Viral hepatitis infections among dialysis patients: Thailand registry report

BACKGROUND: Patients on dialysis are at high risk of acquiring viral hepatitis infections. However, there were only few data from Thailand. The aim of the present study was to assess the prevalence, incidence and associated risk factors of viral hepatitis infections among dialysis patients. METHODS: A retrospective study was conducted to evaluate 5179 medical records of dialysis patients from the Thailand Renal Replacement Therapy Registry. RESULTS: In 2002, the seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections were 6.3% (n = 2454) and 4.8% (n = 2167), respectively. HBV and HCV seroprevalence became 6.5% (n = 2585) and 4.3% (n = 2399) in 2003. The incidence of HBV and HCV infections were 1.5 and 2.4 cases per 1000 patient-years, respectively. Logistic regression analysis showed that age and gender were significant risk factors for HBV infection, but not for HCV infection. CONCLUSION: In Thailand, it was not uncommon for dialysis patients to acquire viral hepatitis infections. However, our prevalence is similar to reports from some other South-East Asian countries.     

左卡尼汀联合红细胞生成素治疗心肾贫血综合征

目的 评价左卡尼汀(LC)联合红细胞生成素(EPO)治疗维持性血液透析心肾贫血综合征(CRAS)患者的临床效果.方法 将91例维持性血液透析患者分为LC联合EPO组(A组)35例、EPO组(B组)30例和对照组26例.各组按常规剂量服用琥珀酸亚铁、叶酸和肌肉注射维生素B12.A组于血液透析后以1.0 g LC加入20 ...     

Technical survival of CAPD catheters: comparison between percutaneous and conventional surgical placement techniques.

BACKGROUND: Percutaneous peritoneal dialysis catheter (PDC) placement is a well-tolerated, rapidly performed bedside procedure that allows a rapid initiation of CAPD. We compared the technical survival of PDCs while comparing the mode of insertion. METHODS: We retrospectively reviewed 215 PDCs inserted over a 60-month period in 191 patients on CAPD therapy. Of these, 133 were placed percutaneously by nephrology staff (group P) and 82 were placed using conventional surgical techniques by surgical staff (group S). The total experience accumulated was 4000 patient-months: 2260 patient-months in group P and 1740 patient-months in group S. RESULTS: The incidence of complications in PDCs did not differ between the groups (1 episode/33 patient-months in group P and 1 episode/29 patient-months in group S). Two episodes of early leakage and 9 episodes of late leakage were observed in group P compared with one early leakage and 4 episodes of late leakage in group S. Of the mechanical complications in group P, 8.86% were due to catheter malfunction, including catheter tip migration and obstruction, compared with 12.63% in group S. The incidence of catheter infections was 1 episode/73 patient-months in group P and 1 episode/62 patient-months in group S. Significantly more catheters were removed in group S compared with group P (40% vs 16%, P<0.001). One-year and 2-year technical survivals were 90% and 82% in group P, and 73% and 60% in group S (P=0.0032), respectively. CONCLUSIONS: Percutaneous bedside placement of PDCs by nephrologists provides a safe and reliable access for peritoneal dialysis.     

Effect of acetate-free biofiltration on the anaemia of haemodialysis patients: a prospective cross-over study.

BACKGROUND: The discussion about the pathogenesis of renal anaemia, whether it is primarily due to relative erythropoietin (Epo) deficiency or to uraemic inhibition of erythropoiesis, is still open. Although it has so far not been possible to identify or isolate a substance retained in uraemia with a suppressive action directed specifically against red-cell production, dialysis therapy can improve the effect of both residual endogenous Epo and exogenous rHuEpo. To what extent the mode and/or the dose of dialysis influence Epo efficacy is as yet poorly understood. METHODS: This study was performed as a single-centre trial. The protocol included a run-in period of 4 months followed by a prospective cross-over study including 6 months each of acetate-free biofiltration (AFB) with a high-flux biocompatible membrane and standard bicarbonate dialysis (BD) with a low-flux cellulosic membrane in a random sequence. AFB is a haemodiafiltration technique based on a continuous post-dilution infusion of a sterile isotonic bicarbonate solution. At the start of the run-in period (and for the entire length of the study), rHuEpo administration was withdrawn; patients whose haemoglobin (Hb) levels dropped at a level <8.0 g/dl at one single monthly check, had to be withdrawn from the study. A blood sample was collected every month for the blood gas analysis and for the determination of blood urea nitrogen, serum creatinine, sodium, potassium, calcium, phosphorus, Hb, erythrocyte, reticulocyte, leukocyte and thrombocyte cell counts, mean globular volume and haematocrit. An equilibrated single pool Kt/V(urea)>1.2 was mandatory in both treatment modalities. Serum iron, total iron-binding capacity, and ferritin were checked every 3 months. RESULTS: Twenty-three of 137 haemodialysis patients were considered eligible for the trial on the basis of the entry criteria. Of these, 15 volunteered and only 10 completed the study. No significant differences in the haematological indices, in the biochemical parameters assessing body iron stores, or in i.v. iron dosage was observed when comparing AFB with BD treatments. The equilibrated single pool Kt/V(urea) was always >1.2 and in no case was a significant difference observed when comparing AFB with BD treatments. Treatment time was significantly different between the two treatments (262+/-2 min in BD and 249+/-1 in AFB, P<0.0001). Neither pre- nor post-dialysis systolic and diastolic blood pressures, pre-dialysis serum bicarbonate and pH, pre-dialysis serum sodium, potassium, calcium, or phosphorus were significantly different when comparing the two treatment modalities. All 10 patients completed the 1-year follow-up without any major side-effects. CONCLUSIONS: Our study did not show any improvement of anaemia when treating a highly selected patient group, in the absence of any Epo therapy, with AFB compared with standard BD. Even though these conclusions cannot be extended in toto to the entire dialysis population, in which there is a large proportion of Epo-treated patients with Hb levels around 11 g/dl, we may nevertheless conclude that when patients are well selected, adequately dialysed, and not iron- and/or vitamin-depleted, the effect of a haemodiafiltration technique with a high-flux biocompatible membrane is less than might be expected from the results of uncontrolled studies.     

Clinical demographics and long-term prognosis after stroke in patients on chronic haemodialysis. The Okinawa Dialysis Study (OKIDS) Group.

BACKGROUND: Stroke is one of the leading causes of death in chronic dialysis patients. However, few epidemiological studies have reported on the demographics and long-term prognosis after stroke. METHODS: We have observed the occurrence of stroke in the chronic dialysis population for the past 10 years in Okinawa, Japan. Definite cases of stroke were registered and categorized as cerebral haemorrhage (CB), cerebral infarction (CI), and subarachnoid hemorrhage (SAH). RESULTS: Among 3741 chronic dialysis patients (2073 men, 1668 women), 271 patients (164 men, 107 women) had strokes (CB 162, CI 97, SAH 12) at least once during the study period from 1 April 1988 to 31 March 1998. The total duration of observation was 15 pound 748.8 patient-years (males 8990.5, females 6758.3). The incidence of stroke per 1000 patient-years was 17.2 overall, 10.3 for CB, 6.2 for CI, and 0.8 for SAH. Twenty-four per cent of stroke cases occurred within 1 year of starting dialysis therapy, and 57.7% occurred within 5 years after the beginning of therapy. The mean (SD) age at onset of stroke was 59.8 (13.0) years overall, 57.2 (12.6) for CB, 65.0 (12.1) for CI, and 53.6 (13.0) years for SAH. The survival rates after stroke were 53.4% at 1 month, 43.5% at 6 months, 35.7% at 12 months, and 23.2% at 60 months. Patients with diabetes mellitus (DM) had higher incidence of CI and a poorer prognosis than those without DM. CONCLUSION: Incidence of stroke was high (17.2 per 1000 patient-years) in the dialysis population of our area and the long-term prognosis after stroke was poor.     

Transplantation of both kidneys from 408 donors; comparison of results

Abstract The outcome of 816 paired kidney transplantations from 408 cadaveric donors was evaluated. The transplantations were divided according to order of transplant surgery into group 1 [mean cold ischemia time (CIT) 22 h] and group 2 (mean CIT 28 h). In group 1 the frequency of delayed onset of graft function (DGF) was 22% versus 35 % in group 2 (P < 0.005). The 1‐year patient survival and graft survival (GS) in group 1 was 98% and 93 % versus 94% (P < 0.005) and 90% in group 2. Hemodialysis patients in group 2 had significantly greater DGF (43 %) and poorer GS (88%) than peritoneal dialysis patients and the success of transplantation was particularly poor in recipients over 50 years of age.     

细菌毒素对人腹膜间皮细胞受体整合素—α3β1分布及细胞骨架的影响

目的通过研究细菌毒素对人腹膜间皮细胞受体整合素分布及细胞骨架的影响，探讨炎症引起间皮细胞脱落的机制。方法分离人腹膜间皮细胞作体外培养，采用活细胞荧光抗体染色，共聚焦显微镜断层扫描的方法，检测细胞整合素α３β１的分布；以考马斯亮兰染色法，观察细胞骨架结构的变化。结果正常培养的人腹膜间皮细胞表达受体整合素α３β１，其分布由细胞底层至顶层逐渐减少；而脂多糖（ＬＰＳ）或肠毒素刺激２０分钟后，测得整合素α３β１的分布由底部至顶端转移。结论细菌毒素引起的人腹膜间皮细胞受体整合素α３β１分布和细胞骨架改变可能是引起间皮细胞脱落的原因之一。     

腹膜透析对腹腔巨噬细胞产生一氧化氮的影响

目的：研究腹膜透析（ＰＤ）对巨噬细胞产生一氧化氮（ｎｉｔｒｉｅ ｏｘｉｄｅ，ＮＯ）和腹膜淋巴孔的影响，探讨ＰＤ失超滤机制。方法：（１）应用Ｂａｘｔｅｒ腹上鼠模型；（２）用全自动酶标仪动定ＮＯ量。（３）用扫描电镜淋巴孔的改变。结果：随着ＰＤ进行，大量巨噬细胞经腹膜淋巴孔游出，进入腹腔形成乳斑。ＮＩＯ浓度逐渐增高，间皮细胞损伤趋严重，腹膜淋巴孔孔径增大、分布密度增高。停止ＰＤ，乳斑减少，ＮＯ量逐渐降员     

Evaluating an Activity Intervention with Hemodialysis Patients in Israel

ABSTRACT

As a life-threatening and potentially disabling disease, End Stage Renal Disease and its treatment cause stress as well as other psychosocial problems for patients and their families. This paper examines the results of an innovative activity-based intervention aimed at reducing some of the psychosocial repercussions of hemodialysis. A modified withdrawal/reversal design was employed to compare patients participating in the intervention and those who did not, at two points in time. The findings confirmed that dialysis patients in general have relatively high levels of psychological distress, difficulty adhering to the treatment regimen and poor self-rated health. Patients participating in the group activity were more anxious and had lower levels of interdialytic weight gain than the non-participants. After the intervention was terminated, levels of psychological distress, hostility and phobic anxiety among patients in the treatment group dropped, while their weight gain continued to be less than that of non-participating patients. The implications of these findings as well as the methodological difficulties entailed in this type of study are examined.