End-stage Renal Disease Group Research Articles

Correlative factors comparing and nursing in the cardiac surgery for patients with end-stage renal disease and non-nephropathy disease

Objective To analyze the correlative differences in the cardiac surgery for patients with end-stage renal disease (ESRD) and non-nephropathy disease, and explore the cardiac perioperative nursing for patients with ESRD. Methods A single-center retrospective comparative analysis was conducted in patients with ESRD (ESRD group, 26 cases) and non-nephropathy disease (control group, 26 cases) treated with cardiac surgery from January 2004 to December 2016 in Peking University First Hospital. Postoperative laboratory indexes, the changes of indexes in the monitoring room and the blood transfusion were compared between two groups. Results At 0, 1 and 2 d after the surgery, hemoglobin levels of patients in ESRD group were significantly lower than those in the control group; creatinine and urea nitrogen levels in ESRD group were significantly higher than those in the control group (P 0.05) . The duration of stay in ICU and postoperative hospital stay were (101.62±49.10) h and (28.23±20.44) d in the ESRD group, which were significantly longer than those in the control group [ (71.35±33.10) h, (16.58±8.43) d]. Conclusions ESRD patients have a higher risk in the cardiac surgery when compared with patients with non-nephropathy disease. Therefore, nurses should pay attention to the perioperative electrolyte balance and infusion of blood products, as well as the prevention of postoperative complications and psychological nursing, to help patients with better prognosis. Key words: Cardiac surgical procedures; Perioperative nursing; Water electrolyte balance; End-stage renal disease; Blood product

Outcomes of dialysis patients with critical limb ischemia after revascularization compared with patients with normal renal function

ObjectiveAn analysis was conducted of intermediate outcomes and possible influencing factors in patients with end-stage renal disease (ESRD) and critical limb ischemia after lower limb revascularization compared with patients with regular renal function (non-ESRD). MethodsData collection was performed by inquiry of the German multicenter registry of First-Line Treatments in Patients with Critical Limb Ischemia (CRITISCH); 102 ESRD patients and 674 non-ESRD patients were included. Four different therapy modalities were analysed: bypass surgery, endovascular therapy (EVT), femoral artery endarterectomy, and no vascular intervention (conservative treatment or primary major amputation). Predefined end points were amputation-free survival (AFS), death, major amputation, and reintervention. Cox regression models were built to analyze independent risk factors for outcome parameters. ResultsESRD patients showed inferior results at 2 years in the rate of AFS (ESRD, 35.4%; non-ESRD, 67.2%; P < .001). Similarly, death rate (ESRD, 55.0%; non-ESRD, 20.7%; P < .001) and major amputation rate (ESRD, 24.5%; non-ESRD, 15.8%; P = .029) were significantly elevated for ESRD patients. The choice of therapeutic approach in ESRD did not influence the incidence of the investigated end points (death or major amputation: EVT, 56.9% vs bypass, 76.9% [P = .225]; death: EVT, 46.2% vs bypass, 61.5% [P = .372]; amputation: EVT, 15.4% vs bypass, 15.4% [P = 1.000]; reintervention: EVT, 32.3% vs bypass, 15.4% [P = .324]). Cox regression analysis indicated that dialysis patients carry a twofold increased hazard of death or major amputation (hazard ratio, 2.27; 95% confidence interval, 1.67-3.10; P < .001), and open surgical treatment (all patients combined) was associated with reduced risk of death compared with EVT (hazard ratio, 0.58; 95% confidence interval, 0.37-0.91; P = .017). Comorbidities were not found to have a noticeable impact on AFS, survival, reintervention, or major amputation. ConclusionsTwo-year AFS, overall survival, and freedom from major amputation were decreased in ESRD patients compared with non-ESRD patients with critical limb ischemia. Cardiovascular comorbidities were without significant impact on outcome parameters, whereas choice of treatment modality within the ESRD group did not influence AFS. Decision-making in ESRD as to choice of therapeutic approach in dialysis patients should notably account for the individual's lesion characteristics and vascular disease; surgical revascularization and EVT may be used as complementary options.

End-stage renal disease is a risk factor for complex laparoscopic cholecystectomy in patients waiting for renal transplantation.

Introduction:To date, there are no studies investigating whether laparoscopic cholecystectomy (LC) is technically more complex in patients waiting for kidney transplant. The aim of this study is to create a user-friendly score to identify high-risk cases for complex LC integrating end-stage renal disease (ESRD).Materials and Methods:We retrospectively analysed 321 patients undergoing LC during the period 2014–2016. Two groups were compared: ESRD group (n = 25) versus control group (n = 296). Concerning statistical analysis, continuous variables were compared using Kruskal–Wallis’ test, dummy variables with Chi-square test or Fisher's exact test when appropriate. A multivariable logistic regression analysis was performed to identify risk factors for complex LC. A backward conditional method was used to design the final model.Results:Seventy out of 321 (21.8%) cases were considered as complex, with a higher prevalence in the ESRD group (32.0 vs. 20.9%; P = 0.2). Using a multivariable logistic regression analysis, we formulated a score based on the independent risk factors for complex LC: 4×(previous cholecystitis) +5 × (previous ESRD) +1 × (age per decade) +2 × (previous open abdominal surgery). High-risk cases (score ≥ 10) were more commonly reported in the ESRD group (72.0 vs. 24.7%; P < 0.0001).Conclusion:Although several scores investigating the risk for complex LC have been proposed, none of them has focused on ESRD. This is the first series demonstrating that ESRD is an independent risk factor for technical complexity in LC. We developed a score to offer surgeons an extra tool for pre-operative evaluation of patients requiring LC.

Altered intrinsic brain activity and memory performance improvement in patients with end-stage renal disease during a single dialysis session.

Memory deficits are considered to have a great influence on self-management, dietary restriction and therapeutic regimen for end-stage renal disease (ESRD) patients with dialysis treatment. This study was aim to investigate the spontaneous brain activity and its relationship with memory performance in ESRD patients before dialysis (T1) and after 24h (T2) during a single dialysis session. 23 ESRD patients and 25 matched healthy controls (HCs) were scanned using functional magnetic resonance imaging (fMRI) at T1, and all patients were also scanned at T2. Amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) methods were used to evaluate the spontaneous brain activity between two groups. The Auditory Verbal Learning Test-Huashan version (AVLT-H) was performed to assess memory function. Compared with HCs, ESRD group showed a significant decreases in the immediate recall total score (IR-S), short-term delayed recall score (SR-S), and long-term delayed recall score (LR-S) at T1. IR-S, SR-S, LR-S and recognition score (REC-S) were significantly increased at T2. Compared with HCs at T1, ESRD patients showed that the lower mean ALFF (mALFF) values were mainly located in dorsolateral prefrontal cortex (DLPFC), medial frontal gyrus, and precuneus. Higher ReHo in the bilateral inferior temporal gyrus and left hippocampus and lower ReHo in the right precentral gyrus, anterior cingulate cortex were found at T1 too. The mALFF values of the DLPFC and precuneus were significantly increased during a dialysis session, while no significantly difference of ReHo region was found. Furthermore, the increased mALFF values of the DLPFC were significantly positively correlated with the improvement in the IR-S. Our results indicated that increased regional spontaneous activity of the DLPFC may reflect memory performance improvement after a single dialysis treatment, which may provide insight into the effect of hemodialysis on spontaneous brain function during a single dialysis session.

Development of a novel estimation method for hemoglobin A1c using glycated albumin in type 2 diabetes mellitus patients with end-stage renal disease.

We developed a novel estimation method for hemoglobin A1c (HbA1c) in type 2 diabetes (T2D) patients with end-stage renal disease (ESRD). This method is based on the glycated albumin (GA) level. Of the 788 Japanese patients with T2D included in this study, 545 had normal renal function (NRF group) and 243 had ESRD. Oral glucose tolerance tests (OGTTs) were performed in 80 subjects. The variables GA, body mass index (BMI), hemoglobin (Hb), and estimated glomerular filtration rate (eGFR) were significantly associated with the GA-to-HbA1c ratio and were used to determine the estimated HbA1c (eHbA1c). One method of estimating HbA1c involved dividing GA by the GA-to-HbA1c ratio predicted from the estimated regression equation; the estimated HbA1c obtained in this manner was denoted eHbA1c-1. eHbA1c-1 (%)=GA×[4.688-18.833×GA-1-0.015×BMI-0.037×Hb (-0.002×eGFR for patients without ESRD)]-1; adjusted R 2=0.676 for actual HbA1c. The sensitivity of eHbA1c-1 was better than that of GA for diabetes diagnosis using the 75-g OGTT. There were no differences in the slope of eHbA1c-1 versus GA and the variance of eHbA1c-1 between the ESRD and NRF groups. eHbA1c-1 was not associated with Hb, erythropoiesis-stimulating agent use, or ESRD concomitance. eHbA1c-1 may be a useful parameter for estimating HbA1c in T2D patients with ESRD.

Risk of Retinal Vein Occlusion in Patients With End-Stage Renal Disease: A 12-Year, Retrospective, Nationwide Cohort Study in South Korea.

The present study aimed to evaluate the risk of retinal vein occlusion (RVO) in Korean patients with end-stage renal disease (ESRD). In this retrospective, nationwide, propensity score-matched cohort study, subjects were randomly enrolled from the 12-year longitudinal Korean National Health Insurance Service-National Sample Cohort 2002-2013 database comprising 1 million subjects. The ESRD group comprised 988 patients newly diagnosed with ESRD from 2003 onward by washing out data from 2002. The comparison group comprised 4940 (5 for each patient with ESRD) randomly selected propensity score-matched individuals not diagnosed with ESRD. Each sampled patient was tracked until 2013 for RVO development. Multiple conditional Cox regression analysis was performed to compare the risk of RVO between the two groups. The mean follow-up period was 7.37 years. The incidence of RVO was 3.95% in the ESRD group and 2.17% in the comparison group (P = 0.001). ESRD was associated with greater risk of RVO development after adjustment for possible confounders (adjusted hazard ratio [HR], 2.122; 95% confidence interval [CI], 1.396-3.226; P = 0.0004). The 50- to 60-year (adjusted HR, 2.635; 95% CI, 1.100-6.313; P = 0.0297) and 60- to 70-year (adjusted HR, 2.544; 95% CI, 1.059-6.110; P = 0.0368) age groups exhibited higher risk of RVO compared with the <40-year age group. Hyperlipidemia (adjusted HR, 1.670; 95% CI, 1.176-2.371; P = 0.0042) and hypertension (adjusted HR, 1.896; 95% CI, 1.165-3.086; P = 0.01) were also associated with RVO. An association between ESRD and subsequent RVO development was found after adjustment for possible confounding factors.

Predictive factors for poor outcome in pediatric C3 glomerulonephritis.

To clarify the predictive factors for poor outcome in pediatric C3 glomerulonephritis (C3GN), we retrospectively evaluated the relationship between the clinico-pathological findings and prognosis in cases of pediatric C3GN. We enrolled 18 patients diagnosed with C3GN. These patients were divided into two groups, four patients in the end-stage renal disease (ESRD) group and 14 patients in non-ESRD group, based on clinical status at the last examination. Patients in the non-ESRD group were further divided into Subgroup A, consisting of 6 treatment responders, and Subgroup B, consisting of 8 non- responders. The clinical and laboratory findings, as well as the histological findings were investigated for each group. The frequency of nephrotic syndrome at onset in the ESRD group was higher than that in the non-ESRD group. Before treatment and at 2 years after treatment, urinary protein excretion levels and serum creatinine levels in the ESRD group were higher than those in the non-ESRD group. The mean serum C3 and CH50 levels at 2 years after treatment in the ESRD group were lower than those in the non-ESRD group. The degree of renal injury, level of mesangial deposits and degree of alpha SMA staining at the time of the first renal biopsy in the ESRD group were all higher than those in the non-ESRD group. Our results suggest that the severity of C3GN at onset and persistent complements activity are associated with poor prognosis in C3GN.

The relationship between putamen-SMA functional connectivity and sensorimotor abnormality in ESRD patients.

The basal ganglia (BG) are composed of several nuclei involved in neural processing associated with integration of sensory and motor information. Recent neuroimaging studies implicated its key role in control of voluntary motor function. As the sensorimotor abnormality is common among the end-stage renal disease (ESRD) population, in the current study, we aimed to investigate the abnormal structure and functional connectivity patterns of BG in ESRD patients. Twenty-nine ESRD and twenty-nine age and gender-matched healthy controls (HC) were enrolled to compare the volume of the subsets in the BG (e.g., caudate nucleus, putamen and globus pallidus) by using the VBM analysis; resting-state functional connectivity was analyzed by a seed-based method. Compared with the HC group, ESRD patients had a smaller volume in the right putamen. Taking the right putamen as a seed region, we further found reduced functional connectivity in patients mainly between the putamen and supplementary motor area (SMA), insula, posterior mid-cingulate gyrus, and primary motor cortex. In ESRD group, the severity score of restless legs syndrome was negatively correlated with putamen-SMA functional connectivity, while the hemoglobin level was positively correlated with functional connectivity degree between the putamen and SMA. Our results revealed an abnormal volume of the putamen and its decreased functional connectivity patterns during resting state in ESRD with sensorimotor abnormalities. These preliminary results indicated that the decreased functional connectivity in putamen-SMA was associated with sensorimotor abnormalities, and anemia was correlated with this abnormal functional pattern in ESRD patients.

Safety and efficacy of total hip arthroplasty in patients with end stage renal disease

To evaluate the safety and efficacy of total hip arthroplasty (THA) in patients with end stage renal disease (ESRD). Between December 2009 and May 2016, 30 THAs were performed in 28 patients with dialysis-dependent renal failure (18 patients) or renal transplantation (10 patients). A retrospective case control study was carried out to compare these 28 ESRD patients (ESRD group) with a matched cohort of 28 nonrenal patients (control group). There was no significant difference in gender, age, hip side, American Society of Anesthesiology (ASA) classification, comorbidities, and preoperative Harris score and hemoglobin (Hb) level between 2 groups ( P>0.05). The complications during hospitalization, Hb level changes, perioperative transfusion rate, hospital stay, and hospitalization costs in 2 groups were evaluated; and the creatinine changes of dialysis patients in ESRD group were evaluated. During the follow-up period, 90 days readmissions, periprosthetic infection, prosthesis loosening, hip Harris score, and deaths were recorded. There was no loss of follow-up. The mean postoperative follow-up of ESRD group was 3.4 years (range, 1.0-7.4 years) and control group was 3.5 years (range, 1.0-7.4 years). Differences in hospital stay and the drop of Hb was not significant between 2 groups ( P>0.05). The hospitalization costs and perioperative transfusion rate were significantly higher in ESRD group than in control group ( P<0.05). There was no significant difference in creatinine value of dialysis patients in ESRD group between pre- and post-operation ( t=1.804, P=0.089). At last follow-up, the Harris score was significantly higher than preoperative score in both groups ( P<0.05); however, there was no significant difference in Harris score between groups ( t=1.278, P=0.207). In ESRD group, 5 patients presented complications, 1 patient was readmitted to hospital, and 2 patients died during the follow-up. In control group, 1 patient presented complications, and there was no 90 days readmission and no death. During the follow-up period, there was no loosening or revision in 2 groups and the prosthesis was in good position. THA can improve joint function and life quality of ESRD patients, but the risks of operation, perioperative complications, transfusion rate, and cost are high. Correct perioperative evaluation and management can help ESRD patients safely go through the perioperative period.

A proof-of-concept study analyzing the clinical utility of fluorine-18-sodium fluoride PET-CT in skeletal staging of oncology patients with end-stage renal disease on dialysis.

The quality of conventional bone scintigraphy can be poor in patients with end-stage renal disease (ESRD). Fluorine-18-sodium fluoride (F-NaF) PET-computed tomography (CT) has rapid single-pass extraction, fast clearance from the soft tissues and a better target to background ratio. The aim of the present study is to preliminarily assess the superior tracer kinetics of F-NaF in ESRD patients. A cohort comprising of 13 patients with ESRD (mean age 65.5 years; median age 68.5 years; six men and seven women) and a control group of 20 patients with normal renal function (mean age 64±7.7 years, nine men and 11 women) were analyzed qualitatively and quantitatively. Both sets of patients were referred for osseous staging of malignancy. All patients underwent a PET-CT scan after an injection of 0.06 mCi/kg of F-NaF. Qualitative analysis of the ESRD and the control group did not show a significant difference. The signal to noise ratio in the ESRD group (26.24±10.5) and the control group was similar (22.06±10.9), P=0.35. The extraction of radiotracer in bone was higher in ESRD with a bone to soft tissue index of 4.03±2.2 versus 2.48±1.0 in control patients (P=0.01). F-NaF PET-CT was positive for bone metastases in three patients and negative in 10 patients. Of the 48 total lesions, 34 (71%) were classified as benign on F-NaF PET-CT, whereas 10 (21%) were classified as malignant and four (8%) were classified as equivocal. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of F-NaF PET-CT were 91, 89.5, 90, 71.4, and 89.7%, respectively (P<0.001). The image quality of F-NaF PET-CT in patients with ESRD was comparable to imaging in patients with normal renal function. This can potentially translate into better diagnostic performance in patients with ESRD.

Actinic keratosis and diabetes complications: A nationwide population-based study in South Korea (2009–2015)

AimAs the associations between actinic keratosis (AK) and diabetes complications in patients with diabetes mellitus (DM) have never been investigated, this study aimed to evaluate any such associations in patients with DM. MethodsThis retrospective cohort study analyzed clinical data for DM patients aged>40 years who had undergone the health examination recommended by the South Korea National Health Insurance Program between 2009 and 2012 (n=2,056,580). All of these patients were classified according to the presence of diabetic retinopathy (DR), end-stage renal disease (ESRD) and history of DVD; myocardial infarction, stroke, transient ischaemic attacks. Newly diagnosed AK was identified using claims data from baseline to the date of diagnosis or 31 December 2015, whichever came first. ResultsOf the 2,056,580 patients with DM, 6404 (0.31%) developed AK. Those patients in the DR, ESRD and CVD groups were more likely to be diagnosed with AK (P<0.001, by log-rank test). After adjusting for age and gender, the risks for AK were significantly higher in the DR, ESRD and CVD groups: HR (95% CI): 1.29 (1.21–1.39), HR: 4.24 (3.28–5.47) and HR: 1.22 (1.13–1.31), respectively. ConclusionThis study has revealed that the incidence of AK is higher in diabetes patients with ocular, renal and cardiovascular complications.

Clinical Factors and Outcomes of Dialysis-Dependent End-Stage Renal Disease Patients with Emergency Department Septic Shock

BackgroundInfection is the second leading cause of death in end-stage renal disease (ESRD) patients. Prior investigations of acute septic shock in this specific population are limited. ObjectiveWe aimed to evaluate the clinical presentation and factors associated with outcome among ESRD patients with acute septic shock. MethodsWe reviewed patients prospectively enrolled in an emergency department (ED) septic shock treatment pathway registry between January 2014 and May 2016. Clinical and treatment variables for ESRD patients were compared with non-ESRD patients. A second analysis focused on ESRD septic shock survivors and nonsurvivors. ResultsAmong 4126 registry enrollees, 3564 (86.4%) met inclusion for the study. End-stage renal disease was present in 3.8% (n = 137) of ED septic shock patients. Hospital mortality was 20.4% and 17.1% for the ESRD and non-ESRD septic shock patient groups (p = 0.31). Septic shock patients with ESRD had a higher burden of chronic illness, but similar admission clinical profiles to non-ESRD patients. End-stage renal disease status was independently associated with lower fluid resuscitation dose, even when controlling for severity of illness. Age and admission lactate were independently associated with mortality in ESRD septic shock patients. ConclusionESRD patients comprise a small but important portion of patients with ED septic shock. Although presentation clinical profiles are similar to patients without ESRD, ESRD status is independently associated with lower fluid dose and compliance with the 30-mL/kg fluid goal. Hyperlactatemia is a marker of mortality in ESRD septic shock.

Abnormal interaction between cognitive control network and affective network in patients with end-stage renal disease.

End-stage renal disease (ESRD) is a common complicated disorder that is generally associated with an altered central nervous system and cognitive impairment. Neuroimaging studies have recorded aberrant brain circuits in patients with ESRD that were closely associated with abnormal clinical manifestations. However, whether the altered interaction was within and/or between these circuits is largely unclear. We investigated brain topological organization and/or module interaction by employing resting-state functional magnetic resonance imaging (rs-fMRI) and modularity network analysis in 24 patients with ESRD and 20 age- and gender-matched healthy control (HC) subjects. Stroop task was used to evaluate the performance of cognitive control in all subjects. At the global level, ESRD patients exhibited significantly decreased global and local efficiency which were mainly related to abnormal functional connectivity of the amygdala and inferior frontal gyrus (IFG). Stepwise regression analysis was applied to estimate the relationships between network efficiency and blood biochemistry level (urea, creatine, phosphate, Ca2+, hematocrit, cystatin, hemoglobin levels, parathyroid hormone, K+ and Na+), and only the hematocrit level was significantly associated with global efficiency in patients with ESRD. At the modular level, we discovered an aberrant brain interaction between the amygdala- and IFG-related circuits in the ESRD group, and the regional efficiency of the amygdala was observably relative to the performance of cognitive control in patients with ESRD. Our results suggested that ESRD exhibited aberrant brain functional topological organization and module-level interaction between the affective and cognitive control circuits, providing crucial insights into the pathophysiological mechanism of ESRD patients.

Seroprevalence of human herpesvirus 8 and its impact on the hemoglobin level in patients of end stage of renal diseases.

The incidence of Kaposi's sarcoma (KS) is increasing among renal transplant recipients. Patients with end-stage renal disease (ESRD) are immunocompromised and are candidates for renal transplantation, but HHV8 seroprevalence in ESRD patients has not been well documented. A cross-sectional study of 286 ESRD patients and 281 matched subjects without kidney disease was conducted at the First People's Hospital of Huzhou, Zhejiang province to explore the epidemiologic features of HHV8 among ESRD patients in China. Blood samples were collected and HHV8 antibodies and serologic indices were measured. The seroprevalence of HHV8 was 15.3% for ESRD patients and 8.9% for the comparison group. A significant difference in the geometric mean titer (GMT) of the HHV8 antibodies was detected between ESRD patients and the comparison group (617.1 vs 291.7; P = 0.042). The average level of hemoglobin was 11.56 ± 1.78 g/dL for the ESRD group and 13.73 ± 1.42 g/dL for the comparison group, (P > 0.05). Multiple linear regression revealed a negative association between HHV8 infection and plasma hemoglobin concentration (β = -0.682, P = 0.036). We found a higher HHV8 prevalence and a higher level of HHV8 antibody GMT in ESRD patients than the comparison group, which indicate a high risk of posttransplantation KS.

Removal of uremic retention products by hemodialysis is coupled with indiscriminate loss of vital metabolites

BackgroundAlthough dialysis ameliorates uremia and fluid and electrolytes disorders, annual mortality rate remains high in dialysis population reflecting its shortcoming in replacing renal function. Unlike the normal kidney, dialysis causes dramatic shifts in volume and composition of body fluids and indiscriminate removal of vital solutes. Present study was undertaken to determine the impact of hemodialysis on plasma metabolites in end-stage renal disease (ESRD) patients. Methods80 hemodialysis patients and 80 age/gender-matched healthy controls were enrolled in the study. Using ultra performance liquid chromatography-high-definition mass spectrometry, we measured plasma metabolites before, during, and after hemodialysis procedure and in blood entering and leaving the dialysis filter. ResultsPrincipal component analysis revealed significant difference in concentration of 214 metabolites between healthy control and ESRD patients' pre-dialysis plasma (126 increased and 88 reduced in ESRD group). Comparison of post-dialysis with pre-dialysis data revealed significant changes in the 362 metabolites. Among ESI+ metabolites 195 decreased and 55 increased and among ESI− metabolites 82 decreased and 30 increased following hemodialysis. Single blood passage through the dialyzer caused significant changes in 323 metabolites. Comparison of ESRD patients' post-hemodialysis with healthy subjects' data revealed marked differences in metabolic profiles. We identified 55 of the 362 differential metabolites including well known uremic toxins, waste products and vital biological compounds. ConclusionIn addition to uremic toxins and waste products hemodialysis removes large number of identified and as-yet un-identified metabolites. Depletion of vital biological compounds by dialysis may contribute to the high morbidity and annual mortality rate in this population.

The assessment of prosthetic needs of ESRD patients and the general population in Poland on the basis of the Eichner classification and teeth number: A brief, preliminary report.

End-stage renal disease (ESRD) patients are considered as a group of high risk of oral cavity diseases. One of the determinants of alveolar bone loss and increased teeth mobility in ESRD patients might be the bone abnormalities associated with chronic kidney disease-mineral and bone disorder (CKD-MBD). The aim of the study was to compare the general health condition, number and location of teeth in a group of ESRD patients with the group of peers from general population and revealing the risk factors of tooth loss. The ESRD group included 63 patients, 23 females and 40 males, undergoing dialysis with a mean age of 62.4 ± 15.6. The general population sample consisted of 37 people, 20 females and 17 males, applying for general practitioner visit, with a mean age of 65.5 ± 11.1. All the participants were using just public health care insurance. The data analysis was based on anamnesis, history of CKD, selected biochemical parameters of blood tests and clinical examination. There was no statistical difference in the prosthetic needs of patients undergoing dialysis and the general population. In both groups the situation is alarming. The new procedures are needed to develop complex health care for ESRD and general population patients, emphasizing prophylaxis of tooth-loss and prosthetic treatment in order to maintain good level of life quality.

Risk of corneal ulcer in patients with end-stage renal disease: a retrospective large-scale cohort study

Background/AimsTo investigate the risk of corneal ulcer in patients with end-stage renal disease (ESRD).MethodsThis retrospective, nationwide, matched cohort study included 92 967 patients with ESRD recruited between 2000 and 2009...

Cognitive Impairment in Dialysis and Non-Dialysis Patients Suffering from Chronic Renal Failure and Comparing Them with a Control Group

Background: Chronic renal failure and its end-stage disease are one of the most important causes of death and disability, and its prevalence is increasing in the world. This disease can cause many complications in the patients with end- stage renal disease. Objectives: The present study aimed at comparing cognitive impairment in patients with end- stage renal disease (ESRD) and chronic renal failure (CRF) with a control group. Methods: In this cross-sectional study, 85 ESRD, dialysis dependent patients, 200 CRF patients, non-dialysis dependent, as well as 180 patients with high blood pressure or diabetes as control group who referred to Kowsar hospital during 2015 and 2016 were studied. The Persian version of the mini mental status examination (MMSE) questionnaire was used to collect data. It was completed by one of the skilled and trained nurses. Results: The results revealed that 28.2% of ESRD, 1% of CRF patients, and 0.6% of control group patients had severe cognitive impairment. Cognitive health score in ESRD group was lower than that in CRF (P < 0.001) and control group (P < 0.001). In addition, cognitive health score of CRF patients was lower than that in the control group (P = 0.005). ESRD patients had significantly higher impairment in time and place orientation, calculation, recall, language, and repetition compared to control and CRF groups (P < 0.001), but there were no significant differences between control and CRF groups. With respect to complex commands, the control group had a significantly lower impairment, but the other 2 groups were not significantly different in this regard. The three experimental groups were not significantly different in per-test stage. Conclusions: ESRD patients have severe cognitive impairment compared to CRF patients. Therefore, it is recommended that these patients be examined cognitively and proper rehabilitation programs be considered for them.

Prevalence and survival prognosis of prostate cancer in patients with end-stage renal disease: a retrospective study based on the Korea national database (2003-2010).

ObjectiveThe study was aimed to evaluate the prevalence and prognosis of prostate cancer (PC) and end-stage renal disease (ESRD), determine the risk factors for overall survival (OS) and PC-specific survival (CSS), and evaluate differences in PC-related clinical therapeutic patterns between patients with and without PC-ESRD.MethodsThis observational population study, performed at the National Cancer Center and Cancer Research Institute in Korea, included patients with PC and ESRD from the nationwide Korean Health Insurance System and Korean Central Cancer Registry data. Five-year overall and cancer-specific survival. A joinpoint regression analysis was performed to predict incidence and mortality of PC. Survival was analyzed using Kaplan-Meir curves with log rank tests of patients with dialysis or transplantation.ResultsOf 3945 patients with PC-ESRD, 3.9% were on dialysis (N=152), 0.2% had kidney transplantation (N=10, D-TPL group); 3783 (95.9%) had neither dialysis nor transplantation (non-D-TPL ESRD group). There were 697 PC-specific deaths. The median respective OS, PC-specific survival, and 5-year survival rates in the non-ESRD, non-D-TPL ESRD, dialysis ESRD, and transplantation ESRD groups were significantly different (p<0.001). Presence of ESRD, age, body mass index, SEER stage, no treatment within 6 months after diagnosis, no surgery, chemotherapy, radiotherapy or hormonal therapy, non-adenocarcinoma pathology, and Charlson comorbidity index were independent risk factors for OS and CSS.ConclusionsWith a 10.1% nationwide prevalence of PC-ESRD, the presence of ESRD was a significant survival factor along with other significant clinicopathological factors.

Free Tissue Transfers for Head and Neck Reconstruction in Patients with End-Stage Renal Disease on Dialysis: Analysis of Outcomes Using the Taiwan National Health Insurance Research Database.

Background Patients diagnosed with end-stage renal disease (ESRD) are increasing at around 5% annually. Some of these patients will require free tissue transfers to reconstruct their body after trauma or cancer resection. Comorbidities can increase the level of complexity during reconstruction. Aim Our goal is to describe the outcomes of ESRD patients under dialysis who underwent free tissue transfer for head and neck reconstruction. Methods Two cohorts were analyzed: ESRD group on dialysis and a non-ESRD control group after free tissue transfer for head and neck reconstruction. Postoperative complications and mortality were recorded. For coexisting comorbidities, we determine the presence of diabetes mellitus (DM) and peripheral vascular disease (PVD). Results In this study, 85 cases with ESRD on dialysis and 841 controls were analyzed. Most patients were aged ≤ 65 years (82.5%) and nearly 92.9% of them were men. Types of head and neck cancer were neoplasm of other and unspecified parts of the mouth followed by neoplasm of tongue, the gingiva, hypopharynx, and floor of mouth. Patients with ESRD tended to have higher rates of DM and PVD (p &lt; 0.001) and were significantly associated with an increased risk of stroke and increased risk of 30-day mortality. However, there was no significant difference regarding flap failure among groups. Conclusion Despite greater preoperative risk factors, patients with renal failure on hemodialysis do not appear to have a higher rate of free flap failure following head and neck reconstruction. However, other complications can be minimized by optimizing patient's medical condition to succeed with this reconstructive effort.