Dialysis In End-stage Renal Disease Patients Research Articles

Determining the Effect of Hemodialysis on Shortness of Breath and Peak Expiratory Flow at the Onset and After Dialysis in ESRD Patients

Background: End Stage Renal Disease (ESRD) can cause lung dysfunction by several mechanisms. The aim of this study was to determine the effect of hemodialysis on shortness of breath and Peak expiratory flow (PEF) at the onset and after dialysis in hemodialysis and ESRD patients.
 Methods: In this cross-sectional study, 209 patients with ESRD who had been on dialysis for at least 3 months were evaluated. Shortness of breath and PEF were measured before and after dialysis. Data were analyzed significance level of less than 0.05.
 Results: According to the results, 53.1% of patients were male and 46.9% were female. The mean (SD) age of patients was 57.8 (14.3) years and the duration of dialysis was 37.7 (33.6) months. The mean (SD) PEF before dialysis was 267.9 ±106.3 which increased to 284.6 (113.3) liters per minute after dialysis (p value = 0.001). Patients with High-flux filtration had a higher mean PEF before and after dialysis and less dyspnea after dialysis. Spearman correlation showed a positive correlation between hemodialysis duration and PEF (r = 0.2, p value = 0.011) and positive correlation between the number of weekly hemodialysis sessions (r = 0.2, p value = 0.020) and the PEF with patients' age. There was a negative (r = - 0.2, p value = 0.006).
 Conclusion: The results of this study showed that the PEF after dialysis increases in ESRD, which in patients using high-flux filters, in addition to increasing the PEF, decreases the severity of shortness of breath.

Myelodysplastic syndrome: the other cause of anemia in end-stage renal disease patients undergoing dialysis

In end-stage renal disease (ESRD) patients receiving dialysis, anemia is common and related to a higher mortality rate. Erythropoietin (EPO) resistance and iron refractory anemia require red blood cell transfusions. Myelodysplastic syndrome (MDS) is a disease with hematopoietic dysplasia. There are limited reports regarding ESRD patients with MDS. We aim to assess whether, for ESRD patients, undergoing dialysis is a predictive factor of MDS by analyzing data from the Taiwan National Health Insurance Research Database. We enrolled 74,712 patients with chronic renal failure (ESRD) who underwent dialysis and matched 74,712 control patients. In our study, we noticed that compared with the non-ESRD controls, in ESRD patients, undergoing dialysis (subdistribution hazard ratio [sHR] = 1.60, 1.16–2.19) and age (sHR = 1.03, 1.02–1.04) had positive predictive value for MDS occurrence. Moreover, more units of red blood cell transfusion (higher than 4 units per month) was also associated with a higher incidence of MDS. The MDS cumulative incidence increased with the duration of dialysis in ESRD patients. These effects may be related to exposure to certain cytokines, including interleukin-1, tumor necrosis factor-α, and tumor growth factor-β. In conclusion, we report the novel finding that ESRD patients undergoing dialysis have an increased risk of MDS.

Nurse’s Experience As Educator in Hemodialysis Care to End Stage Renal Disease Patient in Hospital X: a Phenomenology Study

End Stage Renal Disease (ESRD) is progressive and irreversible damage to kidney function,which can reduce the quality of life of patients and death due to accumulation of uremia toxins in the blood. Hemodialysis is a temporary therapy used to prolong the life of the patient. The uncertainty of the treatment provides a unique response which became an interesting phenomenon for researchers to conduct research Sethe qualitative strategy for explore the nurses’ experience and to describe it especially in the nurses’ role as educator in hemodialysis care to ESRD patient in Hospital X.Aim of this study to provide an overview of nurse’s experience as educator in ESRD patients during hemodialysis therapy in the Hemodialysis Unit Hospital X. this research used a qualitative method with a phenomenological approach has been conducted. The data collection technique used was using in-depth interviews. A purposive sampling was used to recruited the participant and, namely ten nurses were involded in this study with inclusion critearia as follows: (1) work as an executive nurse in HD unit, (2) have minimum Diploma III as basic education level. Data analysis using Colaizzi’s method and then using thematic analysis. Four themes were found in this study: lifestyle changes, uncooperative patients, responsive patients, and patients do not want to stop dialysis. Future research can be conduct in fourth theme concerning withdrawal dialysis in ESRD patients in various perspectives including: ethical perspective and decision making for futile treatment, health coverage policies, and palliative care.

Warning signs and severe dengue in end stage renal disease dialysis patients.

The 2009 WHO guideline established warning signs (WS) to predict severe dengue (SD). However, their positive predictive value has been found to be low in the general adult population, but they might be higher in a different population. This study investigated the association between WS and SD in end stage renal disease (ESRD) patients on maintenance dialysis in Taiwan where both diseases are prevalent. This study enrolled ESRD dialysis patients with dengue in 2015. Demographic, laboratory data, symptoms/signs and complication of dengue were retrospectively collected from medical records at our hospital. Of 49 ESRD patients with dengue, 44 patients were receiving hemodialysis and 5 peritoneal dialysis. Older patients (>65 years old) tended to have the WS(56% vs 16.7%, P=0.007). The rate of hospitalization, intensive care unit admission and in-hospital mortality was 79.6%, 22.5%, and 8.2%, respectively. Eighteen patients (36.7%) presented WS and eighteen patients (36.7%) developed to SD, including ten with plasma leakage, twelve with hemorrhage, and six with organ failure. Patients with WS were seven times more likely to develop SD than those without (OR: 7.06; 95%CI: 1.34-37.21). WS was associated with plasma leakage (OR: 12.36; 95% CI: 1.56-97.74) and severe hemorrhage (OR: 5.1; 95% CI: 1.03-25.18), but not organ failure. Prevalence of SD is high in ESRD dialysis patients. The presence of WSs in this group was highly correlated with SD. Thus, more attention should be paid to treating ESRD patients with dengue fever if they present WSs.

Modality transition on renal replacement therapy and quality of life of patients: a 10-year follow-up cohort study.

Despite advance in renal replacement therapy (RRT), patients with chronic end-stage renal disease (ESRD) face various limitations, and renal transplantation (Tx) is the treatment that impacts most on quality of life (QoL). This study aimed to assess changes in QoL in a cohort of ESRD dialysis patients. Sociodemographic, clinical, nutritional, lifestyle, and QoL data were collected from 712 patients at baseline (time 1) and after 10years of follow-up (time 2) for patients surviving. The QoL was assessed through the 36-Item Short Form Health Survey (SF-36) and the multiple linear regression model was used to analyze the factors associated with change in QoL. A total of 205 survivors were assessed and distributed into three groups according to current RRT (Dialysis-Dialysis, Dialysis-Tx, and Dialysis-Tx-Dialysis). At time 1, only age was significantly different among groups; at time 2, transplant patients sustained greater social participation, job retention, and improvement in SF-36 scores. The factors associated with change in QoL were more time on dialysis interfering negatively on physical functioning (p = 0.002), role-physical limitations (p = 0.002), general health (p = 0.007), social functioning (p = 0.02), role-emotional (p=0.003), and physical components ( p= 0.002); non-participation in social groups at times 1 and 2 reducing vitality (p = 0.02) scores; and having work at time 2, increasing vitality (p = 0.02) and mental health (p = 0.02) scores. QoL was shown to be dynamic throughout the years of RRT, transplantation being the treatment with more benefits to the ESRD. More time on dialysis and limited social and occupational routine were associated with a reduction in QoL.

Peritoneal Dialysis as an Option for Unplanned Dialysis Initiation in Patients with End-Stage Renal Disease and Diabetes Mellitus

Aims: This study aimed to compare the short-term complications and long-term prognosis between urgent-start peritoneal dialysis (PD) and hemodialysis (HD), and explore the safety and feasibility of PD in end-stage renal disease (ESRD) patients with diabetes. Methods: This retrospective study enrolled ESRD patients with diabetes who required urgent-start dialysis at a single center from January 2011 to December 2014. Short-term (30-day) dialysis-related complications and patient survival trends were compared between patients receiving PD and HD. Results: Eighty patients were included in the study, including 50 (62.5%) who underwent PD. The incidence of dialysis-related complications and complications requiring reinsertion during the first 30 days was significantly lower in PD patients. Logistic regression identified urgent-start HD as an independent risk factor for dialysis-related complications compared with urgent-start PD. The patient survival rate was higher in the PD compared to that in the HD group. Conclusions: PD may be acceptable, safe, and feasible for urgent-start dialysis in ESRD patients with diabetes.

Beneficiary characteristics and vaccinations in the end-stage renal disease Medicare beneficiary population, an analysis of claims data 2006-2015.

The Advisory Committee on Immunization Practices (ACIP) routinely recommends three vaccines - influenza, hepatitis B, and pneumococcal vaccines - for End-Stage Renal Disease (ESRD) dialysis patients. We sought to assess vaccination coverage among fee-for-service (FFS) Medicare beneficiaries with ESRD who received Part B dialysis services at any point from January 1, 2006 through December 31, 2015 (through June 30, 2016 for influenza). To assess influenza vaccination rates in a given influenza season, we restricted the population to beneficiaries who were continuously enrolled in Medicare Parts A and B throughout all twelve months of that season. To assess hepatitis B and pneumococcal vaccine coverage following dialysis initiation, we developed a Kaplan-Meier curve for all patients who began dialysis between 2006 and 2015. For influenza vaccination, we identified an average of approximately 325,000 ESRD dialysis beneficiaries enrolled through each influenza season from 2006-2015. Seasonal influenza vaccination rates steadily increased during the 10-year period, from 52% in 2006-2007 to 71% in 2015-2016. The greatest increases in influenza vaccination appear in non-white beneficiaries with overall utilization in non-whites higher than in whites (p < .001). For the hepatitis B and pneumococcal vaccinations, we identified over 350,000 ESRD dialysis beneficiaries who began dialysis over the 10-year study window. The probability of receiving a hepatitis B vaccine within the first three years of entering into the ESRD program was higher (77%) than the probability of receiving any pneumococcal vaccine (53%). 45% of ESRD patients completed at least one dose of the two hepatitis B series (three-dose or four-dose) at any time during the study period. Opportunities exist at regional and facility levels to improve vaccination coverage. Compliance to ACIP recommendations may directly affect risk for ESRD dialysis patients for complications from diseases that can be mitigated by vaccination.

Epidemiology and outcome of acute pancreatitis in end-stage renal disease dialysis patients: a 10-year national cohort study.

The objective of this study is to determine the incidence and severity of acute pancreatitis (AP) in patients with end-stage renal disease (ESRD) on dialysis and whether the dialysis modality [hemodialysis (HD) versus peritoneal dialysis (PD)] confers a higher risk for AP as well as complications or mortality related to AP. We analyzed national health insurance claims data of 67 078 ESRD patients initiating dialysis between 1999 and 2007 in Taiwan. All patients were followed up from the start of their dialysis to first AP diagnosis, death, end of dialysis or 31 December 2008. Cox proportional hazards models were used to identify risk factors. The cumulative incidence rates of AP were 0.6, 1.7, 2.6, 3.4 and 4% at 1, 3, 5, 7 and 9 years, respectively. ESRD patients on HD and PD had an AP incidence of 5.11 and 5.86 per 1000 person-years, respectively. Independent risk factors for AP in this population were being elderly, being female, having biliary stones or liver disease, and being on PD. Severe AP occurred in 44.9% of the HD patients and in 36% of the PD patients. Patients with AP on HD had a higher incidence of upper gastrointestinal (UGI) bleeding than those on PD (P = 0.002). In contrast, those with AP on PD had a higher incidence of need for total parenteral nutrition (TPN) support than those on HD (P = 0.072). Overall in-hospital mortality was 8.1%. The risk factors for mortality after an AP attack were male gender, increased age, AP severity, and the presence of diabetes mellitus or liver disease. ESRD patients on PD were at higher risk for AP than those on HD. HD patients with AP attacks had a greater incidence of UGI bleeding and PD patients with AP attacks a more frequent need for TPN support.

Epidemiology of cancer in end-stage renal disease dialysis patients: a national cohort study in Taiwan

The incidence and mortality of site-specific cancers in patients with end-stage renal disease (ESRD) on maintenance dialysis have been rarely studied for Asian populations. We tapped Taiwan`s National Health Insurance Research Database to identify and recruit patients starting maintenance dialysis between 1999 and 2004. They were followed from initiation of dialysis until death, discontinuation of dialysis, or the end of 2008. We calculated the survival rate and mortality risk of dialysis patients with cancer. Of 40,833 dialysis patients, 2352 (5.8%) had been newly diagnosed with cancer. Being older, being male, and having chronic liver disease were factors associated with a higher risk for new cancer in ESRD dialysis patients. In men, liver cancer (20.63%) was the most frequent, followed by cancers of the bladder (16.88%) and kidney (11.61%). In women, bladder cancer (25.57%) was the most frequent, followed by cancers of the kidney (16.31%) and breast (11.20%). The 5-year survival rates for kidney and bladder cancer were higher than for other cancers; the survival rates for lung, stomach, and liver cancer were lower. In conclusion, the distribution of site-specific cancer was different between men and women in patients with ESRD on dialysis. More attention should be paid to teaching dialysis patients how to avoid the well-known cancer risks and carcinogens and individualized regular cancer screenings.

Epidemiology and mortality of liver abscess in end-stage renal disease dialysis patients: Taiwan national cohort study.

Background and ObjectivesTo determine the incidence rates and mortality of liver abscess in ESRD patients on dialysis.Design, Setting, Participants, & MeasurementsUsing Taiwan’s National Health Insurance Research Database, we collected data from all ESRD patients who initiated dialysis between 2000 and 2006. Patients were followed until death, end of dialysis, or December 31, 2008. Predictors of liver abscess and mortality were identified using Cox models.ResultsOf the 53,249 incident dialysis patients identified, 447 were diagnosed as having liver abscesses during the follow-up period (224/100,000 person-years). The cumulative incidence rate of liver abscess was 0.3%, 1.1%, and 1.5% at 1 year, 5 years, and 7 years, respectively. Elderly patients and patients on peritoneal dialysis had higher incidence rates. The baseline comorbidities of diabetes mellitus, polycystic kidney disease, malignancy, chronic liver disease, biliary tract disease, or alcoholism predicted development of liver abscess. Overall in-hospital mortality was 10.1%.ConclusionsThe incidence of liver abscess is high among ESRD dialysis patients. In addition to the well known risk factors of liver abscess, two other important risk factors, peritoneal dialysis and polycystic kidney disease, were found to predict liver abscess in ESRD dialysis patients.

Outcomes of Dementia Among Dialysis Patients: A Nationwide Population-Based Study in Taiwan

Background: High prevalence of cognitive impairment or dementia is associated with end-stage renal disease (ESRD). The risk for dementia and its prognostic significance remain unclear. This study aimed to determine the prevalence, correlations and outcomes of dementia in chronic ESRD dialysis patients. Methods: Using Taiwan National Health Insurance Research Database (NHIRD), we analyzed ESRD patients who received dialysis between 1999 and 2005 to determine the associations between baseline dementia and subsequent outcomes after dialysis. The cumulative survival rate after dialysis was calculated using the Kaplan-Meier method. Cox proportional hazards model was used to identify the risk factors for all-cause mortality. Results: A total 51,238 incident dialysis patients were examined in this study, including 867 patients with dementia. The prevalence of dementia was increasing with age. The proportional rate of dementia in elderly (?75) patients was 10 times higher than that in aged 18~44 years old of baseline. The co-morbidity with cerebrovascular disease was independently associated with dementia in dialysis population. The 1-, 5-, and 9- year cumulative survival rate were 82.1, 32.7, and 16.5% in ESRD patients with dementia, and 93.5, 62.8, and 41.6% in those without dementia (log-rank: p &lt;0.001). ESRD patients with dementia were associated with 53% higher death risk than those without dementia (HR 1.53, 95% CI: 1.40-1.68). Conclusions: Dementia was associated with poor outcome and co-morbidities among ESRD dialysis patients.

Evaluation of dialysis in patients with end-stage renal disease by salivary urea, creatinine and uric acid

To explore the changes of saliva urea, creatinine (Cr), and uric acid (UA) before and after hemodialysis in patients with end-stage renal disease (ESRD), and to evaluate the clearing effect of Urea, Cr, and UA. Saliva and serum (2 mL) were collected from the dialysis patients. The concentrations of Urea, Cr, and UA in both samples were measured by biochemical analyzer. The concentrations of Urea, Cr, and UA in the saliva and the serum, and their correlation were analyzed. Before and after the hemodialysis, the reduction ratio (RR) of Urea, Cr, and UA in the saliva and the serum was calculated. In ESRD dialysis patients, the levels of Urea, Cr, and UA in the saliva and the serum were highly correlated (correlation coefficients were 0.979, 0.973, and 0.948, respectively). The concentrations of Urea, Cr, and UA in the saliva and the serum before the dialysis were lower than those after the dialysis, with significant difference (P<0.05). The RR of Urea, Cr, and UA in the saliva and the serum did not differ statistically (P>0.05). The clearing effect of salivar Urea, Cr, and UA is similar to that of the serum. Saliva is expected to replace the serum to evaluate hemodialysis efficacy and monitor the renal disease in ESRD patients.

Epidemiology and mortality among dialysis patients with parathyroidectomy: Taiwan National Cohort Study

Parathyroidectomy (PTx) is usually necessary in patients with end-stage renal disease (ESRD) on dialysis. Risk factors for higher PTx rates are controversial. The objectives of this study were to identify the risk factors for PTx in patients on dialysis and evaluate the mortality after PTx. We analyzed data obtained from the National Health Insurance Research Database and included 35,162 ESRD dialysis patients. Kaplan-Meier method was used to calculate the incidence of PTx and survival rate after PTx. Cox proportional hazards models were used to identify the risk factors. The PTx rate was 8.09 per 1,000 patient-years. Stratified on the basis of gender and diabetic mellitus (DM), the highest incidence rate of PTx was in females without DM. Stratified by age and DM, the highest incidence rate of PTx was in those aged 18-44 years without DM. The significant risk factors for PTx were younger age, female (hazard ratio (HR) 1.409, 95% confidence interval (CI): 1.257-1.580), DM (HR 0.479, 95% CI: 0.413-0.555), peritoneal dialysis (HR 1.657, 95% CI: 1.418-1.938) and hypertension (HTN) (HR 1.317, 95% CI: 1.162-1.492). The cumulative survival rates after PTx were 97.1%, 94.5%, 82.8% and 77.4% at the first, second, fifth and seventh year, respectively. Only age was significantly associated with higher mortality after PTx. Higher PTx rates were found in dialysis patients who were female and younger, did not have DM, were on peritoneal dialysis and had HTN. Advanced age was associated with a higher mortality after PTx.

Hemodiyaliz ve Sürekli Ayakta Periton Diyalizi Tedavisi Uygulanan Hastalarda Sağlığa-İlişkin Yaşam Kalitesinin Karşılaştırılması

ABS TRACT Objective: The purpose of this study was to compare the Health-Related Quality of Life (HRQOL) status of patients with end stage renal disease (ESRD) on hemodialysis (HD) and continuous ambulatory peri toneal dialysis (CAPD) treatment, and to define in which way their perception of quality of life (QOL) is affected by socio-demographic characteristics, disease-related variables and laboratory findings. Material and Methods: In this cross-sectional study, 22 consecutive patients on CAPD treatment at a Training and Research Hospital (42%) and 30 consecutive patients on HD treatment at a private healthcare center (57%) -who met the eligilibity crite ria- were evaluated in a period of three months between November 2004 and January 2005. The patients an swered to two questionnaires with a face to face interview method. The first questionnaire was composed of questions regarding socio-demographic and disease-related variables. The second questionnaire was the Turkish version of The Medical Outcomes Study Short- Form 36 (SF-36) Health Status Survey, which was used to assess the general HRQOL. Data regarding laboratory findings and complications of chronic renal failure were collected from the patients’ medical records. Results: CAPD patients had better physical functioning (p= 0.003) and phys ical role limitation (p= 0.001) scores in certain SF-36 sub-domains compared to HD patients. There was a moder ate positive correlation between albumin levels and physical function, while thrombocyte counts were negatively correlated with vitality and social function in HD patients. In the CAPD group, calcium and hematocrit levels were positively correlated with vitality. There was a negative correlation between phosphorus levels and mental health status and a negative correlation between potassium levels and general health status of CAPD patients. Conclusion: In our study we observed higher quality of life scores in the CAPD group compared to the HD group espe cially in the area of physical function which may be explained by portability, easy application and mobility of these patients, which are some of the advantages compared to HD patients. Since QOL scores are affected by the modal ity of dialysis in ESRD patients, besides clinical parameters QOL status of these patients should also be considered in choosing the treatment modality and follow-up process.

Peptic ulcer bleeding outcomes adversely affected by end-stage renal disease

Patients with end-stage renal disease (ESRD) and peptic ulcer disease (PUD) bleeding may be at high risk of bleeding complications. To investigate the outcomes of patients with ESRD and PUD bleeding. ESRD patients with PUD bleeding were evaluated retrospectively. Two tertiary, university-affiliated hospitals. A total of 150 PUD bleeding patients were evaluated in 3 groups; end-stage renal disease (ESRD) patients on dialysis (ESRD group) (n = 50) were age matched with patients with chronic kidney disease (CKD) not requiring dialysis (CKD group) (n = 50) and those with normal kidney function (normal group) (n = 50). Rebleeding, transfusions, length of hospitalization, mortality. Multivariate analysis showed significant predictors of rebleeding to be ESRD and high-risk stigmata. The ESRD group had an odds ratio (OR) of 3.8 (95% CI, 1.4-10.5; P = .008) for rebleeding compared with the normal group, and an OR of 3.8 (95% CI, 1.4-10.3; P = .01) compared with the CKD group. The mean number of (+/- SD) transfusions was higher in the ESRD group (6.3 +/- 5.7 units) than in the normal group (3.6 +/- 3.9 units; P = .01). The mean length of hospitalization was higher in the ESRD group than in the normal group (34.0 vs 16.6 days; P = .01). A greater level of comorbidity was the only significant predictor of mortality (OR 6.0; 95% CI, 2.9-12.3; P = .001). Retrospective study. ESRD dialysis patients with PUD bleeding have greater rebleeding than patients not on dialysis. ESRD patients should be managed as a high-risk group.

Compositional and Oxidative Analysis in the Saliva and Serum of Predialysis Chronic Kidney Disease Patients and End‐stage Renal Failure Patients on Peritoneal Dialysis

Chronic renal failure (CRF) is often treated with peritoneal dialysis, although increased oxidative stress has been reported in such patients. The purpose of the current study was to analyze and compare oxidative stress and other compositional parameters in the saliva, serum and peritoneal dialytic fluid (PDF) of patients with chronic kidney disease (CKD), including predialysis CKD patients and end-stage renal disease (ESRD) patients treated with peritoneal dialysis. Twenty-three consenting patients participated in the current study. Saliva and serum samples collected from both groups and PDF from the dialysis patients were all examined for uric acid (UA), total antioxidant status, total protein and total albumin. The antioxidant enzyme peroxidase was examined both in saliva and serum, while the antioxidant enzyme superoxide dismutase (SOD) was examined solely in saliva. Various electrolytes were examined. Discrepancies were found between saliva and serum antioxidant status following peritoneal dialysis in ESRD patients. Oxidative stress was enhanced in the saliva but reduced in the serum. Significant changes in both oxidative-related and non-related parameters were demonstrated in saliva, serum and PDF. Salivary lactate dehydrogenase was substantially lower in the dialysis patients (by 92%, P = 0.02), as was the salivary UA concentration (by 22%, P = 0.05) and serum UA concentration (by 20%, P = 0.03). In contrast, salivary peroxidase and SOD were higher by 15% and 35%, respectively (P = 0.01), in these patients. We suggest monitoring salivary UA for assessing the baseline oral oxidative status of CRF and dialyzed patients.

Post-dialysis retention of blood lipoproteins and apolipoproteins in patients with end-stage renal disease on maintenance haemodialysis in Kuwait

Background: The commonest cause of death in patients with end-stage renal disease (ESRD) on maintenance haemodialysis (MHD) is coronary heart disease (CHD). It has been suggested that dyslipidaemia, an important CHD risk factor, may be worsened by dialysis. This study evaluated changes in blood lipoproteins and apolipoproteins after dialysis in ESRD patients on MHD. Methods: The subjects were 57 (20 M, 37 F; 24 diabetic, 33 nondiabetic) patients with ESRD, aged 21–73 years, undergoing MHD at a major Dialysis Unit in Kuwait. Pre- and post-dialysis non-fasting blood samples were collected from each subject on the same day, and analyzed for plasma glucose, urate, triglycerides (TG), total cholesterol (TC), HDL, LDL and apolipoprotein (apo) A1 and B. Pre- and post-dialysis levels for each of the analytes were compared for the diabetic and non-diabetic subgroups of patients and linear correlations sought between Δ values (corresponding to differences between pre- and post-dialysis levels) of the lipoproteins and apolipoproteins. Results: There was a general trend towards significant increases in post-dialysis TC, HDL, LDL, and non-HDL levels in both sub-groups, and additionally for the non-diabetic, TG, apo A1 and apo B. The pre- to post-dialysis increases were essentially similar for the diabetic and non-diabetic groups-Diabetic: TC 14%, HDL 25%, LDL 19%, non-HDL 16%, apo A1 14%, apo B 10%; Non-diabetic: TC 20%, TG 29%, HDL 25%, LDL 26%, non-HDL 21%, apo A1 14%, apo B 14%. Generally, there were significant correlations between Δ values for the lipoproteins and apolipoproteins ( r, 0.50–0.92) in both groups. Conclusion: Levels of atherogenic lipoproteins increase post-dialysis in diabetic and non-diabetic patients with ESRD and the changing levels of these lipoproteins correlate significantly with corresponding changes in levels of apolipoproteins. The increase in lipid levels is therefore related to retention of apo A1 and B with each dialysis. We speculate that, with repeated dialysis, dyslipidaemia may get progressively worse and further accentuate CHD risk.

The Illness Trajectory of End-Stage Renal Disease Dialysis Patients

The Illness Trajectory of End-Stage Renal Disease Dialysis Patients

The illness trajectory of end-stage renal disease dialysis patients.

Chronic illness is the number one health problem in the United States. As a consequence, health care professionals have assumed an increasingly important role in helping patients and families manage illness over an extended period of time. Familiarity with the evolution of chronic illness is needed to increase the effectiveness of these efforts. The concept of a trajectory provides a way for clinicians to gain a fuller understanding of the changing nature of chronic illness. The trajectory model has not yet been used to define the experience of end-stage renal disease (ESRD). ESRD is typically viewed as the static end point of chronic renal failure. The new paradigm suggests that the experience of ESRD continues to evolve from the time of diagnosis until death and that it follows a trajectory that can be described. This article represents the first attempt to delineate the ESRD illness trajectory, including the characteristics of each phase relative to the dimensions of life. The significance of the trajectory for clinical practice is discussed as well as the need for further research to validate and refine the model.

Short-term reproducibility of total homocysteine determinations in stable renal transplant recipients

BETWEEN 1972 and 1996, at least 17 independent investigative groups documented the presence of significantly increased plasma or serum levels of the putatively arteriosclerotic sulfur amino acid homocysteine in endstage renal disease (ESRD) patients. Despite the chronic, modest reduction in fasting total homocysteine (tHcy) levels afforded by successful renal transplantation relative to ongoing maintenance dialysis in ESRD patients, we recently demonstrated that an excess prevalence of both fasting and postmethionine loading hyperhomocysteinemia persists in stable renal transplant recipients versus matched, population-based controls free of renal disease. Hyperhomocysteinemia may contribute to the disproportionately high rate of arteriosclerotic outcomes experienced by renal transplant recipients, which remains unexplained by the traditional vascular disease risk factors. The reproducibility of any putative risk factor measurement (eg, tHcy), determines, to an important extent, the ability to ascertain its potential association with a disease (eg, arteriosclerotic vascular disease) in a given population. Although data are available on the reliability of fasting or postmethionine loading tHcy determinations in general populations, no comparable analyses have been performed in clinically stable renal transplant recipients. The purpose of our study was to evaluate the short-term reproducibility of fasting and postmethionine loading tHcy level measurements in this specific patient population. For comparison, we simultaneously evaluated the short-term reproducibility of fasting total cholesterol, an established arteriosclerotic risk factor in general populations, and a likely arteriosclerotic risk factor in renal transplant recipients.