Young End-stage Renal Disease Patients Research Articles

#1370 Frailty prevalence and short-term outcomes among younger end-stage renal disease patients on maintenance hemodialysis

Abstract Background and Aims Frailty is a medical condition of reduced function and health, or a state of heightened risk for catastrophic decline in vitality and function which is evident among end-stage renal disease (ESRD) patients. There has been only limited data regarding its occurrence in the younger age group since most of the published frailty studies involved the elderly as their study population. It is important to identify who among the younger hemodialysis patients are frail, since frailty is related to a higher risk of hospitalization and mortality. This study aims to estimate the prevalence of frailty among younger ESRD patients on maintenance hemodialysis using the Edmonton Frail Scale (EFS) and its association with short-term outcomes: hospital consultations, use of emergency room services, hospitalizations, and mortality. Method A prospective single-center cohort study was conducted. All ESRD patients aged 18-64 years old on maintenance hemodialysis on an outpatient basis were included. Data collection included the patients’ demographic data, underlying diseases, comorbid conditions, body mass index, and recent laboratory results. The EFS was administered during the first month of the study, and patients were then monitored for consultations, use of emergency room services, hospitalizations, and mortality in the succeeding months until the end of the study period. Results Out of 166 ESRD patients, 94 belong to the younger age group and 87 patients were included: 33 (37.9%) were frail, 21 (24.1%) were vulnerable, and 33 (37.9%) were fit. Chronic Glomerulonephritis was the leading cause of ESRD in the younger population, and Diabetic Nephropathy was the primary cause among those categorized as frail. Hypertension was the predominant comorbid condition across all categories. Frail patients had the greatest number of hospital consultations (54%) and had frequent utilization of emergency room services. They also exhibited the highest number of hospitalizations consisting 69% of the total admissions across all categories. All deaths in this study came from the patients categorized as frail. Conclusion Frailty is prevalent among younger ESRD patients on maintenance hemodialysis and is associated with increased risk for hospital consultation, use of emergency room services, hospitalization, and mortality.

Impact of dialysis modality choice on the survival of end-stage renal disease patients with congestive heart failure in southern China: A retrospective cohort study.

Heart failure is one of the common complications in patients with end-stage renal disease (ESRD) and a major cause of death in these patients. The choice of dialysis modality for ESRD patients with congestive heart failure (CHF) is still inconclusive. The purpose of this study was to compare the prognosis of hemodialysis (HD) and peritoneal dialysis (PD) among ESRD patients with CHF and provide a basis for clinical decision-making. This was a retrospective study conducted at Guangdong Provincial Hospital of Traditional Chinese Medicine that included patients with CHF requiring long-term renal replacement therapy between January 1, 2012 and December 31, 2017. The end of follow-up was December 31, 2020. All patients were divided into HD and PD groups and sub grouped by age, and we used univariate and multifactorial Cox regression analyses to calculate the relative hazard ratios (HR) of the different dialysis types and adjusted for differences in baseline data using propensity score matching (PSM). A total of 121 patients with PD and 156 patients with HD were included in this study. Among younger ESRD patients (≤65 years of age) with CHF, the prognosis of HD was worse than that of PD [HR = 1.84, 95% confidence interval (CI) = 1.01-3.34], and this disadvantage remained significant in the fully adjusted model [sex, age at dialysis initiation, Charlson comorbidities index, body mass index, prealbumin, hemoglobin, and left ventricular ejection fraction (LVEF)] and after PSM. In the older group (>65 years of age), the prognosis of HD was better than that of PD (HR = 0.46, 95% CI = 0.25-0.85), and the protective effect remained in the fully adjusted model and after PSM. The aforementioned survival differences across the cohort were maintained in patients with preserved LVEF (>55%), but could not be reproduced in patients with reduced LVEF (≤55%). In southern China, PD is a better choice for younger patients with ESRD, CHF and preserved LVEF, and HD is the better option for older patients.

Silent neurological lesions detected by magnetic resonance imaging: Relationship to hyperparathyroidism among end-stage renal disease young patients on haemodialysis.

End-stage renal disease (ESRD) patients on haemodialysis (HD) suffer from several peripheral and central neurological complications. They are at high risk for developing silent neurological lesions (SNL) that may be detected accidentally by magnetic resonance imaging (MRI). Many factors are implicated in the development of neurological deficits in ESRD patients on HD. Evaluation of SNL in young ESRD patients by using MRI and assessing its correlation with hyperparathyroidism. The study involved 48 young ESRD patients (mean age of 19.6±6years) with HD and do not have any apparent abnormalities in the neurological examination. Laboratory investigations and conventional brain MRI were done on all. 79.2% have SBI and 45.8% have white matter lesions. Regression analysis revealed that calcium level and duration of dialysis were independent predictor factors for the presence of silent brain MRI lesions (P=.034 & 0.045 respectively). ROC curve showed that parathyroid hormone (PTH) level >585pg/mL, duration of dialysis >2years, and calcium level >7.5mg/dL predicted the presence of SNL. The duration of HD and hyperparathyroidism (HPT) were independent predictors for the presence of SNL. MRI brain is considered as a mandatory affordable tool for HD patients >2years and has HPT for early detection of SNL to help early intervention and avoid neurological complications and disabilities.

Characteristics and Clinical Outcomes of End-Stage Renal Disease Patients on Peritoneal Dialysis for Over 15 Years: A Single-Center Experience.

Maintaining peritoneal dialysis (PD) for a long time is problematic owing to a number of factors. This study aimed to clarify the characteristics and examine the clinical outcomes of patients who received PD as a long-term dialysis modality. All end-stage renal disease (ESRD) patients who initiated PD at Yonsei University Health System between 1987 and 2000 were screened. Patients who maintained PD for over 15 years were classified as the long-term PD group and those who were treated with PD for less than 5 years were included in the short-term PD group. Demographic and biochemical data and clinical outcomes were compared between the groups. Independent factors associated with long-term PD maintenance were ascertained using multivariate logistic regression analysis. Among 1,116 study patients, 87 (7.8%) were included in the long-term group and 293 (26.3%) were included in the short-term group. In the long-term group, the mean patient age at PD initiation was 39.6 ± 11.5 years, 35 patients (40.2%) were male, and the mean PD duration was 205.3 ± 32.7 months. Patients were younger, body weight was lower, the proportion of patients with diabetes or cardiovascular diseases was lower, and the proportion of low to low-average transporters was higher in the long-term group than in the short-term group (p < 0.001). Multiple logistic regression analysis revealed that age, body mass index (BMI), serum creatinine, type of PD solution, and diabetes were significant independent factors associated with long-term PD maintenance. Peritoneal dialysis can be considered as a long-term renal replacement therapy option, especially in non-diabetic, not overweight, and young ESRD patients.

PERK-dependent defective TCR-mediated activation of CD4+ T cells in end-stage renal disease patients

BackgroundPatients with end-stage renal disease (ESRD) have an impaired immune response with a prematurely aged T-cell system. Mitogen-activated protein kinases (MAPKs) including extracellular signal-regulated kinase (ERK) and p38, regulate diverse cellular programs by transferring extracellular signals into an intracellular response. T cell receptor (TCR)-induced phosphorylation of ERK (pERK) may show an age-associated decline, which can be reversed by inhibiting dual specific phosphatase (DUSP) 6, a cytoplasmic phosphatase with substrate specificity to dephosphorylate pERK. The aim of this study was to assess whether ESRD affects TCR-mediated signaling and explore possibilities for intervening in ESRD-associated defective T-cell mediated immunity.ResultsAn age-associated decline in TCR-induced pERK-levels was observed in the different CD4+ (P < 0.05), but not CD8+, T-cell subsets from healthy individuals (HI). Interestingly, pERK-levels of CD4+ T-cell subsets from young ESRD patients were in between young and elderly HI. A differentiation-associated decline in TCR-induced ERK and p38 phosphorylation was observed in T cells, although TCR-induced p38 phosphorylation was not significantly affected by age and/or ESRD. Frequencies of TCR-induced CD69-expressing CD4+ T cells declined with age and were positively associated with pERK. In addition, an age-associated tendency of increased expression of DUSP6 was observed in CD4+ T cells of HI and DUSP6 expression in young ESRD patients was similar to old HI. Inhibition of DUSP6 significantly increased TCR-induced pERK-levels of CD4+ T cells in young and elderly ESRD patients, and elderly HI.ConclusionsTCR-mediated phosphorylation of ERK is affected in young ESRD patients consistent with the concept of premature immunological T cell ageing. Inhibition of DUSP6 specific for pERK might be a potential intervention enhancing T-cell mediated immunity in ESRD patients.

Uremia causes premature ageing of the T cell compartment in end-stage renal disease patients

BackgroundEnd-stage renal disease (ESRD) patients treated with renal replacement therapy (RRT) have premature immunologically aged T cells which may underlie uremia-associated immune dysfunction. The aim of this study was to investigate whether uremia was able to induce premature ageing of the T cell compartment. For this purpose, we examined the degree of premature immunological T cell ageing by examining the T cell differentiation status, thymic output via T cell receptor excision circle (TREC) content and proliferative history via relative telomere length in ESRD patients not on RRT.ResultsCompared to healthy controls, these patients already had a lower TREC content and an increased T cell differentiation accompanied by shorter telomeres. RRT was able to enhance CD8+ T cell differentiation and to reduce CD8+ T cell telomere length in young dialysis patients. An increased differentiation status of memory CD4+ T cells was also noted in young dialysis patients.ConclusionBased on these results we can conclude that uremia already causes premature immunological ageing of the T cell system and RRT further increases immunological ageing of the CD8+ T cell compartment in particular in young ESRD patients.

Incidence, management, and outcomes of end-stage renal disease in the elderly

The elderly constitute a substantial and growing fraction of the end-stage renal disease (ESRD) population. We review recent studies on ESRD incidence, management, and outcomes in the elderly. Rates of treated ESRD among the elderly (>80 years) have risen by more than 50% in the last decade. In studies with a large number of elderly patients, median survival after dialysis initiation is modest, and although a majority have reasonable life expectancy, a substantial minority of elderly patients experience very high early mortality rates after dialysis initiation. Quality of life results are mixed--compared with younger ESRD patients or non-ESRD elderly, mental well being is similar and physical well being is reduced in elderly patients with ESRD. In several studies, elderly patients with ESRD initiating peritoneal dialysis had higher mortality rates than elderly patients with ESRD initiating hemodialysis. Strategies such as nondialytic management of ESRD or dietary protein restriction and delayed dialysis initiation may be alternatives for elderly patients wishing to avoid dialysis initiation, but further studies are needed to determine the patients best suited for these approaches. Quality improvement initiatives in geriatric ESRD care have been successfully implemented in some centers and may ultimately improve care for elderly patients with ESRD. These findings should help to clarify some of the risks and benefits of dialysis in the elderly and may be useful in dialysis decision-making and management.

Social consequences in adult life of end-stage renal disease in childhood

To describe employment achievement and social independence of adults with childhood end-stage renal disease (ESRD) and to explore determining factors. Employment, occupational level, living arrangements, social engagements, and subjective health perception were cross-sectionally established between 1998 and 2000 in 144 of all living 187 adult Dutch patients with ESRD with an onset at age 0 to 15 years between 1972 and 1992. Potential clinical determinants were established by means of a review of all medical charts. Compared with age-matched Dutch citizens, patients were more often involuntarily unemployed (19.4% vs 11.1%), had a lower occupational level, more often still lived with their parents, and more often had no partner. A low occupational level was associated with a dialysis duration >8 years (OR, 9.6; 95% CI, 1.9-47.6); living at the parental home was associated with the male sex (OR, 3.4; 95% CI, 1.5-7.8) and with a dialysis duration >8 years (OR, 3.7; 95% CI, 1.3-10.2). Prolonged dialysis during childhood may decrease the ability to gain high-skilled professions and social independence. Unemployment is twice as high in adult patients with childhood ESRD than in healthy persons, but more than twice as low as compared with young ESRD patients with an adult onset of the disease, according to previous reports.

Results of Coronary Artery Bypass Grafting in End-Stage Renal Disease

We examined the results of coronary artery bypass grafting (CABG) in patients with end-stage renal disease and symptomatic ischemic heart disease who had significant arteriosclerotic narrowing of one or more coronary vessels between 1970 and 1984. Twenty-four such patients underwent bypass grafting, 20 dialysis patients and four who had been transplanted. Bypass grafting completely or partially relieved symptoms in 83%. The hospital mortality associated with this surgery for the 20 dialysis patients was 20% compared with a lower overall hospital mortality for bypass grafting in nondialysis patients of 1.3%. Greater hospital mortality was noted for patients over age 60 undergoing bypass grafting, 33.3% v 1.9% in nondialysis patients. In this study, the most significant factor associated with mortality was older age. We conclude that bypass grafting has an acceptable mortality in younger end-stage renal disease patients anticipating or having had renal transplantation, but it is associated with a high hospital mortality in older dialysis patients.