Incident Dialysis Research Articles

Surgical results of reoperative tricuspid surgery: analysis from the Japan Cardiovascular Surgery Database

Tricuspid valve insufficiency (TI) following cardiovascular surgery causes right-side heart failure and hepatic failure, which affect patient prognosis. Moreover, the benefits of reoperation for severe tricuspid insufficiency remain unclear. We investigated the surgical outcomes of reoperation in TI. From the Japan Cardiovascular Surgery Database (JACVSD), we extracted cases who underwent surgery for TI following cardiac surgery between January 2006 and December 2011. We analysed the surgical outcomes, specifically comparing tricuspid valve replacement (TVR) and tricuspid valve plasty (TVP). Of the 167 722 surgical JACVSD registered cases, reoperative TI surgery occurred in 1771 cases, with 193 TVR cases and 1578 TVP cases. The age and sex distribution was 684 males and 1087 females, with an average age of 66.5 ± 10.8 years. The overall hospital mortality was 6.8% and was significantly higher in the TVR group than in the TVP group (14.5 vs 5.8%, respectively; P < 0.001). Incidences of dialysis, prolonged ventilation and heart block were also significantly higher in the TVR group than in the TVP group. Logistic regression analysis revealed that the risk factors of hospital mortality were older age, preoperative renal dysfunction, preoperative New York Heart Association Class 4, left ventricular dysfunction and TVR. Surgical outcomes following reoperative tricuspid surgery were unsatisfactory. Although TVR is a last resort for non-repairable tricuspid lesions, it carries a significant risk of surgical mortality. Improving the patient's preoperative status and opting for TVP over TVR is necessary to improve the results of reoperative tricuspid surgery.

Safety and effectiveness of 6% hydroxyethyl starch 130/0.4 versus crystalloid solution for patients undergoing elective surgery：a meta-analysis

Objective To systematically review the safety and effectiveness of 6% hydroxyethyl starch （HES） 130/0.4 and crystalloid solution for the patients undergoing elective surgery .Methods We searched the Medline , EMBASE , CENTRAL , CNKI and Wanfang databases for randomized controlled trials involving comparison of the safety and effectiveness of 6% HES 130/0.4 and crystalloid solution for the patients undergoing elective surgery . The major evaluation indexes included intraoperative blood loss , postoperative incidence of dialysis and intraoperative incidence of hypotension . The secondary evaluation indexes included mortality , perioperative incidence of nausea and vomiting , coagulation function , renal function and incidence of adverse events .The two reviewers independently screened ,evaluated and extracted the data .Meta-analysis was performed using the Cochrane Collaboration’s RevMan 5.2 software .Results Ten trials involving 693 patients were included in our meta-analysis .Eight trials were in English and 2 trials were in Chinese .Comparison of the safety and effectiveness of 6% HES 130/0.4 and balanced solution was conducted in 7 trials （498 patients in total） ,and the results showed that 6% HES 130/0.4 reduced the intraoperative incidence of hypotension （OR 0.31 ,95% CI 0.13-0.75 ） and perioperative incidence of nausea and vomiting , （OR 0.08 , 95% CI 0.01 to 0.67 ） in the＆nbsp;patients undergoing spinal anesthesia （ P 0.05 ）;heterogeneity was found in the urine output under general anesthesia （ P 0.05 ） .Conclusion 6% HES 130/0.4 is safe and effective when applied for the patients undergoing elective surgery . Key words: Hetastarch; Crystalloid; Surgical procedures,operative; Fluid therapy

MINING SURPRISING PATTERNS AND THEIR EXPLANATIONS IN CLINICAL DATA

□ We present a new technique for interactively mining patterns and generating explanations by harnessing the expertise of domain experts. Key to the approach is the distinction between what is unexpected from the perspective of the computational data mining process and what is surprising to the domain experts and interesting relative to their needs. We demonstrate the potential of the approach for discovering patterns and generating rich explanations in a clinical domain. Discovering interesting facts in clinical data is a grand challenge, because medical practitioners and clinicians generally have exceptional knowledge in the problem domain in which they work, however, this knowledge is typically difficult to isolate computationally. To identify the desired surprising patterns, we formally record user knowledge and use that knowledge to filter and constrain the output from an objective data mining technique, with the user making the final judgement about whether a rule is surprising. Specifically, we introduce an unexpectedness algorithm based on association rule mining and Bayesian Networks and a ϵ-explanations technique for explanation generation to identify unexpected patterns. An implemented prototype is successfully demonstrated using a large clinical database recording incidence, prevalance, and outcome of dialysis and kidney transplant patients.

Comparison between visual assessment and digital image analysis in evaluating renal interstitial fibrosis in lupus nephritis

<h3>Background</h3> Prediction of the renal outcomes is crucial for patients with lupus nephritis due to high morbidity and mortality. Renal interstitial fibrosis is correlated with progression to renal failure. However evaluation of interstitial fibrosis by subjective visual assessment comparing with digital image analysis has not been well studied. <h3>Method</h3> All kidney core biopsies diagnosed with lupus nephritis at Chiang Mai University hospital during July 1 2011 to December 31 2012 were retrieved from the database. Interstitial fibrosis in percentage was assessed on scanned Picrosirius red-stained histological images (Aperio) using software analysis. Visual assessment was performed under a light microscope by two pathologists (SS, SL). Clinical, laboratory data and renal outcomes [dialysis, doubling of serum creatinine (DSC), end-stage renal disease (ESRD) and complete remission (CR)] were collected retrospectively from the time of biopsy to the last follow-up. <h3>Result</h3> Interstitial fibrosis evaluating by digital image analysis (IF-IA) showed better intraobserver (Pearson correlation coefficient: r=0.98, <i>p</i><0.001) and interobserver reliability (r=0.79, <i>p</i><0.001) compared with interstitial fibrosis evaluating by visual assessment (IF-VA) (intraobserver reliability: r=0.85, <i>p</i><0.001 and interobserver reliability: r=0.61, <i>p</i>=0.001) while IF-VA was more negatively correlated with baseline estimated glomer-ular filtration rate (r=-0.50, <i>p</i>=< 0.001) compared with IF-IA (r=-0.235, <i>p</i>=0.034). A significantly greater degree of interstitial fibrosis evaluated by visual assessment was observed in patients with subsequent dialysis, DSC and ESRD; and a significantly lesser degree of interstitial fibrosis was observed in patients with CR compared with patients without these outcomes. There is no difference in IF-IA between patients with and without such renal outcomes. IF-VA but not IF-IA was positively correlated with incidence of dialysis, DSC and ESRD [Spearman correlation coefficient (rs)=0.309, 0.366, 0.459 and p=0.005, 0.001, <0.001, respectively] and was negatively correlated with CR (rs=-0.306, <i>p</i>=0.005). For Kaplan-Meier survival analysis, IF-VA greater than percentile 75th (P75, interstitial fibrosis=20%) had significantly higher incidence of dialysis, DSC and ESRD and significantly lower incidence of CR compared with IF-VA lesser than P75. However IF-IA had no difference. <h3>Conclusion</h3> Renal interstitial fibrosis evaluating by digital image analysis is more reliable and precise, however assessing by visual assessment is more predictive of renal outcomes in lupus nephritis patients.

Association between the Hemoglobin Level and Cardiothoracic Ratio in Patients on Incident Dialysis

Background/Aim: The present study explores associations between hemoglobin (Hb) levels and patients with cardiac enlargement in end-stage kidney disease (ESKD) to help prevent cardiac remodeling during the predialysis phase of chronic kidney disease (CKD). Methods: This cross-sectional study included 2,249 patients with ESKD (age, 67 w 13 years; male, 67%; diabetic kidney disease, 41%) who started hemodialysis (HD) between January 2006 and October 2013 at eight participating hospitals. We examined associations between Hb levels immediately before the first HD session and cardiothoracic ratios (CTRs). Clinical factors associated with the CTR were also assessed. Results: The mean Hb level was 8.7 w 1.6 g/dl, and the mean and median CTRs were 55.0 and 54.7%, respectively. The correlation between the Hb level and the CTR was linear and negative (r = -0.129, p < 0.001). The mean CTR and the prevalence of patients with a CTR >50% obviously decreased with increasing Hb levels (both p < 0.001 for trend). Univariate logistic regression analysis revealed an approximately 20% reduction in the odds ratio for complicating CTRs >50% per 1 g/dl increase in Hb. Hb levels of <9 g/dl were significantly associated with CTRs >50%. Numerical and categorical Hb remained significantly associated with CTRs >50% after adjusting for confounding variables. Conclusions: Lower Hb levels participate in progressive CTR enlargement in patients with ESKD, and maintaining Hb levels of >9 g/dl might help prevent cardiac remodeling during the predialysis phase of CKD. i 2014 S. Karger AG, Basel

Peritoneal Dialysis: Still work in progress

In the last 4 years the incidence and prevalence of peritoneal dialysis did not increase in Tuscany. The complications of peritoneal catheter, followed by non-clinical reasons, are the main causes of drop-out to hemodialysis. The promotion of the culture of home dialysis and specific policy actions are considered efficient operations to make peritoneal dialysis less marginal.

腹部大動脈瘤術後の腎機能低下に対する予測因子の検討

Whether endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is a relative contraindication in patients with preoperative renal dysfunction (Pre-RD), remains controversial because the contrast medium may induce nephrotoxicity. In this study 1658 patients were treated at ten Japanese medical centers between January 2005 and March 2011 (Open surgery (OS) vs. EVAR: n = 1270 vs. n = 388). They were retrospectively analyzed. Multiple logistic regression analysis (MLRA) with pre- and intra-operative variables was applied to all patients. The endpoints induced onset of new dialysis and postoperative renal dysfunction (Post-RD), were defined as a 50% decrease or more from the preoperative estimated glomerular filtration rate (eGFR) level. Results: Early mortality, Post-RD, incidence of new dialysis in all patients were 1.6% (OS: EVAR = 1.9%:0.8%), 6% (OS: EVAR = 8%:2.3%) and 1.4% (OS: EVAR = 1.5%:1.0%) respectively. MLRA identified operation time, clamp of renal artery as risk factors for Post-RD, and operation time and Pre-eGFR level as risk factors for new dialysis. Conclusion: Although Post-RD was more frequently observed in the OS group, MLRA showed that the choice of OS or EVAR was not a risk factor for Post-RD and new dialysis. It was strongly suggested that using contrast medium during EVAR is not a contraindication to AAA repair in patients with Pre-RD. (This article is a translation of J Jpn Coll Angiol 2014; 54: 13–18.)

Rapport Rein 2011 – Synthèse

Rapport Rein 2011 – Synthèse

L’incidence de l’IRCT en 2011

This chapter provides a set of indicators on incident patients with renal replacement therapy. In 2011, in 25 French regions (99% population), 9 248 patients started a treatment by dialysis (incidence of dialysis: 149 per million inhabitants) and 334 patients with a pre-emptive graft without previous dialysis (incidence of pre-emptive graft: 5 per million inhabitants). One patient among two are over 70 years old at renal replacement therapy initiation. As in 2010, incidence rate seems to stabilize.

Contemporary strategy for aortic valve stenosis in octogenarians

The number of patients with aortic stenosis (AS) has been increasing over recent decades with the longer life expectancy of the general population. AS is life-threatening without surgery and since many elderly patients have a variety of comorbid conditions, 30-40 % of those with severe AS have been denied surgery. However, recent data on standard aortic valve replacement (AVR) for octogenarians have revealed excellent outcomes, with 2.4-6.8 % early mortality and similar survival rates of octogenarians who undergo AVR vs. the general population. The reported incidences of postoperative stroke, dialysis, and pacemaker implantation were 2.4, 2.6, and 4.6 %, respectively. Transcatheter aortic valve replacement (TAVR) is the alternative therapy for patients who are not able to undergo standard AVR and it is developing rapidly. The placement of aortic transcatheter valves (PARTNER) trial showed acceptable early outcomes. The mortality rates from any cause were 3.4 % in the TAVR group and 6.5 % in the AVR group at 30 days, 24.2 and 26.8 % at 1 year, and 33.9 and 35.0 % at 2 years, respectively. Stroke rate was higher in the TAVR group than in the AVR group (3.4 vs. 1.9 %). Vascular complications and paravalvular leakage are frequent procedure-related complications, which must be addressed because they are associated with increased mortality.

Study of the incidence of dialysis in São Paulo, the largest Brazilian city

OBJECTIVES:Chronic kidney disease is a major public health problem worldwide. In Brazil, approximately 100,000 patients (January 2012) receive renal replacement therapy. Nevertheless, data on dialysis incidence in the Brazilian population are scarce. This study aims to analyze the incidence of patients starting dialysis therapy in São Paulo City, the largest Brazilian metropolis.METHOD:This cohort study analyzed data from 9,994 patients starting hemodialysis or peritoneal dialysis funded by the Brazilian Public Health System during a 5-year period (2007–2011). Patient data for this study (recorded as electronic files) were obtained from the São Paulo City's Dialysis Regulatory Bureau, which regulates the allocation of patients requiring dialytic therapy.RESULTS:The dialysis incidence rates were 178, 174, 170, 185 and 188 per million population for the years 2007, 2008, 2009, 2010 and 2011, respectively. The incidence rates increased with age. Hypertension and diabetes were the main etiologies diagnosed. Hemodialysis was the chosen dialysis modality in the majority of patients (92.6%), whereas the percentage of patients referred for peritoneal dialysis decreased from 10.1% to 5.5%.CONCLUSION:The incidence of patients starting renal replacement therapy from 2007–2011 in São Paulo was stable but higher than the projected incidence for the entire country. The authors emphasize the need for further studies of the incidence of dialysis in the Brazilian population and for the creation of a Brazilian registry of dialysis patients, which would be a valuable tool for developing healthcare policies and renal replacement therapy strategies.

The risk factors of diabetic nephropathy in Taiwan, including old age, hypertension and aspirin therapy

Dear editor Taiwan has the highest prevalence and incidence of dialysis in the world and diabetes mellitus (DM) causes about 40 % of end-stage renal failure [1]. Therefore, we would like to investigate the risk factors of diabetic nephropathy. A total of 379 Taiwanese treated for type 2 DM at least one year were analyzed from January 2010 to April 2011. Patients with hypertension (HTN) had lower estimated glomerular filtration rate (eGFR) than those without HTN (64.7±18.3 vs 70.9±20.2 ml/min, P<0.005), but those who accepted angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) therapy showed no harmful effects to renal function. Patients who took aspirin presented lower eGFR than those who didn’t use aspirin (60.4±19.8 vs 67.7±19.5 ml/min, P<0.05). After one year of observation, patients with microalbuminuria had lower eGFR than those withnormoalbuminuria(64.9±19.7vs69.3±19.8ml/min,P< 0.05); in the original normoalbuminuria patients, those who developed microalbuminuria were older than those remained normoalbuminuria (68.3±12.4 vs 62.7±11.5 years, P<0.05). Patientswithpoorbloodglucosecontrol(HbA1c ≧7.0%)had a greater chance of worsening renal parameters. ADA suggested the use of low dose aspirin therapy as a primary prevention strategy for diabetic subjects at increased cardiovascular risk [2]. In the present sample it was reflected, showing that a single drug alone cannot make a difference and requires multifactorial intervention. ADA recommended ACEI or ARB as the treatment of choice for HTN in diabetic patients and the therapeutic goal of HbA1c was less than 7.0 % because it was associated with the preservation of renal function [2, 3]. Rifkin et al. found that microalbuminuria was associated with an over 50 % increase in mortality risk in the elderly. In cases where microalbuminuria combined with chronic kidney disease, there was a nearly 4-fold mortality risk [4]. In conclusion, aspirin therapy, older age and hypertension are the risk factors of diabetic nephropathy. Good blood glucose control could conserve normoalbuminuria.

Factors associated with the incidence of dialysis

There are regional differences in the incidence of dialysis, but few studies have investigated the reasons for such differences. We stratified 81 factors by gender for each of the 47 prefectures in Japan using the Japanese Society for Dialysis Therapy database of 102,011 patients who started chronic dialysis during 2004-2006. The age-adjusted average annual incidence of dialysis was 265.6±38.9 per million population. Among the 81 factors tested, 30 showed significant correlations with the incidence of dialysis among males, and 36 among females by univariate regression analysis. Among those factors, multivariate regression analysis showed that the average duration of hospitalization, the mortality rate from malignancy, a history of leg amputation, and duration of sunshine were extracted as determinants of the incidents of dialysis among males, and a history of acute myocardial infarction, mortality rate from lifestyle-related diseases, vitamin C intake, mortality rate from malignancy, amount of family saving, number of dialysis specialists, birth rate, days of snow, potatoes intake, average annual temperature, average duration of hospitalization, protein intake, and mortality rate from cerebrovascular disease were extracted among females. Many environmental factors were correlated with regional differences in the incidence of dialysis.

The Association of Preoperative Statin Use and Acute Kidney Injury After Noncardiac Surgery

Our objective was to examine the association between preoperative statin therapy and the incidence of postoperative acute kidney injury (AKI) in patients undergoing elective noncardiac surgery. We analyzed the electronic records of 57,246 patients who had elective noncardiac surgery at the Cleveland Clinic Main Campus between December 2004 and March 2010. Patients were divided into 2 groups depending on preoperative therapy with statin drugs. Our primary outcome was AKI, defined as "risk," "injury," or "failure" using the RIFLE (Risk, Injury, Failure, Loss, and End-stage Kidney) criteria. Secondary outcomes included postoperative dialysis and all-cause hospital mortality. Each statin user was matched to a nonuser based on propensity scores. The propensity scores were estimated using a multivariable logistic regression model, incorporating all available baseline potential confounders. After the propensity-matching procedure, we performed final analyses for the primary and secondary outcomes. For the primary analysis, we used a univariable logistic regression model to estimate the odds ratio (OR) (and 95% confidence intervals) for AKI, postoperative dialysis, and hospital mortality between matched statin users and nonusers. Of the total group, 23,745 records were unusable because of missing data. Among the remaining 28,508 patients analyzed, the overall incidence of AKI was 6.1%. Three hundred sixty-one of 4805 statin users (7.5%) and 1377 of 23,703 nonusers (5.8%) experienced AKI. The incidence of postoperative dialysis was 0.05%. Six statin users (0.12%) and 8 nonusers (0.03%) required dialysis postoperatively. The incidence of hospital mortality was 0.62%. Mortality was observed for 47 patients (1.0%) and 130 patients (0.5%), respectively. Among 4172 matched pairs, the incidence (95% confidence interval) of AKI was 7.1% (6.2%, 8.1%) in the matched statin users and 8.0% (7.1%, 9.0%) in the nonusers, corresponding to an OR of 0.88 (0.75, 1.03), which was not statistically significant (P = 0.12, χ(2) test). The secondary outcomes were also not significantly different in matched statin users and nonusers. Postoperative dialysis was required for 0.10% (0.02%, 0.33%) and 0.12% (0.04%, 0.37%) of patients in the respective groups (OR = 0.80 [0.16, 3.70]; P = 0.74). Hospital mortality occurred in 1.0% (0.7%, 1.5%) and 1.3% (0.9%, 1.8%) of patients, respectively (OR = 0.76 [0.47, 1.20]; P = 0.18). Our data did not support the hypothesis that preoperative statin therapy in doses routinely used to treat hypercholesterolemia is associated with a change in the incidence of AKI, postoperative dialysis, or hospital mortality in patients undergoing noncardiac surgery.

Characteristics and clinical outcomes of hyponatraemia in peritoneal dialysis patients

There are few reports on the incidence, aetiology, and mortality of peritoneal dialysis (PD) patients with hyponatraemia. We identified all adults (>18-years-of-age) who received PD between May 2001 and March 2010. The patients were divided into two groups according to the presence of hyponatraemia (<135 mmol/L) during follow-up. Total body water (TBW) was obtained from bioimpedance analysis. Appropriate water gain was defined as a more than 3.6% increase of the mean TBW during normonatraemia in the same patient. Aetiologies of hyponatraemia were divided into two classes according to TBW. Three hundred and eighty seven patients were enrolled in this study. Ninety nine had normonatraemia and 288 developed hyponatraemia during follow-up. Among 241 episodes with simultaneous bioelectrical impedance analysis measurement, there were 71 cases with appropriate water gain and 170 cases with non-appropriate water gain. Low residual renal function and long duration of PD were associated with development of hyponatraemia by appropriate water gain. On multivariate analysis, old age (≥65-years-of-age), hypoalbuminaemia (<35 g/L), low residual renal function (<2 mL/min per 1.73(2) ) and a high comorbid condition were associated with mortality in the PD patients. The patients with intermediate and high Davies index had an odds ratio of 3.25 for development of hyponatraemia during the follow-up period (95% confidence interval, 2.025-5.215; P < 0.001). The prevalence of hyponatraemia increases along with the increased comorbidity status. The comorbidity conditions may be more important than hyponatraemia per se for predicting mortality. Additionally, the preservation of residual renal function may play a role in preventing hyponatraemia.

Frequency of Acute Kidney Injury Following Intravenous Contrast Medium Administration: A Systematic Review and Meta-Analysis

To perform a systematic review and meta-analysis of controlled studies examining the incidence of acute kidney injury (AKI) and other outcomes in patients exposed to intravenous (i.v.) contrast medium compared with patients who underwent an imaging examination without contrast medium or were otherwise unexposed (control group). MEDLINE, EMBASE, Scopus, and the Cochrane Library were searched for all articles published through September 2011 that contained search terms related to nephrotoxicity following intravenous contrast medium administration. Two independent reviewers identified studies in which the incidence of AKI in patients exposed to i.v. contrast medium was directly compared with the incidence of AKI in unexposed patients through analysis of changes in serum creatinine level or estimated glomerular filtration rate 48-72 hours following imaging procedures or admission. Study characteristics and outcomes of AKI, dialysis, and mortality were extracted by using a standardized protocol. Relative risk (RR) was calculated by using random-effects models and was tested in subgroups of different patient comorbidities, contrast medium types, and AKI diagnostic criteria. RR results of less than 1.00 indicated that there was a higher incidence of these outcomes in the group that did not receive contrast medium (non-contrast medium group). Of the 1489 studies originally identified, 13 nonrandomized studies (0.9%) representing 25,950 patients met inclusion criteria. In the group that received contrast medium (contrast medium group), risk of AKI (RR = 0.79; 95% confidence interval [CI]: 0.62, 1.02; P = .07), death (RR = 0.95; 95% CI: 0.55, 1.67; P = .87), and dialysis (RR = 0.88; 95% CI: 0.23, 3.43; P = .85) was similar, compared with the risk of AKI in the non-contrast medium group. This pattern was observed regardless of i.v. contrast medium type, diagnostic criteria for AKI, or whether patients had diabetes mellitus or renal insufficiency. Controlled contrast medium-induced nephropathy studies demonstrate a similar incidence of AKI, dialysis, and death between the contrast medium group and control group. http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12121460/-/DC1.

Technical factors are strongest predictors of postoperative renal dysfunction after open transperitoneal juxtarenal abdominal aortic aneurysm repair

Juxtarenal abdominal aortic aneurysms (AAAs) have predominantly been repaired using an open technique. We present a series of patients with juxtarenal AAAs and analyze multiple factors predictive of postoperative renal dysfunction. Between March 2000 and September 2011, all patients in our prospectively maintained database undergoing juxtarenal AAA repair were evaluated for demographics, operative details, and in-hospital outcomes. Postoperative renal dysfunction was classified using the RIFLE (risk, injury, failure, loss, end-stage renal disease) criteria (glomerular filtration rate decrease >25%). The relationship between perioperative factors and postoperative renal dysfunction was explored using both univariate and multivariate analysis (logistic regression). Of 169 patients, 76 (45%) required clamping above one renal artery, whereas 93 patients (55%) required clamping above both renal arteries. Mean (standard deviation) renal ischemia time was 29.2 (8.9) minutes (range, 12-65 minutes). Twenty-seven patients (16%) underwent adjunctive renal procedures, 19 (11.3%) required left renal vein division, and 130 (76.9%) received intraoperative mannitol. Postoperative renal dysfunction occurred in 63 patients (37.3%), with the majority (69%) resolving during hospital stay. Seven patients (4.1%) required postoperative dialysis, which was permanent in two cases. Patients who developed postoperative renal dysfunction had significantly longer mean renal ischemia times (34.7 [9.3] minutes vs 25.9 [6.6] minutes; P < .001), a higher rate of bilateral suprarenal aortic clamping (68.3% vs 47.2%; P = .008), higher rates of adjunctive renal artery procedures (26.7% vs 8.8%; P = .002), and higher rates of left renal vein division (20.6% vs 5.7%; P = .003). Logistic regression identified left renal vein division, renal ischemia time, and aortic clamp position as the strongest predictors of renal dysfunction. The use of mannitol was seen to be protective. Overall in-hospital mortality was 4.1% and was 9.5% among patients with postoperative renal dysfunction. Postoperative transient renal dysfunction occurred in 37.3% of patients after open juxtarenal AAA repair, with a low incidence of dialysis and a low rate of permanent dysfunction. Technical factors including renal ischemia time, aortic clamp position, and left renal vein division are the strongest predictors of renal dysfunction. The use of intraoperative mannitol was associated with decreased postoperative renal dysfunction.

Progress in research of peritoneal dialysis complicated with peritonitis

In recent years, reports on the effects of nursing intervention on the incidence of peritoneal dialysis complicated with peritonitis have been increasing. With the advancement of medical technology and the development of medical materials, complications of peritoneal dialysis show a decreasing trend. Many experts and scholars have been continually exploring the causa morbid of peritoneal dialysis and excogitating measures that should be taken. In this paper a comprehensive review is done.

Improved Survival over the Last Decade in Pediatric Patients Requiring Dialysis after Hematopoietic Cell Transplantation

It is not unusual for children to require dialysis for fluid and electrolyte management after hematopoietic cell transplantation (HCT). Previous studies have documented high mortality in children who require dialysis after HCT, but recent data are lacking. The purpose of this study was to compare the incidence of dialysis after pediatric HCT and the survival of patients who received dialysis in 2 decades, 1990-1999 and 2000-2009. A total of 1427 patients age <21 years who underwent a first HCT at the University of Minnesota between January 1990 and December 2009 were reviewed using prospectively collected data from the institutional HCT database. The incidence of dialysis during the first 100 days post-HCT and survival at 1 year post-HCT in the 2 cohorts were determined. Comparisons between patients who did and did not require dialysis were made using the χ2 and Fisher exact tests as appropriate. Kaplan-Meier estimates and 95% confidence intervals for 1-year post-HCT overall survival were reported by dialysis group and compared using the log-rank test. Predictors of overall survival among patients requiring dialysis were assessed using univariate and multivariate Cox regression analyses. The incidence of dialysis was not significantly different in the 2 cohorts (8.2% for 1990-1999 versus 8.9% for 2000-2009; P = .6326). Patients requiring dialysis were significantly more likely to survive to or past 1 year in the 2000-2009 cohort compared with the 1990-1999 cohort (23% versus 11%; P < .0001). Multivariate analyses found that older age at the time of HCT, primary disease type, pulmonary hemorrhage, and HCT in 1990-1999 were associated with increased mortality in the dialyzed population. The use of cyclosporine was associated with increased survival in the patients who received dialysis. Dialysis is an important complication of pediatric HCT with an incidence that has remained constant over the last 2 decades. Survival was improved in the 2000-2009 cohort regardless of dialysis status. Despite a recent significant reduction in mortality in patients requiring dialysis, mortality remains higher in these patients than in those who do not need dialysis.

Educational Intervention in CKD Retards Disease Progression and Reduces Medical Costs for Patients with Stage 5 CKD

Background: Nephrologist-based multidisciplinary care (MDC) has a positive impact on slowing chronic kidney disease (CKD) progression. However, the benefits of MDC in patients with stage 5 CKD remain unclear. Methods: Stage 5 CKD patients who visited the Chang Gung Memorial Hospital, Chiayi, Taiwan during the period of 2002–2008 were enrolled. The incident dialysis and medical cost were compared between MDC recipients and nonrecipients. The MDC recipients were divided into two groups by educational duration to observe the clinical renal outcome and medical care expenses. The effect of MDC on renal disease progression was also compared in MDC recipients with and without diabetes. Results: Out of 307 patients, 171 received MDC. For MDC recipients, the temporary usage of catheter was reduced (54.7% vs. 79.4%, p < 0.001), the hospital stay was shorter (18.64 ± 1.20 vs. 24.63 ± 1.22 months, p = 0.001), and the total medical cost was lower [New Taiwan dollars (NTD) 105,948.54 ± 9,967.22 vs. NTD 160,388.61 ± 16,373.97, p = 0.005] than for nonrecipients. Out of the 171 MDC recipients, those with MDC for more than 1 year had slower renal disease progression (0.76 ± 0.27 mL/min per 1.73 m2 per year) and had an estimated per- capita annual cost savings of about NTD 336,500.66. MDC recipients with diabetes had a higher risk of requiring dialysis than those without diabetes. Conclusions: MDC could significantly reduce temporary use of the catheter, hospital stay, and total medical costs in patients with stage 5 CKD. Furthermore, longer (>1 year) MDC could preserve renal function and deliver annual medical cost savings.