Survival Of End-stage Renal Disease Patients Research Articles

End-stage renal disease should not Be considered a contraindication for veno-arterial extracorporeal membrane oxygenation

BackgroundThis study aims to determine whether end-stage renal disease (ESRD) is a true contraindication for extracorporeal membrane oxygenation in adult patients. Materials and methodsAdult patients who received VA-ECMO at National Taiwan University Hospital between January 2010 and December 2021 were included. Patients who received regular dialysis before the index admission were included in the ESRD group. The primary outcome was in-hospital mortality. Results1341 patients were included in the analysis, 121 of whom had ESRD before index admission. The ESRD group was older (62.3 versus 56.8 years; P < 0.01) and had more comorbidities. Extracorporeal cardiopulmonary resuscitation (ECPR) was used more frequently in the ESRD group (66.1% versus 51.6%; P < 0.001). The ESRD group had higher in-hospital mortality rates (72.7% versus 63.3%; P = 0.03). In the ECPR subgroup, there was no difference of survival between ESRD and others(P = 0.56). In the multivariate Cox regression, ESRD was not an independent predictor for mortality (P = 0.20). ConclusionESRD was not an independent predictor of in-hospital mortality after VA-ECMO. The survival of ESRD patients was not inferior to those without ESRD when receiving ECPR. Therefore, ESRD should not be considered a contraindication to VA-ECMO in adults.

Risk factors and mortality in dialysis patients with abdominal aortic aneurysm: A retrospective cohort study.

In the general population, abdominal aortic aneurysm (AAA) is synonymous with vascular disease and associated with increased mortality. Vascular disease is common in end-stage renal disease (ESRD) patients on dialysis, but there is limited information on AAA in this population. To address this issue, we queried the United States Renal Data System for risk factors associated with a diagnosis of AAA as well as the impact of AAA on ESRD patient survival. Incident dialysis patients from 2005 to 2014 with AAA and other clinical comorbidities were identified using ICD-9 and ICD-10 codes. Time to death was defined using the time from the start of dialysis to the date of death or to December 31, 2015. Cox proportional hazards (CPH) modeling was used to determine the adjusted hazard ratio (aHR) and 95% confidence intervals (CI) for death. From a total cohort of 820,826, we identified 21,631 subjects with a diagnosis of AAA. When compared to patients without AAA, AAA patients were older and more likely to be of white race and male gender, have a higher mean Charlson comorbidity index (CCI), have hypertension as the ESRD etiology, and use tobacco. Although a bivariate CPH model showed that AAA patients had an increased mortality risk compared to patients without the diagnosis, in the final CPH model, AAA patients had a decreased risk of mortality (aHR = 0.83, 95% CI 0.81-0.84) due to confounding with age. These results suggest that AAA is not associated with increased risk of death in ESRD patients after controlling for various demographic and clinical risk factors.

Impact of sarcopenia on long-term survival after cardiac surgery for end-stage renal disease patients.

The long-term mortality of end-stage renal disease (ESRD) patients is still unsatisfactory. Therefore, long-term risk assessments in ESRD patients undergoing cardiac surgery are needed. Recently, sarcopenia is major concern in cardiac surgery because of its association with poor long-term survival. However, the impact of sarcopenia on the long-term survival of ESRD patients undergoing cardiac surgery is not well understood. Eighty-two ESRD patients who underwent elective cardiac surgery were enrolled. Sarcopenia was identified based on noncontrast abdominal computed tomography. The impact of preoperative and intraoperative factors on long-term survival was investigated. Forty-three patients (52%) were diagnosed with sarcopenia. The in-hospital mortality rate was 4.9%. The 5-year overall survival rate was 48%. The multivariate analyses revealed that STS score ≥ 4 (odds ratio, 6.0; confidence interval, 2.5-14.7; p < 0.01) and presence of sarcopenia (odds ratio, 2.4; confidence interval, 1.3-4.5; p = 0.03) were independent risk factors for overall survival. The 5-year survival rates of low-risk (Society of Thoracic Surgeons score of < 4) patients without sarcopenia, low-risk with sarcopenia, more than intermediate-risk (Society of Thoracic Surgeons score of ≥ 4) without sarcopenia, and more than intermediate-risk with sarcopenia groups were 80%, 51%, 50%, and 26%, respectively. Among the ESRD patients, the low risk without sarcopenia group showed an excellent long-term survival, in contrast to more than intermediate-risk patients with sarcopenia, who can expect poor long-term survival. Preoperative assessment of sarcopenia in addition to the surgical risk score can be useful in developing a therapeutic strategy.

The Effect of Sleep Disorder Diagnosis on Mortality in End-Stage Renal Disease Patients

Increased risk of all-cause mortality not accounted for by traditional cardiovascular risk factors has been linked to chronic kidney disease. This study tested the hypothesis that mortality may be greater in patients with end-stage renal disease (ESRD) and a sleep disorder diagnosis. The United States Renal Data System database was queried to determine the effect of sleep disorder diagnoses on mortality in ESRD patients enrolled between 2004 and 2015. Sleep disorders were identified using International Classification of Diseases-9 and -10 codes. Mortality risk associated with sleep disorders was examined using Cox proportional hazards (CPH) modeling. In the final CPH model, sleep disorder diagnoses were associated with decreased risk of mortality, with hazard ratios (and 95% confidence intervals) for insomnia, hypersomnolence, restless leg syndrome, and obstructive/central sleep apnea of 0.76 (0.75–0.76), 0.81 (0.78–0.84), 0.79 (0.77–0.80), and 0.82 (0.81–0.82), respectively. Black or other race and Hispanic ethnicity, and to a small extent, female sex and increasing Charlson comorbidity index, were also associated with decreased risk, whereas increasing age, hemodialysis (versus peritoneal dialysis) and catheter or graft access type were associated with increased risk. This study suggests that the diagnosis of a sleep disorder may be associated with improved survival in ESRD patients.

β-Blockers could improve the 28-day and 3-year survival of patients with end-stage renal disease: a retrospective cohort study.

Dialysis or non-dialysis end-stage renal disease (ESRD) patients are accompanied by cardiovascular disease (CVD) or hypertension. We aimed to study the effect of a common treatment for CVD, β-blockers, on the survival of ESRD patients, improving their prognosis from the perspective of drug therapy. It was a retrospective cohort study using the Medical Information Mart for Intensive Care dataset. ESRD patients in the intensive care unit from June 2001 to October 2012 were included. We examined the effect of using versus not using β-blockers in the overall population and subgroups with the risk of 28-day and 3-year mortality through Cox proportional hazards models and Kaplan-Meier curves. A total of 1639 participants were included with 371 (22.64%) β-blockers users. There were 315 (19.22%) 28-day and 970 (59.18%) 3-year mortality events during follow-up. Using β-blockers in overall ESRD patients could reduce all-cause 28-day mortality [adjusted hazard ratio (HR) 0.450, 95% confidence interval (CI) 0.325-0.624] and 3-year mortality (adjusted HR 0.695, 95% CI 0.589-0.821). This result was consistent among subgroups (ESRD without hypertension: adjusted HR 0.412, 95% CI 0.289-0.588; with CVD: adjusted HR 0.478, 95% CI 0.321-0.711; without CVD: adjusted HR 0.448, 95% CI 0.248-0.810; with dialysis: adjusted HR 0.471, 95% CI 0.320-0.694) in 28-day mortality, and the 3-year mortality was consistent. In ESRD patients with hypertension and without dialysis subgroups, β-blockers had no effect on survival. Using β-blockers could reduce the risk of 28-day and 3-year mortality in ESRD patients, including those with CVD. This study provided a reference for the treatment of β-blockers in patients with ESRD.

Longitudinal change in microRNA-130a expression and its correlation with the risk of developing major adverse cardiovascular and cerebral events in patients undergoing continuous ambulatory peritoneal dialysis.

MicroRNA-130a (miR-130a) regulates angio-cellular dysregulation, atherosclerosis, and cardiocerebral injuries, serving as a biomarker for major adverse cardiovascular and cerebral events (MACCE) in several chronic diseases. However, its clinical application in patients with end-stage renal disease (ESRD) undergoing continuous ambulatory peritoneal dialysis (CAPD), who are at a high risk of developing MACCE, has not been reported. Therefore, this study aimed to explore this aspect. miR-130a expression in peripheral blood mononuclear cells obtained from 50healthy controls (HCs) at recruitment and 257 ESRD patients undergoing CAPD at month (M)0, M12, M24, and M36 was determined by reverse transcription-quantitative polymerase chain reaction. ESRD patients undergoing CAPD were followed up until MACCE occurred or M36. Then, MACCE were recorded, and MACCE-free survival was calculated. miR-130a expression was significantly lower in ESRD patients undergoing CAPD than in HCs (p<0.001). In addition, miR-130a expression significantly decreased from M0 to M36 in ESRD patients undergoing CAPD (p<0.001). Moreover, miR-130a expression at M0, M12, and M24 was significantly lower in patients with MACCE than in those without MACCE (all p<0.05). Furthermore, high miR-130a expression at M0, M12, and M36 was significantly correlated with prolonged MACCE-free survival in ESRD patients undergoing CAPD (all p<0.05), and high miR-130a expression at M0 was an independent factor for improved MACCE-free survival (p=0.015; hazard ratio (HR) (95% confidential interval): 0.456 (0.243-0.857)). miR-130a expression decreases continuously with disease progression in patients with ESRD undergoing CAPD. Additionally, this expression is negatively correlated with MACCE risk in these patients.

Prognostic implications of echocardiographic measures of left and right atrial pressures on survival in patients with end stage renal disease

Background Volume excess is common in patients with end stage renal disease (ESRD). We examined the prognostic value of clinical and echocardiographic measures of left (LA) and right atrial (RA) hypertension in this population. Method We prospectively collected demographic, clinical, pharmacological, echocardiographic data on 575 consecutive ESRD patients on hemodialysis undergoing cardiac evaluation before renal transplantation in a dedicated cardiac clinic. Survival was analyzed as a function of clinical and echocardiographic measures of LA and (RA) hypertension. Result Elevated LA pressure was seen in 48% of the patients based on E/e’ velocity ratio of ≥ 15, and 28% had elevated RA pressure based on inferior vena caval size. Physical examination grossly underestimated the prevalence of both LA and RA hypertension. Atrial pressures were normal in 46% and both atrial pressures were elevated in 20% of the patients. Elevated LA pressure in the presence of normal RA pressure was found in 30%. Over a period of 20 ± 8 months, there were 43 deaths. There was a graded increase in mortality with increases in LA and bi-atrial hypertension (p = .009). The 2-year mortality rate was 6% in those with normal atrial pressures, 13% in those with isolated LA hypertension and 28% in those with bi-atrial hypertension. Conclusion Mitral E/e’ ratio and inferior vena caval size are vastly more sensitive than physical examination for recognition of elevated atrial pressures and are strong predictors of survival in ESRD patients. Limited echocardiographic examination may have a role in ESRD patients undergoing dialysis to help achieve euvolemic status.

POS-662 5-YEAR SURVIVAL RATE OF CONTINUOUS AMBULATORY PERITONEAL DIALYSIS IN END-STAGE RENAL DISEASE IN INDONESIA: CAN CAPD BE SOLUTION FOR ESRD IN LOW INCOME DEVELOPING COUNTRY?

There are an increase in End-Stage Renal Disease (ESRD) patients in developing countries every year, including Indonesia. Based on the 2018 Indonesian Basic Health Research, 3.8 ‰ of the Indonesian population is ESRD patient. The number of available hemodialysis machines and hemodialysis nurses in Indonesia is far from optimal, and the number of procedures and success rate of kidney transplants is still very low. Considering those limitations, Continuous Ambulatory Peritoneal Dialysis (CAPD) therapy is chosen as an option for renal replacement therapy in Indonesia. This study is aimed to report the 5-year survival of ESRD patients undergoing CAPD therapy in low income developing countries such as Indonesia. A retrospective cohort study was conducted involving 674 ESRD patients undergoing CAPD therapy. Data was taken from medical records from Malang CAPD Center of Saiful Anwar Hospital from August 2014 to July 2020. The 5-year survival rate and hazard ratio were analyzed using Kaplan-Meier and cox-regression analysis, respectively. 674 ESRD patients undergoing CAPD, 63.2% of patients survived up to 5 years with a general survival rate at 1, 3, and 5 years of 80%, 60%, and 52%, respectively. The 3-year survival rate of CAPD therapy in ESRD patients with comorbid hypertension and type II diabetes mellitus was 80% and 10%, respectively. The hazard ratio of ESRD patients on CAPD therapy with comorbid type II diabetes mellitus was 8.4 times (95% CI = 6.36-11.21). The 5-year survival rate of ESRD patients with CAPD therapy in Indonesia was good. Patients with comorbid type II diabetes mellitus had a worse survival rate. With all the problems of hemodialysis and kidney transplantation that exist in low income developing countries, CAPD can be a solution for renal replacement therapy.

Evaluation of the usefulness of the Monte Carlo method for estimating the optimization of hemodialysis

Adequate hemodialysis minimizes complications and improves end-stage renal disease patient survival. Our study proposed a methodology for estimating hemodialysis parameters using two-compartment modelling together with Monte Carlo simulation of the probabilities of the model outputs. In addition, we modelled the removal of uremic toxins during hemodialysis, in comparison with the actual concentration of these toxins in the blood serum. Blood urea and phosphates were measured every 30 min throughout hemodialysis in 10 patients. Using a Monte Carlo simulation on the two-compartment model we estimated hemodialysis compatibility parameters for each patient individually. In patients with non-diabetic kidney disease, the actual urea and phosphate excretion dynamics were consistent with those predicted by the two-compartment model regardless of age, sex, non-diabetic comorbidities, duration of hemodialysis, residual diuresis, or type of vascular access. To measure compatibility, we used graph matching together with a quantitative measure given by a normalized coefficient of determination. In patients with end-stage diabetic kidney disease, the toxin elimination dynamics were significantly greater in the first 30 min of hemodialysis than in patients with non-diabetic kidney disease.

Značaj polimorfizama regulatornih i katalitičkih antioksidativnih proteina u hroničnoj bubrežnoj slabosti

Both excessive production of reactive oxygen species (ROS) and impaired antioxidant function are found in patients with chronic kidney disease (CKD). Therefore, individual susceptibility towards CKD can be induced by functional variations of genes encoding antioxidant regulatory (nuclear factor erythroid 2 - related factor 2 (Nrf2)) and catalytic (superoxide dismutase (SOD2) and glutathione peroxidase (GPX1)) proteins. Several types of single nucleotide polymorphisms (SNPs) have been found within the genes encoding these proteins, with Nrf2 (-617C/A), SOD2 (Ala16Val) and GPX1 (Pro198Leu) conferring impaired catalytic activity. The most unexplored gene polymorphism in CKD susceptibility, progression and survival, with only two original studies published, is the Nrf2 (-617C/A) polymorphism. The results of these studies showed that there was no individual impact of this polymorphism on the susceptibility towards end stage renal disease (ESRD) development, oxidative phenotype and mortality. However, Nrf2 had a significant role in ESRD risk and survival, when combined with other antioxidant genes. The results regarding the impact of SOD2 (Ala16Val) and GPX1 (Pro198Leu) polymorphisms on either CKD or ESRD are still inconclusive. Namely, some studies showed that patients having variant SOD2 (Val) or GPX1 (Leu) allele were at increased risk of CKD development and progression, while other studies reported only weak or no association between these polymorphisms and CKD. Surprisingly, the only study that reported an association of GPX1 polymorphism with overall/cardiovascular survival in ESRD patients showed a significant impact of low activity GPX1 (Leu/Leu) genotype on better survival. In this review, we comprehensively and critically appraise the literature on these polymorphisms related to oxidative stress in CKD patients, in order to identify gaps and provide recommendations for further clinical research and translation. New developments in the field of antioxidant polymorphisms in CKD patients could lead to better stratification of CKD patients, based on a prognostic antioxidant gene panel, and provide a more personalised medicine approach for the need of antioxidant therapy in these patients.

Long-term prognosis in patients with end-stage renal disease after coronary artery bypass grafting.

BackgroundCardiovascular disease is a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD). Coronary artery bypass grafting (CABG) is beneficial in selected patients with ESRD. This study investigates the survival outcomes and prognostic factors in ESRD patients who underwent CABG.MethodsA retrospective analysis was performed for 149 patients with ESRD who underwent isolated CABG between 2006 and 2015.ResultsMean age was 59.4±8.7 years and 106 patients (71.1%) were male. Operative mortality occurred in 20 patients (13.4%). Overall survival was 81.1%±3.2% at 1 year, 41.5%±4.3% at 5 years and 19.2%±4.2% at 10 years. Median survival was 4.3 years. Multivariable analysis identified age [P=0.001, odds ratio (OR): 1.15 per 1-year increase, 95% confidence interval (CI): 1.06–1.25], preoperative left ventricular ejection fraction (LVEF) (P=0.020, OR: 0.94, 95% CI: 0.89–0.99) and non-elective status of operation (P=0.049, OR: 3.34, 95% CI: 1.00–11.1) as predictors of operative mortality. Cox regression analysis identified age [P<0.001, hazard ratio (HR): 1.05 per 1-year increase, 95% CI: 1.03–1.08], New York Heart Association (NYHA) class III or IV status (P=0.010, HR: 1.75, 95% CI: 1.15–2.67) and the use of a left internal mammary artery (LIMA) to left anterior descending artery (LIMA-LAD) graft (P=0.029, HR: 0.42, 95% CI: 0.19–0.92) as factors influencing long-term survival.ConclusionsCABG is associated with high operative mortality and poor long-term survival in ESRD patients. Age and NYHA class influenced late survival. LIMA-LAD grafting conferred a long-term survival advantage.

Association of Nrf2, SOD2 and GPX1 Polymorphisms with Biomarkers of Oxidative Distress and Survival in End-Stage Renal Disease Patients.

The oxidative stress response via Nuclear factor (erythroid-derived 2)-like 2 (Nrf2) interlinks inflammation- and metabolism-related pathways in chronic kidney disease. We assessed the association between polymorphisms in Nrf2, superoxide dismutase (SOD2), glutathione peroxidase (GPX1), and the risk of end-stage renal disease (ESRD). The modifying effect of these polymorphisms on both oxidative phenotype and ESRD prognosis, both independently and/or in combination with the glutathione S-transferase M1 (GSTM1) deletion polymorphism, was further analyzed. Polymorphisms in Nrf2 (rs6721961), SOD2 (rs4880), GPX1 (rs1050450), and GSTM1 were determined by PCR in 256 ESRD patients undergoing hemodialysis and 374 controls. Byproducts of oxidative stress were analyzed spectrophotometically or by ELISA. Time-to-event modeling was performed to evaluate overall survival and cardiovascular survival. The SOD2 Val/Val genotype increased ESRD risk (OR = 2.01, p = 0.002), which was even higher in combination with the GPX1 Leu/Leu genotype (OR = 3.27, p = 0.019). Polymorphism in SOD2 also showed an effect on oxidative phenotypes. Overall survival in ESRD patients was dependent on a combination of the Nrf2 (C/C) and GPX1 (Leu/Leu) genotypes in addition to a patients’ age and GSTM1 polymorphism. Similarly, the GPX1 (Leu/Leu) genotype contributed to longer cardiovascular survival. Conclusions: Our results show that SOD2, GPX1, and Nrf2 polymorphisms are associated with ESRD development and can predict survival.

Markers of Oxidative Stress and Endothelial Dysfunction Predict Haemodialysis Patients Survival

Introduction: Overall survival of patients with end-stage renal disease (ESRD) remains poor. Oxidative stress is one of the major risk factors associated with mortality in this patient group. As glutathione S-transferases (GST) are well-established antioxidants, we hypothesized that a model including GST gene polymorphisms, oxidative damage byproducts and cell adhesion markers has a prognostic role in ESRD patient survival. Methods: A prospective study of 199 patients with ESRD on haemodialysis was conducted. GST genotype, oxidative stress byproducts and cell adhesion molecules were measured in plasma. Multivariate Cox regression and Kaplan-Meier survival analyses were performed to test the predictive ability of these parameters in the 8-year follow-up period. Results: GSTM1-null genotype was associated with significantly shorter overall (HR 1.6, p = 0.018) and cardiovascular-specific (HR 2.1, p = 0.010) survival. Oxidative stress byproducts (advanced oxidation protein products [AOPP], prooxidant-antioxidant balance [PAB], malondialdehyde [MDA]) and cell adhesion molecules (soluble vascular cell adhesion molecule-1 [sVCAM-1] and soluble intercellular adhesion molecule-1 [sICAM-1]) demonstrated a significant predictive role in terms of overall and cardiovascular survival. When 6 biomarkers (GSTM1 genotype, high AOPP/PAB/MDA/­sVCAM-1/sICAM-1) were combined into a scoring model, a significantly shorter overall and cardiovascular survival was observed for patients with the highest score (p < 0.001). Conclusion: We identified a novel panel of biomarkers that can be utilized in predicting survival in ESRD patients. This biomarker signature could enable better monitoring of patients and stratification into appropriate treatment groups.

Evaluation of long-term outcomes of deceased donor renal transplantation in patients with end-stage renal disease

Introduction: Kidney transplantation is the most viable and cost-effective treatment option for patients with end-stage renal disease (ESRD). However, the limited availability of living donors opens up the option of utilizing deceased donor for kidney transplantation. Objectives: This study evaluated the long-term graft and recipient outcomes of deceased donor kidney transplantation (DDRT) in patients with ESRD. Patients and Methods: A retrospective analysis of ESRD patients who underwent DDRT (January 2002 to December 2018) was conducted. Transplant medical records were reviewed for the recipient’s demographic profile, causes of ESRD, type of transplants, type of induction treatment, and five-year follow-up data related to graft survival and mortality. Results: A total of 147 DDRT recipients with a mean age of 43.1 years were included. Male preponderance (66.67%) was observed. The common causes of ESRD were chronic glomerulonephritis (44.7%) and diabetic nephropathy (22.7%). Post-transplantation, patients were administered with induction therapy (anti-thymocyte globulin (ATG), 57.14%; basiliximab, 27.21%; and other induction agents, 15.65%). Patient survival rate at 1-year, 3-year and 5-year follow-up were 91%, 86% and 73%, respectively and graft survival rates were 89%, 79%, and 68%, respectively. Infection (87.07%) was the leading cause of death, followed by cardiovascular disease (11.56%). Conclusion: Long-term outcomes up to 5-years related to patient survival and graft survival in ESRD patients’ post-DDRT were satisfactory and suggested the use of DDRT as a replacement option for living donors.

Fibroblast growth factor-23 correlates with advanced disease conditions and predicts high risk of major adverse cardiac and cerebral events in end-stage renal disease patients undergoing continuous ambulatory peritoneal dialysis

This study aimed to investigate the correlation of serum fibroblast growth factor-23 (FGF-23) level with clinical indexes, in particular to explore the value of FGF-23 in predicting major adverse cardiac and cerebral event (MACCE) risk in end-stage renal disease (ESRD) patients undergoing continuous ambulatory peritoneal dialysis (CAPD). In 270 ESRD patients undergoing CAPD consecutively enrolled in this prospective cohort study, we collected serum samples and performed enzyme-linked immunosorbent assay to detect FGF-23 expression. MACCE-free survival was defined as the date from enrollment to the date of MACCE occurrence. High levels of FGF-23 correlated with longer duration of dialysis (p = 0.002), elevated levels of calcium (p < 0.001), phosphorus (p = 0.037) and low density lipoprotein cholesterol (p = 0.027). MACCE occurrence rate was higher in the FGF-23 high-expression than low-expression group at 2years (p = 0.028), 3years (p = 0.001) and 4years (p = 0.004). Kaplan-Meier curves revealed that MACCE-free survival was shorter in the FGF-23 high-expression than low-expression group (p = 0.004). Multivariate Cox's analysis showed that high FGF-23 expression (p = 0.011) as well as the duration of dialysis (p = 0.017), C-reactive protein (p = 0.011) and fasting blood glucose (p = 0.038) were independent predictive factors for reduced MACCE-free survival in ESRD patients undergoing CAPD. High FGF-23 expression correlates with advanced disease conditions as well as increased MACCE risk, and is an independent factor predicting worse MACCE-free survival in ESRD patients undergoing CAPD.

Prognosis of Peritoneal Dialysis Compared to Hemodialysis in Patient with End-Stage Renal Disease

End-stage Renal Disease (ESRD) is the terminal stage of Chronic Kidney Disease, where the function of the failing kidney must be substituted with Renal Replacement Therapy (RRT). There are two forms of RRT; Peritoneal Dialysis (PD) and Hemodialysis (HD. However, the issue of which method provide a better survival for patient remains an interesting topic to date. This paper aims to provide evidence on whether PD provides better survival compared to HD in a patient with ESRD. Systematic search was done using two databases; Pubmed® and Scopus®. Cohort studies were selected as appropriate study design to answer a prognosis question. Two restrospective cohorts and one prospective cohort study are relevant for this report. Two studies demonstrated survival advantage of PD over HD described by Relative Risk of Mortality of 0.398 and 0.49. The last study showed worse survival of PD patients compared to HD (RR=1.82). The difference in survival in the last study may be attributed to the fact that patients undergoing PD has worse baseline characteristics. PDand HD bring about comparable survival in ESRD patients.

Competing Risk Analyses of Patients with End-Stage Renal Disease.

IntroductionChronic kidney disease (CKD) is an important health problem that gradually leads to end-stage renal disease (ESRD). In ESRD patients, death due to other diseases or some events, such as renal transplantation (known as competing risks), would change the probability of observing the event of interest. The aim of this study was to estimate the survival of ESRD patients using competing risk analyses.MethodsIn this retrospective longitudinal study, 307 ESRD patients who were older than 20 were recruited from the dialysis and kidney transplant Centers in Kerman City, Iran, from2007 to 2011. To assess the impacts of the investigated factors on the outcome, a cause-specific hazard model and competing risk models were fitted. Also, the cumulative incidence (CI) approach and sensitivity analysis were implemented. All of the analyses were performed using Stata software, V.12.ResultsThe results of competing risk models showed that age and type of dialysis were associated with death (hazard ratio (HR)=1.03, p<0.001 and HR=1.65, p=0.011, respectively). In cause specific hazard model each year increase in age was associated with a 2% increase in the risk of death. Also, the types of dialysis were associated significantly with death (HR=1.93), and the effect of the type of dialysis was estimated as HR=1.51 (p=0.04) when we assumed that all patients who had experienced transplantation survived for the longest survival time. For those for whom receiving the transplantation was considered as death, the HR for the type of dialysis as well as the corresponding p-values were 1.82 and 0.001, respectively.ConclusionIgnoring the competing risks of death due to ESRD, such as renal transplantation, in estimating the survival of these patients might lead to overestimation of the results.

Diabetes mellitus and renal failure: Prevention and management.

Nowadays, diabetes mellitus (DM) and hypertension are considered as the most common causes of end-stage renal disease (ESRD). In this paper, other than presenting the role of DM in ESRD, glucose metabolism and the management of hyperglycemia in these patients are reviewed. Although in several large studies there was no significant relationship found between tight glycemic control and the survival of ESRD patients, it is recommended that glycemic control be considered as the main therapeutic goal in the treatment of these patients to prevent damage to other organs. Glycemic control is perfect when fasting blood sugar is less than 140 mg/dL, 1-h postprandial blood glucose is less than 200 mg/dL, and glycosylated hemoglobin (HbA1c) is 6-7 in patients with type 1 diabetes and 7-8 in patients with type 2 diabetes. Administration of metformin should be avoided in chronic renal failure (CRF) because of lactic acidosis, the potentially fatal complication of metformin, but glipizide and repaglinide seem to be good choices.

MP54-16 FAVORABLE PROGNOSIS IN END-STAGE RENAL DISEASE PATIENTS WITH RENAL CELL CARCINOMA: A LONG-TERM FOLLOW-UP STUDY IN A SINGLE INSTITUTION

You have accessJournal of UrologyKidney Cancer: Localized III1 Apr 2014MP54-16 FAVORABLE PROGNOSIS IN END-STAGE RENAL DISEASE PATIENTS WITH RENAL CELL CARCINOMA: A LONG-TERM FOLLOW-UP STUDY IN A SINGLE INSTITUTION Yoshihiro Ikeda, Yoshio Terasawa, Shinichi Yamashita, Takashi Kudo, Masataka Aizawa, Hisanobu Adachi, Mareyuki Endo, Kensuke Joh, Naomasa Ioritani, and Seiichi Orikasa Yoshihiro IkedaYoshihiro Ikeda More articles by this author , Yoshio TerasawaYoshio Terasawa More articles by this author , Shinichi YamashitaShinichi Yamashita More articles by this author , Takashi KudoTakashi Kudo More articles by this author , Masataka AizawaMasataka Aizawa More articles by this author , Hisanobu AdachiHisanobu Adachi More articles by this author , Mareyuki EndoMareyuki Endo More articles by this author , Kensuke JohKensuke Joh More articles by this author , Naomasa IoritaniNaomasa Ioritani More articles by this author , and Seiichi OrikasaSeiichi Orikasa More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1605AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Patients with end-stage renal disease (ESRD) show an increased risk of renal cell carcinoma (RCC). Some recent reports have revealed better prognosis for ESRD-RCC than for sporadic RCC. We have achieved successful long-term results for RCC patients with ESRD, and evaluated clinical characteristics and oncological outcomes of ESRD-RCC in this study. Methods From November 1985 to January 2013, 187 male and 33 female patients with ESRD-RCC underwent radical nephrectomy in our institute. All patients showed a dialysis status of chronic renal failure at the time of diagnosis. Information about age, sex, symptoms, duration of dialysis therapy, tumor staging and grading, histological subtype and outcome were recorded. Survival was assessed using Kaplan-Meier methods. Results Symptomatic RCC was only seen in 22 cases (10.0%), and gross hematuria was the most frequent complaint (13 cases). Incidental cases comprised 198 (90.0%), with 152 cases (88.2%) diagnosed on routine screening ultrasonography. Radical nephrectomy was performed in 270 cases, and mean age at operation was 55.0}11.0 years. Bilateral RCC was observed in 54 patients (24.5%). Mean duration of dialysis before surgery was 154.1}92.5 months, and mean follow-up period was 90.0}71.9 months. Pathological tumor stage was stage 1 in 265 kidneys (98.1%), and mean maximum tumor size was 2.2}1.3 cm. Eight patients showed advanced RCC, and 1 patient died from renal cancer. Twenty-two patients died from other causes. Estimated 5- and 10-year cancer-specific survival rates were both 99.6%. Five- and 10-year recurrence-free survival rates were 95.5% and 94.8%, respectively. Conclusions RCC arising in native kidneys of dialyzed patients seems to show favorable outcomes. In our institute, most ESRD patients were identified under routine screening ultrasonography and detected in the early stage with small diameter RCC. Careful and regular screening ultrasonography seems important for better survival of ESRD patients with RCC. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e578 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Yoshihiro Ikeda More articles by this author Yoshio Terasawa More articles by this author Shinichi Yamashita More articles by this author Takashi Kudo More articles by this author Masataka Aizawa More articles by this author Hisanobu Adachi More articles by this author Mareyuki Endo More articles by this author Kensuke Joh More articles by this author Naomasa Ioritani More articles by this author Seiichi Orikasa More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Cancer Among End-Stage Renal Disease Patients on Dialysis

The aim of this study is to investigate the risk of cancer among end-stage renal disease (ESRD) patients on dialysis in Singapore. The study looks at a retrospective cohort of 5505 ESRD patients who had received dialysis between 1998 and 2007. The cancer risk of these patients would be compared against the risk of the general population. During a median follow-up time of 3.9 years, 267 (4.9%) dialysis patients developed cancer. The risk of cancer (excluding non-melanoma skin cancer) is 1.66 times higher in dialysis patients than the general population, and is highest at age less than 35 years old and at first year after dialysis. Cancer risk was found to be significantly higher among Chinese dialysis patients, followed by Malays, compared to the general population. The 3 sites with highest elevated cancer risks among dialysis patients compared to the general population are kidney, tongue and multiple myeloma. The finding of elevated cancer risk among younger dialysis patients is similar to other international studies. High cancer risks among specific cancer sites were also consistent with other studies. In view of the lack of screening procedures for these cancers and shortened expected survival of ESRD patients, cancer screening of ESRD patients should be individualised and based on a reasonable life expectancy and transplant candidacy, keeping in mind the competing risk of cardiovascular mortality.