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.     

Valve replacement surgery in patients with end-stage renal disease: long-term results

BACKGROUND: The life expectancy of patients with chronic renal failure who are dependent on dialysis is very poor. This study was undertaken to determine time-related outcomes in dialysis patients requiring cardiac valve replacement. METHODS: From 1994 to 2001, 29 end-stage renal disease (ESRD) patients on hemodialysis (HD) program underwent 30 valve replacement operations: 29 received mechanical valves (97%), and one received bioprosthetic valves. The sites of valve replacement were 11 aortic (36.7%), 18 mitral (60%), and one both aortic and mitral (3.3%). Mean age was 42.46 +/- 14.26 years (range 17-75 years). Follow-up was completed in 28 patients (96.5%). RESULTS: Early postoperative mortality (in the first 30 days) was 3.4% (n = 1). The overall estimated Kaplan-Meier survival was 56.7% at 36 months, 46.7% at 60 months, and 43.3% at 96 months. HD program was discontinued for two patients after renal transplantation in the follow-up period. All patients, except the one with bioprosthesis, used warfarin sodium for anticoagulation and none of them had bleeding. One of the patients had a major cerebrovascular accident (CVA) and another one had a minor CVA at the follow-up (6.7%). CONCLUSIONS: Life quality is better and life expectancy is longer after valve replacement in ESRD patients who have valvular disease. Also, longer life expectancy increases the probability for finding donors for kidney transplantation.     

肥胖症的外科治疗

肥胖及其并发疾病已成为全球主要健康问题。对于严重肥胖的患者而言,手术治疗是长期有效的。在减轻体重的同时,患者原有的肥胖相关疾病也得到了缓解和控制,远期病死率大大降低。大量临床资料已经证明了减肥手术的安全性及有效性。减肥手术为解决肥胖问题及其并发疾病打开了一扇新窗口。     

肥胖症的外科治疗

肥胖及其并发疾病已成为全球主要健康问题.对于严重肥胖的患者而言,手术治疗是长期有效的.在减轻体重的同时,患者原有的肥胖相关疾病也得到了缓解和控制,远期病死率大大降低.大量临床资料已经证明了减肥手术的安全性及有效性.减肥手术为解决肥胖问题及其并发疾病打开了一扇新窗口.     

Therapeutic camping for children with end-stage renal disease

Therapeutic camping experiences for children with end-stage renal disease (ESRD) have proliferated in the United States and abroad. This report is based on the results of a survey designed to accumulate data on the development and implementation of 20 such camps. Children attending camp ranged in age from 1 year to 19 years. Single disease-specific camps were most common, while camps for children with a variety of chronic illnesses, including ESRD, and mainstream camps were also conducted. Facilities were available for hemodialysis and continuous ambulatory peritoneal dialysis, but not automated peritoneal dialysis, in the majority of surveryed camps. Dialysis nurses, pediatric nephrologists, dietitians and social workers were the medical personnel that most frequently participated in the camps. On average, 32 dialysis/transplant patient campers (range 6–100) attended camp for a 1-week session. Therapeutic camping experiences for children with ESRD are extremely successful and attempts to increase the availability of similar camps should be encouraged.Presented in part at the 13th Annual Conference on Peritoneal Dialysis, 7–9 March 1993, San Diego, California, USA.     

老年终末期肾病患者的透析方式选择

随着人口老龄化加剧,在全球范围内需要接受肾脏替代治疗的老年终末期肾脏病(ESRD)患者人数日益增加。老年ESRD患者由于年龄老化、生理机能下降、合并症多、自我维护能力差、预期生存时间短等特点给透析治疗亦带来了诸多困难。老年ESRD患者在透析的治疗时机、透析方式的选择上均具有其特殊性,需要根据患者原发病因、评估透析治疗可能带来的并发症、所在地医疗卫生条件等制定个体化的治疗方案。除了医疗技术因素外,还需综合考虑如患者预期寿命、对生活质量的期望以及对患者家庭的影响等其他非医疗因素。     

Unique risks for mortality in patients with end-stage renal disease undergoing nonemergent colorectal surgery

Background

The aim of this study was to identify unique risk factors for mortality in patients with end-stage renal disease undergoing nonemergent colorectal surgery.

Methods

A multivariate logistic regression model predicting 30-day mortality was constructed for patients with end-stage renal disease undergoing nonemergent colorectal procedures. Data were obtained from the National Surgical Quality Improvement Program (2005–2010).

Results

Among the 394 patients analyzed, those with serum creatinine levels >7.5 mg/dL had .07 times the adjusted mortality risk of those with levels <3.5 mg/dL. For colorectal surgery patients, the average serum creatinine level was 5.52 ± 2.6 mg/dL, and mortality was 13% (n = 50).

Conclusions

High serum creatinine was associated with a lower risk for mortality in patients with end-stage renal disease, even though creatinine is often considered a risk factor for surgery. These results show how variables from a patient-centered subpopulation can differ in meaning from the general population.     

Prevalence of chronic kidney disease and end-stage renal disease in a bariatric versus nonbariatric population: a retrospective analysis of the U.S. National Inpatient Sample database

BackgroundIn the past five 5 years our team has studied the effects of bariatric surgery on chronic kidney disease (CKD) at our institution.ObjectivesThe objective of this study was to assess the impact of bariatric surgery (BaS) on the prevalence and likelihood of CKD and end-stage renal disease (ESRD) nationwide.SettingAcademic hospital, United States.MethodsWe conducted a retrospective analysis of the U.S. National Inpatient Sample (NIS) database for the years 2010–2015 and compared. Univariate and multivariable analysis were performed to assess the impact of BaS on the point prevalence and the probability of CKD and ESRD. Similarly, a multivariable logistic regression was conducted to measure the impact of the most important risk factors for CKD exclusively in a severely obese population.ResultsData on 296,041 BaS cases and 2,004,804 severely obese controls was extracted from the NIS database and relative to controls, all baseline CKD risk factors were less common among bariatric surgery cases. Nonetheless, even after adjusting for all CKD risk factors, controls exhibited marked increases in the odds of CKD-stage III (odds ratio [OR] 3.10 [3.05–3.14], P < .0001) and modes increase for ESRD (OR 1.13 [1.09–1.18], P < .0001). Overall, even after adjusting for risk factors we observed that the rate of CKD is significantly higher in the control group, 12% when compared with 5.3% in the bariatric surgery group (P < .0001).ConclusionIn this retrospective, case control study of a large, representative national sample of patients with severe obesity, BaS was found to be associated with significantly reduced point-prevalence and likelihood for CKD when adjusted for baseline CKD risk factors as compared with patients with obesity who did not undergo BaS. Overall, BaS resulted in a reduced rate and a moderate decrease in the likelihood of 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.     

递增式血液透析对终末期肾病患者肾功能、微炎症及死亡率的影响

目的研究递增式血液透析(IHD)对终末期肾病(ESRD)患者肾功能、微炎症及死亡率的影响。 方法选取2017年7月至2021年6月于我院行血液透析(HD)治疗的ESRD患者84例,按照随机数字表法将84例ESRD患者分为递增组(n＝42)与常规组(n＝42)。治疗前及治疗6个月后,观察两组透析充分及生存情况、血尿素氮(BUN)、胱抑素C(CysC)、血清肌酐(Scr)、残余尿量(RUV)、尿素氮下降率(URR)、Kt/V等肾功能指标,血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和β2微球蛋白(β2-MG)等微炎症指标,以及透析期间不良反应。 结果与常规组相比,递增组透析充分率增高,死亡率降低(P<0.05)。治疗6个月后,与常规组相比,递增组的BUN、CysC、Scr、RUV降低;URR、Kt/V增高(P<0.05);血清CRP、IL-6、TNF-α及β2-MG水平降低(P<0.05);不良反应发生率降低(P<0.05)。 结论IHD可以保护ESRD患者的残余肾功能,抑制机体微炎症,降低不良反应率和死亡率。     

The effects of bariatric surgery on cognition in patients with obesity: a systematic review and meta-analysis

Obesity impairs cognition. Bariatric surgery can result in substantial weight loss in patients with severe obesity; however, the impact of bariatric surgery on cognitive function remains controversial. To quantify the effect of bariatric surgery on cognition in patients with severe obesity, we performed a meta-analysis of 20 studies retrieved from PubMed, Cochrane, and Embase. Of these, 6 cohort studies found that Roux-en-Y gastric bypass leads to better performance for immediate verbal memory function (standardized mean difference [SMD] = .56; 95% confidence interval [CI]: .30–.82, P < .0001; I2 = 0%) and delayed memory function (SMD = .64; 95% CI: .38–.90, P < .00001; I² = 0%) during in the short term. Similarly, positive impacts on immediate verbal memory function (SMD = .46; 95% CI: .09–.83, P < .00001) and delayed memory function (SMD = .84; 95% CI: .46–1.22, P < .0001) were identified during a long-term follow-up. The Roux-en-Y gastric bypass group showed no improvements in attention, cognitive speed, and executive function compared with the control obese group. In 14 longitudinal studies (12 single-arm pre-post comparison studies and 2 cohort studies whose control group had no follow-up cognitive data), patients performed better postoperatively than preoperatively in all cognitive domains during repeated assessments. The analysis for the 20 operative groups showed that individuals treated with bariatric surgery had higher scores after repeated assessment of most neuropsychological tests except for animal fluency and letter fluency than baseline scores. These findings suggest that patients with severe obesity may obtain immediate verbal and delayed memory function benefits from Roux-en-Y gastric bypass.     

Vascular access in elderly patients with end-stage renal disease

During the last few years, the number of elderly patients with end-stage renal disease (ESRD) has been increasing worldwide. Establishment of a viable vascular access is of primary importance in these patients. This review discusses the advantages and disadvantages of the available vascular access modalities [namely arteriovenous (AV) fistulae, AV grafts, and central venous catheters (CVCs)] in elderly ESRD patients. AV fistulae seem to be superior when compared with other vascular access alternatives with respect to patency, morbidity and mortality rates. On the other hand, due to the age-related advanced atherosclerosis in the elderly, higher failure rates for AV fistulae in this age group have been described. Two controversial issues, namely the higher infection and thrombosis rates in elderly ESRD patients, are also discussed. Current evidence suggests that old age should not comprise a drawback when selecting the appropriate vascular access modality (AV fistula, AV graft or CVC) for the performance of hemodialysis. The possible vascular access options in elderly ESRD patients should not be different from younger individuals.     

Bariatric surgery in patients with pulmonary hypertension

Background

Data regarding the outcomes of bariatric surgery in patients with pulmonary hypertension (PH) is limited. The aim of this study was to review our experience on bariatric surgery in patients with PH.

Bariatric surgery improves the employment rate in people with obesity: 2-year analysis

Background

Beyond medical complications, people with obesity experience dramatic impairment of quality of life, including adverse workplace effects. Obesity results in weight-based discrimination and a high rate of unemployment because of work disability, absenteeism, loss of productivity, and cost. A few studies have been performed to assess the relationship between obesity surgery and the workplace, finding an improvement in weekly working hours and productivity and a decrease in absenteeism, days of sick leave, and state benefit claims. However, the results are still controversial concerning the overall employment rate.

Screening for Fabry disease in male patients with end-stage renal disease in western France

ContextFabry disease is a rare X-linked genetic disease due to pathogenic variants in the GLA gene. Classic Fabry disease is characterized by glycosphingolipids accumulation in all organs including the kidney, resulting in end-stage renal disease in a subset of male patients. Fabry disease should therefore be considered in the differential diagnosis of patients with unexplained end-stage renal disease.ObjectiveWe performed a prospective screening study in Western France to determine the prevalence of Fabry disease in a large population of dialyzed and transplanted patients.Patients and methodsPatients meeting the inclusion criteria (males, 18-70 years with end-stage renal disease of unknown or vascular origin) were selected from the REIN® registry and the CRISTAL® database. Screening on filter papers was performed after patient consent was obtained during either a dialysis session or a transplantation follow-up visit.ResultsOne thousand five hundred and sixty-one end-stage renal disease male patients were screened and 819 consented (dialysis: n = 242; transplant: n = 577). One single patient was found with decreased alpha-galactosidase levels <25%. GLA sequencing identified the p.Phe113Leu variant in favor of an unknown superimposed kidney disease responsible for end-stage renal disease since this GLA pathogenic variant is associated with a later-onset cardiac form of Fabry disease with minimal kidney involvement. Family cascade genotyping revealed a previously undiagnosed affected brother.ConclusionThe prevalence of Fabry disease in end-stage renal disease patients was 0.12%, questioning the efficacy of this screening strategy with respect to the low prevalence. However, beside the benefit for the patient and his family, the increased awareness of Fabry disease among participating nephrologists may be of interest for future patients.     

Bariatric surgery

Bariatric surgery is a growing segment of minimally invasive surgery. Laparoscopic bariatric procedures are considered some of the most technically challenging surgeries, requiring advanced surgical skills. Successful care of the morbidly obese patient requires a multidisciplinary team approach. These unique requirements are difficult to meet during residency and surgeons interested in bariatric surgery should pursue fellowship training in bariatric surgery.     

The efficacy of low-dose tadalafil in patients undergoing hemodialysis with end-stage renal disease

Background: Erectile dysfunction (ED) is a disorder that is frequently observed in people with chronic kidney disease who undergo hemodialysis (HD). In the context of evidence-based medicine, we aimed to investigate the effect of low-dose tadalafil on sexual function in patients undergoing HD.

Methods: The medical records of 30 males (aged 29–65?years) with end-stage renal disease (ESRD) on a HD program, and who had received 5?mg tadalafil twice weekly, were retrospectively evaluated. Changes in erectile and ejaculatory function were evaluated using the International Erectile Function Index questionnaire, the Erection Hardness Scale (EHS), and the Male Sexual Health Questionnaire (MSHQ).

Results: The mean age of the patients was 47.6?±?10.1?years, their mean body mass index was 24.3?±?4.2?kg/m², their mean hemoglobin was 11.9?±?0.9?g/dL, and their mean creatinine clearance was 5.8?±?1.1?mL/min. At the third month of treatment, 36.6% of the patients had no ED, 40% had mild ED, 10% had mild-to-moderate ED, and 13.3% had moderate ED. The mean MSHQ scores (p?p?=?.001) were significantly improved. There was no significant difference between Beck's Depression Inventory scores (p?>?.05), but Hamilton anxiety rate scores decreased significantly (p?=?.001). The quality-of-life score improved throughout the study period (p?Conclusions: Tadalafil therapy is an effective therapeutic option in patients with ESRD who undergo HD, not only for the treatment of ED, but also for ejaculatory function, with acceptable adverse effects.     

Bariatric surgery and secondary hyperparathyroidism: a meta-analysis

BackgroundObesity increases the risk of obesity-related medical problems. Weight loss after metabolic and bariatric surgery (MBS) has been well studied. However, the effects of MBS on parathyroid function remain unclear.ObjectiveThe objective of this study was to perform a meta-analysis to examine the impact of MBS on the risk of secondary hyperparathyroidism (SHPT).SettingThe Second Xiangya Hospital, Central South University, Changsha, Hunan, China.MethodsThe PubMed, Embase, Web of Science, and the Cochrane Library databases were systematically reviewed from inception to May 2022 to identify studies reporting quantitative measurements of SHPT risk pre-MBS and post-MBS. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were estimated and compared. Effects were pooled using a random-effects or fixed-effects model. Subgroup analyses were performed according to the follow-up time and surgical procedure.ResultsThe final meta-analysis included 9 studies with a total of 5585 patients. The mean follow-up time was 3.5 years (range 0.25–5). Overall, MBS appears to does not affect SHPT risk (OR = 1.34, 95% CI 0.81–2.20, I² = 95%). Follow-up data showed no evidence of SHPT within 2 years following gastric bypass (GB) and sleeve gastrectomy procedures (OR = 1.42, 95% CI 0.66–3.07 for GB, OR = 0.39, 95% CI 0.09–1.62 for sleeve gastrectomy ). At the 2-year and long-term follow-up intervals, a marked increase in SHPT was detected for GB (OR = 6.06, 95% CI 3.39–10.85 for GB). In addition, the surgical procedure for GB decreased the likelihood of SHPT compared with the surgical procedure for biliopancreatic diversion with duodenal switch (OR = 0.29, 95% CI 0.17–0.49).ConclusionsOur meta-analysis indicated that GB appears to increase SHPT risk. Patients undergoing MBS should be aware of the risk of SHPT. Larger studies are needed to evaluate the outcomes and side effects and may eventually provide a better and more comprehensive understanding of the risks.