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.     

Malnutrition in the Elderly Patient on Dialysis

Approximately one-third of all dialysis patients have mild to moderate malnutrition, while 6–8% have severe malnutrition, which is associated with increased morbidity and mortality rates and numerous pre-existing factors directly correlated with, or existing prior to, replacement hemodialysis. However, moderate to severe malnutrition (present in 10–30% of dialysis patients) is a prevalent cause of death among the elderly. Many of these patients have a particularly unstable cardiovascular and metabolic status that, independent of any underlying uremia and/or dialysis, impacts negatively on both their quality of life and clinical status. Moreover, their condition is often further exacerbated by dialysis itself, with its acute (e.g., hypotension and sensorial alterations) and chronic complications, including an exacerbation of malnutrition and systemic vascular disease. Malnutrition can occur secondary not only to erroneous dietary choices or uremia, but it may also depend on the patient's level of tolerance to dialysis and on the dialysis modality. Despite the improvements made to dialysis techniques, the nutritional condition of elderly patients on dialysis for chronic renal failure remains a cause for concern. In this patient category, it is therefore mandatory to ensure the daily supervision of nutritional status and early control when the first signs of malnutrition appear.     

医用腹膜透析管路护理腰带的改良设计与应用

目的对传统护理腰带进行改良设计,解决长期腹膜透析患者透析管路的护理问题。方法本着方便、安全、可靠的原则,对传统的腹膜透析腰带进行改进。选择2013年5月-2015年5月在西安某院肾病内科长期行腹膜透析治疗的终末期肾脏病患者90例为研究对象。将其中2013年5月-2014年4月接受治疗的45例患者设为对照组,采用传统护理腰带进行护理;将2014年5月-2015年5月接受治疗的45例患者设为观察组,采用改良的腹膜透析护理腰带进行护理。观察比较两组患者腹膜透析期间的透析管出口处感染、导管脱落及隧道炎的发生情况。结果经改良的腹膜透析护理腰带设计合理,能妥善固定腹膜透析管路,安全方便。观察组患者的出口处感染和导管脱落明显低于对照组,差异有统计学意义(P0.05);观察组无隧道炎发生,也明显低于对照组,差异有统计学意义(P0.05)。结论经过改良的腹膜透析管路护理腰带使长期腹膜透析患者的护理更方便、安全、有效,它能减少腹膜透析相关性腹膜炎的发生率,值得临床推广应用。     

Indwelling hemodialysis catheterization by transthoracic way

Abstract

Chronic kidney failure can be described as a chronic and progressive disfunction in metabolic-endocrine function and in adjustment of fluid-electrolyte balance of kidney, as a result of reducing of glomerular filtration value. Besides being a medical issue, chronic kidney failure affects social, economic, and psychological conditions of patients. Indwelling catheters can be placed in the right atrium by right mini thoracotomy in kidney patients who depend on dialysis and all central veins are used. In the patients whose central veins were used, were able to do catheterization by this technique, and this is a procedure that must be retentioned.     

Early Start of Dialysis Has No Survival Benefit in End-Stage Renal Disease Patients

The timing for dialysis initiationis still debated. The aim of this study was to compare mortality rates, using a propensity-score approach, in dialysis patients with early or late starts. From January 2000 to June 2009, incident adult patients (n = 836) starting dialysis for end-stage renal disease (ESRD) were enrolled. The patients were assigned to either an early- or late-start group depending on the initiation time of the dialysis. After propensity-score-basedmatching, 450 patients remained. At the initiation of dialysis, the mean estimated glomerular filtration rate (eGFR) was 11.1 mL/min/1.73 m² in the early-start group compared with 6.1 mL/min/1.73 m² in the late-start group. There were no significant differences in survival between the patients in the early- and late-start groups (Log rank tests P = 0.172). A higher overall mortality risk was observed in the early-start group than in the late-start group for the patients aged ≥ 70 yr (hazard ratio [HR]: 3.29; P = 0.048) and/or who had albumin levels ≥ 3.5 g/dL (HR: 2.53; P = 0.046). The survival of the ESRD patients was comparable between the patients in the early and late-start groups. The time to initiate dialysis should be determined based on clinical findings as well as the eGFR.