血液透析患者原发病因及高血压和贫血状况的多中心调查

目的调查佛山地区血液透析患者的原发病因及高血压、贫血状况。方法收集2012年佛山市21家医院2610例血液透析患者的基本情况、原发病因、合并高血压、贫血状况、血白蛋白水平等有关临床资料进行分析。结果佛山地区21家医院2610例血液透析患者中,其原发病分别为原发性肾小球肾炎1278例（占48．9％）、糖尿病肾脏疾病505例（占19．3％）和高血压肾损害219例（占8．4％）。梗阻性肾病、痛风性肾病、多囊肾病、狼疮肾炎、小管间质性。肾病、其他原因及原因未明者分别为191例（占7．3％）、65例（占2．5％）、60例（占2．3％）、39例（占1．5%）、26例（占1．0％）、89例（占3．4％）、138例（占5．3％）。血液透析患者高血压患者1804例,其发病率达86．6％,治疗率为83．7％,血压控制低于140／90mm Hg水平者1227例（占47.0%A）,血压控制不达标1383例（占53％）。高血压控制常需多种降压药联合应用,仅269例（占14．9％）患者应用1种降压药,应用2、3、4和5种或5种以上者分别为529例（占29．3％）、606例（占33．6％）、312例（占17．3％）和86例（占4．9％）。血红蛋白（hemoglobin,Hb）〈110g／L的患者1832例（占70．2％）,Hb≥110g／L者仅778例（占29．8％）。有493例（占18．9％）患者血浆白蛋白水平低于35g／L,有647例（占24．8％）患者血浆白蛋白水平高于40g／L。结论血液透析患者的病因主要是原发性肾小球肾炎、糖尿病肾脏疾病、高血压肾损害、梗阻性肾病,高血压和贫血控制不达标仍较突出。     

深圳单中心新发终末期肾脏疾病病因变化分析

目的 分析深圳单中心新发终末期肾脏疾病（end-stage renal disease,ESRD）患者病因变化。方法 收集首次诊断为ESRD患者853例的临床资料,分析其性别、年龄、病因等指标。结果 853例ESRD患者中,前3位病因分别为慢性肾小球。肾炎（占49．81％）、糖尿病肾脏病（占16．76％）和高血压性肾病（占8．79％）。女性糖尿病肾脏病所占比率明显高于男性（20．23％ VS 14．40％,P〈0．05）。在60～79岁患者中,糖尿病肾脏病已成为首位病因。结论 慢性。肾小球肾炎仍是ESRD的主要病因,比例无明显下降。糖尿病肾脏病比例略有增加,其中在60～79岁年龄组,已成为首位病因。     

Chronic kidney disease perspectives in Japan and the importance of urinalysis screening

There are racial differences in primary renal diseases for end-stage renal disease (ESRD) and the incidence and prevalence of cardiovascular disease (CVD). To reduce the number of patients with both ESRD and CVD, an effective screening method for CKD should be established. In Japan, screening with the urine dip-stick test for proteinuria has been used since 1972 targeting every child and worker and since 1983 for every resident over 40 years old. There are several reasons for continuing this screening program. First, the positive rate of proteinuria is high in the Japanese general population, especially subjects with neither hypertension nor diabetes. Most of these subjects have no symptoms, and the only sign of renal disease is asymptomatic urinary abnormalities. Second, the prevalence and incidence of glomerulonephritis, especially IgA nephropathy, are high in the Japanese and Asian races, and urinalysis is the only method for early detection of chronic glomerulonephritis. Third, 10-year survival of the ESRD patients due to glomerulonephritis was approximately twice that of ESRD patients due to diabetes and nephrosclerosis. Consequently, reducing the incidence of ESRD due to glomerulonephritis is one of the best ways to reduce the prevalence of ESRD. Furthermore, higher incidence of ESRD in Asian races than in Caucasians was reported. Proteinuria is known to be the best predictor for reducing renal function, and the urine dip-stick test for proteinuria is less expensive and is cost-effective. For an effective screening strategy to reduce the ESRD population in Japanese and Asians, universal screening with the urine dip-stick test for proteinuria could be one solution.     

The application status of vascular access at initiation of hemodialysis in patients with end stage renal disease—a single center study

Objective To investigate the types and outcome of vascular access in patients with end stage renal disease (ESRD) initiated hemodialysis (HD), and provide the basis for advancing the proportion of planned HD with arteriovenous fistula (AVF). Methods Clinical data, vascular access types at the initiation of HD, the outcomes of all types of dialysis access and the conversion of renal replacement therapy of ESRD patients who initiated HD in the first affiliated hospital of zhejiang university between January 2009 and December 2011 were retrospectively studied. Results A total of 836 patients were included in our study. Among them 510 were males and 326 were females. The average age was (49.77±17.65) years old. The major primary diseases were primary glomerular disease (72.73%), diabetic nephropathy (11.60%)and hypertensive nephrosclerosis (3.95%). Only 73 patients (8.73%) used AVF as the vascular access at the initiation of HD, another 763 patients (91.27%) used central venous catheter. Six months after the start of dialysis, 542 patients (81.5%) had used AVF as permanent vascular access, 123 patients (18.5%)had used the tunneled cuffed catheter, 54 patients had received a transplant and 55 patients had converted to peritoneal dialysis. The results of logistic regression analysis suggested that being male, patients from outside hangzhou and patients whose glomerular filtration rate were lower than 5 ml•min-1•(1.73 m2)-1 were the risk factors of using central venous catheters at the initiation of HD. Conclusions Only a minority of patients used AVF at the initiation of HD, but most of the other patients switched to AVF within the following six months. Increasing the proportion of AVF as the vascular access of planned HD is still our current goal.     

Hypertension in primary chronic glomerulonephritis: analysis of 288 biopsied patients

The prevalence of hypertension in 288 patients with primary chronic glomerulonephritis was compared with that observed in a control group of 3,477 subjects from the same geographic area. 23.3% of the patients and 12.8% of the general population were hypertensive (p less than 0.01). However, if only patients with normal renal function were considered, prevalence of hypertension (12.7%) was not higher than in the control group. Hypertension was more frequent in focal segmental sclerosis (30%) and in membranous glomerulonephritis (26%) than in IgA nephropathy (9%), membranoproliferative glomerulonephritis (11%) and IgM mesangial glomerulonephritis (12%). Five years after renal biopsy, 92% of normotensive and 47% of hypertensive patients remained with normal renal function (p less than 0.001). These findings suggest that the high prevalence of hypertension in chronic glomerulonephritis is related to the declining renal function. On the other hand, hypertension appears to represent a bad prognostic sign.     

Incidence of end-stage renal disease in overseas-born, compared with Australian-born, non-indigenous Australians

BACKGROUND: Barriers to immigration from non-European sources were relaxed in the 1970s. As a result, more Australians are now of Middle Eastern, Asian or Pacific Islander origin, rather than British or European. Currently, overseas-born persons comprise one-third of non-indigenous Australians with end-stage renal disease (ESRD). METHODS: Using data recorded by the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, age-standardized incidence rates were calculated for ESRD due to all causes and to certain primary renal diseases for all non-indigenous Australians who were aged over 15 years when first treated for ESRD between 1993 and 2001. Truncated age-standardized incidence rates were calculated for ESRD due to glomerulonephritis by type. RESULTS: Immigrants from the British Isles and 'rest of Europe' had less, and those from the Pacific Island nations, East/South-East Asia, Indian subcontinent, Middle East and Southern Europe more ESRD from all causes than the Australian-born. Two diseases accounted for most of the excess: Type 2 diabetic nephropathy and glomerulonephritis (the latter not significant for the Indian-born). There was a small excess (not always significant) of hypertensive/arteriopathic renal disease in Asian- and Middle Eastern-born persons. The East/South-East Asian-born had the highest rates of ESRD due to mesangial immunoglobulin A (IgA) disease and lupus nephritis, and the Middle Eastern-born the highest rates from focal sclerosing glomerulonephritis. CONCLUSION: For Australians born in the Pacific Island nations, Asia, the Middle East or Southern Europe, excess prevalence of, and/or susceptibility to, diseases that cause ESRD has more than offset any 'healthy migrant' effect.     

The incidence of treated end-stage renal disease in New Zealand Maori and Pacific Island people and in Indigenous Australians.

BACKGROUND: Although Indigenous Australians, New Zealand Maori and Pacific Island people comprise an unduly high proportion of patients treated for end-stage renal disease (ESRD) in the two countries, no population-based age- and disease-specific rates have been published. METHODS: From data provided to the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), truncated age- and sex-standardized incidence rates were calculated for treated ESRD due to all causes and by primary renal disease, in four broad age groups of Maori, Pacific Island people and all 'other' New Zealanders and Indigenous and non-indigenous Australians, for the period 1992-2001. RESULTS: The incidence of ESRD did not differ in persons aged 0-14 years. In adults, Maori and Pacific Island people had similar rates of ESRD, a little more than half those of Indigenous Australians except in persons aged 65 years and over in whom the rates were nearly equal, but two to ten times the rates in 'other' New Zealanders and non-indigenous Australians. The excess of ESRD in Indigenous Australians was due principally to type II diabetic nephropathy and glomerulonephritis (all common types except lupus nephritis), but was seen also in respect of type I diabetic nephropathy, hypertensive renal disease and analgesic nephropathy, while the excess in Maori and Pacific Island people was confined to type II diabetic nephropathy, hypertensive renal disease and glomerulonephritis (especially lupus nephritis and type I mesangiocapillary glomerulonephritis, but not mesangial IgA disease). CONCLUSIONS: The incidence and pattern of treated ESRD differs quantitatively and qualitatively between Maori, Pacific Island people and other New Zealanders, and Indigenous and non-indigenous Australians.     

Spectrum of renal failure in elderly patients

This prospective study was undertaken to study the spectrum of renal failure and the outcome in elderly patients. Patients included in the study group were elderly (age > 60 years) who either attended outpatient renal clinic and or were hospitalized. Renal failure was classified as acute renal failure (ARF), rapidly progressive renal failure (RPRF) and chronic renal failure (CRF). A total of 4255 elderly patients were seen, of these 236 (5.5%) had renal failure. Mean age was 65.1 ± 4.2 years (60–86 years). CRF was the commonest, seen in 137 (58.1%) followed by ARF 69 (29.2%) and RPRF in 30 (12.7%) patients. Diabetic nephropathy was the commonest cause of CRF, seen in 58.4% followed by chronic interstitial nephritis in 9.5% and chronic glomerulonephritis in 8.7% of patients. Of 137 patients 53 (38.7%) presented in end stage renal disease (ESRD). Of these 41 (77.3%) were initiated on maintenance hemodialysis and 12 (22.6%) on continuous ambulatory peritoneal dialysis. Only 15 patients were on dialytic support at the end of 1 year. Sepsis contributed to ARF in 75.4% of cases. Forty of 69 patients (57.9%) needed dialytic support. Forty (57.9%) were critically ill, defined as presence of two or more organ system failures (excluding renal failure). Forty two patients (60.9%) died patients. Acute interstitial nephritis (AIN) was the commonest cause of RPRF seen in 10 (33.3%) patients followed by vasculitis in 7 (23.3%). Myeloma cast nephropathy contributed towards RPRF in 20% of patients. Of 30 patients, 10 (33.3%) reached ESRD at end of 3 months of follow up, 4 (13.3%) died due to sepsis. Only 2 showed complete recovery while 14 (46.6%) had partial improvement. AIN patients had a relatively better outcome.     

End-stage renal disease in the El-Minia Governorate, upper Egypt: an epidemiological study

We had earlier conducted two cross-sectional studies on the epidemiology of endstage renal disease (ESRD) in the El-Minia Governorate. The aim of this study is to assess the prevalence, etiology and risk factors for ESRD in the El-Minia Governorate during the year 2006. Patients on renal replacement therapy (RRT), numbering 1356, were recruited into this study. A standardized questionnaire was completed including demographics, family history, risk factors for ESRD, environmental exposure to toxins, work conditions, social history and causes of death. Only 800 (59%) of the 1356 patients agreed to participate in this study. Their mean age was 46 ± 13 years, median 43 (range 18-80). The male vs. female ratio was 65% vs. 35%. The etiology of ESRD was unknown in 27%, hypertension in 20%, chronic glomerulonephritis in 11%, obstructive uropathy in 12%, bilhaziasis in 3%, analgesic nephropathy in 5%, chronic pyelonephritis in 5%, diabetic nephropathy in 8% and others, e.g. lupus in 9%. The overall prevalence of ESRD was 308 per million population (pmp). The modalities of RRT used on the study patients included hemodialysis (HD) in 1315 (97%), peritoneal dialysis (PD) in 27 (2%) and renal transplantation in 14 patients (1%). The death rate was 190/1000. Our study suggests that the epidemiology of ESRD in the El-Minia Governorate is different from that in European countries and the US and thus, region-specific interventions must be developed to control the epidemic of ESRD in the world.     

Rate of change of end-stage renal disease treatment incidence 1978-1987--has there been selection?

End-stage renal disease (ESRD) treatment rates in the United States have increased steadily since 1973. Decreasing selection against elderly patients with a poor prognostic primary cause of ESRD (i.e., diabetic nephropathy) may partly account for this increase in rates. To test this hypothesis, we calculated log ESRD treatment incidence (ESRDI) rates by four major primary causes of ESRD (diabetic nephropathy (DN), hypertensive nephropathy (HN), glomerulonephritis (GN), and cystic kidney disease (PC); two age groups (old (O), greater than 65 and young (Y), 15 to 44 yr of age) for black and white, male and female, new ESRD patients from 1978 to 1987. As predicted, summary log ESRDI slopes (produced by analysis of covariance) occurred in the following decreasing order, ODN (0.19), OGN = OHN = YDN (0.134). YHN = YPC = YGN (in white patients) = slope not significantly different from 0. Log ESRDI slopes for young black males and females with GN increased significantly between 1978 and 1987, possibly as a result of an increased incidence of GN. In conclusion, decreasing selection may be a factor in the continuing increase in the U.S. ESRD population.     

Impact of HLA on the Underlying Primary Diseases in Turkish Patients with End-Stage Renal Disease

The number of patients with end stage renal disease (ESRD) is increasing faster than the number of renal transplantations performed per year worldwide. Of the primary diseases leading to ESRD, diabetic nephropathy is the leading cause. The purpose of the present study is to investigate the association of HLA with the primary diseases leading to ESRD in Turkish patients. A total of 3230 individuals comprising 587 ESRD patients and 2643 healthy controls were enrolled into the study. Class I HLA-A, -B typing was performed by CDC method, while class II HLA-DRB1 typing was performed by low resolution PCR-SSP. We found a significant negative association between almost all A locus antigens and primary disease groups classified as chronic glomerulonephritis and hypertensive nephrosclerosis (p?<?0.05). HLA-B58 and HLA-DRB1*03 significantly correlated with amyloidosis and diabetic nephropathy, respectively. Determination of HLAs as risk factors for primary diseases leading to ESRD might be beneficial in preventing progression to ESRD and recurrence of the primary disease post-transplantation.     

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.     

Clinical Spectrum of Chronic Renal Failure in the Elderly: a Hospital Based Study from Eastern India

The aim of this study was to describe the clinical spectrum of chronic renal failure (CRF) in the elderly. The diagnosis of CRF was made using standard clinical criteria. The elderly was defined as person with over 60 years of age. In total, 200 elderly patients with CRF were evaluated between July 2002 and February 2004. Their age (male: 146; female: 54) ranged between 60 and 90 (mean 64.31 ± 4.18) years. Diabetic nephropathy was the most common (46%) cause of CRF. Hypertensive nephrosclerosis, chronic interstitial nephritis and obstructive uropathy were responsible for CRF in 18%, 14% and 13% of patients, respectively. We observed chronic glomerulonephritis in 7% of elderly CRF. Urinary tract infection (55.5%), hypovolemia (22.2%), accelerated hypertension (11.1%) and sepsis (11.1%) were responsible for acute exacerbation of renal failure in 36 (18%) patients. Associated co-morbid conditions were noted in 93 (46.5%) patients. They included; coronary artery disease 46 (49.46%), cerebrovascular disease 20 (21.50%), osteoarthritis 13 (13.97%), chronic obstructive pulmonary disease 6 (6.45%), dilated cardiomyopathy 5 (5.37%), and malignancy in 3 (3.22%) patients. Acute dialytic support was required in 164 (82%) cases and remaining 36 (18%) patients received conservative management. Mortality was noted in 25 (12.5%) cases. The coronary artery disease (48%), acute pulmonary edema (20%) and hyperkalemia (12%) were the main causes of death. Subsequent evaluation revealed that 102 (51%) patients had ESRD of which only 3 (2.94%) patients could afford CAPD. A total of 11 (10.7%) patients underwent chronic maintenance hemodialysis for 3–4 months and then discontinue dialysis mainly because of financial constraints. Remaining 88 (86.27 %) patients with ESRD were discharged from hospital after symptomatic improvement with acute dialysis. Thus, diabetic nephropathy related to type-2 diabetes was the commonest cause of CRF in our elderly patients. Chronic renal failure in elderly was associated with a number of co-morbid conditions, which contributed significantly to morbidity and mortality. Acute on chronic renal failure with severe uremic complications were an important cause of hospitalization. The financial constraint was the major limiting factor for the management of elderly ESRD patients.     

Family history of end-stage renal disease among hemodialyzed patients in Poland

BACKGROUND: In previous reports of end-stage renal disease (ESRD) patients, family history of ESRD was associated with race, younger age, higher education levels and ESRD etiology. This study aimed to analyze how often Polish caucasian dialysis patients reported relatives with ESRD, and to evaluate which risk factors are associated with family history of ESRD. METHODS: 4808 ESRD patients provided data about renal disease etiology, diabetes and hypertensive status of first- and second-degree relatives, socioeconomic status and education level. RESULTS: Reported ESRD etiologies were: chronic glomerular disease, 19.4 %; diabetic nephropathy, 11.3%; interstitial nephritris, 11.2%; hypertension, 7.8%; polycystic kidney disease (PKD), 7.1%; other or no response, 40.0%. Positive ESRD family history was reported by 745 patients (15.5%); positive history of diabetes, 932 (19.4%); hypertension, 1904 (39%). Positive ESRD family history according to kidney disease etiology was: PKD, 53.1%; glomerulonephritis, 12%; diabetic nephropathy, 11.9%; hypertension, 11.8%; interstitial nephritis, 10.8%. PKD as ESRD etiology (odds ratio (OR) 8.06, 95% confidence interval (CI) 6.35-10.23, p < 0.0001), positive family history of diabetes (OR 1.64, 95% CI 1.34-1.99, p < 0.0001) and positive history of hypertension (OR 1.64, 95% CI 1.39-1.95, p < 0.0001), were independently associated with positive ESRD history. Patients with later ESRD onset had a less frequent positive ESRD family history: for ESRD < 45 yrs, 16% (OR 1.0); 45-64 yrs, 14.4% (OR 0.83, 95% CI 0.70-0.99); > or = 65 yrs, 9.2 % (OR 0.5, 95% CI 0.35-0.72). CONCLUSIONS: Results of our study strongly support the contention that familial predisposition contributes to ESRD development.     

Genetic polymorphisms of the renin-angiotensin-aldosterone system in end-stage renal disease.

BACKGROUND: Hypertension contributes to the progression to renal failure. A genetic susceptibility to hypertension may predispose to the development of end-stage renal disease (ESRD) and promote a more rapid progression to ESRD in patients with renal diseases. Genes encoding for angiotensinogen (AGT), angiotensin-converting enzyme (ACE), and aldosterone synthase (CYP11B2) are candidates for abnormal blood pressure regulation. METHODS: Genotyping was performed in 327 control subjects and 260 ESRD patients for the M235T-AGT, the insertion/deletion (I/D)-ACE, and the -344T/C-CYP11B2 gene polymorphisms using polymerase chain reaction, gel analysis, and appropriate restriction digest when required. RESULTS: Genotype frequencies did not differ significantly between ESRD patients and controls. When ESRD diabetic subjects were compared with diabetic patients without nephropathy, the prevalence of the AGT-MM genotype was lower (28.1 vs. 52.8%, P < 0.01), while the AGT-TT genotype was higher (15.6 vs. 2.7%, P < 0.05). The AGT-TT genotype was associated with a faster progression to ESRD in patients with glomerulonephritis (P < 0.05). In the total ESRD population, progression of renal disease was faster with the ACE-DD than with the DI and II alleles (P < 0.05). This association was particularly strong when the interaction with the AGT genotype was analyzed, with a rapid progression in ACE-DD as compared with ACE-DI and II in patients with the AGT-MM genotype (P < 0.01). CONCLUSIONS: Susceptibility for ESRD and faster progression to ESRD are linked with the AGT genotype in diabetic patients. Faster progression to ESRD is associated with the ACE genotype when the total population with ESRD and with the AGT genotype when patients with glomerulonephritis are considered. Thus, genes of the renin-angiotensin-aldosterone system are candidate genes for further understanding of the interindividual differences in the development and course of ESRD.     

A comparison of survival among dialytic therapies of choice: in-center hemodialysis versus continuous ambulatory peritoneal dialysis at home

Analyses were performed on a series of 2,754 dialysis patients between the ages of 20 and 60 years whose end-stage renal disease (ESRD) therapy started in Michigan from 1980 through 1987 with the selection of either center hemodialysis (CH) or continuous ambulatory peritoneal dialysis (CAPD). The dialytic treatment at 6 months after first ESRD therapy was selected as the dialytic "treatment of choice" for each patient. Analyses of subsequent survival showed lower death rates for black patients than for white patients with hypertension (P less than 0.01) and diabetes (P less than 0.01). Death rates increased with patient age more dramatically among glomerulonephritis patients than among the other diagnostic groups (P less than 0.05). Females had significantly lower death rates than did males among diabetic patients (P less than 0.01). While no significant difference was found in average death rates between CH and CAPD (NS), there was a significant difference (P less than 0.05) in the trend in death rates. Death rates among CH patients increased significantly (P less than 0.001) during the study period, whereas death rates among CAPD patients have improved slightly (NS).     

Clinical correlates of hypertensive end-stage renal disease

Although there has been much discussion regarding the etiology of hypertensive renal disease, clinical characteristics of this condition have not been thoroughly studied. The purpose of this investigation was to identify clinical correlates of hypertensive end-stage renal disease (ESRD) in a population of patients older than 50 years and to compare these clinical findings with those in a group of ESRD patients with certain known disorders (established diagnoses). Data regarding demographics, cause of ESRD, educational level, presence of diabetes mellitus, angina, myocardial infarction, and peripheral vascular disease were obtained from the Southeastern Kidney Council for patients starting renal replacement therapy between January 1, 1990, and August 1, 1996. Clinical characteristics were compared for white and black patients. Demographic variables and comorbid conditions were compared between groups with general linear regression or logistic regression contrast techniques. A logistic regression model was formed with hypertensive ESRD or established diagnoses as the outcome variable and comorbid and socioeconomic variables as the independent variables. Hypertensive ESRD was diagnosed in 24% of white and 38% of black patients, while established diagnoses were present in 17% of white and 7% of black ESRD patients. The most common established diagnoses were polycystic kidney disease, specified glomerulonephritis, and nephrolithiasis or obstruction. In a logistic regression model, white patients were found more likely to be classified as having hypertensive ESRD if they were older, suffered from angina and other forms of atherosclerosis, smoked, and were less educated. White patients with hypertensive ESRD were more than 2.4 times as likely to suffer from angina as patients with established diagnoses. For black patients, the presence of peripheral vascular disease and female gender were associated with an increased chance of being diagnosed as having hypertensive ESRD. The results of this investigation show that there is a strong association between atherosclerosis and hypertensive ESRD in older white patients. In black patients, the association between atherosclerosis and hypertensive ESRD was also present, but not as strong. The unique association of hypertensive ESRD with atherosclerosis suggests that atherosclerosis is a risk factor for chronic renal failure and that a primary renal microvascular disorder may lead to both hypertension and progressive renal insufficiency.     

Patterns of end-stage renal disease in US African-Americans

Summary: Although African-Americans constitute only about 12.4% of the population of the United States of America (USA), they comprise over 30% of the end-stage renal disease (ESRD) patient population. Diabetes mellitus (predominantly type 2) is the most frequently reported cause of ESRD in all racial and ethnic groups in the USA. However, hypertensive renal disease is reported as the dominant cause of ESRD in African-Americans. In general, all racial and ethnic minority groups in the USA have greater incidence and prevalence rates of ESRD than Caucasians. However, survival probabilities in all ESRD patients, dialysis patients, and cadaveric renal allograft recipients are greater in African-Americans than in Caucasians. the suggested reasons for these racial and ethnic disparities are discussed.     

温州市1999-2006年血液透析状况及其变化调查

目的 了解温州市1999-2006年血液透析状况及其变化。 方法 收集1999年1月至2006年12月温州市18家医院血液透析中心的数据，回顾性研究温州市终末期肾脏疾病（ESRD）血液透析(HD)患者发病人数、患病人数和死亡人数，原发疾病构成及其相关因素的变迁。 结果 温州市血液透析患者年发病人数、患病人数逐年增加，年死亡人数相对稳定。各年度患者男性均多于女性，但男女比例有逐年下降趋势；青年组、老年组有增长趋势。慢性肾炎导致的ESRD的比例虽然在逐年下降，但仍然是ESRD血液透析的主要病因。糖尿病和高血压所占比例在逐年上升。血液透析患者透析龄的构成比，1~2年组逐年下降，<1年、2~3年、3~4年组均相对稳定，4~5年、5~10年、>10年组均呈增长趋势。肾移植及改作腹膜透析人数逐年均有所增长。心血管事件居死因之首,占19.9%；第2、3位为脑血管意外与全身衰竭，各占10.8%；第4位为出血性疾病，占4.7%；第5位为感染性疾病，占4.3%。1999-2006年心血管、脑血管事件构成比均相对稳定；全身衰竭、出血性疾病则波动较大；感染、营养不良所占比例有下降趋势。 结论 温州市血液透析患者数量在逐年增加，呈年轻化和老年化趋势现象。慢性肾炎仍然是主要病因，糖尿病和高血压所占比例在逐年上升。血液透析患者长期存活率逐年提高。首要死亡原因为心血管事件。     

End-stage renal disease and renal replacement therapy in Kuwait--epidemiological proffle over the past 41/2 years

Data on end-stage renal disease (ESRD) patients in Kuwait werecollected retrospectively and prospectively starting in mid-1988.The study period covered 4 years from 1 January 1986 to 30 June1990. Epidemiological characteristics of ESRD patients and theirdisposal by dialysis and transplantation were analysed and comparedwith previous reports from Kuwait, neighbouring countries, Europe,and USA. A total of 647 patients received renal replacementtherapy (RRT) in Kuwait during the study period. This gave anincidence rate of 72 patients per year per million of population.The prevalence rate for patients on maintenance dialysis was80.6 per million population in mid-1988. Nearly one-fifth oftotal patients (19.6%) were older than 60 years of age and one-third(30.8%) were identified as ‘high risk’ category.As for Kuwaiti nationals alone on RRT 29.7% were above 60 yearsof age and 44.2% were high-risk patients. We have noticed asteady decline in the number of patients who accepted continuousambulatory peritonial dialysis (CAPD) for dialytic support. Chronic tubulointerstitial disease resulting from atrophic pyelonephritiswas the leading cause of ESRD amongst both Kuwaiti nationalsand expatriates. Though diabetic nephropathy was only the thirdlead ing cause of ESRD (14.7%) in the total population, it wasmore frequent (21.2%) among Kuwaitis. The gross mortality rateon dialysis was 14.7%. The major causes of death were relatedto cardiovascular diseases (60%) and sepsis (24.2%). Our analysisshowed that age of the patient at admission to dialysis contributedto overall mortality, but it was not an isolated risk factorwhereas diabetic nephropathy (relative risk 1.9) and associatedserious co-morbid illness/es (relative risk 30.3) were. Despitestrict precautionary measures in the dialysis units and earlyuse of erythropoietin, 68 new patients were detected to be HBsAgpositive, 85% of whom remained persistently antigenaemic formore than 6 months. At follow-up 9.8% (4/41) had died of liverfailure. The 50 months patient survival for patients who received unrelatedkidney transplantation (abroad) was lower than in those whoreceived live related kidneys in Kuwait. The most distressingobservation was, however, the very high patient loss associatedwith imported cadaver kidneys transplanted in Kuwait comparedto those who received cadaver kidneys harvested locally (65%versus 94.8% respectively at 16 months).