End-stage Renal Disease Comorbidities Research Articles

Correlations between serum inflammatory markers and comorbidities in patients with end-stage renal disease

ObjectivesChronic inflammatory processes are common in patients with renal disease, especially those with end-stage renal disease (ESRD), in whom inflammatory markers have been shown to increase with renal function deterioration. ESRD is usually accompanied by other chronic diseases such as hypertension and diabetes. The relationships between ESRD comorbidities and serum levels of inflammatory markers have not yet been fully understood. The aim of this study was to assess serum levels of inflammatory markers in different ESRD cohorts and to investigate the correlations between these inflammatory markers and disease comorbidities.MethodsA total of 147 patients were grouped according to their comorbid conditions: diabetic only, hypertensive only, diabetic and hypertensive, and neither diabetic nor hypertensive. Serum levels of C-reactive protein (CRP), tumour necrosis factor-alpha (TNF-α), and interleukin-1-beta (IL-1β) were investigated in different ESRD cohorts by enzyme-linked immunosorbent assay.ResultsSerum CRP and TNF-α levels were high in diabetic patients (p = 0.0001), hypertensive patients (p = 0.0001), and those who had both diseases (p = 0.0001), when compared to ESRD patients without these comorbidities. There was no significant change in serum IL-1β levels between patients with diabetes mellitus and/or hypertension compared to patients who did not have these diseases.ConclusionsOur results showed that, in ESRD patients, CRP and TNF-α seem to be largely affected by patients’ comorbidities, unlike IL-1β, which might be affected more by the dialysis process even in the absence of comorbidities.

Pharmacological and non-pharmacological treatment options for depression and depressive symptoms in hemodialysis patients

Depression is a mental disorder with a high prevalence among patients with end stage renal disease (ESRD). It is reported that depression afflicts approximately 20-30% of this patient population, being associated, amongst other, with high mortality rate, low adherence to medication and low perceived quality of life. There is a variety of medications known to be effective for the treatment of depression but due to poor adherence to treatment as well as due to the high need for medications addressing other ESRD comorbidities, depression often remains untreated. According to the literature, depression is under-diagnosed and undertreated in the majority of the patients with chronic kidney disease. In the current review the main pharmacological and non-pharmacological approaches and research outcomes for the management of depressive symptoms in hemodialysis patients are discussed.

Access to the Kidney Transplant Wait List

The study examines selection for kidney transplantation and determines who are referred, how many had contraindications and whether comorbidity indices predict transplant status. Of 113 consecutive adult incident end-stage renal disease (ESRD) patients at this single center 47 (41.6%) were referred. Using published guidelines, 48 (42.5%) had a specific contraindication. However 26 (23%) were neither referred nor had contraindications. An ESRD mortality score, acute renal failure status and albumin were independent predictors of referral but only the mortality score was predictive of contraindication status. The Charlson and ESRD comorbidity indices were less predictive of contraindication or referral status. In a comparison of patients who were Candidates (referred and no contraindication, n = 39) compared to those who were Neither (not referred and no contraindications, n = 26), age was the most discriminating factor (c = 0.99, 95% CI 0.97-1.00). Comorbidity and mortality indices were inferior. Neither patients were older (75 +/- 7 years) and had comorbidity scores that were higher than Candidates but similar to those with contraindications (ESRD index; Neither 3.3 +/- 2.5, Candidate 1.4 +/- 1.8, and contraindication 4.1 +/- 3.4). Comorbitity indices do not help explain selection practices whereas age is an important discriminator. How many Neither patients would benefit from transplantation is not known.

Adapting the charlson comorbidity index for use in patients with ESRD

Background:Accurate prediction of survival for patients with end-stage renal disease (ESRD) and multiple comorbid conditions is difficult. In nondialysis patients, the Charlson Comorbidity Index has been used to adjust for comorbidity. The purpose of this study is to assess the validity of the Charlson index in incident dialysis patients and modify the index for use specifically in this patient population. Methods:Subjects included all incident hemodialysis and peritoneal dialysis patients starting dialysis therapy between July 1, 1999, and November 30, 2000. These 237 patients formed a cohort from which new integer weights for Charlson comorbidities were derived using Cox proportional hazards modeling. Performance of the original Charlson index and the new ESRD comorbidity index were compared using Kaplan-Meier survival curves, change in likelihood ratio, and the c statistic. Results:After multivariate analysis and conversion of hazard ratios to index weights, only 6 of the original 18 Charlson variables were assigned the same weight and 6 variables were assigned a weight higher than in the original Charlson index. Using Kaplan-Meier survival curves, we found that both the original Charlson index and the new ESRD comorbidity index were associated with and able to describe a wide range of survival. However, the new study-specific index had better validated performance, indicated by a greater change in the likelihood ratio test and higher c statistic. Conclusion:This study indicates that the original Charlson index is a valid tool to assess comorbidity and predict survival in patients with ESRD. However, our modified ESRD comorbidity index had slightly better performance characteristics in this population.