Health-related quality of life,depression and mortality in peritoneal dialysis patients in Turkey: seven-year experience of a center

Introduction: Impairment of health-related quality of life (HRQoL) and being in a depressive mood were found to be associated with increased mortality in peritoneal dialysis (PD) patients. We aimed to investigate the association between HRQoL, depression, other factors and mortality in PD patients. Materials and methods: Totally 171 PD patients were included and followed for 7 years in this prospective study. Results: Of 171 PD patients, 45 (26.3%) deceased, 18 (10.5%) maintained on PD, 87 (50.9%) shifted to hemodialysis (HD) and 21 (12.3%) underwent transplantation. The most common cause of death was cardiovascular disease (32, 71.1%) followed by infection (6, 13.3%), cerebrovascular accident (5, 11.2%). The etiology of patients who shifted to HD was PD failure (41, 47.1%), peritonitis (33, 37.9%), leakage (6, 6.9%), catheter dysfunction (3, 3.4%), self willingness (4, 4.6%). Non-survivors were older than survivors (56.6?±?15.0 vs. 43.6?±?14.6, p?=?0.003). There were also statistically significant difference in terms of albumin, residual urine, presence of diabetes and co-morbidity. When the groups were compared regarding HRQoL scores, non-survivors had lower physical functioning (p?<?0.001), role-physical (p?=?0.0045), general health (p?=?0.004), role-emotional (p?=?0.011), physical component scale (PCS) (p?=?0.004), mental component scale (MCS) (p?=?0.029). Age, presence of residual urine, diabetes, albumin, PCS and MCS were entered in regression analysis. Decrease of 1?g/dL of albumin and being diabetic were found to be the independent predictors of mortality. Conclusions: Diabetes and hypoalbuminemia but not HRQOL scores were associated with higher mortality in PD patients after 7 years of following period.     

Risk factors of severe peritoneal sclerosis in chronic peritoneal dialysis patients

Peritoneal dialysis (PD) offers the healthiest way for starting renal replacement therapy (RRT) in End Stage Renal Disease patients, however exposes long-term PD patients to a dangerous complication named encapsulating peritoneal sclerosis (EPS). In this study, we searched for possible risk factors of EPS. Data were collected from two PD centers covering period 1995–2012 and comprised 464 patients. Control group defined as PD patients stayed on PD >42 month (n?=?122), and case group was 12 confirmed EPS patients. Associations were analyzed using linear regression analysis. Prevalence and incidence of EPS were 2.59% and 8.9% with an incidence of 0.7% patient-years, respectively. The age at start of PD in EPS patients (32.75?±?10.8 year) was significantly lower compared with control group (49.61?±?16.18 year, p?=?.0001). The mean duration of PD in EPS and control group were 2494.4?±?940.9 and 1890.2?±?598.8 days (p?=?.002). Control group had 145 episodes of peritonitis during total duration of 7686 patient months (peritonitis rate of 1/53). This was 1/26 with a total 38 episodes of peritonitis during the total duration of 997 patient months (p?=?.01) for EPS group. In regression analysis, PD duration, age at PD start and duration of Ultrafiltration failure (UFF) were associated with EPS. Longer time being on PD, younger age, and higher UFF duration were the risk factors for EPS development.     

Potassium metabolism in continuous ambulatory peritoneal dialysis patients

Background: Hypokalemia is common and may have contributed to the poor clinical outcome in peritoneal dialysis (PD) patients. In this study, we made a detailed investigation on the potassium metabolism in continuous ambulatory peritoneal dialysis (CAPD) patients and tried to find out the possible factors associated with the high prevalence of hypokalemia in PD patients. Methods: A cross-sectional survey in 243 clinically stable CAPD patients was made in our PD center in 2010. Patients were divided into four groups according to whether they were anuric or not and different dialysis regimens. Patients’ demographic data and data on potassium metabolism including dietary potassium intakes, residual renal potassium, and peritoneal dialysis potassium removal were collected. Results: The average potassium intake in our 243 PD patients was 32.1?±?11.1?mmol/day. The total potassium removal was significantly higher in non-anuric patients as compared to anuric patients (33.2?±?9.1 vs. 23.0?±?4.7?mmol/day for 3 exchanges per day and 35.2?±?8.9 vs. 28.6?±?6.3?mmol/day for 4 exchanges per day, respectively, p?p?p?p?R² linear?=?0.645, p?Conclusions: Our study suggested that if potassium intake was limited in PD patients, we should be aware of the risk of hypokalemia with high doses of PD when patients have good RRF. Our study also suggested that potassium removal in PD patients may not necessarily reflect potassium intake even if serum potassium is normal, the effect of ICW should be considered when evaluating potassium homeostasis.     

Effect of Dialysis Type on Serum Lipids,Apolipoproteins, and Lipoproteins

Aim. Dyslipidemia is common among patients with end-stage renal disease, whether treated by hemodialysis (HD) or peritoneal dialysis (PD). However, there are not enough data about the effect of dialysis type on serum lipoprotein (a) [Lp(a)], apolipoprotein (a) [Apo(a)], apolipoprotein (b) [Apo(b)], and lipid levels. The aim of this study was to determine the effect of dialysis type on serum lipid levels. Materials and Methods. This study enrolled 40 HD patients (20 men and 20 women, aged 48.1?±?17.6 years) and 69 PD patients (35 men and 34 women, aged 45.2?±?16.3 years). Serum lipid profile including total cholesterol (TC), low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), triglyceride (TG), Apo(a), Apo(b), and Lp(a) were determined in HD and PD patients. Patients who have used statins within the last six months were not included in the study. Results. No significant differences in TC, LDL-C, HDL-C, TG, Apo(a), Apo(b), or Lp(a) serum levels were found between HD and PD patients. Serum TC, LDL-C, HDL-C, TG, Apo(a), Apo(b), and Lp(a) in HD and PD patients were 172.2?±?42.7 (mg/dL) vs. 181.0?±?53.0 (mg/dL), 97.2?±?36.2 (mg/dL) vs. 101.4?±?33.6 (mg/dL), 45.3?±?11.9 (mg/dL) vs. 41.4?±?11.1 (mg/dL), 144.7?±?71.8 (mg/dL) vs. 173.0?±?76.8 (mg/dL), 1.2?±?0.5 (g/L) vs. 1.0?±?0.2 (g/L), 0.9?±?0.3 (g/L) vs. 1.2?±?0.3 (g/L), and 43.1?±?40.6 (mg/dL) vs. 46.0?±?42.7 (mg/dL), respectively. Conclusion. The results of this study show that the maintenance CAPD treatment is associated with more pronounced alterations of the lipoproteins and lipid metabolism than those observed during HD treatment.     

High mobility group box 1 and tumor growth factor β: useful biomarkers in pediatric patients receiving peritoneal dialysis

Background: Peritonitis, the most important limitation of peritoneal dialysis (PD), could be detected by biomarkers in dialysate effluent, representing a noninvasive method to indirectly assess the peritoneum status. The aim of our study was to test high mobility group box 1 (HMGB1) in PD patients, evaluating its role as precocious marker of peritoneum damage during peritonitis. Transforming growth factor (TGF)-β was correlated with peritoneal transport characteristics.

Methods: Six patients, treated by ambulatory PD, were enrolled. Samples were collected at the onset of peritonitis (T1) and every day until its resolution (T-end). Serum (s) and peritoneal (p) white blood cell (WBC) count was also evaluated. Peritoneal Equilibration Test evaluated the filter activity of peritoneum.

Results: In patients with acute peritonitis, the highest serum and peritoneal HMGB1 values (64?±?3.6 and 70?±?5.3?ng/mL, respectively) were assessed, with a progressive decrease of their levels at the resolution time (T-end: sHMGB1:36?±?2.5; pHMGB1:30.5?±?7.0?ng/mL). While no differences of sWBC and pWBC were observed between baseline and T-end values, pHMGB1 levels remained higher at T-end than those observed at T0 (pHMGB1:30.5?±?7.0 versus 6.9?±?3.6; p?p?=?0.01). An inverse correlation was found between TGF-β levels and dialysate/plasmatic creatinine values (r = ?0.83; p?=?0.03).

Conclusion: HMGB1 represents a useful biomarker for peritoneum evaluation in PD patients. A prognostic role of this alarmin, as a marker of response to therapy, could be hypothesized. TGF-β could predict the peritoneal transport status and dialysis technique adequacy.     

Association of dialysate calcium concentration with fetuin a level and carotid intima-media thickness in peritoneal dialysis patients

Serum fetuin A has been shown to be associated with the risk of vascular calcification and atherosclerosis, and it can predict the onset of cardiovascular mortality in dialysis patients. The carotid intima-media thickness (cIMT) is an accessible and reliable method to identify the subclinical atherosclerosis. The aim of this study was to investigate the relationships between dialysate calcium concentrations and fetuin A or cIMT in patients undergoing peritoneal dialysis (PD). Forty patients, newly diagnosed end-stage renal disease (ESRD) and undergoing peritoneal dialysis, were enrolled in the study, with a calcium content of the peritoneal dialysis (PD) solution of 1.25?mmol/L in 20 patients (low-Ca group) and 1.75?mmol/L in 20 patients (standard-Ca group). The patients were followed up for 12 months after the PD conducted. Serum fetuin A was determined using a human fetuin A enzyme-linked immunosorbent assay kit and cIMT was detected using ultrasonic wave. We observed no difference between two groups with regard to the baseline data of fetuin A, cIMT, calcium, phosphorus, calcium-phosphorus product, high sensitivity CRP (hsCRP), parathyroid hormone (PTH), or lipid parameters. After 12 months follow-up, fetuin A (263.92?±?16.1 vs. 282.76?±?21.0, p?=?0.017) and calcium-phosphorus product (39.85?±?7.76 vs. 47.50?±?6.65, p?=?0.009) were obviously lower in the low-Ca group than standard-Ca group, the other serum parameters were not different between these two groups. Compared with baseline data, serum fetuin A concentration significantly reduced in low-Ca group (?p?p?相似文献   

Effect of polyflux membranes on the improvement of hemodialysis-associated eosinophilia: a case series

Hemodialysis-associated eosinophilia (HAE) is believed to be associated with allergic reactions to dialyzer materials. This study aimed to investigate the use of Polyflux membranes to improve HAE. Thirty-one patients suffering from HAE were included. Patients were dialyzed with polysulfone membranes when they developed HAE. After that, patients were dialyzed with Polyflux membranes three times every week, 4?h every time without changing the dialysis parameters and medication. Levels of peripheral eosinophils, hsCRP, IgE, C3a, IL-5 and peripheral CD4+ lymphocytes and CD8+ lymphocytes were assessed before Polyflux treatment, and at 4th, 8th and 12th weeks of treatment. Any symptoms including chest tightness and skin itching were observed during the study period. After 12 weeks of Polyflux membrane dialysis and compared with polysulfone membrane dialysis, levels of peripheral eosinophils were significantly decreased (1.26?±?0.61 vs. 0.71?±?0.29?×?10⁹/L, p?<?0.001); serum IL-5 levels were significantly decreased (24.43?±?10.21 vs. 9.11?±?4.21?pg/mL, p?<?0.001); and chest tightness and skin itching were significantly improved (45.2% vs. 19.4%, p?=?0.028). After 12 weeks, there was no significant change in serum levels of hsCRP (2.00?±?0.94 vs. 1.81?±?0.79?mg/L, p?=?0.352), IgE (104.61?±?98.79 vs. 114.95?±?101.07?IU/mL, p?=?0.422) and C3a (121.61?±?34.04 vs. 120.29?±?32.81?µg/L, p?=?0.316), and in peripheral levels of CD4+ (589?±?181 vs. 569?±?171?cells/mm³, p?=?0.672) and CD8+ (443?±?123 vs. 414?±?140 cells/mm³, p?=?0.395) cells. Eosinophil count was correlated with serum IL-5 levels (r?=?0.873, p?<?0.001). Changing to a Polyflux membrane may alleviate HAE and reduce serum IL-5 levels. Therefore, this could be a strategy to manage HAE in the clinical practice.     

A single-center experience on percutaneously performed partial omentectomy in pediatric peritoneal dialysis patients

Objective: This study describes a single-center experience on percutaneously performed partial omentectomy procedure in pediatric peritoneal dialysis (PD) patients who showed early catheter dysfunction and required catheter replacement due to catheter flow obstruction. Materials and methods: We performed a retrospective review of clinical outcomes from pediatric PD patients who underwent percutaneous catheter replacement by pediatric nephrologists between November 1995 and December 2012. Partial omentectomy was performed in those patients in whom omental or adhesion trapping to the catheter tip was seen. Results: During the study period, catheter dysfunction that eventually required percutaneous catheter replacement occurred in 32 (23.7%) children. Of these, 9 patients were performed partial omentectomy. Mean age at initiation of PD and time of omentectomy was 97.48?±?46.06 and 98.53?±?45.55 months, respectively. Catheter dysfunction appeared after a mean 1.20?±?1.0 months. The causes of catheter dysfunction were omental wrapping and malposition. No peritonitis occurred before omentectomy. Mean total operation time was 60?±?8.83?min. No complications were encountered during the procedure. After omentectomy, mean catheter survival period was 5.92?±?6.88 months. A total of five peritonitis episodes occurred. Three patients were transferred to hemodialysis. Six patients were on PD treatment without any problem at the end of the first year of their follow-up. Two patients underwent kidney transplantation. Four patients were still on chronic PD treatment at the end of the study period. Conclusion: When performed by an experienced nephrologist, the performance of partial omentectomy by percutaneous route, when required, is an easy, safe and efficient therapeutic procedure in children on chronic PD treatment.     

Echocardiographic measures of atrial function may predict atrial fibrillation in stroke patients

Objective: In patients with a prior stroke or transient ischemic attack (TIA) and atrial fibrillation anticoagulant treatment is indicated. This study’s purpose was to investigate if echocardiography can predict unknown AF in patients after stroke.

Design: Prospectively, 174 stroke/TIA patients without diagnosed AF underwent echocardiographic evaluation including tissue Doppler imaging (TDI) focusing on functional parameters of the left atrium and left ventricular diastolic function. AF screening was performed during 30 d.

Results: Fifteen patients (8.6%) were diagnosed with AF. Echocardiography in the AF group compared to those without AF, showed larger left atrial volume index (LAVI), (37.2?±?6.7 vs. 31.6?±?8.6?ml/m², p?=?0.018), lower A’ velocities in ventricular (5.9?±?2.2 vs. 7.2?±?1.6, p?=?0.010) and atrial (4.8?±?1.4 vs. 5.9?±?1.4, p?=?0.013) septa, higher LAVI/A’ in ventricular septum (6.7 (5.0–8.7) vs. 4.2 (3.2–5.5), p?=?0.001) and atrial septum (8.5 (5.9–11.0) vs. 5.1 (4.1–6.8), p?=?0.003). Receiver operating characteristic analyses to detect AF was performed, area under the curve for LAVI was 0.71 (0.61–0.83), p?=?0.008, and for LAVI/A’ in ventricular septum 0.76 (0.59–0.93), p?=?0.006 and atrial septum 0.78 (0.63–0.93), p?=?0.002, respectively.

Conclusions: LAVI and measures of atrial contraction as measured by TDI predict unknown AF in patients after an stroke/TIA and may be used to detect silent AF.     

Comparison of peritonitis rates and patient survival in automated and continuous ambulatory peritoneal dialysis: a 10-year single center experience

Peritonitis is a common complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). In this retrospective study, peritonitis rates and patient survival of 180 patients on CAPD and 128 patients on APD were compared in the period from January 2005 to December 2014 at Al-Nafisi Center in Kuwait. All patients had prophylactic topical mupirocin at catheter exit site. Patients on CAPD had twin bag system with Y transfer set. The peritonitis rates were 1 in 29 months in CAPD and 1 in 38 months in APD (p?<?0.05). Percentage of peritonitis free patients over 10-year period in CAPD and APD were 49 and 60%, respectively (p?<?0.05). Time to develop peritonitis was 10.25?±?3.1 months in CAPD compared to 16.1?±?4 months in APD (p?<?0.001). Relapse and recurrence rates were similar in both groups. Median patient survival in CAPD and APD groups with peritonitis was 13.1?±?1 and 14?±?1.4 months respectively (p?=?0.3) whereas in peritonitis free patients it was 15?±?1.4 months in CAPD and 23?±?3.1 months in APD (p?=?0.025). APD had lower incidence rate of peritonitis than CAPD. Patient survival was better in APD than CAPD in peritonitis free patients but was similar in patients who had peritonitis.     

The assessment of P-wave dispersion and myocardial repolarization parameters in patients with chronic kidney disease

Objective: The risks of sudden death and cardiac arrhythmia are increased in patients with chronic kidney disease (CKD). Here, we aimed to evaluate the indicators of arrhythmias, such as p-wave dispersion (P-WD), QTc dispersion, Tp-e and Tp-e/QT ratio in patients with CKD stages 3–5 on no renal replacement therapy (RRT).

Material and methods: One-hundred and thirty three patients with CKD stages 3–5 and 32 healthy controls were enrolled into the study. No patients received RRT. QTc dispersion, P-WD and Tp-e interval were measured using electrocardiogram and Tp-e/QT ratio was also calculated.

Results: Mean age rates were found similar in patients and controls (60.8?±?14.2 and 61?±?12.9?y, p?=?.937, respectively). Compared patients with controls, P-WD (45.85?±?12.42 vs. 21.17?±?6.6?msec, p?p?p?p?p?p?=?.001) were found to be different. QTc-max and Tp-e interval were found to be similar in both groups.

Conclusion: P-WD and QTc dispersion, Tp-e interval and Tp-e/QTc ratio were found to be increased in with CKD stages 3–5 on no RRT.     

Stroke-free status and depression scores among Saudi dialysis patients

Abstract

Background: To assess the prevalence of stroke symptoms and depression among Saudi dialysis patients and related factors. Methods: This is a cross-sectional multicentre study of Saudi dialysis patients. Demographics, clinical and laboratory’s data were collected. Freedom from stroke symptoms was assessed using the Questionnaire for Verifying Stroke-Free Status and depression using the Geriatric Depression Scale. Results: Five-hundred and forty-nine patients (77.3% response rate); 94.6% were receiving hemodialysis and 5.4% peritoneal dialysis were included in the study. Freedom from stroke was reported in 76.6% of patients, was higher in females (p?=?0.07), and was not affected by the presence of diabetes mellitus coronary artery disease or peripheral vascular disease. However, it was significantly lower in hypertensive patients (p?=?0.035) and was not affected by age, dialysis duration, Kt/V, albumin or hemoglobin levels. It was, however, more prevalent in the non-depressed patients compared to depressed patients (p?=?0.036). Mild and major depression scores were noted in 45.2% and 6.1%, respectively; the depression score being significantly higher in HD than in PD patients (6.3?±?3.4 vs. 5.0?±?3.2 p?=?0.049) but was not related to sex, employment, vascular access type, age, dialysis duration, Kt/V or serum albumin or hemoglobin levels. Conclusion: A quarter of the patients were not stroke symptom-free and these were more likely the depressed patients, in females, but significantly less in hypertensive patients. Almost half of the patients were depressed with 6.1% having major depression. The depression score was significantly higher in HD than in PD patients.     

Significance of mast cell renal infiltration in patients with anti-GBM nephritis

To investigate the role of mast cells (MCs) renal infiltration in the progression of human anti-GBM nephritis, 38 patients diagnosed with anti-GBM nephritis were enrolled. Renal biopsies were performed. Immunohistochemistry was conducted to detect MCs in renal tissues. Patients were divided into group 1 (MCs?<50?mm^?2, n?=?18) and group 2 (MCs?≥50?mm^?2, n?=?20) according to the infiltrating renal MC count. The clinical–pathological indices were compared. And, correlation between MCs and the clinical–pathological indices was analyzed. Patients of group 2 had more severe renal dysfunctions, expressed as higher levels of serum creatinine (SCr 8.95?±?3.66 vs. 4.75?±?2.73?mg/dL, p?<?0.001), urine retinol-binding protein (RBP 29.8?±?13.9 vs. 15.7?±?11.5?mg/dL, p?=?0.005), and lower urinary osmotic pressure. Pathologically, patients of group 2 had a higher percentage of fibrous/fibrocellular crescents (66.7?±?21.9 vs. 47.0?±?33.6%, p?=?0.037) but a lower percentage of cellular crescents. More CD8 (268?mm^?2 vs. 180?mm^?2, p?=?0.045) and CD68 (268?mm^?2 vs. 180?mm^?2, p?=?0.045) positive cells infiltrating the interstitium were observed in group 2. Furthermore, renal MCs correlated significantly with the total number of crescents and the tubular interstitial CD8 and CD68 positive cells. And, the number of MCs was associated with the histological types. The renal function was significantly different between the two groups at presentation. However, at 3 and 6 month follow-up, the patient outcome was associated with the histological types. Our study showed that MC infiltrations were associated with chronic lesions in anti-GBM nephritis and may be involved in the loss of renal function with pathological changes.     

Effect of triptolide on expression of thrombospondin-1 and transforming growth factor-β1 in renal tubular cells

Abstract

The objective of our study is to investigate the effect of triptolide on expression of thrombospondin-1 and transforming growth factor β1 in renal tubular cells. Human renal tubular epithelial cells were stimulated by different concentrations of triptolide (0.1, 1, and 10?μg/L) in the presence of angiotensin-II (10^?7?mol/L). Real Time PCR was used to detect the mRNA expression of thrombospondin-1 and transforming growth factor β1. Western blot analysis was used to detect the protein expression. ELISA was used to detect the level of total and active transforming growth factor β1. The mRNA expression of thrombospondin-1 (3.66?±?0.48 vs. 1.33?±?0.26, p?<?0.05) and transforming growth factor β1 (3.58?±?0.59 vs. 1.26?±?0.28, p?<?0.05) were up-regulated obviously when stimulated by angiotensin-II. And the protein expression of thrombospondin-1 (0.5126?±?0.0936 vs. 0.1025?±?0.0761, p?<?0.01) and transforming growth factor β1 (0.5948?±?0.0736 vs. 0.1318?±?0.0614, p?<?0.01) were also up-regulated simultaneously when stimulated by angiotensin-II. The expression of thrombospondin-1 and transforming growth factor β1 induced by angiotensin-II were down-regulated markedly with 1?μg/L and 10?μg/L of triptolide in mRNA and protein levels (p?<?0.05, p?< 0.01). And triptolide (1 and 10?μg/L) could reduce the expression of total and active transforming growth factor β1 (p?<?0.05, p?<?0.01). In conclusion, triptolide can inhibit the expression of thrombospondin-1 and transforming growth factor β1 in mRNA and protein levels and down-regulate the levels of total and active transforming growth factor β1.     

Barriers to medication adherence and its relationship with outcomes in pediatric dialysis patients

Background

Medication adherence is a major factor determining outcome in children with chronic disease. Children with end-stage renal disease are challenged with requirements for renal replacement therapy in addition to complicated medication regimens.

Methods

We assessed barriers to medication adherence in 22 pediatric patients receiving chronic dialysis [63.6 % hemodialysis (HD), 36.4 % peritoneal dialysis (PD); age 15.9?±?0.7 years, dialysis vintage 31.6?±?6.5 months]. Adherence was assessed by a 16-question survey with a maximum score (difficulty) of 64.

Results

The overall mean adherence score was 30.9?±?2.4 (range 16–49; median? 27.5). There was a trend for lower adherence scores in patients on HD (27.5?±?2.9) compared to those on PD (36.8?±?3.7) (p?=?0.06). Compared to HD patients, the mean score/question was significantly higher in PD patients (1.7?±?0.2 vs. 2.4?±?0.2, respectively; p?=?0.006). Of the 16 questions, HD and PD patients gave a mean response of ≤1.2 for five and zero questions, respectively. Neither gender, age nor dialysis vintage was related to adherence scores. There was also a trend for adherence scores to be higher in females (35.6?±?3.7) than in males (27.5?±?2.9) (p?=?0.1), but this difference did not reach statistical significance. Markers of mineral bone disease were similar in HD and PD patients. Among all targets in HD and PD patients combined, there was no relationship between adherence scores and number of targets reached (r?=??0.09, p?=?0.7).

Conclusion

There are many barriers to medication adherence in pediatric patients receiving dialysis. In our patient group the difficulties were more evident in patients receiving PD than in those receiving HD.     

The influence of low calcium dialysate on left ventricular diastolic function in peritoneal dialysis patients

Left ventricular (LV) diastolic function was found to be a significant predictor of cardiovascular events and general mortality in dialysis. Studies have indicated that dialysate calcium concentrations were significantly associated with cardiac function. However, the relationship between low calcium dialysate and LV diastolic function has not been clear. The aim of this study was to investigate the influence of low calcium dialysate on cardiac function in peritoneal dialysis (PD) patients. A total of 60 PD patients were enrolled in this study, with a calcium content of the PD solution of 1.25?mmol/L in 30 patients (low-calcium group) and 1.75?mmol/L in 30 patients (standard-calcium group). Standard M-mode and two-dimensional ultrasound measurements were applied to detect the cardiac function. After 12-month follow-up, we found no significant difference in blood pressure, calcium, phosphorus, parathyroid hormone (PTH), etc., between the two groups. Residual renal function (RRF), which is associated with LV cardiac function, was significantly decreased in the standard-calcium group compared with the low-calcium group (5.64?±?3.23 vs. 9.38?±?3.17, p?=?.001). Compared with the low-calcium group, E_max (peak early diastolic velocity) and A_max (peak late diastolic velocity) were significantly decreased (p?p?相似文献   

Absence of interaction of diabetes mellitus with chronic kidney disease on mortality in acute heart failure

Objectives: To evaluate how chronic kidney disease (CKD) and diabetes mellitus (DM) influence in-hospital mortality in patients urgently admitted for acute heart failure (HF). Methods: We used data from the Spanish “Minimum Basic Data Set” for 2006–2007 to evaluate clinical differences and crude mortality rates for patients having versus non-having CKD or DM. We tested pre-specified predictive factors of in-hospital mortality in a multivariate logistic regression model, which included age, sex, CKD, DM, acute respiratory failure, a modified Charlson Comorbidity Index—excluding CKD/DM- and a CKD?×?DM-interaction variable. p Values?Main findings: A total of 275,176 episodes of acute HF were analyzed (47.9% male, mean age 76.2?±?12.8 years). CKD patients (N?=?25,174, 9.1%) were older (78.4?±?10.1 vs. 76.0?±?13.1 years; p?N?=?88,994, 32.3%) more often had vascular risk factors and CKD (11.4% vs. 8.1%; p?p?p?p for interaction?=?0.73). DM remained protective (OR?=?0.85, 95% CI: 0.82–0.87; p?p?Conclusions: In patients urgently admitted for HF, the association of CKD with higher in-hospital mortality was homogeneous irrespectively of the absence or presence of DM.     

Urokinase can reduce heparin dose in patients with hypercoagulable states during hemodialysis

Abstract

Heparin is routinely administered at high doses during hemodialysis to patients with hypercoagulable states. This study aimed to evaluate the safety and efficacy of low-dose heparin in combination with urokinase in this patient population. The presence of a hypercoagulable state was confirmed by thromboelastography. Doses of heparin and urokinase were adjusted based on activated partial thromboplastin time (APTT). Clotting in the extracorporeal circuit was evaluated by a semi-quantitative index. Prothrombin time (PT) and APTT were measured before, during and after dialysis. Kt/V_urea was used to assess the efficacy of dialysis. D-dimer levels were measured 2?h after the start of hemodialysis. Hemodialysis data with heparin administered alone prior to dialysis were used as control in the present study. With urokinase treatment, the initial dose of heparin was reduced by 45.0?±?11.4% during hemodialysis and the maintenance dose by 46.8?±?12.8% compared with heparin alone. No side effects due to urokinase were observed. Bleeding events were rare. Post-dialysis PT (12.99?±?1.41 vs. 15.22?±?3.12?s, p?=?0.02) and APTT (97.75?±?43.62 vs. 140.16?±?30.12?s, p?=?0.002) with urokinase plus heparin were significantly shorter than with heparin alone. Finally, during dialysis, D-dimer levels were significantly higher with heparin alone (0.21?±?0.11?mg/L) than with heparin and urokinase (0.169?±?0.122?mg/L, p?=?0.017). In conclusion, urokinase significantly reduced the dose of heparin required during hemodialysis without any side effects in patients with hypercoagulable states during hemodialysis.     

Relationship between late arteriovenous fistula (AVF) stenosis and neutrophil–lymphocyte ratio (NLR) in chronic hemodialysis patients

Objectives: Primary cause of late arteriovenous fistula (AVF) dysfunction is venous stenosis as result of neointimal hyperplasia. The mechanism of AVF stenosis is not exactly understood. But inflammation is a contributing factor for development of AVF stenosis. Neutrophil–lymphocyte ratio (NLR) reflects systemic inflammation, and it was investigated in many diseases. The aim of this study was to investigate the relationship between NLR and AVF stenosis in chronic hemodialysis patients. Materials and methods: Of 593 patients applied to the department of interventional radiology between January 2011 and November 2012, a total of 108 patients meeting the appropriate criteria were included in this study. All patients were assessed with Color Doppler ultrasonography and then digital subtraction angiography was used for the patients with abnormal results. Sixty-four patients were classified as patients with AVF stenosis (group 1) and 44 patients without AVF stenosis (group 2). Routine biochemical and complete blood count values measured six months ago were recorded for all patients. Results: Mean NLR (3.47?±?0.46 vs. 2.27?±?0.22; p?p?r?=?0.625; p?p?Conclusions: For hemodialysis patients with increased level of NLR and decreased level of HDL, regular monitoring with regard to the development of AVF stenosis may be beneficial. Our study suggests that the mechanism of AVF stenosis might have similarities to that of atherosclerosis.     

Effect of gradually lowering dialysate sodium concentration on the interdialytic weight gain,blood pressure,and extracellular water in anuric hemodialysis patients

Background: The majority of hemodialysis (HD) patients are overhydrated and have high interdialytic weight gain (IDWG) which induces increased blood pressure (BP). The positive sodium balance resulting from a high sodium diet, a high dialysate sodium concentration (DNa), or a combination of both is major causes of this disease. We evaluated the effects of lowering DNa on IDWG, BP, and volume status in anuric HD patients with dietary sodium restriction. Methods: Thirty-two patients were enrolled in this study and the period was divided by phase 1 and 2 according to DNa which decreased from 140 to 135 mEq/L at a rate of 1 mEq/L per month; phase 1, 140 mEq/L; phase 2, 135 mEq/L. We compared the IDWG, BP, volume status measured by multifrequency bioimpedance spectroscopy, and adverse events such as intradialytic hypotension, cramps, and headache of both phases. Results: The IDWG was significantly reduced by 0.39?±?0.38?kg (p?=?0.000). Pre-dialysis BP showed significant reduction (systolic pressure 146?±?18 vs. 138?±?22?mmHg; p?=?0.012, diastolic pressure 80?±?10 vs. 75?±?11?mmHg; p?=?0.008). Pre-dialysis extracellular water (ECW) was reduced significantly by 0.13?±?2.22 L (p?=?0.02). There was no significant increase in adverse events (all p?>?0.05). Conclusions: This study showed that gradually lowering DNa could bring a significant reduction in pre-dialysis IDWG, BP, and ECW without increased adverse events. Large and crossover designed study will be needed to demonstrate the clear causal relationship.