additional social work support and counselling, in addition to financial assistance from government and nongovernment agencies, may help to improve adjustment to the diagnosis and treatment plans as patients approach ESKD.

  11. Electrolyte and Acid-Base Disturbances in End-Stage Liver Disease: A Physiopathological Approach.

    Science.gov (United States)

    Jiménez, José Víctor; Carrillo-Pérez, Diego Luis; Rosado-Canto, Rodrigo; García-Juárez, Ignacio; Torre, Aldo; Kershenobich, David; Carrillo-Maravilla, Eduardo

    2017-08-01

    Electrolyte and acid-base disturbances are frequent in patients with end-stage liver disease; the underlying physiopathological mechanisms are often complex and represent a diagnostic and therapeutic challenge to the physician. Usually, these disorders do not develop in compensated cirrhotic patients, but with the onset of the classic complications of cirrhosis such as ascites, renal failure, spontaneous bacterial peritonitis and variceal bleeding, multiple electrolyte, and acid-base disturbances emerge. Hyponatremia parallels ascites formation and is a well-known trigger of hepatic encephalopathy; its management in this particular population poses a risky challenge due to the high susceptibility of cirrhotic patients to osmotic demyelination. Hypokalemia is common in the setting of cirrhosis: multiple potassium wasting mechanisms both inherent to the disease and resulting from its management make these patients particularly susceptible to potassium depletion even in the setting of normokalemia. Acid-base disturbances range from classical respiratory alkalosis to high anion gap metabolic acidosis, almost comprising the full acid-base spectrum. Because most electrolyte and acid-base disturbances are managed in terms of their underlying trigger factors, a systematic physiopathological approach to their diagnosis and treatment is required.

  12. Physical activity and risk of end-stage kidney disease in the Singapore Chinese Health Study.

    Science.gov (United States)

    Jafar, Tazeen Hasan; Jin, Aizhen; Koh, Woon-Puay; Yuan, Jian-Min; Chow, Khuan Yew

    2015-02-01

    To explore the relationship between physical activity and risk of end-stage kidney disease (ESKD). We analysed data on a prospective cohort of 59,552 Chinese adults aged 45-74 years enrolled in the Singapore Chinese Health Study. Information on physical activity was collected with a structured questionnaire. Physically active individuals were defined as those who engaged in any moderate activities for 2 h or more per week and any strenuous activities 30 min or more per week. Incident ESKD was identified via record linkage with the Singapore Registry of Birth and Death and Singapore Renal Registry. Cox proportional hazards regression method was used for analysis for risk of incident ESKD alone or ESKD plus death associated with physical activity. During a median follow-up of 15.3 years, a total of 642 incident ESKD occurred, and 9808 study participants died. A 24% lower adjusted risk of ESKD (hazard ratio: 0.76; 95% confidence interval: 0.62-0.93) was associated with moderate or strenuous physical activities compared with no regular physical activity. This association appeared to be dose dependent with the lowest risk for subjects at highest intensity of physical activity (P trend <0.003). Similar results were observed for risk of ESKD plus death. Higher levels of physical activity are associated with lower risk of ESKD. Our findings highlight the role of physical activity for prevention of ESKD, which deserves further evaluation in intervention trials. © 2014 Asian Pacific Society of Nephrology.

  13. 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....

  14. Causes and outcome of late referral of children who develop end-stage kidney disease.

    Science.gov (United States)

    Kennedy, Sean E; Bailey, Rohan; Kainer, Gad

    2012-03-01

    This study aims to characterise the timing of referral to a paediatric nephrology unit of children who develop end-stage kidney disease (ESKD). This study also aims to determine whether late referral (LR) influences outcomes and to explore factors that may lead to LR. A retrospective case review of all incident patients with ESKD who received renal replacement therapy (RRT) at a single paediatric centre. Time between referral to a paediatric nephrologist and commencement of RRT, demographic and clinical data were collated. Estimated glomerular filtration rate (eGFR) at referral was calculated using height and creatinine. LR was defined as having an eGFR ≤ 30 mL/min/1.73 m(2) when first seen by a paediatric nephrologist. RRT was initiated for 74 patients Children referred before age 1 year (41%) had a more prolonged course before ESKD. Median (interquartile range) eGFR at referral of children > 1 year was 27.2 (9.0-52.0) mL/min/1.73 m(2) . Twenty-two (55%) of these children were referred late (LR) with an eGFR ≤ 30 mL/min/1.73 m(2) . LR patients were more likely to have glomerulonephritis or haemolytic uraemic syndrome and to live in a remote or outer regional area. LR patients had higher urea, lower haemoglobin and were more likely to receive haemodialysis via a vascular catheter. A significant proportion of children who develop ESKD are referred late to nephrology units with potentially preventable complications. Aetiology of renal disease and geographic isolation contribute to LR. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  15. Worldwide access to treatment for end-stage kidney disease: a systematic review.

    Science.gov (United States)

    Liyanage, Thaminda; Ninomiya, Toshiharu; Jha, Vivekanand; Neal, Bruce; Patrice, Halle Marie; Okpechi, Ikechi; Zhao, Ming-hui; Lv, Jicheng; Garg, Amit X; Knight, John; Rodgers, Anthony; Gallagher, Martin; Kotwal, Sradha; Cass, Alan; Perkovic, Vlado

    2015-05-16

    End-stage kidney disease is a leading cause of morbidity and mortality worldwide. Prevalence of the disease and worldwide use of renal replacement therapy (RRT) are expected to rise sharply in the next decade. We aimed to quantify estimates of this burden. We systematically searched Medline for observational studies and renal registries, and contacted national experts to obtain RRT prevalence data. We used Poisson regression to estimate the prevalence of RRT for countries without reported data. We estimated the gap between needed and actual RRT, and projected needs to 2030. In 2010, 2·618 million people received RRT worldwide. We estimated the number of patients needing RRT to be between 4·902 million (95% CI 4·438-5·431 million) in our conservative model and 9·701 million (8·544-11·021 million) in our high-estimate model, suggesting that at least 2·284 million people might have died prematurely because RRT could not be accessed. We noted the largest treatment gaps in low-income countries, particularly Asia (1·907 million people needing but not receiving RRT; conservative model) and Africa (432,000 people; conservative model). Worldwide use of RRT is projected to more than double to 5·439 million (3·899-7·640 million) people by 2030, with the most growth in Asia (0·968 million to a projected 2·162 million [1·571-3·014 million]). The large number of people receiving RRT and the substantial number without access to it show the need to both develop low-cost treatments and implement effective population-based prevention strategies. Australian National Health and Medical Research Council. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Blood pressure influences end-stage renal disease of Cd151 knockout mice

    NARCIS (Netherlands)

    Sachs, Norman; Claessen, Nike; Aten, Jan; Kreft, Maaike; Teske, Gwendoline J. D.; Koeman, Anneke; Zuurbier, Coert J.; Janssen, Hans; Sonnenberg, Arnoud

    2012-01-01

    Podocytes of the kidney adhere tightly to the underlying glomerular basement membrane (GBM) in order to maintain a functional filtration barrier. The clinical importance of podocyte binding to the GBM via an integrin-laminin-actin axis has been illustrated in models with altered function of alpha 3

  17. Oxidative stress in hepatitis C infected end-stage renal disease subjects

    Directory of Open Access Journals (Sweden)

    Koylu Ahmet O

    2006-07-01

    Full Text Available Abstract Background Both uremia and hepatitis C infection is associated with increased oxidative stress. In the present study, we aimed to find out whether hepatitis C infection has any impact on oxidative stress in hemodialysis subjects. Methods Sixteen hepatitis C (+ hemodialysis subjects, 24 hepatitis C negative hemodialysis subjects and 24 healthy subjects were included. Total antioxidant capacity, total peroxide level and oxidative stress index were determined in all subjects. Results Total antioxidant capacity was significantly higher in controls than hemodialysis subjects with or without hepatitis C infection (all p 0.05/3. Conclusion Oxidative stress is increased in both hepatitis C (+ and hepatitis C (- hemodialysis subjects. However, hepatitis C infection seems to not cause any additional increase in oxidative stress in hemodialysis subjects and it may be partly due to protective effect of dialysis treatment on hepatitis C infection.

  18. Oxidative stress in hepatitis C infected end-stage renal disease subjects

    OpenAIRE

    Koylu Ahmet O; Aslan Mehmet; Bolukbas Filiz F; Bolukbas Cengiz; Horoz Mehmet; Selek Sahbettin; Erel Ozcan

    2006-01-01

    Abstract Background Both uremia and hepatitis C infection is associated with increased oxidative stress. In the present study, we aimed to find out whether hepatitis C infection has any impact on oxidative stress in hemodialysis subjects. Methods Sixteen hepatitis C (+) hemodialysis subjects, 24 hepatitis C negative hemodialysis subjects and 24 healthy subjects were included. Total antioxidant capacity, total peroxide level and oxidative stress index were determined in all subjects. Results T...

  19. Oxidative stress in hepatitis C infected end-stage renal disease subjects.

    Science.gov (United States)

    Horoz, Mehmet; Bolukbas, Cengiz; Bolukbas, Filiz F; Aslan, Mehmet; Koylu, Ahmet O; Selek, Sahbettin; Erel, Ozcan

    2006-07-14

    Both uremia and hepatitis C infection is associated with increased oxidative stress. In the present study, we aimed to find out whether hepatitis C infection has any impact on oxidative stress in hemodialysis subjects. Sixteen hepatitis C (+) hemodialysis subjects, 24 hepatitis C negative hemodialysis subjects and 24 healthy subjects were included. Total antioxidant capacity, total peroxide level and oxidative stress index were determined in all subjects. Total antioxidant capacity was significantly higher in controls than hemodialysis subjects with or without hepatitis C infection (all p total peroxide level and oxidative stress index were significantly lower (all p total antioxidant capacity compared to hepatitis C (+) hemodialysis subjects (all p Total peroxide level and oxidative stress index was comparable between hemodialysis subjects with or without hepatitis C infection (p > 0.05/3). Oxidative stress is increased in both hepatitis C (+) and hepatitis C (-) hemodialysis subjects. However, hepatitis C infection seems to not cause any additional increase in oxidative stress in hemodialysis subjects and it may be partly due to protective effect of dialysis treatment on hepatitis C infection.

  20. A New "online" Method to Measure Increased Exhaled Isoprene in end-stage Renal Failure

    Czech Academy of Sciences Publication Activity Database

    Davies, S.; Španěl, Patrik; Smith, D.

    2001-01-01

    Roč. 16, - (2001), s. 836-839 ISSN 0931-0509 R&D Projects: GA ČR GA203/97/P130 Institutional research plan: CEZ:AV0Z4040901 Keywords : biocompatibility * haemodialysis * SIFT-MS Subject RIV: CF - Physical ; Theoretical Chemistry Impact factor: 2.432, year: 2001

  1. End-stage renal disease treatment options education: What matters most to patients and families.

    Science.gov (United States)

    St Clair Russell, Jennifer; Boulware, L Ebony

    2018-03-01

    Treatment modality education can offer many important benefits to patients and their families. Evidence suggests such education can increase use of home dialysis, reduce catheter use, decrease 90-day mortality, and increase transplantation. While these benefits are encouraging, not all patients are offered options education and when they are, it may not be presented in a way that is immediately applicable to them and their lives. Furthermore, little is known regarding specific characteristics (e.g. format such as group or individual or in-person or online, duration, teaching methods, location, content) of educational programs that are most successful. No single approach has emerged as a best practice. In the absence of such evidence, adult learning principles, such as involving patients and families in the development programs and materials, can serve as a guide for educational development. Adult learning principles can enhance options education, evolving them from information delivery to a person-centered, values-based endeavor that helps match treatment to values and lifestyle. © 2018 Wiley Periodicals, Inc.

  2. Management of hyperphosphatemia in patients with end-stage renal disease: focus on lanthanum carbonate

    Directory of Open Access Journals (Sweden)

    Veerle P Persy

    2009-04-01

    Full Text Available Veerle P Persy, Geert J Behets, Marc E De Broe, Patrick C D’HaeseLaboratory of Pathophysiology, University of Antwerp, BelgiumAbstract: Elevated serum phosphate levels as a consequence of chronic kidney disease (CKD contribute to the increased cardiovascular risk observed in dialysis patients. Protein restriction and dialysis fail to adequately prevent hyperphosphatemia, and in general treatment with oral phosphate binding agents is necessary in patients with advanced CKD. Phosphate plays a pivotal role in the development of vascular calcification, one of the factors contributing to increased cardiovascular risk in CKD patients. Treatment of hyperphosphatemia with standard calcium-based phosphate binders and vitamin D compounds can induce hypercalcemic episodes, increase the Ca × PO4 product and thus add to the risk of ectopic mineralization. In this review, recent clinical as well as experimental data on lanthanum carbonate, a novel, non-calcium, non-resin phosphate binding agent are summarized. Although lanthanum is a metal cation no aluminium-like toxicity is observed since the bioavailability of lanthanum is extremely low and its metabolism differs from that of aluminium. Clinical studies now document the absence of toxic effects of lanthanum for up to 6 years of follow-up. The effects of lanthanum on bone, vasculature and brain are discussed and put in perspective with lanthanum pharmacokinetics.Keywords: lanthanum carbonate, phosphate binding, chronic kidney disease

  3. 76 FR 70227 - Medicare Program; End-Stage Renal Disease Prospective Payment System and Quality Incentive...

    Science.gov (United States)

    2011-11-10

    ...-Neutrality Adjustment for CY 2011 4. Transition Budget-Neutrality Adjustment for CY 2012 5. Low-Volume... Adjustment for CY 2012 7. Updates to the Wage Index Values and Wage Index Floor for the Composite Rate Portion of the Blended Payment and the ESRD PPS Payment a. Reduction to the ESRD Wage Index Floor b...

  4. Relative blood volume monitoring during hemodialysis in end stage renal disease patients.

    Science.gov (United States)

    Ion Titapiccolo, Jasmine; Ferrario, Manuela; Garzotto, Francesco; Cruz, Dinna; Moissl, Ulrich; Tetta, Ciro; Ronco, Claudio; Signorini, Maria G; Cerutti, Sergio

    2010-01-01

    A crucial point in the haemodialysis (HD) treatment is the reliable assessment of hydration status. An inadequate removed volume may lead to chronic fluid overload which can lead to hypertension, left ventricular hypertrophy and heart failure. Therefore, the estimation of the hydration state and the management of a well-tolerated water removal is an important challenge. This exploratory study aims at identifying new parameters obtained from continuous Blood Volume Monitoring (BVM) allowing a qualitative evaluation of hydration status for verifying the adequacy of HD setting parameters (e.g UFR, target dry weight). The percentage of blood volume reduction (BVR%) during HD was compared against a gold standard method for hydration status assessment. The slope of the first 30 minute of blood volume reduction (BVR) was proposed as a useful parameter to identify overhydrated patients.

  5. 75 FR 49029 - Medicare Program; End-Stage Renal Disease Prospective Payment System

    Science.gov (United States)

    2010-08-12

    ... independent dialysis facilities, and provided a process under which facilities with costs in excess of their... alfa (ARANESP[supreg]) used to treat anemia, and vitamin D analogues (paracalcitol, doxercalciferol...

  6. Patients' representations of their end-stage renal disease : relation with mortality

    NARCIS (Netherlands)

    van Dijk, Sandra; Scharloo, Margreet; Kaptein, Adrian A.; Thong, Melissa S. Y.; Boeschoten, Elisabeth W.; Grootendorst, Diana C.; Krediet, Raymond T.; Dekker, Friedo W.

    2009-01-01

    Background. Self-regulation theory explains how patients' illness perceptions influence self-management behaviour (e. g. via adherence to treatment). Following these assumptions, we explored whether illness perceptions of ESRD-patients are related to mortality rates. Methods. Illness perceptions of

  7. [Muscle-wasting in end stage renal disease in dialysis treatment: a review].

    Science.gov (United States)

    Battaglia, Yuri; Galeano, Dario; Cojocaru, Elena; Fiorini, Fulvio; Forcellini, Silvia; Zanoli, Luca; Storari, Alda; Granata, Antonio

    2016-01-01

    Progressive and generalized loss of muscle mass (muscle wasting) is a frequent complication in dialysis patients. Common uremic signs and symptoms such as insulin-resistance, increase in glucocorticoid activity, metabolic acidosis, malnutrition, inflammation and dialysis per se contribute to muscle wasting by modulating proteolytic intracellular mechanisms (ubiquitin-proteasome system, activation of caspase-3 and IGF-1/PI3K/Akt pathway). Since muscle wasting is associated with an increase in mortality, bone fractures and worsening in life quality, a prompt and personalised diagnostic and therapeutic approach seems to be essential in dialysis patients. At present, nuclear magnetic resonance (NMR), computed tomography (CT), dual-energy x-ray absorptiometry (DXA), impedance analysis, bioelectric impedance analysis (BIA) and anthropometric measurements are the main tools used to assess skeletal muscle mass. Aerobic and anaerobic training programmes and treatment of uremic complications reduce muscle wasting and increase muscle strength in uremic patients. The present review analyses the most recent data about the physiopathology, diagnosis, therapy and future perspectives of treatment of muscle wasting in dialysis patients.

  8. Modern technology for the treatment of type 1 diabetes mellitus with end-stage renal failure

    OpenAIRE

    Julia Aleksandrovna Krupinova; Sergei Andreevich Martinov; Alexandra Mikhaylovna Glazunova; Evgeny Vladimirovich Tarasov

    2015-01-01

    This article describes the clinical case of a patient with early development of terminal complications of type 1 diabetes with chronic decompensated carbohydrate metabolism. For 1 year, the patient was treated with hemodialysis and she subsequently underwent successful kidney transplantation.

  9. 77 FR 34047 - Medicare Program; Proposal Evaluation Criteria and Standards for End Stage Renal Disease (ESRD...

    Science.gov (United States)

    2012-06-08

    ... by section 1881(c)(2) of the Act. These functions are to: Encourage participation in vocational... strives to promote health care that is respectful of and responsive to individual patient preferences...

  10. 76 FR 627 - Medicare Program; End-Stage Renal Disease Quality Incentive Program

    Science.gov (United States)

    2011-01-05

    ... important components of the Medicare ESRD payment system. In the proposed rule, we described the evolution...) of the Social Security Act (the Act), as the next step in the evolution of the ESRD quality program...-mix (for example, nursing home patients, patients with complex conditions) that may make meeting the...

  11. Effects of end-stage renal disease and dialysis modalities on blood ammonia level.

    Science.gov (United States)

    Vaziri, Nosratola D; Khazaeli, Mahyar; Nunes, Ane C F; Harley, Kevin T; Said, Hyder; Alipour, Omeed; Lau, Wei Ling; Pahl, Madeleine V

    2017-07-01

    Uremia results in a characteristic breath odor (uremic fetor) which is largely due to its high ammonia content. Earlier studies have shown a strong correlation between breath ammonia and blood urea levels and a 10-fold reduction in breath ammonia after hemodialysis in patients with chronic kidney disease. Potential sources of breath ammonia include: (i) local ammonia production from hydrolysis of urea in the oropharyngeal and respiratory tracts by bacterial flora, and (ii) release of circulating blood ammonia by the lungs. While the effects of uremia and hemodialysis on breath ammonia are well known their effects on blood ammonia are unknown and were explored here. Blood samples were obtained from 23 hemodialysis patients (immediately before and after dialysis), 14 peritoneal dialysis patients, and 10 healthy controls. Blood levels of ammonia, creatinine, urea, and electrolytes were measured. No significant difference was found in baseline blood ammonia between hemodialysis, peritoneal dialysis and control groups. Hemodialysis procedure led to a significant reduction in urea concentration (P ammonia level in 10 of the 23 patients studied. Change in blood ammonia pre- and post-hemodialysis correlated with change in serum bicarbonate levels (r = 0.61, P ammonia levels after dialysis, there was a strong correlation with drop in mean arterial pressure (r = 0.88, P ammonia compared to the patients who manifested a fall in blood ammonia (124 ± 8 vs. 136 ± 6 mmHg respectively, P = 0.27). Fall in blood urea following hemodialysis in ESRD patients was paradoxically accompanied by a modest rise in blood ammonia levels in 43% of the patients studied, contrasting prior reported effects of hemodialysis on breath ammonia. In this subgroup of patients, changes in blood ammonia during hemodialysis correlated with rise in blood bicarbonate and fall in mean arterial blood pressure. © 2016 International Society for Hemodialysis.

  12. Yearly Data for Spoken Language Preferences of End Stage Renal Disease Medicare Claimants (2011-2015)

    Data.gov (United States)

    Social Security Administration — This data set provides annual volumes for language preferences at the national level of individuals filing claims for ESRD Medicare benefits for federal fiscal year...

  13. 42 CFR 488.60 - Special procedures for approving end stage renal disease facilities.

    Science.gov (United States)

    2010-10-01

    ... of the Public Health Service concerning the facility's contribution to the ESRD services of the network. (3) Data concerning the facility's compliance with professional norms and standards. (4) Data pertaining to the facility's qualifications for approval or for any expansion of services. (b) Determining...

  14. Echocardiography Criteria for Structural Heart Disease in Patients With End-Stage Renal Disease Initiating Hemodialysis.

    Science.gov (United States)

    Hickson, LaTonya J; Negrotto, Sara M; Onuigbo, Macaulay; Scott, Christopher G; Rule, Andrew D; Norby, Suzanne M; Albright, Robert C; Casey, Edward T; Dillon, John J; Pellikka, Patricia A; Pislaru, Sorin V; Best, Patricia J M; Villarraga, Hector R; Lin, Grace; Williams, Amy W; Nkomo, Vuyisile T

    2016-03-15

    Cardiovascular disease among hemodialysis (HD) patients is linked to poor outcomes. The Acute Dialysis Quality Initiative Workgroup proposed echocardiographic (ECHO) criteria for structural heart disease (SHD) in dialysis patients. The association of SHD with important patient outcomes is not well defined. This study sought to determine prevalence of ECHO-determined SHD and its association with survival among incident HD patients. We analyzed patients who began chronic HD from 2001 to 2013 who underwent ECHO ≤1 month prior to or ≤3 months following initiation of HD (n = 654). Mean patient age was 66 ± 16 years, and 60% of patients were male. ECHO findings that met 1 or more and ≥3 of the new criteria were discovered in 87% and 54% of patients, respectively. Over a median of 2.4 years, 415 patients died: 108 (26%) died within 6 months. Five-year mortality was 62%. Age- and sex-adjusted structural heart disease variables associated with death were left ventricular ejection fraction (LVEF) ≤45% (hazard ratio [HR]: 1.48; confidence interval [CI]: 1.20 to 1.83) and right ventricular (RV) systolic dysfunction (HR: 1.68; CI: 1.35 to 2.07). An additive of higher death risk included LVEF ≤45% and RV systolic dysfunction rather than neither (HR: 2.04; CI: 1.57 to 2.67; p = 0.53 for test for interaction). Following adjustment for age, sex, race, diabetic kidney disease, and dialysis access, RV dysfunction was independently associated with death (HR: 1.66; CI 1.34 to 2.06; p < 0.001). SHD was common in our HD study population, and RV systolic dysfunction independently predicted mortality. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  15. Quarterly Data for Spoken Language Preferences of End Stage Renal Disease Medicare Claimants (2014-2015)

    Data.gov (United States)

    Social Security Administration — This data set provides quarterly volumes for language preferences at the national level of individuals filing claims for ESRD Medicare benefits for fiscal years 2014...

  16. 78 FR 40835 - Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program...

    Science.gov (United States)

    2013-07-08

    ... and Labor- related Share for ESRD Facilities for CY 2014 c. Proposed Productivity Adjustment d. Calculation of the ESRDB Market Basket Update, Adjusted for Multifactor Productivity for CY 2014 4. The... Facility Performance on Clinical Measures Based on Improvement c. Proposals for Calculating Facility...

  17. Yearly Data for Spoken Language Preferences of End Stage Renal Disease Medicare Claimants (2016 Onwards)

    Data.gov (United States)

    Social Security Administration — This data set provides annual volumes for language preferences at the national level of individuals filing claims for ESRD Medicare benefits for federal fiscal year...

  18. 75 FR 49215 - Medicare Program; End-Stage Renal Disease Quality Incentive Program

    Science.gov (United States)

    2010-08-12

    ... providing access to facility service and quality information; provide quality improvement support to... for quality improvement, such as weighting scores to ensure that providers/facilities have strong... information to the public for comparing the quality of dialysis facilities across the country, including...

  19. Long-term survival of implantable cardioverter defibrillator recipients with end-stage renal disease

    Directory of Open Access Journals (Sweden)

    Mikhael F. El-Chami, MD, FACC, FHRS

    2017-10-01

    Conclusion: ESRD patients are at significantly increased risk of mortality as compared with a non-dialysis cohort. While the majority of these patients survive more than one year post-diagnosis, the three-year mortality is high (43%. Randomized studies addressing the benefits of ICDs in ESRD patients are needed to better define their value for primary prevention of SCD.

  20. Physical and psychOLOGical functions in Patients WITH THE END-STAGE RENAL DISEASE

    Directory of Open Access Journals (Sweden)

    Andrea Mahrova

    2012-06-01

    The ESRD patients, especially the elderly, should be encouraged to pay attention to increased physical activity levels in order to maintain functional independence and high quality of the life for as long as possible.

  1. 77 FR 67449 - Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program...

    Science.gov (United States)

    2012-11-09

    .... Thirty-Day Hospital Readmissions b. Efficiency c. Population/Community Health 6. Scoring Background and... Statistics BMI Body Mass Index BSA Body Surface Area CAH Critical Access Hospital CBSA Core-Based Statistical....89, Bad debts, charity, and courtesy allowances. Additionally, this rule will remove the cap on bad...

  2. 77 FR 40951 - Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program...

    Science.gov (United States)

    2012-07-11

    .... Thirty-Day Hospital Readmissions b. Efficiency c. Population/Community Health 6. Proposed Scoring for the...-96) by revising 42 CFR 413.89, Bad debts, charity, and courtesy allowances. B. Summary of the Major... current hospital wage data to account for differing wage levels in areas in which ESRD facilities are...

  3. Erythropoietin resistance in end-stage renal disease patient with gastric antral vascular ectasia

    Directory of Open Access Journals (Sweden)

    Desiree Ji Re Lee

    2015-09-01

    Full Text Available AbstractWe observed a case of recombinant human erythropoietin resistance caused by Gastric Antral Vascular Ectasia in a 40-year-old female with ESRD on hemodialysis. Some associated factors such as autoimmune disease, hemolysis, heart and liver disease were discarded on physical examination and complementary tests. The diagnosis is based on the clinical history and endoscopic appearance of watermelon stomach. The histologic findings are fibromuscular proliferation and capillary ectasia with microvascular thrombosis of the lamina propria. However, these histologic findings are not necessary to confirm the diagnosis. Gastric Antral Vascular Ectasia is a serious condition and should be considered in ESRD patients on hemodialysis with anemia and resistance to recombinant human erythropoietin because GAVE is potentially curable with specific endoscopic treatment method or through surgical procedure.

  4. Disparities in treatment rates of paediatric end-stage renal disease across Europe

    DEFF Research Database (Denmark)

    Chesnaye, Nicholas C; Schaefer, Franz; Groothoff, Jaap W

    2015-01-01

    /1321 km, P rates were found in wealthier countries (2.47 pmc/€10 378 GDP per capita, P among those...... and physical access to treatment were collected through an online survey and from the World Bank database. The estimated effect is presented per 1SD increase for each indicator. RESULTS: The incidence of paediatric RRT in Europe was 5.4 cases pmc. Incidence decreased from Western to Eastern Europe (-1.91 pmc...... that tend to spend more on healthcare (1.45 pmc/1.7% public health expenditure, P among countries where patients pay less out-of-pocket for healthcare (-1.29 pmc/11.7% out-of-pocket health expenditure, P

  5. Dialysis modality choice in elderly patients with end-stage renal disease

    DEFF Research Database (Denmark)

    Segall, Liviu; Nistor, Ionuţ; Van Biesen, Wim

    2017-01-01

    on comprehensive and unbiased information. A multidisciplinary team should review elderly patients starting on dialysis, aiming to identify possible barriers to PD and home HD, including physical, visual, cognitive, psychological and social problems, and to overcome such barriers by adequate care, education...

  6. Mortality risk in European children with end-stage renal disease on dialysis

    DEFF Research Database (Denmark)

    Chesnaye, Nicholas C.; Schaefer, Franz; Groothoff, Jaap W.

    2016-01-01

    We aimed to describe survival in European pediatric dialysis patients and compare the differential mortality risk between patients starting on hemodialysis (HD) and peritoneal dialysis (PD). Data for 6473 patients under 19 years of age or younger were extracted from the European Society of Pediat...... dialysis (HD/PD adjusted HR 6.55, 95% CI 2.35–18.28, PSM HR 2.93, 95% CI 1.04–8.23). Because unmeasured case-mix differences and selection bias may explain the higher mortality risk in the HD population, these results should be interpreted with caution....

  7. Artificial intelligence for optimal anemia management in end-stage renal disease.

    Science.gov (United States)

    Brier, Michael E; Gaweda, Adam E

    2016-08-01

    Computational intelligence for the prediction of hemoglobin to guide the selection of erythropoiesis-stimulating agent dose results in improved anemia management. The models used for the prediction result from the use of individual patient data and help to increase the number of hemoglobin observations within the target range. The benefits of using these modeling techniques appear to be a decrease in erythropoiesis-stimulating agent use and a decrease in the number of transfusions. This study confirms the results of previous smaller studies and suggests that additional beneficial results may be achieved. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

  8. Patients' representations of their end-stage renal disease: relation with mortality

    NARCIS (Netherlands)

    van Dijk, Sandra; Scharloo, Margreet; Kaptein, Adrian A.; Thong, Melissa S. Y.; Boeschoten, Elisabeth W.; Grootendorst, Diana C.; Krediet, Raymond T.; Dekker, Friedo W.; Apperloo, A. J.; Bijlsma, J. A.; Boekhout, M.; Boer, W. H.; van der Boog, P. J. M.; Büller, H. R.; van Buren, M.; de Charro, F. Th; Doorenbos, C. J.; van den Dorpel, M. A.; van Es, A.; Fagel, W. J.; Feith, G. W.; de Fijter, C. W. H.; Frenken, L. A. M.; van Geelen, J. A. C. A.; Gerlag, P. G. G.; Grave, W.; Gorgels, J. P. M. C.; Huisman, R. M.; Jager, K. J.; Jie, K.; Koning-Mulder, W. A. H.; Koolen, M. I.; Kremer Hovinga, T. K.; Lavrijssen, A. T. J.; Luik, A. J.; van der Meulen, J.; Parlevliet, K. J.; Raasveld, M. H. M.; van der Sande, F. M.; Schonck, M. J. M.; Schuurmans, M. M. J.; Siegert, C. E. H.; Stegeman, C. A.; Stevens, P.; Thijssen, J. G. P.; Valentijn, R. M.; Vastenburg, G. H.; Verburgh, C. A.; Vincent, H. H.; Vos, P. F.

    2009-01-01

    BACKGROUND: Self-regulation theory explains how patients' illness perceptions influence self-management behaviour (e.g. via adherence to treatment). Following these assumptions, we explored whether illness perceptions of ESRD-patients are related to mortality rates. METHODS: Illness perceptions of

  9. Analgesic nephropathy as a cause of end-stage renal disease in a ...

    African Journals Online (AJOL)

    2011-03-09

    Mar 9, 2011 ... He was not a diabetic and did not use mercury-containing soap or cream or herbal ... Grade 2 hypertensive retinopathy. A diagnosis of analgesic .... Early detection of AN and discontinuation of analgesic use stabilizes or ...

  10. 78 FR 72155 - Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program...

    Science.gov (United States)

    2013-12-02

    ... and casts, and IOLs inserted in a physician's office. SUPPLEMENTARY INFORMATION: Electronic Access... rule, we did not readily have access to the 2007 utilization data for the ESRD facilities located in... the amount of the adjustment. We solicited comments on the proposal to include data on the utilization...

  11. Prevalence, predictors, and survival in pulmonary hypertension related to end-stage chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Andersen, Kasper Hasseriis; Iversen, Martin Jes; Kjaergaard, Jesper

    2012-01-01

    The prevalence, prognostic importance, and factors that predict the presence and degree of pulmonary hypertension (PH) diagnosed with right heart catheterization (RHC) in patients with end-stage chronic obstructive pulmonary disease (COPD) remain unclear....

  12. Impact of end stage kidney disease on costs and outcomes of Clostridium difficile infection

    Directory of Open Access Journals (Sweden)

    Abhinav Goyal

    2017-09-01

    Conclusions: The presence of end stage kidney disease in hospitalized patients with Clostridium difficile infection is associated with higher mortality, a longer length of stay, and a higher cost of hospitalization.

  13. Percutaneous coronary revascularization in patients with formerly "refractory angina pectoris in end-stage coronary artery disease" – Not "end-stage" after all

    Directory of Open Access Journals (Sweden)

    Khattab Ahmed A

    2009-08-01

    Full Text Available Abstract Background Patients with refractory angina pectoris in end-stage coronary artery disease represent a severe condition with a higher reduction of life-expectancy and quality of life as compared to patients with stable coronary artery disease. It was the purpose of this study to invasively re-evaluate highly symptomatic patients with formerly diagnosed refractory angina pectoris in end-stage coronary artery disease for feasible options of myocardial revascularization. Methods Thirty-four Patients formerly characterized as having end stage coronary artery disease with refractory angina pectoris were retrospectively followed for coronary interventions. Results Of those 34 patients 21 (61.8% were eventually revascularized with percutaneous interventional revascularization (PCI. Due to complex coronary morphology (angulation, chronic total occlusion PCI demanded an above-average amount of time (66 ± 42 minutes, range 25–206 minutes and materials (contrast media 247 ± 209 ml, range 50–750 ml; PCI guiding wires 2.0 ± 1.4, range 1–6 wires. Of PCI patients 7 (33.3% showed a new lesion as a sign of progression of atherosclerosis. Clinical success rate with a reduction to angina class II or lower was 71.4% at 30 days. Surgery was performed in a total of8 (23.5% patients with a clinical success rate of 62.5%. Based on an intention-to-treat 2 patients of originally 8 (25% demonstrated clinical success. Mortality during follow-up (1–18 months was 4.8% in patients who underwent PCI, 25% in patients treated surgically and 25% in those only treated medically. Conclusion The majority of patients with end-stage coronary artery disease can be treated effectively with conventional invasive treatment modalities. Therefore even though it is challenging and demanding PCI should be considered as a first choice before experimental interventions are considered.

  14. The Total Artificial Heart in End-Stage Congenital Heart Disease.

    Science.gov (United States)

    Villa, Chet R; Morales, David L S

    2017-01-01

    The development of durable ventricular assist devices (VADs) has improved mortality rates and quality of life in patients with end stage heart failure. While the use of VADs has increased dramatically in recent years, there is limited experience with VAD implantation in patients with complex congenital heart disease (CHD), despite the fact that the number of patients with end stage CHD has grown due to improvements in surgical and medical care. VAD use has been limited in patients with CHD and end stage heart failure due to anatomic (systemic right ventricle, single ventricle, surgically altered anatomy, valve dysfunction, etc.) and physiologic constraints (diastolic dysfunction). The total artificial heart (TAH), which has right and left sided pumps that can be arranged in a variety of orientations, can accommodate the anatomic variation present in CHD patients. This review provides an overview of the potential use of the TAH in patients with CHD.

  15. Lifestyle modification and progressive renal failure.

    Science.gov (United States)

    Ritz, Eberhard; Schwenger, Vedat

    2005-08-01

    There is increasing evidence that lifestyle factors impact on the risk of developing chronic kidney disease (CKD) and the risk of progression of CKD. Equally important is the consideration that patients with CKD are more likely to die from cardiovascular disease than to reach the stage of end-stage renal failure. It is advantageous that manoeuvres that interfere with progression at the same time also reduce the risk of cardiovascular events. Lifestyle factors that aggravate progression include, among others, smoking, obesity and dietary salt intake. Alcohol consumption, according to some preliminary information, has a bimodal relationship to cardiovascular risk and progression, with moderate consumption being protective.

  16. Patients with end-stage interstitial lung disease may have more problems with dyspnea than end-stage lung cancer patients

    Directory of Open Access Journals (Sweden)

    Ryo Matsunuma

    2016-01-01

    Full Text Available Introduction: Patients with end-stage interstitial  lung disease (ILD do not appear to receive adequate palliative care despite apparent suffering before death. The aim of this study was to evaluate their signs, symptoms, and treatment received before death. Methods: Patients with ILD and lung cancer (LC who were hospitalized and died in our hospital were enrolled retrospectively. Signs and symptoms and treatments at 7 days, 3 days, and 1 day before death were evaluated and compared between the two groups of patients. Results: A total of 23 patients with ILD and 59 patients with LC group were eligible for participation. Significantly more LC patients had loss of consciousness than ILD patients on 7 days (ILD: LC = 1 [5.6%]:24 [41%], P = 0.013, 3 days (1 [5.6%]:33 [56%], P < 0.001. Significantly more ILD patients had dyspnea than LC patients on 3 days (16 [89%]:38 [64%], P = 0.047 1 day before death (21 [91%]:33 [56%], P = 0.001. On 1 day before death, significantly more LC patients received morphine than ILD patients (2 [8.7%]: 14 [24%], P = 0.015. More ILD patients received sedation (11 [48%]: 11 [19%], P = 0.007. Conclusions: End-stage ILD patients may experience dyspnea more frequently than terminal LC patients, and they need sedation. Morphine should be administered to ILD patients who have dyspnea. Additional prospective studies are needed.

  17. Novel clinical staging for patients with end-stage gastrointestinal carcinoma.

    Science.gov (United States)

    Yasuda, Naokuni; Nakashima, Osamu; Ohnaka, Toru; Kamisaka, Koji; Tsunoda, Akira; Kusano, Mitsuo

    2006-01-01

    We created a new clinical staging system for end-stage gastrointestinal (GI) carcinoma to clarify the therapeutic goals for these patients. Data were obtained from a retrospective review of medical charts. Based on daily clinical observation of 144 patients with end-stage GI carcinoma, we classified the terminal stages as A, B, C, and D. The mean durations of terminal stages A, B, C, and D were 19, 16.6, 6.6, and 1.8 days, respectively, in patients with end-stage gastric cancer and 28.5, 9.1, 5.4, and 1.9 days, respectively, in patients with colorectal cancer. Moreover, 88.0% of patients with gastric carcinoma and 82.6% of patients with colorectal carcinoma passed through terminal stages A, B, C, and D sequentially. The patients in terminal stage B experienced temporary relief of symptoms, but those in terminal stage C did not (P terminal stages can easily be judged by clinical observation and may be an effective new tool with which to manage patients with end-stage GI carcinoma and their families.

  18. Study on microbial persistence in end-stage idiopathic dilated cardiomyopathy.

    NARCIS (Netherlands)

    Leeuw, N. de; Melchers, W.J.G.; Balk, A.H.M.M.; Jonge, N. de; Galama, J.M.D.

    1999-01-01

    Microbial persistence may be involved in the pathogenesis of idiopathic dilated cardiomyopathy (IDC). Therefore, we evaluated the role of various cardiopathogenic microorganisms in patients with end-stage IDC. In a previous study, we did not find evidence for the persistence of enterovirus RNA in

  19. Impact of Depression on Long-Term Outcome After Renal Transplantation : A Prospective Cohort Study

    NARCIS (Netherlands)

    Zelle, D.M.; Dorland, H.F.; Rosmalen, J.G.M.; Corpeleijn, E.; Gans, R.O.B.; van der Heide, J.J.H.; van Son, W.J.; Navis, G.; Bakker, S.J.L.

    2012-01-01

    Background. Renal transplantation is the treatment of choice for end stage renal disease. Although there is more depression in wait-listed versus transplant patients, depression persists after transplantation. We investigated the determinants of depression in renal transplantation recipients (RTRs)

  20. Cost analysis of substitutive renal therapies in children.

    Science.gov (United States)

    Camargo, Maria Fernanda Carvalho de; Barbosa, Klenio de Souza; Fetter, Seiji Kumon; Bastos, Ana; Feltran, Luciana de Santis; Koch-Nogueira, Paulo Cesar

    End-stage renal disease is a health problem that consumes public and private resources. This study aimed to identify the cost of hemodialysis (either daily or conventional hemodialysis) and transplantation in children and adolescents. This was a retrospective cohort of pediatric patients with End-stage renal disease who underwent hemodialysis followed by kidney transplant. All costs incurred in the treatment were collected and the monthly total cost was calculated per patient and for each renal therapy. Subsequently, a dynamic panel data model was estimated. The study included 30 children who underwent hemodialysis (16 conventional/14 daily hemodialysis) followed by renal transplantation. The mean monthly outlay for hemodialysis was USD 3500 and USD 1900 for transplant. Hemodialysis costs added up to over USD 87,000 in 40 months for conventional dialysis patients and USD 131,000 in 50 months for daily dialysis patients. In turn, transplant costs in 50 months reached USD 48,000 and USD 70,000, for conventional and daily dialysis patients, respectively. For conventional dialysis patients, transplant is less costly when therapy exceeds 16 months, whereas for daily dialysis patients, the threshold is around 13 months. Transplantation is less expensive than dialysis in children, and the estimated thresholds indicate that renal transplant should be the preferred treatment for pediatric patients. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  1. Advanced strategies for end-stage heart failure: combining regenerative approaches with LVAD, a new horizon?

    Directory of Open Access Journals (Sweden)

    Cheyenne eTseng

    2015-04-01

    Full Text Available Despite the improved treatment of cardiovascular diseases the population with end-stage heart failure is progressively growing. The scarcity of the gold standard therapy, heart transplantation, demands novel therapeutic approaches. For patients awaiting transplantation ventricular assist devices have been of great benefit on survival. To allow explantation of the assist device and obviate heart transplantation, sufficient and durable myocardial recovery is necessary. However, explant rates so far are low. Combining mechanical circulatory support with regenerative therapies such as cell(-based therapy and biomaterials might give rise to improved long-term results. Although synergistic effects are suggested with mechanical support and stem cell therapy, evidence in both preclinical and clinical setting is lacking. This review focuses on advanced and innovative strategies for the treatment of end-stage heart failure and furthermore appraises clinical experience with combined strategies.

  2. Impact of end stage kidney disease on costs and outcomes of Clostridium difficile infection

    OpenAIRE

    Abhinav Goyal; Kshitij Chatterjee; Sujani Yadlapati; Janani Rangaswami

    2017-01-01

    Objectives: To assess the impact of end stage kidney disease (ESKD) on the outcomes of Clostridium difficile infection (CDI), including complications of infection, length of hospital stay, overall mortality, and healthcare burden. Methods: The National Inpatient Sample (NIS) database created by the Agency of Healthcare Research and Quality (AHRQ) was used, covering the years 2009 through 2013. Manufacturer-provided sampling weights were used to produce national estimates. Results: All-c...

  3. The Coagulation Profile of End-Stage Liver Disease and Considerations for Intraoperative Management.

    Science.gov (United States)

    Forkin, Katherine T; Colquhoun, Douglas A; Nemergut, Edward C; Huffmyer, Julie L

    2018-01-01

    The coagulopathy of end-stage liver disease results from a complex derangement in both anticoagulant and procoagulant processes. With even minor insults, cirrhotic patients experience either inappropriate bleeding or clotting, or even both simultaneously. The various phases of liver transplantation along with fluid and blood product administration may contribute to additional disturbances in coagulation. Thus, anesthetic management of patients undergoing liver transplantation to improve hemostasis and avoid inappropriate thrombosis in the perioperative environment can be challenging. To add to this challenge, traditional laboratory tests of coagulation are difficult to interpret in patients with end-stage liver disease. Viscoelastic coagulation tests such as thromboelastography (Haemonetics Corporation, Braintree, MA) and rotational thromboelastometry (TEM International, Munich, Germany) have helped to reduce transfusion of allogeneic blood products, especially fresh frozen plasma, but have also lead to the increased use of fibrinogen-containing products. In general, advancements in surgical techniques and anesthetic management have led to significant reduction in blood transfusion requirements during liver transplantation. Targeted transfusion protocols and pharmacologic prevention of fibrinolysis may further aid in the management of the complex coagulopathy of end-stage liver disease.

  4. The cost of caring for end-stage kidney disease patients: an analysis based on hospital financial transaction records.

    Science.gov (United States)

    Bruns, F J; Seddon, P; Saul, M; Zeidel, M L

    1998-05-01

    The costs of care for end-stage renal disease patients continue to rise because of increased numbers of patients. Efforts to contain these costs have focused on the development of capitated payment schemes, in which all costs for the care of these patients are covered in a single payment. To determine the effect of a capitated reimbursement scheme on care of dialysis patients (both hemodialysis [HD] and peritoneal dialysis [PD]), complete financial records (all reimbursements for inpatient and outpatient care, as well as physician collections) of dialysis patients at a single medical center over 1 year were analyzed. For the period from July 1994 to July 1995, annualized cost per dialysis patient-year averaged $63,340, or 9.8% higher than the corrected estimate from the U.S. Renal Data Service (USRDS; $57,660). The "most expensive" 25% of patients engendered 44 to 48% of the total costs, and inpatient costs accounted for 37 to 40% of total costs. Nearly half of the inpatient costs resulted from only two categories (room charges and inpatient dialysis), whereas other categories each made up a small fraction of the inpatient costs. PD patients were far less expensive to care for than HD patients, due to reduced hospital days and lower cost of outpatient dialysis. Care for a university-based dialysis population was only slightly more expensive than estimates predicted from the USRDS. These results validate the USRDS spending data and suggest that they can be used effectively for setting capitated rates. Efforts to control costs without sacrificing quality of care must center on reducing inpatient costs, particularly room charges and the cost of inpatient dialysis.

  5. Neuropsychological dysfunction in patients suffering from end-stage chronic obstructive pulmonary disease

    Science.gov (United States)

    Crews, W. David; Jefferson, Angela L.; Bolduc, Tara; Elliott, Jennifer B.; Ferro, Nikola M.; Broshek, Donna K.; Barth, Jeffrey T.; Robbins, Mark K.

    2009-01-01

    Few studies have examined the neuropsychological sequelae associated with end-stage pulmonary disease. Neuropsychological data are presented for 47 patients with end-stage chronic obstructive pulmonary disease (COPD) who were being evaluated as potential candidates for lung transplantation. Although patients exhibited a diversity of neurocognitive deficits, their highest frequencies of impairment were found on the Selective Reminding Test (SRT). Specifically, over 50% of the patients completing the SRT exhibited impaired immediate free recall and consistent long-term retrieval deficits, while more than 44% of these individuals displayed deficient long-term retrieval. Deficient SRT long-term storage strategies, cued recall, and delayed recall were exhibited by between 26% and 35% of these patients, while more than 32% of this sample displayed elevated numbers of intrusion errors. Over 31% of the patients completing the Wisconsin Card Sorting Test (WCST) failed to achieve the expected number of categories on this measure, while more than 23% of these individuals demonstrated elevated numbers of perseverative errors and total errors. Clinically notable frequencies of impairment (greater than 20% of the sample) were also found on the Trail Making Test (TMT): Part B and the Wechsler Memory Scale-R (WMS-R) Visual Reproduction II subtest. Minnesota Multiphasic Personality Inventory-2 (MMPI-2) personality assessments indicated that patients were experiencing a diversity of somatic complaints and that they may have been functioning at a reduced level of efficiency. These findings are discussed in light of patients’ end-stage COPD and factors possibly contributing to their neuropsychological test performances. Implications for clinical practice and future research are also included. PMID:14589783

  6. Regenerative therapy and tissue engineering for the treatment of end-stage cardiac failure

    Science.gov (United States)

    Finosh, G.T.; Jayabalan, Muthu

    2012-01-01

    Regeneration of myocardium through regenerative therapy and tissue engineering is appearing as a prospective treatment modality for patients with end-stage heart failure. Focusing on this area, this review highlights the new developments and challenges in the regeneration of myocardial tissue. The role of various cell sources, calcium ion and cytokine on the functional performance of regenerative therapy is discussed. The evolution of tissue engineering and the role of tissue matrix/scaffold, cell adhesion and vascularisation on tissue engineering of cardiac tissue implant are also discussed. PMID:23507781

  7. Phrenic neuropathy in chronic renal failure.

    OpenAIRE

    Zifko, U.; Auinger, M.; Albrecht, G.; Kästenbauer, T.; Lahrmann, H.; Grisold, W.; Wanke, T.

    1995-01-01

    BACKGROUND--Peripheral neuropathy and alterations in diaphragmatic muscle function are frequently caused by uraemia. Phrenic nerve function in patients with end stage renal failure, however, has not been examined to date. METHODS--An electrophysiological study of the phrenic nerve was performed to determine its possible involvement in 32 nondiabetic patients with end stage renal disease undergoing chronic haemodialysis. RESULTS--Seventeen patients had electrophysiological signs of peripheral ...

  8. Caring for Migrants and Refugees With End-Stage Kidney Disease in Europe.

    Science.gov (United States)

    Van Biesen, Wim; Vanholder, Raymond; Ernandez, Thomas; Drewniak, Daniel; Luyckx, Valerie

    2018-05-01

    With the number of migrants and refugees increasing globally, the nephrology community is increasingly confronted with issues relating to the management of end-stage kidney disease in this population, including medical, logistical, financial, and moral-ethical questions. Beginning with data for the state of affairs regarding refugees in Europe and grounded in moral reasoning theory, this Policy Forum Perspective contends that to improve care for this specific population, there is a need for: (1) clear demarcations of responsibilities across the societal (macro), local (meso), and individual (micro) levels, such that individual providers are aware of available resources and able to provide essential medical care while societies and local communities determine the general approach to dialysis care for refugees; (2) additional data and evidence to facilitate decision making based on facts rather than emotions; and (3) better information and education in a broad sense (cultural sensitivity, legal rights and obligations, and medical knowledge) to address specific needs in this population. Although the nephrology community cannot leverage a change in the geopolitical framework, we are in a position to generate accurate data describing the dimensions of care of refugee or migrant patients with end-stage kidney disease to advocate for a holistic approach to treatment for this unique patient population. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  9. Parathyroid Scintigraphy in Renal Hyperparathyroidism

    Science.gov (United States)

    Taïeb, David; Ureña-Torres, Pablo; Zanotti-Fregonara, Paolo; Rubello, Domenico; Ferretti, Alice; Henter, Ioline; Henry, Jean-François; Schiavi, Francesca; Opocher, Giuseppe; Blickman, Johan G.; Colletti, Patrick M.; Hindié, Elif

    2015-01-01

    Secondary hyperparathyroidism (sHPT) is a major complication for patients with end-stage renal disease on long-term hemodialysis or peritoneal dialysis. When the disease is resistant to medical treatment, patients with severe sHPT are typically referred for parathyroidectomy (PTx), which usually improves biological parameters as well as clinical signs and symptoms. Unfortunately, early surgical failure with persistent disease may occur in 5%–10% of patients and recurrence reaches 20%–30% at 5 years. Presently, the use of parathyroid scintigraphy in sHPT is usually limited to the management of surgical failures after initial PTx. This review describes the strengths and limitations of typical 99mTc-sestamibi imaging protocols, and highlights the potential benefits of using parathyroid scintigraphy in the initial workup of surgical patients. PMID:23751837

  10. The evolving role of the total artificial heart in the management of end-stage congenital heart disease and adolescents.

    Science.gov (United States)

    Ryan, Thomas D; Jefferies, John L; Zafar, Farhan; Lorts, Angela; Morales, David L S

    2015-01-01

    Advances in medical therapies have yielded improvement in morbidity and a decrease in mortality for patients with congenital heart disease, both surgically palliated and uncorrected. An unintended consequence is a cohort of adolescent and adult patients with heart failure who require alternative therapies. One intriguing option is placement of a total artificial heart (TAH) either as a bridge to transplant or as a destination therapy. Of the 1091 Jarvik-7 type TAH (Symbion, CardioWest and SynCardia) placed between 1985 and 2012, only 24 have been performed in patients with congenital heart disease, and a total of 51 were placed in patients younger than 21. At our institution, the SynCardia TAH was implanted in a 19-year-old patient with cardiac allograft failure because of chronic rejection and related multisystem organ failure including need for hemodialysis. Over the next year, she was nutritionally and physically rehabilitated, as were her end organs, allowing her to come off dialysis, achieve normal renal function and eventually be successfully transplanted. Given the continued growth of adolescent and adult congenital heart disease populations with end-stage heart failure, the TAH may offer therapeutic options where previously there were few. In addition, smaller devices such as the SynCardia 50/50 will open the door for applications in smaller children. The Freedom Driver offers the chance for patients to leave the hospital with a TAH, as does the AbioCor, which is a fully implantable TAH option. In this report, we review the history of the TAH and potential applications in adolescent patients and congenital heart disease.

  11. Time to reach tacrolimus maximum blood concentration,mean residence time, and acute renal allograft rejection: an open-label, prospective, pharmacokinetic study in adult recipients.

    Science.gov (United States)

    Kuypers, Dirk R J; Vanrenterghem, Yves

    2004-11-01

    The aims of this study were to determine whether disposition-related pharmacokinetic parameters such as T(max) and mean residence time (MRT) could be used as predictors of clinical efficacy of tacrolimus in renal transplant recipients, and to what extent these parameters would be influenced by clinical variables. We previously demonstrated, in a prospective pharmacokinetic study in de novo renal allograft recipients, that patients who experienced early acute rejection did not differ from patients free from rejection in terms of tacrolimus pharmacokinetic exposure parameters (dose interval AUC, preadministration trough blood concentration, C(max), dose). However, recipients with acute rejection reached mean (SD) tacrolimus T(max) significantly faster than those who were free from rejection (0.96 [0.56] hour vs 1.77 [1.06] hours; P clearance nor T(1/2) could explain this unusual finding, we used data from the previous study to calculate MRT from the concentration-time curves. As part of the previous study, 100 patients (59 male, 41 female; mean [SD] age, 51.4 [13.8] years;age range, 20-75 years) were enrolled in the study The calculated MRT was significantly shorter in recipients with acute allograft rejection (11.32 [031] hours vs 11.52 [028] hours; P = 0.02), just like T(max) was an independent risk factor for acute rejection in a multivariate logistic regression model (odds ratio, 0.092 [95% CI, 0.014-0.629]; P = 0.01). Analyzing the impact of demographic, transplantation-related, and biochemical variables on MRT, we found that increasing serum albumin and hematocrit concentrations were associated with a prolonged MRT (P calculated MRT were associated with a higher incidence of early acute graft rejection. These findings suggest that a shorter transit time of tacrolimus in certain tissue compartments, rather than failure to obtain a maximum absolute tacrolimus blood concentration, might lead to inadequate immunosuppression early after transplantation.

  12. Ethnic differences in mortality, end-stage complications, and quality of care among diabetic patients: a review

    NARCIS (Netherlands)

    L.C. Lanting (Loes); I.M.A. Joung (Inez); J.P. Mackenbach (Johan); S.W.J. Lamberts (Steven); A.H. Bootsma (Aart)

    2005-01-01

    textabstractOBJECTIVE: To determine the influence of ethnic differences in diabetes care on inequalities in mortality and prevalence of end-stage complications among diabetic patients. The following questions were examined: 1) Are there ethnic differences among diabetic patients

  13. Maturity-onset diabetes of the young with end-stage nephropathy

    DEFF Research Database (Denmark)

    Saudek, Frantisek; Pruhová, Stepánka; Boucek, Peter

    2004-01-01

    -onset diabetes of the young (MODY). SPK was performed in a 47-year old man who has MODY3 because of a Arg272His mutation in the hepatocyte nuclear factor-1alphagene. He developed overt diabet