Duration Of Hemodialysis Therapy Research Articles

Prevalence and Association of Insulin Resistance in Non-Diabetic Hemodialysis Patients: A Descriptive-Analytic Cross-Sectional Study in Vietnam

Background Patients with chronic kidney disease (CKD) experience high mortality rates from cardiovascular disease (CVD). Insulin resistance (IR) is a frequent complication of CKD and is associated with poorer cardiovascular outcomes. This study investigates the prevalence and associations of IR in hemodialysis (HD) patients. Materials and Methods A descriptive-analytic cross-sectional study was conducted on 103 HD patients. We used the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and the Quantitative Insulin Sensitivity Check Index (QUICKI) to measure IR. We examined potential associations between IR and the following factors: age, gender, etiology of kidney failure, BMI, waist circumference, blood lipids, hemoglobin concentration, uric acid, and duration of HD. Results The prevalence of IR, as measured by HOMA-IR, was 61.2%, and by QUICKI, it was 48.5%. Age, gender, etiology of kidney failure and increased waist circumference did not significantly influence IR. A significant associations were observed between IR and higher BMI, anemia, dyslipidemia, and longer duration of HD therapy. Interestingly, the HOMA-IR and QUICKI indices correlated for most factors except total cholesterol, LDL-C, and uric acid. Conclusion This study found a high prevalence of IR in HD patients, with 61.2% identified by HOMA-IR and 48.5% by QUICKI. We confirmed significant associations between IR and BMI, anemia, dyslipidemia, and duration of HD therapy in this population.

Iron Management and Anemia in Patients on the Active Kidney Transplant List

IntroductionIron metabolism disorders and anemia are one of the main complications of end-stage renal disease that may affect the evaluation process for kidney transplantation. The study aimed to assess the iron metabolism in hemodialysis patients in relation to waiting list status. Study MethodThe study included 5068 hemodialysis patients, including those on the active waiting list (N = 449) and those who were not eligible for the waitlist (N = 4619). Demographic and biochemical data, Charlson's comorbidity index, duration of hemodialysis therapy and, respectively, hemoglobin, ferritin, and transferrin saturation levels were compared in both groups of patients. ResultsPatients on the active waiting list were significantly younger −53.2 vs 67.2 years (P < .001), with a lower Charlson comorbidity index score: 3.33 vs 4.42 (P < .001). The duration of hemodialysis therapy was similar: 66.0 vs 63.2 months (P = .416), the incidence of anemia according to World Health Organization (90.6%, vs 91.2%) and KDIGO (72.4% vs 70.4%). The degree of anemia correction in terms of hemoglobin concentration and transferrin saturation was comparable in both groups and amounted to an average of 10.9 g/dL (P = .349) for hemoglobin concentration and 32.7% vs 33.4% (P = .513) for transferrin saturation. However, there was a statistically significant difference in ferritin concentration: 554 ug/L vs 733 ug/L (P = .001). ConclusionsPatients on the active list have significantly lower ferritin levels despite similar duration of hemodialysis treatment and comparable hemoglobin values. This may be due to lower inflammation, and less frequent blood transfusions, and lead to a lower risk of immunization and an increased chance of potential kidney transplantation.

Depression and Anxiety in Chronic Kidney Disease Patients Undergoing Hemodialysis Therapy at Hemodialysis Installations General Hospital Dr. Moewardi Surakarta

&lt;p&gt;&lt;em&gt;This study is an analytical descriptive study with a cross-sectional design that aims to determine the proportion and level of depression and anxiety of patients, as well as the relationship between the length of hemodialysis therapy with depression and anxiety of patients with Chronic Kidney Disease undergoing hemodialysis therapy at the Hemodialysis Installation of Dr. Moewardi Surakarta Regional General Hospital. Samples in this study were taken by purposive sampling. The sample in this study amounted to 31 research subjects. The specified data analysis is a Chi-square test analysis to test the relationship between variables. The percentage of anxiety among Chronic Kidney Disease patients receiving hemodialysis treatment at Dr. Moewardi Surakarta Regional General Hospital's Hemodialysis Facility is 29%, while the percentage of depressed patients with Chronic Kidney Disease undergoing hemodialysis therapy at the same facility is 41.9%. It has been determined that there is no discernible correlation between the duration of hemodialysis therapy and the emergence of anxiety and depression in patients with Chronic Kidney Disease at this specific healthcare center. To gain a more comprehensive understanding, additional research is warranted to investigate other factors linked to anxiety and depression in patients with chronic kidney disease undergoing hemodialysis therapy. Furthermore, there is a pressing need for the implementation of a screening program for Chronic Kidney Disease patients undergoing hemodialysis therapy at hospitals, with a potential referral to the Department of Psychiatry for the assessment and management of any mental symptoms that may arise. &lt;/em&gt;&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Keyword: Anxiety, Chronic kidney disease, Depression&lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;

Relationship between lenght of undergoing hemodialysis therapy with insomnia in chronic renal failure patients

Complications that are often experienced by patients with chronic kidney failure undergoing hemodialysis are sleep disturbances. Sleep disturbances are experienced by at least 50-80% of patients undergoing hemodialysis &gt; 12 months. The purpose of this study was to determine the relationship between duration of hemodialysis therapy and insomnia in patients with chronic kidney failure at Arifin Achmad Hospital, Riau Province. The research method is a cross sectional approach. The population of this study were all 58 patients undergoing hemodialysis at Arifin Achmad Hospital. The sampling method was purposive sampling. The measuring instrument used in this research is the Insomia Severity Index (ISI) questionnaire. Statistical test using Chi Square test. Results Most of the levels of mild insomnia were 26 respondents (44.8%), moderate insomnia was 21 respondents (36.2%), not clinically significant as many as 8 respondents (13.8%), and severe insomnia was 3 respondents (5.2%). The results of statistical tests obtained p value of 0.487 &gt; (0.05). It can be concluded that there is no relationship between undergoing hemodialysis therapy with insomnia in patients with chronic kidney failure at Arifin Achmad Hospital, Riau Province. Suggestions for further research that can be expected to examine the factors associated with insomnia in patients with chronic kidney failure.

Hepatitis C and hepatitis B virus infection in hemodialysis patients after nationwide direct antiviral agents therapy-experience of 10 Romanian HD centers.

End-stage kidney disease patients (ESKD) receiving hemodialysis (HD) are at a greater risk of hepatitis virus (HV) infections due to the invasive nature of the procedures, frequent hospital stays and surgeries, as well as the immune deficiency status of ESKD. This study was to reassess the hepatitis virus infections prevalence in the HD population in Romania after 5years of oral DAAs therapy and assess the impact on HD patients' outcomes in two cohorts (2015 and 2019). We compared ESKD patients treated with HD in 10 HD centers from the historical regions of Romania in 2015 (n = 1401, Mean age 59.7 ± 12.92years) with patients treated in the same centers in 2019 (n = 1698, mean age 61 ± 12.93years). All patients went through HD therapy for more than 90days. The patients from the 2019 cohort were significantly older (p = 0.005), had a longer duration of HD therapy (p < 0.0001), and had more vascular calcifications (p = 0.015); the crude one-year mortality rate did not differ from the 2015 cohort (9.9 vs. 10.7%, p = 0.46). The prevalence of HBV infection did not differ between the cohorts (4.7% vs. 4.8, p = 0.604) but the prevalence of HCV significantly decreased from 2015 to 2019 (16.9 vs. 10.5%, p < 0.0001). After 15years of a nationwide infection prevention program for HV infections and 5years of DAAs treatment in Romania, the prevalence of HBV did not change but HCV infections decreased significantly, however, it still remained high.

A simultaneous pancreas-kidney transplantation for type 1 diabetes mellitus after a long-term of receiving hemodialysis renal replacement therapy. Clinical сase

At the present time, a simultaneous pancreas-kidney transplantation (SPKT) is an effective method of treatment for patients on renal replacement therapy by hemodialysis program in the outcome of the terminal stage of diabetic nephropathy. This method of treatment solves several problems: it reduces the severity of intoxication syndrome, contributes to the achievement of euglycemia in most cases, which certainly allows to slow the progression of micro- and macrovascular complications of diabetes. Despite of positive effect of euglycaemia and kidney function normalization, the accumulated metabolic memory legacy of long-term uncompensated diabetes mellitus is realized, which makes a posttransplantational rehabilitation of patients difficult. A duration of hemodialysis therapy is known as a cardiovascular events risk factor, which affects the surgery result and favorable posttransplant period. More often after successful SPKT microvascular diabetic complications are stabilized, but macrovascular diabetic complications, diabetic neuroosteoarthropathy and mineral and bone disease are progressed. That’s why is necessary to perform regular examination after SPKT by a team of specialists, including nephrologist, endocrinologist, cardiologist, ophthalmologist with correction of ongoing therapy. Therefore both the preparation of the patient for transplantation with the earliest possible placement on the waiting list and the post-transplant rehabilitation afterwards are extremely important.

HUBUNGAN LAMA TERAPI HEMODIALISIS DENGAN DUKACITA KRONIS PADA PASIEN CHRONIC KIDNEY DISEASE (CKD) (The Association between Duration of Hemodialysis Therapy with Chronic Sorrow in Patients with Cronic Kidney Disease (CKD))

HUBUNGAN LAMA TERAPI HEMODIALISIS DENGAN DUKACITA KRONIS PADA PASIEN CHRONIC KIDNEY DISEASE (CKD) (The Association between Duration of Hemodialysis Therapy with Chronic Sorrow in Patients with Cronic Kidney Disease (CKD))

P1579PREVALENCE OF PROTEIN-ENERGY WASTING IN HEMODIALYSIS PATIENTS IN THE EUROPEAN REGION OF THE RUSSIAN FEDERATION

Abstract Background and Aims One of the complications of hemodialysis therapy (HD) is the development of protein-energy wasting (PEW), which is an independent predictor of morbidity and mortality in this cohort of patients. The prevalence of PEW in hemodialysis patients in different regions of the world varies from 15% to 75% but has not been practically studied in the Russian Federation. To assess the prevalence of protein-energy wasting in hemodialysis patients in the European region of the Russian Federation. Method 645 hemodialysis patients were examined in 9 hemodialysis centers in 5 regions of the European part of the Russian Federation. Among the patients there were 345 women and 300 men, the average age was 56.8 ± 12.8 years. The duration of hemodialysis therapy was 8.4 ± 5.3 years. The diagnosis of PEW was established in accordance with the criteria: biochemical criteria (serum albumin &amp;lt; 3.8 g per 100 ml; serum prealbumin (transthyretin) &amp;lt; 30 mg per 100 ml; serum cholesterol &amp;lt; 100 mg per 100 ml); low body weight, reduced total body fat, or weight loss; a decrease in muscle mass; and low protein or energy intakes. The level of blood albumin was determined using the BCG method (bromocresol green). Estimation of protein and calorie intake was performed using 3-day food diaries filled out by patients. Results Insufficient protein intake according to the International Society of Renal Nutrition and Metabolism (ISRNM) recommendations was observed in 5.5 % of patients, calories in 4.1 %, combined deficiency in protein and calorie intake in 2.7% of patients. The prevalence of PEW was 51.2 %. The relationship between age and gender was not identified. The lowest prevalence of PEW is observed in patients with a hemodialysis therapy experience of fewer than 5 years (25,4 %) and gradually increasing by 2.5 times in patients with survival rates on HD for more than 10 years (χ2 = 22,580 р = 0.0001). Conclusion The prevalence of protein-energy wasting in hemodialysis patients in the European region of the Russian Federation is 51,2 %.

Characterization of melatonin-forming function of pineal gland in patients with end-stage chronic kidney disease

Series of studies have proved the relationship between functional state of pineal gland and renal excretory function. However, there are unresolved questions about the features of melatonin-forming function of pineal gland (MFF) in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD), depending on cause of CKD, duration of the pathology and HD, and patients’ age. Objective — to investigate the MFF in patients with CKD stage 5D who are treated with HD. Materials and methods. The study involved 130 patients (50 % of men) with CKD 5D treated with HD. The average age is 54.5 ± 13.6 years. The average duration of HD therapy is 11.1 ± 3.5 years. Based on melatonin level, patients treated with HD were divided into two groups: I — with impaired MFF (n = 110) and II — with normal MFP (n = 20). Levels of creatinine, blood hemoglobin, albumin, total protein, total cho­­lesterol, triglycerides, uric acid, day and night salivary melatonin levels by enzyme-linked immunosorbent assay, and office blood pressure (BP) were determined for all patients. Results and discussion. Compared with patients of group II, patients of group I had a significantly lower level of melatonin in saliva during night and day (82.2 % and 41.9 %, respectively). Compared with patients of group II, patients with impaired MFFhad a higher body mass index (by 7 %) and waist circu­mference (by 10 %), a longer duration of HD treatment (by 32 %), higher systolic (by 15.2 %) and diastolic blood pressure (11 %) and lower albumin level (6 %), which was confirmed by correlation analysis. Elderly patients, compared with a group of patients of young and middle age, had lower levels of melatonin at night (by 38.3 % and 37.5 %, respectively). Conclusions. For patients with chronic kidney disease undergoing renal replacement therapy with hemodialysis, frequent impairment of the melatonin-forming function of the pineal gland (84.6 %) is inhe­rent and more pronounced at night. In the examined patients, melatonin-forming dysfunction is age-depen­dent in nature — the most pronounced decrease in melatonin synthesis, both during the day and mainly at night, is typical for older people. In patients with chronic kidney disease of stage 5D, impairment of melatonin-forming function of pineal gland is determined by the duration of hemodialysis, levels of systolic and diastolic blood pressure, body weight, hemoglobin level and the degree of disturbance of protein and purine metabolism.

PULMONARY HYPERTENSION IN END STAGE KIDNEY DISEASE (ESKD) PATIENTS ON MAINTENANCE HEMODIALYSIS (MHD) VIA SURGICALLY CREATED ARTERIOVENOUS FISTULA.

Background Pulmonary hypertension is a disorder which worsens systemic diseases. One of the important underlying pathology is end stage chronic kidney disease The aim of this study was to assess the incidence of unexplained PHT, and to relate this to the cardiovascular status and arteriovenous fistula characteristics in ESKD patients on maintenance hemodialysis&#x0D; Methods: 159 patients with end stage kidney disease on maintenance hemodialysis were evaluated, 103 were excluded. Clinical, laboratory parameters were recorded. Systolic Pulmonary artery pressure and cardiac functions were evaluated by echocardiography. Flow across arteriovenous fistula was assessed by Doppler sonography. Patients were divided between the group with and without pulmonary hypertension. It was a cross sectional study.&#x0D; Result: Out of 159 patients, 56 patients who fulfilled inclusion criteria were evaluated, 36% had systolic pulmonary artery pressure of 35 mm Hg, mean age was 52.42 ± 9.12 years, 71.4% were males, and mean duration of end stage kidney disease was 33.66 ±11.56 months. Pulmonary hypertension patients were exposed to longer duration of hemodialysis therapy (p=0.0001) as compared to the patients with no pulmonary hypertension group, they also had a longer duration of functional Arterio venous fistula (p=0.0001), and flow across Arterio venous fistula was significantly more in pulmonary hypertension group (p=0.022), and these also had higher cardiac output (p=0.0001). Patients with Pulmonary hypertension were significantly more anemic, had more hypoalbuminemia and more interdialytic weight gain.&#x0D; Conclusions: Pulmonary hypertension is frequent in end-stage kidney disease patients on maintenance hemodialysis. It appears to be a late complication of hemodialysis with surgically created AVF with implications on cardiovascular status.&#x0D; Keywords: Arterio venous fistula (AVF), End-stage kidney disease (ESKD), Maintenance hemodialysis (MHD), pulmonary hypertension (PHT).Systolic pulmonary artery pressure (sPAP)

Associations between pulmonary congestion on chest ultrasound and survival in hemodialysis patients

BackgroundVolume overload in hemodialysis patients is an independent risk factor for cardiovascular event-related mortality. The number of B-lines observed using lung ultrasound is correlated with the severity of pulmonary congestion. The aim of this study was to evaluate the association between the number of B-lines and mortality among hemodialysis patients.MethodsA total of 61 patients receiving maintenance hemodialysis were enrolled in this study. Clinical data including age, sex, duration of hemodialysis therapy, presence of diabetes mellitus and/or hypertension and/or dyslipidemia complications, the results of biological examinations, and outcome were collected from the patients’ clinical records. We performed echographic examinations at three time points (just after the start, during the middle, and just before the end of hemodialysis therapy). A univariate Cox proportional hazard model was used to identify predictors of the overall outcomes. Furthermore, we divided patients into two groups according to the median number of the B-lines at the end of dialysis and compared the mortality between the two groups.ResultsThe mean follow-up period was 507 ± 385 days. During the follow-up period, 24 deaths were recorded. Predictive variables for mortality included age; serum level of albumin, creatinine, and N-terminal pro-brain natriuretic peptide; and body weight (P < 0.001, P < 0.0001, P < 0.001, P = 0.014, and P = 0.019, respectively). The number of B-lines at the start, middle, and end of dialysis therapy was correlated with mortality (hazard ratio (95% confidence interval) 1.20 (1.09–1.32), P = 0.0002; 1.17 (1.07–1.28), P = 0.0008; and 1.23 (1.12–1.37), P = 0.0001; respectively). The mortality was statistically higher in the group with 5 or more B-lines than in the group with less than 5 B-lines (P = 0.013).ConclusionsThe number of B-lines at the start, middle, and end of hemodialysis therapy may be correlated with mortality among hemodialysis patients.

Accumulation of coronary risk factors is associated with progression of mitral annular calcification in patients undergoing dialysis therapy: A long-term follow-up study

BackgroundIn patients undergoing dialysis therapy, mitral annular calcification (MAC) is a powerful predictor of cardiovascular events and all-cause mortality. However, there is little data on predictors for MAC progression in patients undergoing dialysis therapy. Methods and resultsWe retrospectively analyzed 98 hemodialysis-dependent patients in Japanese Red Cross Kumamoto Hospital who underwent routine transthoracic echocardiography (TTE) in 2017. Three patients with history of surgical valve replacement or severe valvular heart diseases were excluded. In the 95 enrolled patients, MAC was detected by TTE in 28 patients (29%). A multivariate logistic regression analysis revealed that duration of hemodialysis therapy was independently associated with presence of MAC (odds ratio [OR]: 1.09; 95% confidence interval [CI]: 1.02–1.16; p < 0.01). Among the 95 patients, 72 patients also underwent routine TTE 5 years previously in 2012. In these patients, progression of MAC from 2012 to 2017 was observed in 11 patients (15%). A multivariate logistic regression analysis revealed that number of coronary risk factors (OR: 2.67; 95% CI: 1.24–5.76; p = 0.01), baseline MAC diameter (OR: 1.23; 95% CI: 1.05–1.45; p = 0.01), and left atrial diameter (OR: 0.81; 95% CI: 0.68–0.95; p = 0.01) were significantly associated with progression of MAC. ConclusionsAccumulation of coronary risk factors was associated with progression of MAC in patients undergoing dialysis. Management of coronary risk factors may be important for inhibition of MAC progression.

MANAJEMEN CAIRAN PADA PASIEN PENYAKIT GINJAL KRONIS YANG MENJALANI HEMODIALISIS

Introduction: The cause of serious problems in patients with chronic kidney disease on hemodialysis is due to uncontrolled fluid intake problems. Factors affect the restriction of patient's fluid intake include internal factors such as age, education, level duration of hemodialysis therapy and external factors such as closest people relationships. Method: Analytical descriptive method with total sampling; 57 patients at Dr. H. Soewondo Kendal Hospital. The instrument used Fluid Management Instrument from António Filipe (2015). Result: fluid restriction mostly in bad category were 55 respondents (96,5%) and salt reduction in bad category 47 respondent (82,5%). Discussion: It is advisable to the hospital to require education and evaluation for the patient about structured fluid management by health personnel so that people with chronic kidney disease (CKD) on hemodialysis in accordance with the expected results more leverage.&#x0D;

Role of Uremic Toxins on Apoptosis With Varying Periods of Hemodialysis.

Increased apoptotic cell death in uremic patients has been confirmed by a variety of studies. The present study aimed to investigate the effect of uremic toxins and duration of hemodialysis (HD) therapy on apoptosis by means of measuring serum caspase cleaved CK18 (CCCK-18) levels. Seventy chronic HD patients were recruited and divided into three groups with differing periods of HD, from 6months to 10years. Twelve healthy subjects served as controls. Serum CCCK-18 level was found significantly higher in HD patient groups (Group 2; 189±71IU/L, Group 3; 182±65IU/L, Group 4; 204±111IU/L) as compared to the control group (122±20U/L) (P<0.05). When all hemodialysis patients considered together serum CCCK-18 showed positive correlation with serum uric acid and phosphorus (P<0.05). In conclusion, our results suggest that apoptosis is enhanced in HD patients, phosphorus and uric acid might play a role in this increment, but duration of HD therapy has no effect on apoptosis.

Correlation ofhemochromatosisgene mutations and cardiovascular disease in hemodialysis patients

BACKGROUND AND OBJECTIVESCardiovascular disease (CVD) is a major cause of death in hemodialysis (HD) patients. Hemochromatosis (HFE) gene mutations are reported to be associated with CVD. The present study aims to investigate the association of HFE gene polymorphism with CVD in HD patients.DESIGN AND SETTINGSCross-sectional case-control.METHODSC282Y/H63D mutations of HFE gene were evaluated in 560 HD patients and 480 healthy controls from 4 HD centers in North China. The results obtained from this evaluation process were correlated with biochemical parameters including iron status (serum iron, ferritin, and transferrin concentration), cardiovascular disease, and inflammation marker CRP, IL-6, TNF-α.RESULTSNo C282Y mutations were detected in HD patients or healthy controls in this study. The genotype of H63D heterozygous mutation was similar in HD patients with CVD, HD patients without CVD, and controls. H63D homozygous mutation was 7.4% (19/257), 3.1% (9/303), and 1.0% (5/480) for the 3 groups, respectively. Compound heterozygosity was not found in this study. The relative risk for CVD in HD patients with H63D homozygous mutation was 2.59 (95% CI: 1.15–5.84). H63D homozygous mutation had significantly higher serum ferritin concentrations compared with wild-type individuals. Moreover, HD patients had significantly higher levels of inflammatory biomarkers such as CRP, IL-6, and TNF-α. The multivariate logistic regression analysis revealed that H63D mutation instead of ferritin level was an independent risk factor of CVD for HD patients.CONCLUSIONSOur study demonstrates for the first time that there was an association between H63D homozygous mutations and CVD in HD patients. Elevated serum CRP, IL-6, and TNF-α levels were also related to CVD in HD patients.

Association between high-molecular-weight adiponectin and bone mineral density in hemodialysis patients

Chronic kidney disease-mineral and bone disorder is a regular complication seen in hemodialysis patients and leads to substantial increases in the fracture rate, morbidity, and mortality. Discovered a few years ago, several clinical studies have shown a negative correlation between adiponectin and bone mineral density (BMD) independently of confounding factors. The relationship between adiponectin and bone metabolism in hemodialysis patients has not been fully described yet. We conducted this study to investigate the relationship between serum adiponectin concentration and the BMD in hemodialysis patients. We enrolled 92 hemodialysis patients who were receiving maintenance hemodialysis therapy at Towa Hospital. A peripheral blood sample was obtained, and standard biological data and the serum high-molecular-weight (HMW) adiponectin level were measured. BMD was assessed using dual-energy X-ray absorptiometry scans. In male hemodialysis patients, BMD was negatively related to age (r = -0.299, P = 0.012), duration of hemodialysis therapy (r = -0.31, P = 0.009), and log [HMW-adiponectin] (r = -0.31, P = 0.009) and positively related to body weight (r = 0.332, P = 0.004) and BMI (r = 0.297, P = 0.013). In female hemodialysis patients, BMD was negatively related to age (r = -0.499, P = 0.018) and log [HMW-adiponectin] (r = -0.46, P = 0.030) and positively related to triglyceride (r = 0.491, P = 0.020). HMW adiponectin may affect bone metabolism in both male and female hemodialysis patients.

Psychosocial quality of life of elderly hemodialysis patients using visual analog scale: Comparison with healthy elderly in Japan

BackgroundThe number of elderly hemodialysis (HD) patients is increasing in Japan, and the psychosocial impact of HD to the elderly remains unclear. The main purpose of this study was to evaluate quality of life (QOL) of elderly patients undergoing regular HD. MethodsWe examined the psychosocial status in elderly HD patients and compared it with that in healthy elderly individuals. The correlations between each item of QOL, laboratory data and comorbidities were explored. This study cohort consisted of 142 people (70 healthy elderly participants and 72 elderly HD patients). We assessed 10 items of QOL, i.e., health condition, appetite, sleep, mood, memory, family relationship, friendship, economical status, satisfaction in daily life, and happiness by visual analog scale (VAS). ResultsOverall, elderly HD patients had lower scores of VAS than healthy elderly participants, especially in sleep, mood, and happiness, but not in family relationship and friendship. Lower VAS scores for sleep were significantly correlated with the duration of HD therapy and the troubles in vascular access for HD. VAS scores for family relationship were also correlated with the duration of HD therapy. ConclusionThe QOL of elderly HD patients was poorer than that in healthy elderly individuals, particularly in sleep, mood and happiness. Further study is needed to improve the QOL of elderly HD patients. This is of great importance, since the number of elderly HD patients is estimated to escalate in the future.

Osteoporosis and Related Risk Factors in Renal Transplant Recipients

Decreased bone mineral density is a common problem after kidney transplantation. Osteoporosis has a major role in morbidity in these patients. We evaluated the incidence of osteoporosis and determined risk factors in 77 patients aged 17 to 50 years who had undergone renal transplantation 6 months to 2 years previously. Bone mineral densitometry was performed using dual-energy x-ray absorptiometry. The incidence of osteoporosis was 26% (20 of 77 patients). Mean (SD) age of affected patients was 34.6 (8.7) years. The most common sites of osteoporosis were the hip (osteoporotic in 19 patients [24.7%] and osteopenic in 42 [54.5%]) and the spine (osteoporotic in 6 patients [7.8%] and osteopenic in 52 [67.5%]). There was a significant relationship between posttransplantation creatinine concentration and hip osteoporosis (P = .01). No relationship was observed between osteoporosis and age, sex, body mass index, duration of hemodialysis therapy, cumulative dosage of any drugs, or use of pulsed methylprednisolone therapy. A hip or spine z score of 1 or less had no relationship to the number of steroid pulse sessions but was significantly related to the total dosage of cyclosporine (P < .001), prednisolone (P < .001), and mycophenolate mofetil (P < .05). A hip z score of less than 1 was related to the posttransplantation period (P = .02). In conclusion, osteoporosis is a frequent complication that requires detection and treatment to reduce morbidity.

The importance of low blood urea nitrogen levels in pregnant patients undergoing hemodialysis to optimize birth weight and gestational age

Most published reports indicate that intensified hemodialysis results in better pregnancy outcomes. Here we studied clinical characteristics and the outcomes of 28 pregnant women receiving hemodialysis. We found an association between maternal blood data and birth weight, and gestational age and outcomes. There were 18 surviving infants who were followed up for one year. In the others there were 4 spontaneous abortions, 1 stillbirth, 3 neonatal deaths and 2 deaths after birth. Analysis of blood chemistry for 20 pregnancies from 12 weeks of gestation until delivery showed that the average hemoglobin level was significantly higher in the group that successfully delivered than in the unsuccessful group. There were significant negative relationships between the blood urea nitrogen (BUN) level and the birth weight or gestational age in the latter cohort. A birth weight equal to or greater than 1500 g or a gestational age equal to or exceeding 32 weeks corresponded to BUN levels of 48-49 mg/dl or less. Whether the low BUN is the direct cause of the improved outcome remains to be examined.

The Risk of Gallbladder Stone Formation Is Increased in Patients with Predialysis Chronic Kidney Disease but Not Those Undergoing Chronic Hemodialysis Therapy

Background: It is unclear whether the prevalence of gallbladder stones (GBS) is higher in patients with chronic kidney disease (CKD). Methods: A total of 398 patients with CKD of each of the 5 disease stages [CKD1: 26; CKD2: 52; CKD3: 58; CKD4: 48; CKD5: 214, of whom 61 were predialysis and 153 were on dialysis (CKD5D)] were included in this study. Those in whom GBS were detected by ultrasonographic examination or who had a history of cholecystectomy owing to GBS were considered GBS patients. Results: In comparison to the GBS prevalence of 5.9% in the control group, that in CKD patients increased with the advancement of the disease stage (CKD1: 7.7%; CKD2: 15.4%; CKD3: 19.0%; CKD4: 20.8%; CKD5 predialysis: 21.3%; CKD5D: 22.9%). The prevalence was significantly greater in CKD5 patients than in the control group. CKD5 is a risk factor for GBS independent of age or sex. However, no significant relationship was found between the prevalence of GBS and the duration of hemodialysis therapy in CKD5D patients. Age was the only factor that was associated with GBS in predialysis CKD patients. Conclusion: The risk of GBS formation was high in predialysis CKD patients. Although the risk disappeared in CKD5D patients, the prevalence of GBS was still significantly higher than in the control population. Factors that promote GBS formation in predialysis CKD patients and/or that inhibit GBS formation in CKD5D patients remain unknown.