High prevalence of irritable bowel syndrome and upper gastrointestinal symptoms in patients with chronic renal failure

BACKGROUND: Gastrointestinal symptoms and psychiatric disorders are common among patients with chronic renal failure since uremia affects all systems as well as the gastrointestinal tract. Irritable bowel syndrome (IBS) is a frequent functional disorder worldwide. We aimed to evaluate the frequency of IBS and upper gastrointestinal symptoms in patients with chronic renal failure (CRF). The relationships between IBS, sex and additional psychiatric disorders in the same patient group were determined and results were compared with controls. METHODS: Ninety-three hemodialysis (HD) and 35 peritoneal dialysis (PD) patients and 51 healthy volunteers were enrolled in this cross-sectional study. They completed the questionnaires that were later evaluated to determine the frequency of IBS in HD, PD and control groups; the frequency of depression and anxiety in these three groups and their relationship to sex. Symptoms of upper gastrointestinal system and their relation to sex were also investigated in all groups. RESULTS: In this study, we have demonstrated that prevalence of IBS in patients with chronic renal failure on hemodialysis or peritoneal dialysis is higher than the controls though the type of dialysis does not seem to influence the IBS prevalence itself. Epigastric pain was more prevalent in HD patients than PD patients. CONCLUSIONS: The present study suggests that though IBS is common in patients with CRF, it is generally underestimated. Type of dialysis does not seem to change the clinical picture much. Accompanying mood disorders must also be taken into consideration.     

Bone mineral density and bone turnover markers in children with chronic renal failure

Bone mineral density (BMD) at lumbar spine (L₂-L₄) was measured by dual-energy X-ray absorptiometry (DEXA) in 21 children with predialysis chronic renal failure (CRF) and 44 children with end-stage renal failure (ESRF) on regular hemodialysis. BMD results were expressed as Z-scores. Osteopenia was documented in 13 predialysis patients (61.9%) and 26 patients (59.1%) with ESRF. No significant correlation was observed between Z-scores and the duration of CRF or estimated creatinine clearance. In osteopenic children there was a negative correlation between Z-scores and serum phosphorus (r=–0.61, P=0.004), intact parathyroid hormone (iPTH) (r=–0.47, P=0.03), and bone-specific alkaline phosphatase (r=–0.52, P=0.02) and a positive correlation with total calcium (r=0.41, P=0.07) and 25-hydroxycholecalciferol (r=0.53, P=0.02). Osteopenic children who had iPTH values 200 pg/ml were more osteopenic than those who had lower iPTH levels (P=0.006). In conclusion, osteopenia, assessed by DEXA, is frequent in children with CRF. It occurs early irrespective of the duration or the severity of CRF. In children with ESRF the degree of osteopenia is correlated with laboratory markers of renal osteodystrophy and patients with biochemical findings of secondary hyperparathyroidism are more osteopenic than the others.     

Serum bile acids and pruritus in hemodialysis patients

BACKGROUND: Chronic renal failure (CRF) patients usually suffer from pruritus. The pathophysiology of pruritus is still incompletely understood. SUBJECTS, MATERIALS AND METHODS: In this paper we determined serum total bile acids (STBA) in hemodialysis patients with advanced CRF (ACRF) in order to obtain STBA concentration in predialysis, to assess their probable relation among patients with pruritus and in postdialysis using a polysulfone membrane for dialysis. STBA were determined in 49 ACRF patients with chronic hemodialysis and values were compared to 20 control subjects. Hemodialysis patients were divided in two groups: with and without pruritus. In all these patients, month of renal replacement therapy, diabetic patients, dose of dialysis (Kt/V), viral markers, serum creatinine, serum glucose, aspartate and alanine aminotransferase, alkaline phosphatase, hematocrits and albumin were determined. The intensity of itching among pruritic patients was measured by a score system: mild (M), moderate (MO) and severe (S). RESULTS: No significant differences were found in patients with and without pruritus in months of renal replacement therapy, duration of dialysis or dose of dialysis (Kt/V). STBA were determined in all ACRF patients in predialysis and they showed significant differences compared to controls (p < 0.05), however, no differences were observed in the results obtained when control subjects were compared to ACRF patients without pruritus. Also in predialysis, pruritic patients showed significant differences in STBA compared to patients without pruritus (p < 0.001). STBA concentration showed a significant decrease in postdialysis using a polysulfone membrane in ACRF patients with and without pruritus. Finally, correlation with STBA and itch score of pruritus was significant (p < 0.02). CONCLUSION: Hemodialysis patients with ACRF and pruritus showed an increase of STBA in predialysis and a decrease in postdialysis.     

Skeletal status in children and adolescents with chronic renal failure before onset of dialysis or on dialysis

Bone status was assessed in 15 children and adolescents with predialysis chronic renal failure (CRF) and in 25 subjects with end-stage renal failure (ESRF). The mean age in the whole group was 14.6+/-3.2 years and CRF had been recognized 5.8+/-4.0 years earlier. The mean age, body size, duration of the disease and Tanner stages did not differ significantly between patients with predialysis CRF and ESRF. The control group consisted of 890 healthy subjects matched with patients for age. Bone mineral density (BMD) was measured by DPX-L (Lunar, Madison, WI) at the spine (s-BMD) and total body (TB-BMD); quantitative ultrasound (QUS) was performed by DBM 1200 (IGEA, Italy) at the hand phalanges (Ad-SoS). Laboratory investigations included the evaluation of intact parathyroid hormone (i-PTH), total and ionized serum calcium, and serum phosphate. In the whole group of patients the following mean values were obtained: Ad-SoS 1952+/-79 m/s (significantly lower than in controls, who had Ad-SoS 2022+/-85 m/s, p<0.05; the difference remained significant after adjusting for body mass index), s-BMD 0.87+/-0.22 g/cm2 ( Z-score -1.6), TB-BMD 0.92+/-0.12 g/cm2 ( Z-score -1.44), i-PTH 276+/-300 pg/ml, total calcium 2.46+/-0.19 mmol/l, ionized calcium 1.14+/-0.08 mmol/l, phosphate 1.68+/-0.61 mmol/l. Skeletal measurements correlated significantly with age, body size and Tanner stages (also after adjusting for age), while significant correlations of these parameters with the duration of CRF and laboratory investigations (except of correlations of i-PTH with Ad-SoS and with TB-BMD in predialysis patients) were not observed. None of the studied variables differed significantly between predialysis and dialysis patients. In conclusion, both predialysis and dialysis children and adolescents showed a decrease in BMD and quantitative ultrasound measurements. The severity of skeletal alterations was similar in the early phase (predialysis patients) and end stage (dialysis patients) of the disease and did not show a tendency to progress with CRF duration.     

Multi-method assessment of behavior adjustment in children with chronic kidney disease

To describe the psychological adjustment in children with chronic kidney disease (CKD), we studied behavioral problems in 19 patients with CKD stage 5 on regular hemodialysis, 19 patients in the predialysis stage, and 19 control children, using the child behavior checklist (CBCL) and the semi-structured clinical interview for children and adolescents (SCICA). For CBCL scales, the mean score on the internalizing scale was significantly higher in the children on dialysis than in predialysis and control children. No significant differences in the mean scores of the total problem or externalizing scales were found between the groups studied. The mean score of SCICA observed problems and total self-reports were significantly higher in the control group than in the CKD groups. The mean score on total self-report was significantly higher in the control children than in the predialysis group. There were significant positive correlations between SCICA self-report and all CBCL scales. No significant correlations were found between these CBCL and SCICA scales and age, gender, severity of anemia, duration of CKD or the efficiency or the duration of hemodialysis in the CKD patients. In conclusion, multi-method assessment of children’s adjustment through different informants yields a comprehensive view of child psychopathology in CKD that calls for psychosocial support and early identification of maladjustment.     

Sleep disorders in chronic renal failure

Sleep disorders are common in patients with chronic renal failure (CRF), especially in those receiving hemodialysis. Sleep-related complaints in this patient population may include insomnia, daytime sleepiness or fatigue and depression. In addition to causing impairment of daytime function and quality of life, sleep apnea may also increase the cardiovascular morbidity and mortality, especially in dialysis patients. In CRF patients, an increased prevalence of sleep apnea, restless legs syndrome and periodic limb movement during sleep has been reported. Epidemiology, pathophysiology and treatment of sleep disorders in CRF and dialysis patients are still unclear and require further research.     

The prevalence of peripheral arterial disease and medial arterial calcification in patients with chronic renal failure: requirements for diagnostics

BACKGROUND: Knowledge of the prevalence of peripheral arterial disease (PAD) in patients with chronic renal failure (CRF) is limited because of a lack of uniformity in disease definition and recognition. Furthermore, little is known of the prevalence of medial arterial calcification (MAC) in patients with CRF. Our goal is to study the prevalence of PAD and MAC defined by ankle brachial index (ABI) or toe brachial index (TBI) measurements in a Finnish population of patients with CRF consisting of predialysis and dialysis patients, as well as renal transplant recipients. METHODS: We examined 136 patients with CRF and 59 control subjects. Fifty-nine of the patients with CRF had moderate to severe predialysis CRF, 36 patients were on dialysis treatment, and 41 were renal transplant recipients. Mean age of patients was 51.9 +/- 11.5 years, and 39 patients (29%) had diabetes. ABI and TBI were measured by means of photoplethysmography. The definition of PAD required an ABI value of 0.90 or less, a TBI value of 0.60 or less, or a previous positive lower-extremity angiogram result. ABI values of 1.3 or greater or incompressible arteries at ankle level indicated MAC. The presence of claudication was determined by an interview. RESULTS: Prevalences of PAD on this study were 22.0% in patients with predialysis CRF, 30.6% in patients on dialysis treatment, 14.6% in renal transplant recipients, and 1.7% in the control group (P = 0.001). Prevalences of MAC were 23.7%, 41.7%, 23.1%, and 3.4% (P < 0.001), respectively. Only 9 patients had claudication, and 6 of those patients had PAD. CONCLUSION: Both asymptomatic PAD and MAC are common in patients with CRF. Therefore, we recommend the use of both ABI and TBI measurements in the evaluation of PAD in patients with CRF.     

Plasma Secretin,Pancreozymin, and Somatostatin-like Hormone in Chronic Renal Failure Patients

Twenty patients with chronic renal failure (CRF) and ten patients on hemodialysis were included in the study of plasma secretin and pancreozymin measurement. Plasma somatostatin-like hormone (SLH) was measured in seven patients with CRF, eight patients in continuous ambulatory peritoneal dialysis (CAPD), and ten patients on hemodialysis. Normal subjects were used as sex- and age-matched healthy controls. Plasma secretin, pancreozymin, and SLH were determined by radioimmunoassay. Basal plasma concentration of secretin and pancreozymin was found significantly increased in hemodialysis patients in comparison to controls. Also test meal induced a significant increase of both hormones in hemodialysis patients. Basal plasma SLH was found significantly increased in both predialysis and dialysis (hemodialysis, CAPD) patients in comparison to controls. Correlation between clinical gastrointestinal disturbances and elevated hormone levels was not found. We believe that more reliable plasma measurement of these hormones will help the clinical investigation of gastrointestinal pathophysiology in uremia for the future.     

Efficacy, safety and tolerability of atorvastatin in dyslipidemic subjects with advanced (non-nephrotic) and endstage chronic renal failure

Background Patients with dyslipidemia and advanced renal failure are at markedly increased risk of cardiovascular morbidity and mortality. We evaluated the efficacy, safety, and tolerability of atorvastatin in non-nephrotic, dyslipidemic patients with chronic renal failure (CRF) or endstage renal failure (ESRF) receiving dialysis. Methods Following a 6-week baseline period, adult patients meeting Australian Heart Foundation treatment guidelines received atorvastatin for 16 weeks: 19 with CRF (predialysis), 17 on hemodialysis (HD), and 13 on continuous ambulatory peritoneal dialysis (CAPD). Dose (10–40 mg daily) was titrated to achieve lipid-lowering targets. Efficacy was determined by monitoring lipids (principally triglycerides and low-density lipoprotein [LDL] cholesterol); safety and tolerance by monitoring clinical and laboratory parameters. Results Atorvastatin was effective in reducing LDL cholesterol from baseline at each of weeks 4, 8, 12, and 16 in all study groups, with reductions of more than 40% at week 16. Sixty-two percent of PD, 73% of HD, and 100% of CRF patients were at or below target (<2.6 mmol/l) for LDL cholesterol at week 16. Significant reductions in triglycerides (approximately 27%) were seen in the CRF and combined HD/CAPD groups at all time points. Depending on the group, 65%–83% of patients were at or below target (<2.0 mmol/l) for triglycerides at week 16. The majority of patients received the 10-mg dose. Atorvastatin also reduced total cholesterol and apolipoprotein B levels in all groups and very-low-density lipoprotein (VLDL) cholesterol in the CRF group. Significant increases in LDL particle size were found in the HD and combined HD/CAPD groups. Minor, particularly gastrointestinal, symptoms were common. Three patients reported musculoskeletal symptoms, but creatine kinase was raised in only one. Conclusion Atorvastatin is an effective lipid-lowering agent for dyslipidemic subjects with advanced and endstage renal failure, and was reasonably well tolerated.     

Chronic renal failure in Iranian children

We investigated chronic renal failure (CRF) in 166 Iranian children (95 boys and 71 girls) from July 1991 to June 1999. The mean age at onset of CRF was 7.9±4.5 years. The most common cause of CRF was congenital urological malformations (78 cases). The second most common cause of CRF was hereditary nephropathy (21%). Glomerular diseases accounted for only 10% of children who later went on to develop renal failure. High rates of cystinosis and primary hyperoxaluria were seen, and these elevated rates could be due to a high prevalence of parental consanguinity. Eighty-six patients required renal replacement therapy, of whom the majority underwent hemodialysis. The prevalence of primary reflux as a cause of CRF was high compared with reports from western countries. Earlier diagnosis and management of urinary tract infections in this group could reduce the prevalence of reflux as a cause of CRF in this population. Received: 15 May 2000 / Revised: 2 October 2000 / Accepted: 5 October 2000     

Chronic renal failure in children: a report from Port Harcourt,Nigeria (1985–2000)

A 15-year review of children who presented with chronic renal failure (CRF) to the University of Port Harcourt Teaching Hospital, Rivers State of Nigeria, was carried out. Forty-five children (28 boys, 17 girls) with CRF, defined as a glomerular filtration rate below 30 ml/min per 1.73 m(2) body surface area or a rise in serum creatinine above 120 micro mol/l for at least 6 months, often accompanied by other biochemical abnormalities, were identified. The median annual incidence of CRF was 3.0 per million children. The prevalence of CRF increased from 12.5 in the 1985-1990 periods to 15 per million children after 1995. Acquired disorder was the major cause of CRF. Glomerulopathies were the cause in 53.3% of patients, mainly chronic glomerulonephritis (56.5%) and nephrotic syndrome (30.4%). Hepatitis B surface antigen was positive in 2 patients. Congenital disorders accounted for 28.9% of all cases of CRF, which is lower than data from other countries. Posterior urethral valve was the only congenital disorder causing CRF in the study. No child with hereditary renal disorder as a cause of CRF was identified. Children with congenital disorders were diagnosed at an earlier age. The mortality rate was high (46.7%), as most patients were managed conservatively, since there were no permanent facilities for chronic dialysis or renal transplantation in Nigeria. The study shows that CRF is common in Nigerian children, and there is an urgent need for the establishment of facilities for renal replacement therapy.     

A review of the effects of correction of acidosis on nutrition in dialysis patients

Metabolic acidosis is a condition that is commonly encountered in both chronic renal failure (CRF) and in end-stage renal disease (ESRD). Known complications and surmised consequences associated with the acidosis of renal disease include bone lesions, depression of myocardial contractility, and growth retardation. Conversely the correction of acidosis in children with renal tubular acidosis improves growth velocity. This is also the case in children with CRF. The conclusion drawn from this study was that the correction of metabolic acidosis improved serum albumin concentrations in patients on hemodialysis and that this correction also induced a decrease in the nPCR.     

Psychiatric disorders among patients undergoing hemodialysis therapy

We examined the incidence rates of psychiatric disorders in end-stage renal failure patients on hemodialysis (HD) based on 4-year long-term follow-up. Among various psychiatric disorders, the frequency of three psychiatric disorders, dementia, delirium, and major depression, was relatively high. One-year incidence rate of whole psychiatric disorders was 10.6% (7.1% in non-aged and 13.7% in aged). One-year incidence rate of dementia in aged patients was 4.2% (dementia of the Alzheimer's disease, 0.5%; multi-infarct dementia, 3.7%). One-year incidence rate of multi-infarct dementia in aged HD patients was 7.4 times as large as that in the elderly general populations, suggesting that aged HD patients tend to exhibit multi-infarct dementia. The high incidence rate may be closely related to advanced arteriosclerosis and other medical conditions. Psychiatric management is required for ESRD patients with three major psychiatric disorders, dementia, delirium, and major depression, in particular for aged patients with multi-infarct dementia who has received long-term HD therapy.     

Autonomic neuropathy in chronic renal insufficiency. Comparative analysis of diabetic and nondiabetic patients

Disturbances of peripheral and autonomic nervous system function were evaluated in 37 normal subjects, in 52 patients with non diabetic chronic renal insufficiency (25 predialysis patients, 27 dialysis patients), and in 21 patients with diabetic chronic renal failure (10 predialysis patients, 11 dialysis patients). In nondiabetic patients, the predialysis group showed abnormal test results indicating parasympathetic lesions, in dialysis patients these derangements were nearly normalized. In predialysis diabetic patients, the autonomic alterations were much more extensive, corresponding to alterations of electroneurographical findings; in addition to parasympathetic lesions, sympathetic disturbances were seen. In contrast to the nondiabetic groups, in dialysis patients a deterioration of autonomic lesions was observed. In conclusion, these data indicate that deranged autonomic functions are common in uremia; they improve in dialysis patients with nondiabetic renal failure in contrast to diabetic patients; in this group the autonomic functions worsen in dialysis patients as a function of duration of diabetes and hemodialysis.     

Adherence, depression and quality of life in patients on a renal transplantation waiting list

To study nonadherence, and its relationship with depression and quality of life (QOL) in patients on a cadaveric renal transplantation waiting list (RTWL). In 86 RTWL patients (56 men/30 women), there were 49 nonadherent patients (age, 46.8 +/- 21.8 years) and 37 adherent patients (age, 42.8 +/- 12.1 years). Clinical nonadherence was defined as skipping or shortening dialysis sessions, interdialytic weight gain (IDWG) of >5.7% body weight, a predialysis potassium level of >6 mEq/l and a predialysis phosphate level of >7.5 mg/dl. For each study subject, marital status, level of education duration of dialysis, prior renal transplantation, IDWG, predialysis blood urea nitrogen (BUN) value and creatinine, potassium, phosphate levels were recorded as were scores from the short form-36 and Beck depression inventory (BDI). A high IDWG (33.7% of the subjects) was the most common nonadherence pattern noted. Age, sex, marital status, duration of dialysis, prior transplantation, comorbid conditions the predialysis BUN values, the levels of creatinine, potassium, and phosphate were not significantly different between the two groups (P > 0.05). The level of education was higher in adherent group (P = 0.018). QOL and BDI scores were negatively correlated (P = 0.001, r = -0.561). Nonadherent patients had lower QOL (P = 0.04) and higher depression scores (P = 0.01) than did adherent patients. Of the depressed patients, 77.8% had a comorbid condition. Nonadherence was only associated with BDI scores (OR, 2.146; CI, 2.052-2.350; P = 0.002). In dialysis patients, close monitoring of adherence, early diagnosis of depression, and the treatment of disease may further enhance QOL during the waiting period for a cadaveric renal transplant.     

Carboxymethyllysine in dermal tissues of diabetic and nondiabetic patients with chronic renal failure: relevance to glycoxidation damage

Carboxymethyllysine (CML) is currently recognized as a major advanced glycation end product and a marker for glycoxidation. Plasma CML levels are increased in patients with chronic renal failure (CRF). However, significance and mechanism of CML accumulation in these patients are poorly understood. The objective of the present study was to analyze CML in soluble and collagen-binding fractions of the dermis to investigate CML deposition and formation and collagen damage related to CML accumulation in patients with CRF. Skin samples (among them autopsy samples) were obtained from 33 subjects: 8 nondiabetic CRF patients, 7 diabetic predialysis patients with CRF (CRF-DM), 7 hemodialysis patients, and 11 control subjects without either CRF or DM. The dermal samples were extracted sequentially by phosphate-buffered normal saline, pepsin, and collagenase. The extracts were referred to as the soluble fraction and the proteinase-extracted fraction (including pepsin-extracted and collagenase-extracted fractions). Our ELISA assay for CML in dermal collagen from predialysis patients with CRF (CRF and CRF-DM groups) demonstrated that the levels of CML in both the soluble fraction (containing soluble CML which was mainly determined by serum clearance) and the structural collagen-binding proteinase-extracted fraction (in which high CML levels could be a strong indication of in situ formation) were increased and could not be completely reduced after hemodialysis in CRF-DM and CRF groups. These results suggest that accumulation of CML may be due to both a low serum clearance and/or increased in situ CML formation in CRF. CML contents in the proteinase extracted fraction inversely correlated with the susceptibility of collagen to extraction by proteinases (n = 33, r = -0.59, p < 0.001). Our results provide the first biochemical evidence that CML level is increased in both the soluble and collagen-binding fractions and that increased CML level resulted in increased fractions of proteinase-resistant collagen in dermal extracts of patients with CRF.     

Nutritional assessment of children on haemodialysis: value of IGF-I, TNF-&agr; and IL-1{beta}

Background: Protein-energy malnutrition (PEM) is associated with increased morbidity and mortality in haemodialysis (HD) patients. Insulin-like growth factor I (IGF-I) has proved to be a sensitive marker of malnutrition, while interleukin-1 (IL-1{beta}) and tumour necrosis factor (TNF) have been found to be raised in catabolic states. Methods: We have investigated the nutritional status of 17 chronic renal failure (CRF) paediatric patients (8 boys, 9 girls) on maintenance HD. Eight predialysis CRF children (5 boys and 3 girls; mean creatinine 5.1±3.2 mg/dl) and 10 healthy children served as control groups. PEM was defined according to anthropometric measurements (triceps skinfold thickness (TST), mid-arm circumference (MAC), and mid-arm muscle circumference (MAMC). These were correlated with serum IGF-I, IL-1 TNF-&agr; transferrin, and albumin (all sampled before the HD session). Results: In the HD group, TST was reduced in 41.2% of the patients, whereas MAC and MAMC were reduced in 82.4 and 76.5% respectively. TST was depleted in only one of the predialysis CRF children. The degree of reduction in MAC and MAMC were 62.5 and 62.5% respectively. Median serum IGF-I level was decreased in both HD and predialysis CRF patients (205.1 interquartile range (IQR) 194.4 &mgr;g/l and 258.8 IQR 155.0 &mgr;g/l respectively) compared to the healthy children (418.0 IQR 310.5&mgr;g/l) (P=0.0009 and P=0.01 respectively). Within the HD group, IGF-I levels were lower in patients with malnutrition defined according to TST (145.0 IQR 125.5 &mgr;g/l) compared to children with normal TST (201.2 IQR 218.8 &mgr;g.l) (P=0.05). IGF-I levels of the HD patients with malnutrition according to TST was also lower than predialysis CRF patients and healthy children (P=0.04 and P=0.002 respectively). Serum IL-1{beta} was undetectable in all groups. Median serum TNF-&agr; levels were higher in HD and predialysis CRF patients compared to healthy children, albeit statistically insignificant. There was no correlation between TNF-&agr;, transferrin or albumin and anthropometric parameters. Conclusions: Our results support the high prevalence of malnutrition in CRF children, which becomes more pronounced when treatment by HD is initiated. We suggest that determination of IGF-I levels in childhood HD patients in conjunction with anthropometric measurements is useful for identification of malnutrition. We have not been able to demonstrate the catabolic effects of cytokines on this state of protein-energy malnutrition.     

Depression, Anxiety, Activities of Daily Living, and Quality of Life Scores in Patients Undergoing Renal Replacement Therapies

The aim of this study was to investigate anxiety, depression, quality of life (QOL), and activities of daily living (ADL) among our hemodialysis and renal transplant subjects. Psychological disorders were prevalent among patients with end-stage renal disease (ESRD), adversely affecting QOL and ADL. All patients ≥18 years under renal replacement therapy were asked to participate in the study. Patients completed 4 questionnaires including the Symptom Checklist-90 subscales of depression and anxiety, the Nottingham Extended ADL scale, and the Duke Health Profile questionnaire. We examined a total of 100 transplant and 63 hemodialysis patients. Transplant patients were significantly younger, better educated, and with lower morbidity than the hemodialysis patients. Transplant patients also showed less depression and anxiety as well as better ADL and physical health. Of the variance in anxiety scores, 12.2% was explained by gender and the presence of cardiac disease (P = .022). For depression, replacement therapy and gender explained 16.4% of the variance (P = .004). Replacement therapy accounted for 35.3% of the variance of the ADL score (P < .001), while together with the additional factors of age, gender, and education these 52.8% (P = .007) was accounted for. For the general health score, gender, and cardiac disease explained 11.6% of the variance (P < .001). This study demonstrated that depression and anxiety are more prevalent among hemodialysis patients compared with kidney transplant subjects; the method of treatment was a major contributor to the variance in ADL and depression scores among ESRD patients.     

Epidemiology investigation of initial hemodialysis patients in Shanxi province during 2010-2011

Objective To investigate the incidence, primary disease and vascular access of the initial hemodialysis patients in Shanxi province during 2010-2011. Methods A total of 3434 chronic renal failure (CRF) patients starting their first-time hemodialysis in Shanxi province during 2010-2011 were surveyed. Their data were registered in Chinese national renal data system. All related data were collected from Chinese national renal data system. Results In Shanxi province, 1514 cases began hemodialysis in 2010 and the annual incidence was 46.62 per million people (pmp), 1920 cases began hemodialysis in 2011 and the annual incidence was 53.44 pmp. The most common causes of CRF in these hemodialysis patients were glomerulonephritis (62.4%), diabetic nephropathy (22.0%), and hypertensive nephrosclerosis (8.1%). The most popular vascular access in CRF patients at the beginning of hemodialysis was temporary central venous catheter (48.9%), then arteriovenous fistula (40.9%). Conclusions In Shanxi province, maintenance hemodialysis patients are increasing and there are more male patients. Main causes of ESRD patients on hemodialysis are chronic glomerulonephritis, diabetic nephropathy and hypertensive nephrosclerosis. The major vascular access of CRF patients at the beginning of hemodialysis is temporary central venous catheter, which indicates that delayed hemodialysis is still a glaring problem in Shanxi province.     

Psychiatric disorders and large interdialytic weight gain in patients on chronic haemodialysis

AIMS: Psychiatric disorders have been considered in terms of non-compliant behaviour and low life quality in haemodialysis patients. The aim of this study is to investigate the potential association of psychiatric disorders with compliance of fluid restriction and nutritional status and to measure the effects of psychiatric disorders on the life quality in chronic renal failure patients on haemodialysis. METHODS: The study was conducted between April 2002 and December 2002 at a University hospital haemodialysis unit. The study population included 40 chronic renal failure patients (15 females/25 males). The Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS) and Primary Care Evaluation of Mental Disorders (PRIME-MD), The Mini Mental State Examination (MMSE) and Short Form Health Survey 36 (SF-36) were used for patient assessment by a trained psychiatrist. The subjects' medical charts were reviewed by a physician who was unaware of the the results of the psychiatric assesments. Interdialytic weight gain (IDWG %) and nutritional status were used as an index of diet compliance. Nutrition was assessed by using subjective global assessment (SGA), serum albumin, predialysis phosphorus and potassium levels. RESULTS: All patients' MMSE were normal. A diagnosis of a depressive or anxiety or somatoform disorder by the PRIME MD was made in 65% of the patients. Fourteen (35%) of the patients had a depressive disorder, 13 (32.5%) of the patients had a somatoform disorder, and 12 (30%) had an anxiety disorder. We found no relationship between any psychiatric disorder and age, sex, duration of dialysis therapy, education, marital status, employment, socioeconomic status, serum albumin, phosphorus, potassium or SGA (P > 0.05). In patients with depression or a somatoform disorder, the interdialytic weight (%) was significantly higher than those of the patients without these disorders (P < 0.05). All indices of quality of life decreased in patients diagnosed with a psychiatric disorder. CONCLUSION: Depressive symptoms are important determinants of patients' large interdialytic weight gain and psychiatric disorders that effect a patients' overall quality of life. Evaluation of psychiatric status should be part of the care provided to haemodialysis patients.