Survival analysis of Korean end-stage renal disease patients according to renal replacement therapy in a single center

This study was to investigate clinical characteristics and any differential trends in survival among renal replacement therapy (hemodialysis [HD], peritoneal dialysis [PD], and kidney transplantation [KT]) in Korean end-stage renal disease (ESRD) population. We tried to analyze retrospectively the survival rate adjusted by risk factors and the relative risk stratified by key risk factors among 447 ESRD patients who began dialysis or had a kidney transplant at Ajou University Hospital from 1994 to 2004. In adjusted Cox survival curves, the KT patients had the best survival rate, and the HD patients had better survival than PD patients. The consistent trends in different subgroups stratified by age and diabetes were as following: 1) The risk of death for PD and HD was not proportional over time, 2) The relative risk of PD was similar or lower than that of HD for the first 12 months, but it became higher at later period. The significant predictors for mortality were age (over 55 yr), presence of diabetes, cerebrovascular accident at ESRD onset, and more than one time of hospitalization caused by malnutrition. Further large-scaled, multicenter-based comparative study is needed in Korean ESRD patients and more meticulous attention is required in high-risk patients.     

Comparative study of renal replacement therapy in Korean diabetic end-stage renal disease patients: a single center study

The number of diabetic ESRD patients has increased and death rates of diabetic patients on hemodialysis (HD), peritoneal dialysis (PD) and renal transplantation (RT) have remained higher than the death rate of non-diabetic patients. An attempt was made to compare the clinical characteristics, patients' cumulative survival, and technical survival among the three groups retrospectively according to the mode of renal replacement therapy(RRT), and to analyze the risk factors associated with mortality. A total of 229 diabetic ESRD patients diagnosed between 1986 and 1995 at the Severance Hospital who began dialysis or who underwent a kidney transplant were included and their medical charts were reviewed. Hypertension was the most common co-morbid disease in all study groups. The prevalence of cardiovascular disease was the only co-morbid condition that was significantly different among the three groups, which was highest in the PD group (24.4%) and lowest in the RT group (8%). In the analysis of a patient's cumulative survival rate not adjusted for age and sex, the RT group had the highest survival rate, and the cumulative survival rate of the HD and PD group were similar. The 5-year survival rate of the patients treated with HD, PD and RT was 28.8%, 19.8%, and 72.0%, respectively. No differences were observed in the patient's cumulative survival rate between the HD and PD patients even when it was adjusted for age. When adjusted for age, sex and risk factors, the relative death rate of the RT group was significantly lower in male patients younger than 60 years of age. With the exception of male patients younger than 60 years of age, the PD group showed a slightly lower relative death rate although it was not significant. The multiple Cox regression analysis of patient survival showed that age, serum albumin, BUN, mean hospital days, the presence of cardiovascular disease at the initiation of RRT were associated with mortality. The analysis of the technique survival rate revealed a better result in the HD group compared to PD group, but a limitation in being able to investigate the AVF function disturbed the accuracy of the analysis of technical survival rate. In conclusion, the survival rate between the PD and HD patients was not different and the RT group had the best survival rate. Therefore, kidney transplantation in diabetic ESRD patients should be considered positively if no other contraindicated condition for RT exit.     

The evolution of lupus activity among patients with end-stage renal disease secondary to lupus nephritis

The aim of this study was to evaluate the evolution of lupus activity in end-stage renal disease (ESRD) patients due to lupus nephritis and to determine the long-term prognosis. We reviewed the clinical courses of 45 patients with ESRD due to systemic lupus erythematosus (SLE). We analyzed the course of SLE following the onset of ESRD, with special attention to the clinical and serological manifestations, survival time on dialysis, and renal transplantation outcome. Disease activity was measured using the SLE Disease Activity Index (SLEDAI). Of the 45 patients, 21 patients were being treated with hemodialysis (HD), 11 were undergoing peritoneal dialysis (PD), and 13 underwent transplantation. Duration of follow- up was 53 +/- 29 months. The SLEDAI score on commencement of renal replacement therapy was not significantly different among the 3 groups (HD: 4.2 +/- 4.2, PD: 4.3 +/- 2.3, Transplant: 3.2 +/- 1.9). However, disease activity scored by follow-up maximal SLEDAI during dialysis or transplantation showed a significant increase after peritoneal dialysis (HD: 5.0 +/- 3.6, PD: 7.4 +/- 3.7, Transplant: 2.2 +/- 1.7, p < 0.05). When the individual changes in the maximal SLEDAI score were considered, a significant increase was apparent after peritoneal dialysis (p < 0.05), but not after either hemodialysis or renal transplantation. There was no significant difference in cumulative survival rate, and also in technique or graft survival rates of the 3 groups. Among the variables tested, follow-up maximal SLEDAI score was the only significant factor associated with patient survival (odds ratio: 1.15, p < 0.05). The incidence (36% versus 19%) of high disease activity was greater, but not significantly, in the peritoneal dialysis group, as compared to the hemodialysis group. Clinical activity of SLE was apparent in 65% of patients in the first year of dialysis, but none showed any activity after the third year of dialysis. We found that although lupus disease activity declined after patients progressed to ESRD, lupus disease activity still affected patients' survival. An incremental increase in postdialysis lupus activity was not uncommon, especially during the first one year of dialysis. During the follow-up period, maximal SLEDAI score increased significantly after peritoneal dialysis. However, the long-term prognosis was not significantly different according to the treatment modality.     

Five-year survival in comparable HD and PD patients: one center's experience

Several studies have yielded conflicting results regarding morbidity and mortality in peritoneal dialysis (PD) and hemodialysis (HD) patients. We performed a retrospective analysis in end-stage renal disease (ESRD) patients in our department, who were equally distributed between HD and PD, in order to compare 5-year survival probabilities and hospitalization rates in the two modalities. Of the total 94 new ESRD patients who initiated dialysis in our department from January 1995 to December 2000, 48 were allocated to PD and 46 to HD. All patients were followed up for five years. There were no significant differences regarding demographics and serious co-morbidities upon dialysis initiation between HD and PD patients. Unadjusted 5-year survival probability in as-treated analysis was higher in PD patients (0.79 vs 0.6, p=0.04), whereas there was no significant difference in intent-to-treat analysis between HD and PD patients (p=0.5). Hospitalization rates were similar in both modalities. Despite the small number of patients included in our study, it seems that when HD and PD are both available in one department they have equivalent results regarding morbidity and mortality rates. Therefore we suggest that, when possible, PD and HD should be equally offered to all ESRD patients.     

Elder Patients - What is the Best Vascular Hemodialysis Access?

BackgroundThe incidence of end stage renal disease (ESRD) has increased in recent years. Elderly patients constitute the most rapidly growing group who need renal replacement therapy. In 2003, persons over 65 comprised 35% of all hemodialysed patients in Poland, and by the end of 2005 more than 44%.MethodsFrom January 1984 through July 2004, patients 65 or older (n = 133) starting hemodialysis (HD), were considered. The study group consisted of 80 men and 53 women (mean age 71.8 ± 4.9 years). Patients-survival probability, primary, primary-assisted, and secondary patency of the vascular access (VA) were calculated using Kaplan-Mayer curves and log-rank analysis. Cox's proportional-hazards model was used to assess the influence of risk factors on VA patency.ResultsA total of 196 VAs were created. Of the 108 native arteriovenous fistulas (AVF) created, 24 were radiocephalic (RCAVF), 15 were brachiobasilic (BBAVF), and 64 were brachiocephalic (BCAVF). Arteriovenous grafts (AVG) were used in 35 patients and permanent tunneled cuffed catheters (PTCC) in 53. Secondary patency at 1-year was: 49% for native AVF, 62% for AVG, and 19% for PTCC. The survival rate of the 133 elderly patients was 63% at 1-year, 50% at 2 years, and 26% at 5 years.ConclusionPeople 65 and older are a predominant population in whom HD can preserve life. In elderly patients AVG had the best secondary patency. When limited life expectancy was taken into consideration AVGs were a good alternative for vascular access in hemodialysis.     

Comparing Survival between Peritoneal Dialysis and Hemodialysis Patients with Subclinical Peripheral Artery Disease: a 6-Year Follow-Up

Peripheral artery disease (PAD) is known to be an increased mortality risk in patients with end-stage renal disease (ESRD). The aim of this study was to compare patient survival between patients with subclinical PAD undergoing peritoneal dialysis (PD) and hemodialysis (HD). Subclinical peripheral artery was defined as an ankle-brachial index of less than 0.9. This study was conducted from April 2005, and the observation period ended on 30 June 2011. At the end of the follow-up, the status of all patients was assessed and data on mortality were obtained for the entire cohort. A total of 91 patients (61 HD and 30 PD) were included for analyses in this study. Mortality rate was 60.0% (18/30) for PD and 52.5% (32/61) for HD. Kaplan-Meier estimate demonstrate that PD patients had a higher mortality rate than those underwent HD (log-rank p = 0.0039). Cox regression model demonstrated that PD was an independent predictor for further mortality in ESRD patients with subclinical peripheral artery disease.(p = 0.012, HR: 1.776, 95% CI: 1.136-2.775). In multivariate analysis, the HD group still had a greater survival than PD group (p = 0.005, HR:1.916, 95% CI: 1.218-3.015). In patients with subclinical peripheral artery disease, the patient survival is better in HD patients as compared with PD patients.     

血液透析和肾移植患者的生存质量比较

目的 对比血液透析（HD）和肾移植（KT）病人现阶段的一般情况、睡眠状况、回归工作的情况和现阶段的生活质量，为临床医生和患者选择替代疗法提供更多有用的信息和依据．方法 对上述2组患者通过门诊、信件及电话追踪等随访方式获得患者现阶段的一般情况、工作情况、平均血红蛋白浓度和现阶段生活质量（SF-36）等资料，进行总结、分析和统计学处理．结果 共获得75例的资料，其中KT组40例，HD组35例；KT组的年龄较HD组组年轻（P=0．001），而在性别、文化程度和原发疾病等方面无差别；KT组的一般情况、回归工作情况、血红蛋白浓度和SF-36量表的6个维度上优于HD组．结论 在生存质量方面，肾移植成功者在整体上优于HD，肾移植是较好的肾脏替代疗法．     

The Efficacy of Mycophenolate Mofetil in Remission Maintenance Therapy for Microscopic Polyangiitis and Granulomatosis with Polyangiitis

PurposeThe present study compared the efficacy of mycophenolate mofetil (MMF) with that of azathioprine (AZA) in Korean patients with microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA).Materials and MethodsThe medical records of 69 patients with MPA and GPA who received cyclophosphamide and subsequently received AZA or MMF for remission maintenance therapy were reviewed. All-cause mortality, relapse, end-stage renal disease (ESRD), cerebrovascular accident, and cardiovascular disease were evaluated as poor outcomes. Having a lower Birmingham Vasculitis Activity Score (BVAS) was defined as the lowest tertile of BVAS (BVAS ≤11 in this study).ResultsIn comparative analysis of the occurrence of poor outcomes among patients taking AZA only, MMF only, and MMF after AZA, patients taking MMF only exhibited a significantly lower cumulative ESRD-free survival rate than patients taking AZA only (p=0.028). In terms of ESRD occurrence between the groups based on BVAS at diagnosis, among patients with MPA and GPA with higher BVAS at diagnosis, patients taking MMF only exhibited a significantly lower cumulative ESRD-free survival rate than those taking AZA only (p=0.047). Among patients with MPA and GPA with the lowest tertile of BVAS at diagnosis, cumulative ESRD-free survival rates did not differ.ConclusionWith regard to ESRD occurrence, the efficacy of MMF in remission maintenance therapy was less effective than AZA in patients with MPA and GPA. However, among patients with lower BVAS, there was no difference in the occurrence of poor outcomes between patients taking MMF and those taking AZA.     

The burden of chronic kidney disease in systemic lupus erythematosus: A nationwide epidemiologic study

ObjectiveTo analyze the impact of chronic kidney disease (CKD) on major clinical outcome in SLE by using a nationwide database.Patients and methodsCharacteristics of all admitted SLE patients experiencing CKD (eGFR <60 mL/min/1.73 m2) in France from 2009 to 2015 were analyzed through the French medico- administrative database. Factors associated with CKD and major clinical outcomes such as end-stage renal disease (ESRD), cardiovascular event (CVE), septic shock and death were assessed. We used a multivariate Cox proportional hazard model and subdistribution hazard models to analyze survival without major clinical events according to the presence of CKD.ResultsFrom 2009 to 2015, 26,320 SLE patients were hospitalized in France. Among them, 6439 (86.5% women; mean age 45.7 [16.5] years old) had a baseline stay in 2009 during which CKD was reported in 428 (6.7%) cases. Multivariate analysis showed that lupus nephritis (OR 6.6 [5.2–8.4]), high blood pressure (OR 3.5 [2.8–4.5]), septic shock (OR 3.2 [1.7–6.0]) and past cardiovascular history (OR 1.4 [1.0–2.0]) were associated with CKD status. From 2009 to 2015, ESRD, CVE, septic shock, and death occurred in 4.0%, 14.4%, 6.3% and 9.6% of the 6439 SLE patients. CKD at baseline was independently and strongly associated with the occurrence of ESRD (sdHR 15.9 [11.6–21.9]), CVE (sdHR 1.7 [1.4–2.2]), septic shock (sdHR 2.1 [1.5–2.8]) and death (HR 1.7 [1.3–2.2]) during the follow up.ConclusionCKD is a major risk factor for overall morbidity and mortality in SLE patients, highlighting the need for early pre-CKD lupus nephritis diagnosis and treatment.     

The Relationship between Magnesium and Endothelial Function in End-Stage Renal Disease Patients on Hemodialysis

PurposeChronic kidney disease (CKD) patients tend to have higher serum magnesium values than healthy population due to their positive balance of magnesium in kidney. Recent studies found that magnesium level is positively correlated with endothelial function. Therefore, this study was conducted to define the relationship between magnesium level and endothelial dysfunction in end stage renal disease (ESRD) patients on hemodialysis (HD).ResultsIn the univariate analysis, higher magnesium levels were associated with better endothelium-dependent vasodilation (EDV) of the FMD in ESRD patients on HD (r=0.516, p=0.007). When the participants were divided into two groups according to the median magnesium level (3.47 mg/dL), there was a significant difference in EDV of FMD (less than 3.47 mg/dL, 2.8±1.7%; more than 3.47 mg/dL, 5.1±2.0%, p=0.004). In multivariate analysis, magnesium and albumin were identified as independent factors for FMD (β=1.794, p=0.030 for serum magnesium; β=3.642, p=0.012 for albumin).ConclusionThis study demonstrated that higher serum magnesium level may be associated with better endothelial function in ESRD patients on HD. In the future, a large, prospective study is needed to elucidate optimal range of serum magnesium levels in ESRD on HD patients.     

The association of diabetes with all-cause mortality in patients with end-stage renal disease compared to the general population in Poland – a comparative analysis

IntroductionEnd-stage renal disease (ESRD) is an important complication of diabetes, which is the leading cause of ESRD worldwide. The aim of the study was a comparative analysis of all-cause mortality in patients with ESRD with diagnosed diabetes mellitus (DM) and no diagnosed DM.Material and methodsData for the analysis were obtained from the resources of the Polish National Health Fund, and they concerned patients with end-stage renal disease from the entire population of Polish patients in the period from 1.01.2011 to 31.12.2013. In addition, the period from 1.01.2012 to 31.12.2012 was analysed for two subpopulations: diabetic and non-diabetic patients.ResultsThe all-cause mortality in patients with end-stage renal disease in Poland per 100,000 representatives of the general population was 17.7, 15.9, and 12.50 persons in 2011, 2012, and 2013, respectively. The all-cause mortality rates for patients with ESRD and diabetes in Poland in 2012 were more than 15 times higher, for both men and women, than the all-cause mortality rates for non-diabetic patients with ESRD. Mortality in the study group of diabetic men with ESRD amounted to 147.59 ±29.07/100,000 men, whereas in the study group of diabetic women with ESRD it was 105.13 ±26.77/100,000 women. Regarding non-diabetic men with ESRD and non-diabetic women with ESRD, mortality amounted to 9.58 ±6.29/100,000 and 6.87 ±2.27/100,000 men and women, respectively.ConclusionsThe occurrence of diabetes in patients with ESRD significantly increases the risk of death compared to patients with ESRD without diabetes.     

PRURITUS AND HLA IN HEMODIALYSIS PATIENTS

Hepatitis C virus (HCV) infection is known to increase morbidity and mortality in the dialysis population. Renal transplantation is an offered treatment option after a careful pretransplant evaluation. This study assessed the impact of HCV infection on patient and allograft survival rates in a selected group of dialysis patients and kidney transplant recipients.
The study included 252 end-stage renal disease patients who were receiving hemodialysis (HD) treatment or who received renal transplantation at our centre in 1995–96. Of the total, 116 [94 HCV (–) and 22 HCV (+)] underwent transplantation and 134 [106 HCV (–) and 30 HCV (+)] remained on HD. We retrospectively investigated 5 years of follow-up findings in the records of these patients. All 22 HCV (+) individuals underwent liver biopsy to ensure there was no advanced liver disease before transplantation. None of the recipients or HD patients showed decompensation related to liver disease during follow up.
The overall 5-year patient survival rates for the kidney recipient and HD groups were 85.2% and 74.5%, respectively. Comparison of outcomes for the HCV (+) recipients had a significantly higher 5-year survival rate than the HCV (+) HD patients ( P <0.04). The 3-year graft survival rates for the HCV (+) and HCV (–) transplant recipients were comparable, but the risks of chronic rejection and graft loss at 5 years were higher in the HCV (+) group ( P <0.02, P <0.006, respectively). In conclusion, renal transplantation should be the preferred therapy in HCV-infected dialysis patients because it improves the survival rates. HCV infection is associated with increased rates of chronic rejection and graft loss at 5 years post-transplantation.     

Appraisal of lung cancer survival in patients with end-stage renal disease

IntroductionThe survival outcome of lung cancer patients with end-stage renal disease has been poorly studied in the literature. In this study, we evaluated the effect of end-stage renal disease on lung cancer survival.Material and methodsA retrospective, multicenter, matched-cohort study of lung cancer patients with end-stage renal disease under renal replacement therapy (WITH-ESRD) and without end-stage renal disease (WITHOUT-ESRD) was performed. One WITH-ESRD patient was matched to four WITHOUT-ESRD patients.ResultsBaseline clinical characteristics did not differ statistically significantly after matching between the WITH-ESRD and WITHOUT-ESRD groups. WITH-ESRD included 133 patients and WITHOUT-ESRD included 532 patients. Kaplan-Meier survival analysis demonstrated no significant difference in median overall survival between WITH-ESRD patients and WITHOUT-ESRD patients (7.36 months versus 12.25 months, respectively, p = 0.133). Lung cancer WITH-ESRD patients receiving medical treatment had a median overall survival of 5.98 months (95% CI: 4.34–11.76) compared to 14.13 months (95% CI: 11.30–16.43) for WITHOUT-ESRD patients, p = 0.019. Although patients receiving surgical treatment compared to those receiving medical treatment had an improvement of survival by 46% (HR = 0.54, 95% CI: 0.19–1.53, p = 0.243), the difference did not reach statistical significance. Cox regression analysis revealed that male gender and stage IIIA-IV were independent factors associated with poor outcome for WITH-ESRD patients.ConclusionsIn our limited experience, the survival for lung cancer with ESRD is not inferior to lung cancer patients without ESRD. The reasons for poor survival for the WITH-ESRD medical treatment group and late diagnosis despite frequent medical visits merit further investigation.     

The pattern,clinical characteristics and outcome of ESRD in Ile-Ife,Nigeria: Is there a change in trend?

Background

The prevalence of chronic renal failure and End Stage Renal Disease (ESRD) has remained high worldwide and the epidemiology has changed significantly in the last decade in industrialised countries. While there have been significant improvements in these patient''s outcomes in developed countries, their state and survival is still appalling in developing countries.

Objective

To determine the clinical pattern, presentation and management outcomes in our ESRD population over a 19-year period (1989–2007).

Methods

Seven hundred and sixty patients'' records were reviewed. Data on major causes, clinical presentation, management and survival were retrieved and collated. Data was analysed using SPSS package version 16.

Results

Their ages ranged between 15–90 years (mean ± SD; 39.9±1.67years) with male preponderance (70.3%). Major presenting complaints were body swelling and uraemic symptoms in most studied patients. The predisposing conditions included chronic glomerulonephritis, hypertension, obstructive uropathy and diabetes mellitus. Renal replacement therapy offered included HD in 556(73.2%), Continous Ambulatory Peritoneal Dialysis (CAPD) in only 9(1.2%) patients and renal transplantation in only 7(0.9%). Only 38(6.8%) survived on HD for longer than three months while 7(77.8%) CAPD patients and all transplanted patients survived for between six months and four years (p<0.00001). Median duration of survival after diagnosis for all the patients was 2 weeks (range 0–50 months).

Conclusion

End stage renal disease is still prevalent with chronic glomerulonephritis and hypertension being the common causes. Prognosis is still grave hence subsidized renal replacement therapy and preventive nephrology should be targeted in such underserved populations.     

Lupus nephritis: clinicopathological study of 162 cases in Thailand

One hundred and sixty two cases of lupus nephritis biopsied over three years in Thailand were studied. A pattern of clinical and histological renal disease very similar to that seen in the United States or Europe emerged. The predominant histological type was World Health Organisation class IV (diffuse proliferative; 58.6%). Patients with renal insufficiency (creatinine greater than or equal to 2 mg/100 ml) or hypertension at the time of biopsy had a considerably worse three year survival. Certain features such as sclerotic glomeruli, tubular atrophy, and an interstitial mononuclear cell infiltrate were significantly associated with a worse outcome (0.05 greater than p greater than 0.01), and patients who died with poor renal function had significantly higher chronicity scores than those in other groups (p less than 0.05). These findings emphasise the importance of chronic renal damage in the morbidity and mortality of patients with lupus nephritis.     

Class III-IV proliferative lupus nephritis and pregnancy: a study of 42 cases

PROBLEM: A growing number of women with lupus nephritis wish pregnancy. Our aim was to analyze maternal and fetal outcome in pregnancies with the most severe forms (proliferative or class III-IV) of lupus nephritis. METHOD OF STUDY: Forty-two pregnancies in 35 women with class III or IV lupus nephritis confirmed by renal biopsy (group 1); 12 pregnancies in 10 patients having histologically proven lupus nephritis class II or V (group 2); and 54 pregnant women randomly selected among our cohort of pregnant lupus patients without nephropathy who were matched for age, parity and duration of lupus to patients with class III or IV lupus nephritis (group 3) were studied. RESULTS: Pregnancy outcome and mean gestational age of neonates were similar in the three groups studied with hypertension and preeclampsia, being significantly more prevalent in patients in group 1 (37.1%) than among patients in groups 2 (11.1%) and 3 (11.6%) (P < 0.05). Mean birthweight (+/-S.D.) was significantly lower in group 1 (2214 +/- 802 g) than in groups 2 (2783 +/- 721 g) and 3 (2870 +/- 835 g) (P < 0.05). CONCLUSION: Lupus nephritis class III-IV is a risk factor for hypertensive disease during pregnancy, but it does not contraindicate gestation.     

Retrospective analysis of patients with lupus nephritis: data from a large clinical immunological center in Hungary

The aim of this study was to review the development, histological type and outcome of 117 patients with lupus nephritis managed and followed by the Division of Clinical Immunology, 3rd Department of Internal Medicine, University of Debrecen, Debrecen, Hungary. The method used was a retrospective study in 117 patients with lupus nephritis followed between 1974 and 2004. The average occurrence of lupus nephritis was 3 (women) and 4.4 (men) years later after the diagnosis of systemic lupus erythematosus, 43 (46.2%) patients had class IV lupus nephritis. The initial therapy was intravenous cyclophosphamide treatment for 6 months in 37 (31.6%) patients. End-stage renal disease had developed in nine (7.6%) patients. The 5-year survival rate was 99.1%. Despite the well-known and proved risk factors like hypertension, high serum creatinine, renal failure at onset or membranous glomerulonephritis, the outcome of the disease in our patient population was more favourable than one would expect according to the data available in the literature. The authors would like to draw attention to the importance of systematic care of patients with systemic lupus erythematosus, which may lead to a better clinical outcome.     

Cytomegalovirus infection in patients with lupus nephritis: clinical and laboratory features and therapeutic considerations

To better clarify the clinical features and therapeutic strategy of CMV infection in lupus nephritis patients, we retrospectively surveyed a total of 40 lupus nephritis patients, who had been hospitalized and underwent renal biopsy and diagnosed as having CMV infection during their hospitalization at our institution within the last 10 years. The percentage of CMV infections in the entire hospitalized lupus nephritis population was 5.3% (40/755). The principal clinical features of the 40 CMV-infected patients were hematological disorders (n = 25), fever (n = 21), liver dysfunction (n = 19), and respiratory symptoms (n = 12). Active SLE (SLEDAI 16 ± 5), hypertriglyceridemia (3.16 ± 2.57 mmol/L), and a history of potent immunosuppressive therapy were commonly observed in this patient group. There were no significant differences of SLEDAI (P = 0.290), proteinuria (P = 0.065), hematuria (P = 0.497), CL_CR (P = 0.463), and the distribution of histopathologic classes between patients with symptomatic and asymptomatic infection. Ganciclovir was administered in 33 cases; in patients with symptomatic infection, the improvement in CMV symptoms was not observed until ganciclovir was administered, while in asymptomatic patients, no treatment benefit was observed as for survival, the duration of hospital stays, and the number of patients who progressed from asymptomatic to symptomatic infection. In conclusion, CMV infection is not rare in lupus nephritis patients. SLE activity and renal clinical and pathological features between patients with symptomatic and asymptomatic infection are of no significant difference. Although therapy consensus guideline is still lacking, we observed no treatment benefit for the asymptomatic patients.     

Improving Survival Rate of Korean Patients Initiating Dialysis

Purpose

The aim of this study was to investigate whether the survival rate among Korean dialysis patients changed during the period between 2005 and 2008 in Korea.

Materials and Methods

A total of 32357 patients who began dialysis between January 1, 2005 and December 31, 2008 were eligible for analysis. Baseline demographics, comorbidities, and mortality data were obtained from the database of the Health Insurance Review & Assessment Service.

Results

Kaplan-Meier curves according to the year of dialysis initiation showed that the survival rate was significantly different (log-rank test, p=0.005), most notably among peritoneal dialysis (PD) patients (p<0.001), although not among hemodialysis (HD) patients (p=0.497). In multivariate analysis, however, patients initiating either HD or PD in 2008 also had a significantly lower risk of mortality compared to those who began dialysis in 2005. Subgroup survival analysis among patients initiating dialysis in 2008 revealed that the survival rate of PD patients was significantly higher than that of HD patients (p=0.001), and the survival benefit of PD over HD remained in non-diabetic patients aged less than 65 years after adjustment of covariates.

Conclusion

Survival of Korean patients initiating dialysis from 2005 to 2008 has improved over time, particularly in PD patients. In addition, survival rates among patients initiating dialysis in 2008 were different according to patients'' age and diabetes, thus we need to consider these factors when dialysis modality should be chosen.     

Treatment of diffuse proliferative lupus nephritis with prednisone and combined prednisone and cyclophosphamide.

To evaluate the effectiveness of cyclophosphamide in the treatment of lupus nephritis, we designed a prospective study of patients with diffuse proliferative lupus nephritis. Twenty-six patients received prednisone (average dose, 40 mg per day) and 24 combined prednisone (average dose, 29 mg per day) and cyclophosphamide (average dose, 107 mg per day) for six months. Thereafter, all patients received maintenance doses of prednisone. Most of the patients improved (84 per cent) after six months of initial treatment with either program. Early progression of disease, ending mainly in end-stage renal disease, was equally frequent in the two treatment groups in patients with already advanced disease. In a four-year follow-up study there was a higher incidence (P approximately 0.04) and average rate (P approximately 0.02) of clinical recurrence of nephritis in the group initially given only steroid than in the group initially given both drugs. However, the proportion of patients alive after four years with stable or improved renal function was similar in the two treatment groups.