A comparison of quality of sleep between patients with chronic kidney disease not on hemodialysis and end-stage renal disease on hemodialysis in a developing country

Few studies have compared quality of sleep between pre-dialysis chronic kidney disease (pre-dialysis CKD) patients and end-stage renal disease patients on dialysis (ESRD) and have found inconsistent results. Objective of this study is to compare quality of sleep between patients with pre-dialysis CKD and ESRD in a developing country. This study was conducted in an out-patient department and hemodialysis unit of a tertiary care facility. Patients included had either pre-dialysis CKD or ESRD. Assessment of quality of sleep was done using Pittsburgh sleep quality index (PSQI). A total of 152 patients were included in the study. Out of these patients, 79 (52%) had ESRD and 73 (48%) had pre-dialysis CKD. Median PSQI score was 6 (IQR 3–8.8). Poor sleep quality (PSQI ≥5) was present in 100 (65.8%) patients. Only hemoglobin (β?=??0.39, p?β?=?0.56, p?β?=?0.22, p?r?=??0.34, p value .80) in pre-dialysis CKD patients. Poor sleep quality is common in patients with CKD including hemodialysis patients in a developing country, which is independent of kidney function in non-dialysis patients. There is no difference in quality of sleep between pre-dialysis CKD and ESRD patients.     

Depression in end-stage renal disease hemodialysis patients

Depression has been identified as a complicating comorbid diagnosis in a variety of medical conditions, including end-stage renal disease (ESRD). Despite this, the psychological health of hemodialysis patients is understudied. The purpose of this paper is to review the research and issues involved in the assessment of depression and its sequelae in ESRD. Accurate estimation of the prevalence of depression in the ESRD population has been difficult due to the use of different definitions of depression and varied assessment techniques, the overlap of depressive symptomatology with symptoms of uremia, and the confounding effects of medications. We suggest that depressive affect is a more important construct to study than diagnosis of depression syndromes per se in patients with chronic kidney disease. The Beck Depression Inventory is a reasonable measure of depressive affect in the ESRD population, if a higher than usual cutoff score is used or if its somatic components are omitted. Several pathways link depression and ESRD, and are probably bidirectional. As such, treatment of depressive affect could impact medical as well as psychological outcomes. The need for treatment intervention trials is great. Limited evidence regarding the safety and efficacy of treatment of hemodialysis patients with selective serotonin reuptake inhibitors is available, and cognitive behavioral therapy holds promise as an intervention for depression in this complex medical population.     

FGF-23 in patients with end-stage renal disease on hemodialysis

BACKGROUND: Fibroblast growth factor (FGF)-23 is a recently identified circulating factor which causes renal phosphate wasting disorders. Although the mechanism of regulation of FGF-23 secretion is unknown, plasma FGF-23 level may be regulated or affected by serum phosphate levels because of its hypophosphatemic effect. METHODS: We tested the hypothesis that plasma FGF-23 levels may be increased in hyperphosphatemia in patients with end-stage renal disease (ESRD) on maintenance hemodialysis. We measured plasma FGF-23 levels in 158 male uremic patients on maintenance hemodialysis. Plasma samples were obtained before starting dialysis sessions to determine FGF-23 levels by enzyme-linked immunosorbent assay (ELISA). RESULTS: Plasma FGF-23 level exhibited significant and positive correlations with inorganic phosphate, intact parathyroid hormone (PTH), corrected calcium, and duration of hemodialysis on simple regression analyses. All these associations remained significant in multiple regression analyses. CONCLUSION: Serum phosphate, calcium, and intact PTH could be regulators of FGF-23 levels in uremic patients on maintenance hemodialysis. Our results may provide new insights into the pathophysiologic effects of FGF-23 on calcium-phosphate homeostasis.     

终末期肾脏病血液透析患者不安腿综合征

不安腿综合征属周围神经系统疾病,分原发性和继发两种类型。大多发生于终末期肾脏病(ESRD)或患者开始透析治疗以后,症状较原发性患者重。但具体发病机制迄今仍然尚不清楚。本文就终末期肾病透析患者不安腿综合征病因、发病机制、临床表现、检查、诊断、治疗及目前进展情况作一综述。     

终末期肾脏病腹膜透析患者的心血管疾病

目的 了解终末期肾脏病（ESRD）腹膜透析患者的心血管疾病（CVD）发病率和有关高发危险因素,以及并发CVD的腹膜透析患者治疗时需关注的问题。 方法 研究对象为上海交通大学医学院附属仁济医院慢性肾脏病（CKD）5期接受腹膜透析的患者,共254例入选,采用横断面回顾性调查分析方法。平均随访时间中位数为49个月。采集病史、血生化检测结果、腹膜透析充分性评估、颈动脉及心脏彩色多普勒超声检测结果。评估CVD事件的发生、发展和预后,以及进行相关因素分析。 结果 CVD事件发生率为37%（93/254）。发生CVD的患者多伴有糖尿病、透析龄较长、血三酰甘油水平较高、血清白蛋白较低、前白蛋白较低。彩色多普勒超声显示,发生CVD组的左房内径（LAD）（mm）、室间隔厚度（LVST）（mm）、左室心肌质量指数（LVMI）（g/m2）显著高于未发生CVD组（43.16±4.93比 38.02±4.77、11.19±2.05比10.01±1.45、中位数192.03比150.28,均P < 0.05）;颈动脉内膜中层厚度（IMT）较厚（中位数0.80比0.65）,颈动脉内径增宽;收缩期峰值流速（SPV）和舒张期峰值流速（DV）流速降低。既往无CVD的患者在随访过程中发生CVD时,其Ccr、Kt/V、D/Pr、理想体质量校正的蛋白分解率（nPCR）及血清白蛋白水平与无发生CVD组差异有统计学意义（P = 0.045、0.015、0.051、0.029及0.005）。在随访过程中出现新发CVD或CVD病情恶化的原有CVD的患者,都是透析龄较长以及三酰甘油水平较高者。LAD、LVST、LVMI及IMT在新发CVD和未发CVD两组间差异有统计学意义（P=0.033、0.022、0.045及0.029）。Kaplan-Meier生存分析显示,既往CVD史和CVD症状是生存的独立危险因素。血清白蛋白<330 g/L、LAD>39.6 mm及曾患腹膜炎的患者生存率较低。 结论 ESRD腹膜透析患者是CVD的高发群体,需了解这些患者的病史和伴随症状;保持透析的充分性;同时要防止腹膜炎的发生。     

Cardiovascular calcification in patients with end-stage renal disease: a century-old phenomenon

The mortality risk from cardiovascular disease is increased in patients with end-stage renal disease (ESRD). This is due to both traditional and dialysis-specific factors. Recently, a number of the dialysis-specific risk factors have been implicated in the pathogenesis of cardiovascular calcification. These include: hyperphosphatemia, high calcium-phosphate (Ca x P) product, elevated parathyroid hormone levels, duration of dialysis, and treatment with calcium-containing phosphate binders and vitamin D analogs. The recent availability of electron beam computed tomography (EBCT) has triggered increased awareness of the occurrence of cardiovascular calcification in ESRD patients. Given the development of transient hypercalcemia with calcium-containing binders, a link between calcium load from use of calcium-containing phosphate binders and development coronary calcification has been proposed. However, a causal relationship between use of these agents and cardiovascular calcification has not been established. Moreover, this phenomenon had been recognized over a century ago, long before these phosphate binders became available. Although its pathogenesis is likely to be multifactorial, available data strongly implicate elevated serum phosphorus as the primary culprit. Furthermore, the risk of calcification may be aggravated by vitamin D therapy, particularly in patients with severe secondary hyperparathyroidism. Therefore, achieving vigorous control of serum phosphorus, Ca x P product and parathyroid hormone level might decrease cardiovascular calcification and improve survival of patients on maintenance hemodialysis. Since calcium acetate is the most cost-effective phosphate binder available, we recommend that it should remain the first line treatment of hyperphosphatemia in patients with ESRD.     

Comorbidities in patients with end-stage renal disease in developing countries

Patients with end-stage renal disease (ESRD) who are on renal replacement therapy (RRT) usually have a certain number of comorbid factors. Cardiovascular diseases are the most common comorbidities and the most common causes of mortality in ESRD patients. Noncardiovascular comorbid factors including nutrition also have impact on survival of ESRD patients on RRT. There are scarce data regarding comorbidity in developing countries. Available data have shown that hypertension, diabetes, and various cardiovascular disorders are the leading comorbidities. Improvement in outcome for ESRD patients would depend on improving quality in RRT as well as a better understanding and management of comorbid conditions.     

Complications of joint arthroplasty in patients with end-stage renal disease on hemodialysis

The mortality and morbidity after hip and knee arthroplasty were reviewed retrospectively during a 3-year period in 14 patients who had chronic renal failure and who were receiving hemodialysis. The patients had a primary total hip or knee replacement, or a revision arthroplasty or resection arthroplasty. Four of the patients (29%) died in the hospital during the postoperative period. One of the seven patients (14%) having a primary joint replacement died, whereas three of the seven patients (86%) having a revision or resection died. Every patient had multiple medical comorbidities, and every patient had a complication. The results indicate that arthroplasty procedures, especially revisions and resections, in this patient population are associated with a high rate of complications and death, and that in-depth informed consent should be provided for all patients contemplating these procedures. Meticulous treatment of medical comorbidities is mandatory. Finally, data in the literature and in the current report question whether joint arthroplasty procedures should be done in patients with end-stage renal disease who are receiving hemodialysis.     

Cardiovascular care in end-stage renal disease

Cardiovascular disease (CVD) accounts for the majority of morbidity and mortality in patients with end-stage renal disease (ESRD). Chronic kidney disease, and ESRD as its most severe form, are now acknowledged to be independent risk factors for CVD. The spectrum of CVD includes accelerated atherosclerosis, myocardial disease and heart failure, cardiac arrhythmias, and valvular heart disease. In addition, CKD and ESRD are independent and powerful factors that complicate cardiovascular procedures and have been directly linked to increased mortality. This issue of Advances in Chronic Kidney Disease will explore the spectrum of risk and the opportunities to improve care in ESRD in outpatient management, during dialysis, after kidney transplantation, and in coronary revascularization.     

Muscle ubiquitin m-rNA levels in patients with end-stage renal disease on maintenance hemodialysis

BACKGROUND: Loss of lean body mass is frequently reported in patients with end-stage renal disease (ES-RD). Inadequate nutrient intake, superimposed illnesses, endocrine disorders, uremia and acidosis are some of the potential causes of muscle depletion. Previous reports on experimental models show that lean body mass depletion results from enhancement of muscle tissue protein catabolism, mainly associated with activation of ATP-ubiquitin-dependent proteolysis. Little is known, however, about the affects on this proteolytic system in ESRD patients on maintenance hemodialysis (HD). The present study was designed to investigate the expression of ubiquitin mRNAs in skeletal muscle of patients with ESRD on maintenance HD. METHODS: Biopsies from the rectus abdominis muscle were obtained from eight ESRD patients and from six control subjects undergoing surgery for benign disease. Ubiquitin mRNA levels were measured by Northern blotting analysis. RESULTS: Patients with ESRD had mild metabolic acidosis, as a result of chronic intermittent HD. There were no significant differences between HD patients and controls with regard to the 1.2kb polyubiquitin mRNA species (332.9+/-139 vs 324.2+/-60; ns), but the levels of the 2.4 kb mRNA species were significantly lower in HD patients than in controls (1687+/-542 vs 2529.9+/-325, p=0.01). No correlation was observed between ubiquitin mRNA levels and nutritional parameters and degree of acidosis. CONCLUSIONS: The present study found that the ubiquitin mRNA levels were not increased in the muscle of stable, mildly acidotic hemodialysis patients.     

Off-pump coronary artery bypass grafting in patients with end-stage renal disease on hemodialysis

BACKGROUND: Coronary artery bypass grafting (CABG) for hemodialysis patients is high risk compared with other patient groups. The aim of this study was to analyze the potential benefits of off-pump CABG for hemodialysis patients. METHODS: From April 1994 through December 2000, 26 hemodialysis patients underwent CABG. The off-pump group consisted of 15 patients operated on without a pump and the on-pump group consisted of 11 patients operated on with a pump. RESULTS: There was no difference between the two groups with regard to mean age, mean number of diseased vessels and mean number of anastomoses per patient. No patient died in either group during hospitalization. The postoperative complication rate was low in both groups. The postoperative ventilation time was shorter in the off-pump group (8.5 vs 26.1 hours, p < 0.001, respectively [off-pump group vs on-pump group]). The length of ICU stay was shorter in the off-pump group (1.7 vs 3.5 days, p = 0.01, respectively [off-pump group vs on-pump group]). The medial cost was lower in the off-pump group (26,200.80 dollars versus 44,024.10 dollars p = 0.0001 respectively [off-pump group vs on-pump group]). CONCLUSIONS: Off-pump CABG provided excellent less-invasive cardiac surgical results for dialysis patients.     

非糖尿病终末期肾病患者血液透析期间血糖变化

目的 探讨非糖尿病终末期肾病患者血液透析过程中血糖变化并分析其原因.方法 选取我院非糖尿病终末期肾病血液透析患者20例,其中非进食组11例,进食组9例(于透析1.5～2h进食).测定患者血液透析0、0.5、1.0、2.0、4.Oh时血糖浓度.收集患者透析废液,检测其中葡萄糖含量.结果 20例患者均未出现低血糖反应,其中非进食组2例患者出现无症状低血糖.进食组血糖呈逐渐增高趋势,而非进食组血糖呈逐渐降低趋势.进食组透析废液中葡萄糖丢失量为(17.70±6.33)g,非进食组透析废液葡萄糖丢失量为(15.43±8.52)g,两组比较差异无统计学意义.结论 非糖尿病肾病血液透析期间有低血糖发生风险,血液透析中葡萄糖丢失是其主要原因,建议非糖尿肾病血液透析患者使用含糖透析液,以减少低血糖发生风险.     

Tuberculous spondylitis in patients with end-stage renal disease undergoing chronic hemodialysis therapy

Tuberculosis of the spine is not rare in immunocompromised patients and particularly in those with end-stage renal disease (ESRD). Furthermore, the possible vascular compromise of the spinal cord in patients with diabetic nephropathy may result in symptoms of neurological involvement that could lead to deterioration and paralysis. We report a series of 4 patients with ESRD undergoing dialysis that developed tuberculous spondylitis of the thoracic spine. Diabetic nephropathy was the primary cause for chronic kidney disease in 2 patients; 3 of these patients were treated conservatively with anti-tuberculous medication and orthotic splints and were cured. The fourth patient with diabetes mellitus and clinically evident signs and symptoms of severe vascular insufficiency has additionally developed incomplete paraplegia. A complete sensory recovery and partial recovery of the hip flexors and abductors within 3 months occurred, following decompression of the spine and drainage of the abscess, in combination with long-term anti-tuberculous treatment and spinal orthosis.     

Impact of nocturnal home hemodialysis on anemia management in patients with end-stage renal disease

AIM: Anemia is adversely associated with poor uremia control and is an established cardiovascular risk factor in patients with end-stage renal disease (ESRD). Nocturnal home hemodialysis (NHD) is a novel form of renal replacement therapy that offers superior clearance of uremic solutes and improvements in several cardiovascular outcome parameters. We conducted a retrospective cohort study to test the hypotheses that augmenting the dose and frequency of dialysis by NHD would improve hemoglobin (Hb) concentrations and decrease requirement of erythropoietin (EPO) in ESRD patients. METHODS: In 63 patients (mean age: 46 +/- 2 years) receiving NHD (mean duration: 2.1 +/- 0.2 years), Hb, EPO dose, iron saturation, ferritin were determined before and at six monthly repeated intervals after conversion to NHD. For comparison, 32 ESRD patients (mean age: 57 +/- 3 years) who remained on self-care conventional hemodialysis (CHD) were also studied. RESULTS: There were no differences in baseline Hb concentrations, iron saturation, ferritin, or EPO dose between the two cohorts. After transfer from CHD to NHD, there were significant improvements in Hb concentrations (from 115 +/- 2 to 122 +/- 3 (6 months) and 124 +/- 2 (12 months) g/l, p = 0.03) despite a fall in EPO requirement (from 10,400 +/- 1400 to 8500 +/- 1300 (6 months) and 7600 +/- 1100 (12 months) U/week, p = 0.03). In contrast, CHD cohort had no change in EPO requirement (from 8300 +/- 1100 to 8100 +/- 1300 (6 months) and 8600 +/- 1000 (12 months) U/week, p > 0.05) or Hb concentrations (from 110 +/- 2 to 115 +/- 3 (6 months) and 115 +/- 2 (12 months), p > 0.05). There was a higher percentage of ESRD patients who did not require EPO in the NHD cohort (24% vs. 9.4%, p = 0.01). Lower Hb concentrations were noted in the CHD cohort despite higher iron saturation (0.25 +/- 0.01 (NHD) vs. 0.33 +/- 0.02 (CHD), p = 0.02) at the end of follow-up. CONCLUSIONS: Enhancing uremic clearance by NHD resulted in a rise in Hb and a fall in EPO requirement.     

Cardiovascular calcification in end-stage renal disease.

Cardiovascular diseases are common in patients with end-stage renal disease (ESRD) and cardiovascular morbidity and mortality among dialysis patients are substantially higher than in the general population. The reasons for this high incidence are multiple. They include traditional factors such as hypertension, diabetes, dyslipidaemia, sodium overload, and elevated homocysteine levels as well as disturbances of mineral metabolism, specifically abnormalities in phosphorus and calcium homeostasis. This review will describe the specific cardiovascular complications related to calcifications in ESRD, the implications of the abnormalities of mineral metabolism in its pathogenesis and the current imaging techniques available for the detection of cardiovascular calcifications. Excess of calcium load contributes to the development of cardiac calcifications; therefore, alternative strategies to diminish exogenous calcium load should be considered in patients with ESRD.     

Cardiovascular complications in pediatric end-stage renal disease

Mortality from end-stage renal disease (ESRD) is often due to cardiac causes. Although cardiovascular complications of ESRD have long been recognized, only recently has the presence of traditional cardiovascular risk factors been associated with late cardiovascular complications. This review presents a history of cardiac involvement in ESRD, the pathophysiology of accelerated atherosclerosis and left ventricular hypertrophy, and a summary of the literature on cardiovascular risk assessment in children. Techniques for non-invasive assessment of cardiac end-organ injury are also discussed. Recommendations for monitoring of risk factors and treatment in the pediatric ESRD population are presented.     

Changes of irisin in patients with end-stage renal disease before and after hemodialysis

Objective To observe the changes of irisin in patients before and after hemodialysis (HD), as well as the differentiation of irisin change in patients with diabetes mellitus and protein energy waste. Methods Clinical parameters of patients on maintenance hemodialysis (MHD) in Shanxi People's Hospital from September 2016 to November 2016 were collected. A total of 33 cases were enrolled——14 cases of diabetic MHD group and 19 cases of non-diabetic MHD group as divided according to etiology. Based on the presence of protein energy waste, patients were also grouped into 17 cases with and 16 cases without protein waste. Before and after HD, the non parametric test was used to compare the changes of irisin in each group. Results After HD, the irisin value of 33 patients with ERSD decreased, with the difference being statistically significant [0.666(0.218, 1.365) ng/L vs 0.977(0.202, 1.820) ng/L, P=0.01]. The difference was not statistically significant in the diabetes MHD group; statistically significant in the non diabetes group [0.666(0.178, 1.351) ng/L vs 0.913(0.100, 1.497) ng/L, P﹤0.05]; and not statistically significant in the protein energy group. The irisin of diabetic MHD group and non-diabetic MHD group were compared after HD: the difference was not statistically significant. Conclusions After HD, plasma irisin levels were reduced in patients with end-stage renal disease. Diabetes and protein wasting effects are not important for irisin at HD.     

The efficacy of udenafil in end-stage renal disease patients undergoing hemodialysis

Introduction Erectile dysfunction (ED) is frequently observed in end-stage renal disease (ESRD) patients on hemodialysis (HD) compared to non-uremic patients. This situation causes severe psychogenic problems in patients and disrupts the quality of life. Different phosphodiesterase type 5 (PDE-5) inhibitors have been used, and efficacies revealed, for the treatment of ED in HD patients; however, there are no studies related to udenafil use or results for HD patients. This study retrospectively evaluated the efficacy and reliability of udenafil for HD patients. Materials and methods The laboratory findings, side effects after treatment, and International Index of Erectile Function (IIEF) scores before and after treatment were compared and evaluated for HD patients who applied to our urology clinic with ED complaints and were treated with udenafil. Results The results showed that in the HD patient group with ED, apart from ED, there were severe rates of other sexual dysfunction. In our patient group, there was a statistically significant improvement in all scores for erectile function (p?=?0.033), orgasmic function (p?0.001), sexual desire (p?0.001), relationship satisfaction (p?0.001), and general satisfaction (p?0.001) after treatment. The reported side effects were headache in one patient and dyspepsia in one patient. Conclusion We concluded that udenafil is an effective and reliable treatment approach for HD patients; however, our results require support from prospective randomized crossover studies with sildenafil.