Apelin and nutritional status in children on dialysis

Background: We aimed to evaluate whether serum apelin could reflect the nutritional status of children on dialysis. Methods: Twelve patients on peritoneal dialysis (PD) and 20 patients on hemodialysis (HD) were enrolled. Patients received individualized diet for six months. Anthropometric and laboratory indices were measured at onset and the end of the study. Results: The anthropometric indices were all significantly lower in patients than in controls whereas similar in PD and HD patients. The protein catabolic rate (nPCR), height, mid-arm circumference (MAC), triceps skinfold thickness (TSF), arm muscle area (AMA) and arm fat area (AFA) z scores were significantly increased in dialysis patients after nutritional intervention. Weight z scores statistically increased in HD group whereas did not statistically change in PD group. Serum albumin levels were significantly improved in PD and HD patients. Apelin levels were similar in PD, HD and control groups. Post nutritional apelin values did not differ in each dialysis groups. On multivariate analysis, apelin was independently associated with age, weight, ESR and TG. Conclusions: Apelin seems to be not a useful indicator for monitoring the nutritional status in children on dialysis. However, the close link of apelin with inflammatory and lipid parameters suggested that apelin might be a novel target for slowing the atherogenic process in pediatric dialysis patients.     

Determinants of haemoglobin carbamylation in haemodialysis and peritoneal dialysis patients.

BACKGROUND: Carbamylation is an irreversible process of non-enzymatic modification of proteins by the breakdown products of urea. For haemoglobin (Hb), the extent of carbamylation is a marker of urea exposure and has been proposed as an indicator of the control of uraemia by dialysis, analogous to the use of Hb glycosylation in diabetic patients. METHODS: We performed a cross-sectional study of haemodialysis (HD) and peritoneal dialysis (PD) patients in order to study potential determinants of carbamylated Hb (CarbHb) and to investigate the relationship between CarbHb and established measures of dialysis dose/adequacy by multivariate analysis. RESULTS: In 80 HD patients, CarbHb was independently predicted by post-dialysis urea (r=0.40, P:<0.01), serum albumin (r=0.24, P:<0.05) and serum bicarbonate (r=-0.40, P:<0. 05). No correlation was found between CarbHb and measures of dialysis dose/adequacy (Kt/V, urea reduction ratio, weekly dialysis duration, and normalized protein catabolic rate (nPCR)). In 42 PD patients, serum urea was the only significant independent predictor of CarbHb (r=-0.51, P:=0.001). No relationship was found between CarbHb and Kt/V, corrected creatinine clearance (CrCl) or nPCR in PD patients. CONCLUSIONS: Serum urea is the most consistent independent predictor of CarbHb in dialysis patients. This association in combination with the lack of a relationship with conventional measures of dialysis dose and a positive relationship with serum albumin suggest that a single measurement of CarbHb is unlikely to be a useful indicator of the adequacy of dialysis.     

Health status and quality of life reported by incident patients after 1 year on haemodialysis or peritoneal dialysis.

BACKGROUND: It has been suggested that there are no large differences in the quality of life of incident patients starting on haemodialysis (HD) and peritoneal dialysis (PD), but few studies have addressed this issue. METHODS: Association of modality with incident patients' health status and quality of life scores was investigated with propensity score (PS) analysis and also with traditional multivariable regression analyses. We compared patient reported health status and quality of life scores after 1 year of therapy in 455 HD and 413 PD patients who participated in a national study, stayed on the same modality and had complete socio-demographic and clinical information needed to create a PS indicating their expected probability of starting on PD. RESULTS: One year scores on the majority of health status and quality of life measures were not significantly different for HD and PD patients within propensity-matched quintiles. PD patients' scores were higher than HD patients' scores on effects of kidney disease, burden of kidney disease, staff encouragement and satisfaction with care in some quintiles, and traditional regression analyses confirmed that dialysis modality was associated with patients' scores on these variables. CONCLUSIONS: This study provides support for making the choice of PD more widely available as an option to patients initiating chronic dialysis therapy. Patient lifestyle opportunities associated with use of PD, a home-based and self-care therapy, may also apply to home-based HD or in-centre self-care HD. Patients' expectations regarding treatment and their attitudes toward management of their health may interact with treatment modality to shape patient-reported experience on dialysis; this is an important focus for future studies.     

Quality of life on chronic dialysis: comparison between haemodialysis and peritoneal dialysis.

BACKGROUND: Quality of life (QOL) assessment in patients on chronic haemodialysis (HD) or peritoneal dialysis (PD) has only rarely been carried out with the generic Euroqol-5D questionnaire. METHODS: All chronic HD and PD patients in the 19 centres of western Switzerland were requested to fill in the validated Euroqol-5D generic QOL questionnaire, assessing health status in five dimensions and on a visual analogue scale, allowing computation of a predicted QOL value, to be compared with the value measured on the visual analogue scale. RESULTS: Of the 558 questionnaires distributed to chronic HD patients, 455 were returned (response rate 82%). Fifty of 64 PD patients (78%) returned the questionnaire. The two groups were similar in age, gender and duration of dialysis treatment. Mean QOL was rated at 60+/-18% for HD and 61+/-19% for PD, for a mean predicted QOL value of 62+/-30 and 58+/-32% respectively. Results of the five dimensions were similar in both groups, except for a greater restriction in usual activities for PD patients (P = 0.007). The highest scores were recorded for self-care, with 71% HD and 74% PD patients reporting no limitation, and the lowest scores for usual activities, with 14% HD and 23% PD patients reporting severe limitation. Experiencing pain/discomfort (for HD and PD) or anxiety/depression (for PD) had the highest impact on QOL. CONCLUSIONS: QOL was equally diminished in HD and PD patients. The questionnaire was well accepted and performed well. Improvement could be achievable in both groups if pain/discomfort and anxiety/depression could be more effectively treated.     

Race, gender, and incident dialysis patients' reported health status and quality of life

Patient-reported physical and mental health status, along with disease-specific concerns ("quality of life") reported by patients, provide information about experience on dialysis that can help to improve patient care. Among prevalent hemodialysis (HD) patients, blacks have been shown to report higher health status and quality of life scores than whites, but whether similar race differences characterize incident patients who start regular dialysis is not known. Health status and quality of life, measured by the Kidney Disease Quality of Life-Short Form, reported by black men, black women, white men, and white women who initiated HD and peritoneal dialysis (PD) in the Dialysis Morbidity and Mortality Study (DMMS) Wave 2 were examined. After adjustment for patients' sociodemographic and clinical characteristics, the only race differences observed were that among HD patients, black women scored highest on the burden of kidney disease measure (lower perceived burden), and among PD patients, black men had the lowest satisfaction with care scores. It is possible that differences between blacks' and whites' reported health status and quality of life become more evident as patients' dialysis vintage increases, a hypothesis that requires following a well-characterized incident cohort over time. These findings add to existing evidence that minority patients on dialysis report less satisfaction with their care than do white patients, an important area for continued study.     

Changes in quality of life during hemodialysis and peritoneal dialysis treatment: generic and disease specific measures

Despite more than 20 yr of use, relative differences in health-related quality of life (HRQOL) between hemodialysis (HD) and peritoneal dialysis (PD) are not clearly known. The objective of this study was to compare self-reported HRQOL and overall health status for HD and PD patients at the initiation of dialysis therapy and 1 yr later. A prospective cohort of incident ESRD patients was enrolled between October 1995 and June 1998 at 81 outpatient dialysis units in 19 states and included 698 HD and 230 PD patients who completed a baseline CHOICE Health Experience Questionnaire. The main outcome measured was change in qualify-of-life scores from start of dialysis to 1 yr on dialysis and overall health status. Of 928 patients who completed the baseline questionnaire, 585 also completed the 12-mo questionnaire; 101 had died, 55 had received a kidney transplant, and 88 had moved to a new dialysis clinic. PD patients were slightly younger, were more likely to be white, were well-educated, were employed, were married, had less comorbidity, and had higher hematocrit. Unadjusted baseline scores showed better HRQOL for PD patients in both generic and ESRD domains (bodily pain, travel, diet restrictions, and dialysis access [P < 0.05]). At 1 yr, SF-36 scores improved, whereas some ESRD domains improved and others deteriorated. HD patients had greater improvements in two SF-36 domains (physical functioning and general health perception) than PD patients, but results were mixed for ESRD domains (PD is better for finances, HD is better for sleep and overall quality of life). HD and PD patients did not differ in change in overall health status. HD and PD are associated with similar HRQOL outcomes at 1 yr. Generic HRQOL in two domains improved more for HD patients. However, for ESRD-specific HRQOL, results were not consistent; some domains were better for PD patients whereas others were better for HD patients. In advising patients about modality choices, trade-offs should be discussed and individual preferences for specific aspects of HRQOL should be elicited.     

Brain natriuretic peptide and its relationship to left ventricular hypertrophy in patients on peritoneal dialysis or hemodialysis less than 3 years

An increase of brain natriuretic peptide (BNP) levels is commonly observed in patients on dialysis. Increased circulating levels of BNP are related to future cardiac events and associated with shorter survival in patients on chronic hemodialysis (HD). During the first 1 or 2 years on dialysis, patients on peritoneal dialysis (PD) have been shown to have an improvement in left ventricular hypertrophy, blood pressure, and volume status. This study compares BNP levels and cardiac status of PD and HD patients without cardiovascular disease and on dialysis for less than 36 months. The correlation between plasma BNP concentration and findings of echocardiography before HD scans were examined and compared with findings of PD. Twenty-two HD patients (15 men, 7 women; mean age, 52.5 +/- 13.9 years) and 19 PD patients (10 men, 9 women; mean age, 47.6 +/- 11.3 years) were studied. There were no significant differences between HD and PD patients with regard to age, gender, duration of dialysis, left ventricular mass, left ventricular mass index (p > 0.05). Plasma BNP levels were markedly greater in HD patients (467.8 +/- 466.5 pg/ mL) than those of PD patients (143.1 +/- 165.2 pg/mL). Urine output was significantly higher in PD patients compared with HD patients (p < 0.05). A positive correlation between systolic blood pressure, diastolic blood pressure, and plasma BNP in HD patients (r: 0.653, p: 0.001; r: 0.493, p: 0.023, respectively) was detected. Additional studies are needed to investigate whether lower BNP level in PD patients is an advantage.     

Serum indoleamine 2,3 dioxygenase and tryptophan and kynurenine ratio using the UPLC-MS/MS method,in patients undergoing peritoneal dialysis,hemodialysis, and kidney transplantation

Background: The level and activity of indoleamine 2,3-dioxygenase (IDO) and the concentrations of L-tryptophan and its metabolite L-kynurenine were determined in association with various renal diseases. However, there have been no data regarding these parameters in patients on peritoneal dialysis compared to those undergoing hemodialysis or kidney transplantation.

Methods: This study investigated the level and activity of IDO and determined oxidative balance by calculating the total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI). We enrolled 60 kidney disease patients, including 20 on peritoneal dialysis (PD group), 19 on hemodialysis (HD group), and 21 with kidney transplantation (KT group), as well as 21 control group.

Results: IDO levels were increased in the PD, HD, and KT groups compared to the control group. The concentration of kynurenine was significantly increased in the PD group compared to the other groups (p?p?p?Conclusion: The results showed that IDO levels were increased in peritoneal dialysis and hemodialysis patients and in renal transplant recipients, while oxidative stress was found to be related to IDO activity and was most increased in the patients on peritoneal dialysis.     

Physical symptoms and quality of life in patients on chronic dialysis: results of The Netherlands Cooperative Study on Adequacy of Dialysis (NECOSAD)

BACKGROUND: So far, little attention has been paid to the value of dialysis adequacy for patients' quality of life (QL). Therefore we studied the impact of demographic, clinical, and dialysis characteristics on physical symptoms and perceived QL. METHODS: The study population consisted of 120 incident chronic haemodialysis (HD) and 106 peritoneal dialysis (PD) patients, starting dialysis treatment in 13 Dutch centres. Data were collected 3 months after the start of dialysis. Nine physical symptoms were assessed with a self-administered questionnaire. Patient's self-assessment of QL was measured with the 36-item MOS Short Form (SF-36). RESULTS: The most common symptoms in HD and PD were fatigue (respectively 82 and 87%) and itching (73 and 68%). In HD only a medium to high comorbidity--age risk index was associated with greater symptom burden. In PD also a lower percentage lean body mass, a lower rGFR, and past episodes of underhydration were associated with greater symptom burden. The explained variance by these variables was only 12% in HD and 21% in PD. However, greater symptom burden explained a substantial additional amount of impaired physical and mental QL on top of demographics and clinical status. Dialysis variables were associated neither with symptoms nor with QL. CONCLUSION: Symptom burden can be explained to a limited extent by demographic and clinical variables and not by dialysis characteristics. Addition of symptom burden to the other variables makes it possible to explain one-third of perceived QL. This underlines the importance of symptom reduction in order to improve patient's QL.     

Dyspepsia and gastroparesis in chronic renal failure: the role of Helicobacter pylori

AIMS: Many patients with chronic renal failure have dyspeptic symptoms. In the present study, we assessed the Helicobacter pylori (Hp) status, dyspeptic symptoms and gastric emptying rates in uremic patients. The present study was undertaken to compare chronic renal failure patients not under dialysis therapy (predialysis), hemodialysis (HD) patients and peritoneal dialysis (PD) patients for these variables and to search for a possible causative role of Hp. METHODS: We used a standardized questionnaire to assess dyspeptic symptoms. Gastric emptying rates were determined by the 13C-octanoic acid breath test. HD patients were examined outside a dialysis session, PD patients were examined with a "full" abdomen. Specific Helicobacter pylori IgG was measured by a second-generation enzyme-linked immunosorbent assay. RESULTS: Sixty-six HD patients. 58 predialytic patients and 28 PD patients were included. Prevalences of Hp infection were highest in HD patients (46.2%) and predialysis patients (42.3%) compared to PD patients (28.6%) (p < 0.02). On the contrary, the prevalence of dysmotility-like dyspepsia was higher in PD patients (67.9%) when compared to HD patients (33.3%) (p < 0.01) and predialytic patients (53.6%) (difference not significant). Neither dyspepsia nor delayed gastric emptying were related to the presence of Helicobacter pylori IgG antibodies. CONCLUSION: A positive Helicobacter status based on serology was not related to the presence of dyspepsia or gastroparesis in uremic patients, whether on dialysis therapy or not. Dyspeptic complaints as well as gastroparesis are most prevalent in patients on peritoneal dialysis. The physiopathological mechanisms and clinical impact of these findings merit further investigation.     

Brain Natriuretic Peptide and Its Relationship to Left Ventricular Hypertrophy in Patients on Peritoneal Dialysis or Hemodialysis Less Than 3 Years

An increase of brain natriuretic peptide (BNP) levels is commonly observed in patients on dialysis. Increased circulating levels of BNP are related to future cardiac events and associated with shorter survival in patients on chronic hemodialysis (HD). During the first 1 or 2 years on dialysis, patients on peritoneal dialysis (PD) have been shown to have an improvement in left ventricular hypertrophy, blood pressure, and volume status. This study compares BNP levels and cardiac status of PD and HD patients without cardiovascular disease and on dialysis for less than 36 months. The correlation between plasma BNP concentration and findings of echocardiography before HD scans were examined and compared with findings of PD. Twenty-two HD patients (15 men, 7 women; mean age, 52.5 ± 13.9 years) and 19 PD patients (10 men, 9 women; mean age, 47.6 ± 11.3 years) were studied. There were no significant differences between HD and PD patients with regard to age, gender, duration of dialysis, left ventricular mass, left ventricular mass index (p > 0.05). Plasma BNP levels were markedly greater in HD patients (467.8 ± 466.5 pg/mL) than those of PD patients (143.1 ± 165.2 pg/mL). Urine output was significantly higher in PD patients compared with HD patients (p < 0.05). A positive correlation between systolic blood pressure, diastolic blood pressure, and plasma BNP in HD patients (r: 0.653, p: 0.001; r: 0.493, p: 0.023, respectively) was detected. Additional studies are needed to investigate whether lower BNP level in PD patients is an advantage.     

Body mass index as a predictor of continued survival in older chronic dialysis patients

Objective: To investigate the contribution of body mass index (BMI) to mortality over 11 years of follow-up in a prevalent sample of dialysis patients aged 60+. Design: Multivariate Cox proportional hazards regression analysis. Setting: Multicenter stratified random sample of black and white older chronic dialysis patients in a southeastern state. Subjects: 316 patients on hemodialysis (HD) and peritoneal dialysis (PD). Main outcome measure: Continued survival from baseline interview in 1988 to June1999. Results: Adjusting for age, primary diagnosis of diabetes, cardiovascular comorbidity, HD/PD therapy, and patient-reported functional impairment, the interaction of baseline BMI with race and gender was associated with older patients' risk of mortality. Black females, black males, and white males with higher BMI had a reduced risk of mortality, while no protective effect of higher BMI was found for white females. Patients with cardiovascular comorbidity and greater functional impairment at baseline had increased mortality risk. BMI was not significantly correlated with serum albumin or functional impairment. Conclusion: BMI, a simple anthropometric measure that provides a marker of nutritional status,interacts with race and gender to predict long-term survival in older dialysis patients. The association of survival with dialysis adequacy,nutritional indicators, and cardiovascular status in black and white dialysis patients is an important area of study. This revised version was published online in September 2006 with corrections to the Cover Date.     

Nutritional status over time in hemodialysis and peritoneal dialysis

Malnutrition is a risk factor for mortality in the dialysis population. So far, prospective studies comparing the time course of nutritional status in new hemodialysis (HD) and peritoneal dialysis (PD) patients have not been published. The aims of this study were to compare the time course of nutritional status in patients who were starting HD or PD and to identify the baseline determinants of that time course. In this prospective multicenter cohort study, data were collected from 3 (baseline) to 24 mo after the start of dialysis. Repeated measures ANOVA was used to establish the time course of nutritional status. Differences were adjusted for baseline characteristics. A total of 250 consecutive new patients were included: 132 started on HD, and 118 started on PD. A univariate analysis demonstrated a decrease in serum albumin (SA) in patients who started on HD and an increase in patients who started on PD. Body fat increased in PD; LBM did not change. The protein equivalent of nitrogen appearance normalized to ideal weight decreased in PD after 1 yr. In a multivariate analysis, SA at 2 yr was 2.0 g/L (95% confidence interval [CI], 0.3 to 3.8) higher in patients who started on PD compared with patients who started on HD. The increase in body fat was 3.2 kg (95% CI, 1.6 to 4.9) higher in women who started on PD than in others. Patients who had diabetes gained 2.3 kg (95% CI, 0.6 to 4.1) more fat than patients who did not have diabetes. Kt/V(urea) did not affect the time course of nutritional status, but a higher Kt(urea) was associated with a higher SA at 24 mo. Nutritional status at the start of dialysis, gender, and diabetic status might be considered in making the choice for dialysis modality. Furthermore, providing a higher Kt(urea) may improve protein metabolism.     

Improving Compliance in Dialysis Patients: Does Anything Work?

Noncompliance with prescribed therapy significantly impacts dialysis patient care and outcome. At least one-half of hemodialysis (HD) patients are likely to be noncompliant with some part of their treatment regimen, and one-third of peritoneal dialysis (PD) patients are believed to miss prescribed exchanges. Psychosocial issues, younger age, and smoking behavior have been linked with compliance problems in multiple studies. Few interventions have been rigorously tested, but patient education and/or individualized attention, supervision, encouragement, and support are widely advocated strategies to improve patient compliance. Areas in need of continued study include psychosocial determinants of compliance in PD as well as HD patients, compliance behavior patterns over time, and the parameters within which dialysis compliance can vary and still achieve specified treatment goals.     

Cholecystokinin and leptin: their influence upon the eating behaviour and nutrient intake of dialysis patients.

BACKGROUND: We have used serial visual analogue scores to demonstrate disturbances of the appetite profile in dialysis patients. This is potentially important as dialysis patients are prone to malnutrition yet have a lower nutrient intake than controls. Appetite disturbance may be influenced by accumulation of appetite inhibitors such as leptin and cholecystokinin (CCK) in dialysis patients. METHODS: Fasting blood samples were drawn from 43 controls, 50 haemodialysis (HD) and 39 peritoneal dialysis (PD) patients to measure leptin and CCK. Hunger and fullness scores were derived from profiles compiled using hourly visual analogue scores. Nutrient intake was derived from 3 day dietary records. RESULTS: Fasting CCK was elevated for PD (6.73 +/- 4.42 ng/l vs control 4.99 +/- 2.23 ng/l, P < 0.05; vs HD 4.43 +/- 2.15 ng/l, P < 0.01). Fasting CCK correlated with the variability of the hunger (r = 0.426, P = 0.01) and fullness (r = 0.52, P = 0.002) scores for PD. There was a notable relationship with the increase in fullness after lunch for PD (r = 0.455, P = 0.006). When well nourished PD patients were compared with their malnourished counterparts, CCK was higher in the malnourished group (P = 0.004). Leptin levels were higher for the dialysis patients than controls (HD and PD, P < 0.001) with pronounced hyperleptinaemia evident in some PD patients. Control leptin levels demonstrated correlation with fullness scores (e.g. peak fullness, r = 0.45, P = 0.007) but the dialysis patients did not. PD nutrient intake (energy and protein intake, r = -0.56, P < 0.0001) demonstrated significant negative correlation with leptin. CONCLUSION: Increased CCK levels appear to influence fullness and hunger perception in PD patients and thus may contribute to malnutrition. Leptin does not appear to affect perceived appetite in dialysis patients but it may influence nutrient intake in PD patients via central feeding centres.     

Oxidative stress markers and C-reactive protein in end-stage renal failure patients on dialysis

OBJECTIVE: The inflammatory status is a well-documented factor influencing the development of oxidative stress in dialysis patients. This study intends to evaluate the inflammatory activity and the plasma levels of total antioxidant capacity (TAC) and lipid peroxidation products in patients on peritoneal dialysis (PD), by comparison with hemodialysis (HD) patients. PATIENTS AND METHODS: Plasma concentration of TAC, lipid peroxidation products and C-reactive protein (CRP) were measured in 24 patients on PD, 32 HD patients (pre and post treatment) and 16 normal controls (NC). RESULTS: All patients had higher levels of TAC and lipid peroxidation products than NC (p < 0.001). Patients on PD, had similar levels to patients before HD but significantly higher (p < 0.001) than those post HD. The CRP concentration was higher in HD than in PD patients (p < 0.05). The percentage of patients with CRP > 10 mg/l was 48% in HD patients and 21% in PD patients. No correlation was observed between CRP and TAC nor CRP and MDA levels. CONCLUSIONS: We conclude that although PD and HD patients show an equal susceptibility in oxidative stress, CRP levels are higher in HD patients and this is indicative of a higher degree of inflammatory activity in these patients.     

Polydipsia: a feature of peritoneal dialysis.

BACKGROUND: Some dialysis patients fail to comply with their fluid restriction causing problems due to volume overload. These patients sometimes blame excessive thirst. There has been little work in this area and no work documenting polydipsia among peritoneal dialysis (PD) patients. METHODS: We measured motivation to drink and fluid consumption in 46 haemodialysis patients (HD), 39 PD patients and 42 healthy controls (HC) using a modified palmtop computer to collect visual analogue scores at hourly intervals. RESULTS: Mean thirst scores were markedly depressed on the dialysis day (day 1) for HD (P<0.0001). The profile for day 2 was similar to that of HC. PD generated consistently higher scores than HD day 1 and HC (P = 0.01 vs. HC and P<0.0001 vs HD day 1). Reported mean daily water consumption was similar for HD and PD with both significantly less than HC (P<0.001 for both). However, measured fluid losses were similar for PD and HC whilst HD were lower (P<0.001 for both) suggesting that the PD group may have underestimated their fluid intake. CONCLUSION: Our results indicate that HD causes a protracted period of reduced thirst but that the population's thirst perception is similar to HC on the interdialytic day despite a reduced fluid intake. In contrast, the PD group recorded high thirst scores throughout the day and were apparently less compliant with their fluid restriction. This is potentially important because the volume status of PD patients influences their survival.     

Advanced glycation end products,aortic stiffness,and wave reflection in peritoneal dialysis as compared to hemodialysis

Background

Modification of vascular extracellular matrix by advanced glycation end products (AGEs) may result in vascular stiffness. Because of higher exposure to glucose, we hypothesized that patients on peritoneal dialysis (PD) may have higher tissue levels of AGEs, increased vascular stiffness, and enhanced central augmentation pressure as compared to hemodialysis patients (HD).

Methods

In a cross-sectional study, 43 PD were matched to 43 HD based on age, gender, diabetes, and dialysis vintage. Tissue levels of AGEs were assessed by skin autofluorescence (skin AF). Aortic stiffness was measured by carotid-femoral pulse wave velocity (cf-PWV), and heart rate-adjusted augmentation pressure (AP@75) was performed by arterial tonometry.

Results

Baseline characteristics were similar in both groups except for lower prevalence of cardiovascular disease (CVD) and higher exposure to smoking in PD. Skin AF and cf-PWV were not statistically different, but PD patients had a lower AP@75 (P = 0.023). However, after adjustments for prevalence of CVD and smoking status, skin AF was higher in PD by 0.587 AU (95 % CI 0.091–1.215, P = 0.020), and cf-PWV was higher in PD by 2.20 m/s (95 % CI 0.56–3.84, P = 0.009), while AP@75 was not different. Overall, there was a significant association between skin AF and cf-PWV and AP@75.

Conclusion

Skin AF and aortic stiffness were higher in PD after adjustments for imbalances in baseline characteristics. Independent of dialysis modality, there was a positive association between skin AF, aortic stiffness, and enhanced wave reflection.     

Hemoglobin predicts long-term survival in dialysis patients: a 15-year single-center longitudinal study and a correlation trend between prealbumin and hemoglobin

BACKGROUND: Dialysis patients have much higher mortality rates than the general population. Anemia is a common complication of uremia and a major contributor to morbidity and mortality in dialysis patients. The benefits of anemia correction using recombinant human erythropoietin (rHuEPO) are well established. Optimum hemoglobin level for dialysis patients remain controversial. We have investigated the association of enrollment hemoglobin with long-term survival in hemodialysis (HD) and peritoneal dialysis (PD) patients. METHODS: We enrolled 529 HD and 326 PD patients from 1987 and followed them to April 2003. Demographics, enrollment, and clinical and laboratory data were recorded. The Kaplan-Meier method was used to compute observed survival, and the multivariate Cox regression analysis was used to identify the independent predictors of mortality risk. RESULTS: Mean ages of HD and PD patients were 60 +/- 16 (SD) and 54 +/- 16 (SD) years, respectively. Forty-seven percent of HD patients and 41% of PD patients were diabetic. Mean enrollment hemoglobin levels of HD and PD patients were 9.44 +/- 1.9 and 9.61 +/- 1.77 g/dL respectively. Cumulative 15 year observed survivals of HD (P = 0.05) and PD (P = 0.032) patients with hemoglobin levels greater or equal to 12 g/dL were higher than those with hemoglobin levels less than 12 g/dL. Hemoglobin <12 g/dL was a better predictor of mortality in nondiabetics than diabetics, particularly in HD patients. Both in HD and PD diabetic patients, hemoglobin was not a significant predictor of mortality. By Cox regression analysis, after adjusting for age, race, gender, and months on dialysis at enrollment, the relative risk of mortality of patients with hemoglobin <12 g/dL was 2.13-fold (P = 0.008) higher for HD and 1.85-fold (P = 0.06) higher for PD compared to those with hemoglobin >/=12 g/dL (P = 0.035). A logistic regression analysis revealed a strong inverse relationship between the hemoglobin level and the odds risk of death in HD (OR = 0.83, P = 0.008) and in PD (OR = 0.85, P = 0.02) patients. CONCLUSION: Enrollment hemoglobin is a predictor of long-term survival in HD and PD patients. Patients with hemoglobin levels that are higher than current treatment recommendations (>12 g/dL) may benefit from long-term survival. Survival of dialysis patients may be improved by better management of malnutrition and anemia.     

Health profiles and health preferences of dialysis patients.

BACKGROUND: Health-related quality of life (HRQOL) of haemodialysis (HD) and peritoneal dialysis (PD) patients has been assessed with health profiles and health preferences methods. Few studies have used both types of HRQOL instruments. The main objective of this study was to assess the relationship between information from the two types of HRQOL instruments in dialysis patients. METHODS: We interviewed 135 patients, using two health profiles (Short Form 36 and EuroQol/EQ-5D) and two health preferences methods (Standard Gamble and Time Trade Off). Socio-demographic, clinical, and treatment-related background data were collected from patient charts and during the interview. Relationships between the outcome measures were assessed with Pearson correlation coefficients. Multiple regression models were used to study the relationship of HRQOL outcomes to background variables. RESULTS: The HRQOL of dialysis patients as measured with health profiles was severely impaired. The health preferences scores were higher (0.82-0.89) than scores previously reported in the literature. Correlations between health profiles and health preferences were poor to modest. HRQOL outcomes were poorly explained by background characteristics. Differences between HD and PD groups could not be demonstrated. CONCLUSIONS: Health profiles and health preferences represent different aspects of HRQOL. An impaired health status may not be reflected in the preference scores. Coping strategies and other attitudes towards health may affect the preference scores more than they influence health profile outcomes. The added value of health preferences methods in clinical research is limited.