BACKGROUND Since the beginning of corona virus disease 2019(COVID-19)pandemic,there has been a widespread use of remdesivir in adults and children.There is little known information about its outcomes in patients with ...BACKGROUND Since the beginning of corona virus disease 2019(COVID-19)pandemic,there has been a widespread use of remdesivir in adults and children.There is little known information about its outcomes in patients with end stage renal disease who are on dialysis.AIM To assess the clinical outcomes with use of remdesivir in adult patients with end stage kidney failure on hemodialysis.METHODS A retrospective,multicenter study was conducted on patients with end stage renal disease on hemodialysis that were discharged after treatment for COVID-19 between April 1,2020 and December 31,2020.Primary endpoints were oxygen requirements,time to mortality and escalation of care needing mechanical ventilation.RESULTS A total of 45 patients were included in the study.Twenty patients received remdesivir,and 25 patients did not receive remdesivir.Most patients were caucasian,females with diabetes mellitus and hypertension being the commonest comorbidities.There was a trend towards reduced oxygen requirement(beta=-25.93,X^(2)(1)=6.65,P=0.0099,probability of requiring mechanical ventilation(beta=-28.52,X^(2)(1)=22.98,P<0.0001)and mortality(beta=-5.03,X^(2)(1)=7.41,P=0.0065)in patients that received remdesivir compared to the control group.CONCLUSION Larger studies are justified to study the effects of remdesivir in this high-risk population with end stage kidney disease on dialysis.展开更多
Castleman's disease(CD), also known as angiofolicular lymph node hyperplasia, is a rare heterogenous group of lymphoproliferative disorders. Histologically, it can be classified as hyaline vascular type, plasma ce...Castleman's disease(CD), also known as angiofolicular lymph node hyperplasia, is a rare heterogenous group of lymphoproliferative disorders. Histologically, it can be classified as hyaline vascular type, plasma cell type, or mixed type. Clinically two different subtypes of the CD are present: Unicentric and multicentric. Unicentric CD is generally asymptomatic and associated with hyaline vascular type, and its diagnoses depend on the localized lymphadenopathy on examination or imaging studies. However, multicentric CD presents with generalized lymphadenopathy and systemic symptoms including malaise, fever, night sweats, weight loss, and it is associated with the plasma cell type and mix type. Herein, we report a patient with unicentric CD of the plasma cell type without systemic symptoms, who developed end stage renal failure caused by amyloidosis 6 years after onset of CD.展开更多
Background: Nowadays cardiovascular diseases remain as the single most common cause of death in chronic dialysis patients;the aim of this study was to evaluate the effects of two different regimens of dialysis potassi...Background: Nowadays cardiovascular diseases remain as the single most common cause of death in chronic dialysis patients;the aim of this study was to evaluate the effects of two different regimens of dialysis potassium removal in patients with a tendency to develop arrhythmias during haemodialysis (HD). Methods and Materials: There were 88 (36 men and 52 women) end stage renal disease (ESRD) patients recruited for the study. They received regular haemodialysis three times per week at the haemodialysis units of a university medical centre (Golestan hospital) during year 2011. We compared the arrhythmogenic effects of two dialysis techniques. Results: There was a tendency in the HD solution with constant (3 mEq/l) K for premature ventricular complex (PVC) appearance in to be reduced as compared with constant (2 mEq/l) K in the time of dialysis period, although this reduction was not statistically significant(P = 0.09). There was a significant reduction in SVC in the HD solution with constant (3 mEq/l) K as compared with constant (2 mEq/l) K. Discussion: In conclusion, the use of a model of intra-HD potassium that is more close to potassium serum concentration of ESRD patients can reduce the arrhythmogenic effect of HD in patients on regular HD treatment.展开更多
Neurotoxicity is an infrequent adverse reaction to iodinated contrast agents. Contrast induced neurotoxicity following coronary angiogram is very rare. Renal disease is a risk factor for contrast induced neurotoxicity...Neurotoxicity is an infrequent adverse reaction to iodinated contrast agents. Contrast induced neurotoxicity following coronary angiogram is very rare. Renal disease is a risk factor for contrast induced neurotoxicity. We report a case of contrast induced neurotoxicity following coronary angiogram and intervention using Iohexol(Omnipaque 350) in an end stage renal disease patient on peritoneal dialysis who had prior exposure to iodinated contrast without any adverse reaction. Hemodialysis had to be initiated for rapid removal of the contrast agent with subsequent complete resolution of neurological deficits. This case highlights the need for interventionalists to be aware of an important adverse reaction to iodinated contrast agents, especially in individuals with renal dysfunction, and that neurotoxicity is a possibility even with prior uneventful exposures. The role and timing of hemodialysis in contrast induced neurotoxicity in patients with chronic kidney disease and in those without chronic kidney disease needs further deliberation.展开更多
AIM:To understand factors associated with quality of life(QOL),examine types of QOL instruments,and determine need for further improvements in QOL assessment.METHODS:The method used databases(Pubmed,Google scholar) an...AIM:To understand factors associated with quality of life(QOL),examine types of QOL instruments,and determine need for further improvements in QOL assessment.METHODS:The method used databases(Pubmed,Google scholar) and a bibliographic search using key words QOL,end stage renal disease,Hemodialysis,Peritoneal dialysis,instruments to measure QOL,patients and qualitative/quantitative analysis published during 1990 to June 2014.Each article was assessed for sample size,demographics of participants,study design and type of QOL instruments used.We used WHO definition of QOL.RESULTS:For this review,109 articles were screened,out of which 65 articles were selected.Out of 65 articles,there were 19 reports/reviews and 12 questionnaire manuals.Of the 34 studies,82% were quantitative while only 18% were qualitative.QOL instruments measured several phenomenon such as physical/psychological health,effects and burdens of kidney disease,social support etc.those are associated with QOL.Few studies looked at spiritual beliefs,cultural beliefs,personal concerns,as per the WHO definition.Telemedicine and Palliative care have now been successfully used however QOL instruments seldom addressed those in the articles reviewed.Also noticed wasthat longitudinal studies were rarely conducted.Existing QOL instruments only partially measure QOL.This may limit validity of predictive power of QOL.CONCLUSION:Culture and disease specific QOL instruments that assess patients' objective and subjective experiences covering most aspects of QOL are urgently needed.展开更多
End stage renal disease (ESRD),with a prevalence in China of about 200-250 cases per million,is one of the major diseases that seriously threaten human health and cause poverty.Recently,with the advancement of healthc...End stage renal disease (ESRD),with a prevalence in China of about 200-250 cases per million,is one of the major diseases that seriously threaten human health and cause poverty.Recently,with the advancement of healthcare system reform in China,basic medical insurance now covers over 95％ of urban and rural residents,and a high-reimbursement system for the catastrophic diseases including ESRD has been established.The improvement of healthcare policy calls on the medical community to strengthen healthcare service capability for severe illness,establish standardized pathways for prevention,diagnosis,treatment and rehabilitation according to disease spectrum and characteristics of Chinese population,organize multicenter clinical trials,promote the research and development of medical equipments,devices and drugs,and achieve the overall progress of China's healthcare industry finally.So to say,we are now facing the unprecedented opportunities and challenges as well.展开更多
AIM To estimate the risk of end-stage renal disease(ESRD)in patients with inflammatory bowel disease(IBD).METHODS From January 2010 to December 2013, patients with Crohn's disease(CD) and ulcerative colitis(UC) we...AIM To estimate the risk of end-stage renal disease(ESRD)in patients with inflammatory bowel disease(IBD).METHODS From January 2010 to December 2013, patients with Crohn's disease(CD) and ulcerative colitis(UC) were identified, based on both the International Classification of Diseases, 10 th revision(ICD-10) and the rare,intractable disease registration program codes from the National Health Insurance(NHI) database in South Korea. We compared 38812 patients with IBD to ageand sex-matched non-IBD controls with a ratio of 1:3.Patients newly diagnosed with ESRD were identified with the ICD-10 code.RESULTS During a mean follow-up of 4.9 years, ESRD was detected in 79(0.2%) patients with IBD and 166(0.1%)controls. The incidence of ESRD in patients with IBD was0.42 per 1000 person-years. Patients with IBD had a significantly higher risk of ESRD than controls [adjusted hazard ratio(HR) = 3.03; 95% confidence interval(CI):1.77-5.20; P < 0.001]. The incidences(per 1000 personyears)of ESRD were 0.51 in patients with CD and 0.13 in controls, respectively(adjusted HR = 6.33; 95%CI:2.75-14.56; P < 0.001). In contrast, the incidence of ESRD was similar between the UC and control groups(0.37 vs 0.37 per 1000 person-years; adjusted HR = 2.01;95%CI: 0.90-4.51; P = 0.089).CONCLUSION The risk of ESRD was elevated in patients with CD, but not UC. Patients with CD should be monitored carefully for signs of renal insufficiency.展开更多
The diagnosis of extra-pulmonary tuberculosis(TB) seems relatively difficult due to the absence of specific symptoms and signs in patients on peritoneal dialysis or hemodialysis.We report four cases of extra-pulmonary...The diagnosis of extra-pulmonary tuberculosis(TB) seems relatively difficult due to the absence of specific symptoms and signs in patients on peritoneal dialysis or hemodialysis.We report four cases of extra-pulmonary tuberculosis on dialysis,with two cases on peritoneal dialysis and two cases on hemodialysis.The presentations,therapy,and outcomes of TB infection in these patients were reviewed.Otherwise,the English literature published in the PubMed database associating extra-pulmonary tuberculosis on dialysis over the last three decades is reviewed.A total of 61 studies containing 70 cases were included.The most common primary disease was diabetic nephropathy(22.86%,16/70).The peritoneum(31.42%,22/70),bone(21.42%,15/70),and lymph node(20%,14/70) were the most frequently infected.Single organ infection was common(90%,63/70).Fever(58.57%,41/70),pain(35.71%,25/70),and enlarged lymph node(20%,14/70) were the most common symptoms.Biopsy(67.14%,47/70) and culture(40%,28/70) provided most reliable methods for clear diagnosis of tuberculosis.The combined treatment of isoniazid,rifampicin,pyrazinamide,and ethambutol(44.29%,31/70) was the most common therapy.The majority of patients improved(82.86%,58/70);however,12 cases got worse(17.14%),with 10 of them dying(14.29%).Physicians should be aware of the non-specific symptoms and location of infection,and consider tuberculosis in their differential diagnoses in dialysis patients presenting with symptoms such as fever,pain,and weight loss.展开更多
End stage renal disease (ESRD) and cardiovascular disease are induced by arteriosclerosis (AS). The latest investigation shows that AS is a special inflammatory state. The constant inflammation,which has been defined ...End stage renal disease (ESRD) and cardiovascular disease are induced by arteriosclerosis (AS). The latest investigation shows that AS is a special inflammatory state. The constant inflammation,which has been defined as a micro inflammatory state is related to the decline of renal function and blood purification, but not the result of infections caused by external pathogenic microorganisms or internal opportunistic pathogenic microorganisms. We investigated the mechanism of interleukin-10 (IL-10) gene-1082 A/G protection effect to keep ESRD patients away from micro inflammation and AS. METHODS Patients Eight hundred and seventy ESRD patients were randomly chosen, 437 were male and 433 were female. Five hundred patients were treated with hemodialysis and the dialytic time ranged from 1 to 114 months. Normal control group consisted of 1000 healthy persons, 500 were male and 500 were female.展开更多
AIM To determine if end-stage renal disease (ESRD) is a risk factor for post endoscopic retrograde cholangio-pancreatography (ERCP) adverse events (AEs). METHODS We performed a retrospective cohort study using the Nat...AIM To determine if end-stage renal disease (ESRD) is a risk factor for post endoscopic retrograde cholangio-pancreatography (ERCP) adverse events (AEs). METHODS We performed a retrospective cohort study using the Nationwide Inpatient Sample (NIS) 2011-2013. We identified adult patients who underwent ERCP using the International Classification of Diseases 9^(th) Revision (ICD-9-CM). Included patients were divided into three groups: ESRD, chronic kidney disease (CKD), and control. The primary outcome was post-ERCP AEs including pancreatitis, bleeding, and perforation determined based on specific ICD-9-CM codes. Secondary outcomes were length of hospital stay, in-hospital mortality, and admission cost. AEs and mortality were compared using multivariate logistic regression analysis.RESULTS There were 492175 discharges that underwent ERCP during the 3 years. The ESRD and CKD groups contained 7347 and 39403 hospitalizations respectively, whereas the control group had 445424 hospitalizations. Post-ERCP pancreatitis (PEP) was significantly higher in the ESRD group (8.3%) compared to the control group (4.6%) with adjusted odd ratio (aOR) = 1.7 (95% CI: 1.4-2.1, ~aP < 0.001). ESRD was associated with significantly higher ERCP-related bleeding (5.1%) compared to the control group 1.5% (aOR = 1.86, 95%CI: 1.4-2.4, ~aP < 0.001). ESRD had increased hospital mortality 7.1% vs 1.15% in the control OR = 6.6 (95%CI: 5.3-8.2, ~aP < 0.001), longer hospital stay with adjusted mean difference (aMD) = 5.9 d (95% CI: 5.0-6.7 d, ~aP < 0.001) and higher hospitalization charges aMD = $+82064 (95%CI: $68221-$95906, ~aP < 0.001). CONCLUSION ESRD is a risk factor for post-ERCP AEs and is associated with higher hospital mortality. Careful selection and close monitoring is warranted to improve outcomes.展开更多
Diabetic muscle infarction(DMI) refers to spontaneous ischemic necrosis of skeletal muscle among people with diabetes mellitus, unrelated to arterial occlusion. People with DMI may have coexisting end-stage renal dise...Diabetic muscle infarction(DMI) refers to spontaneous ischemic necrosis of skeletal muscle among people with diabetes mellitus, unrelated to arterial occlusion. People with DMI may have coexisting end-stage renal disease(ESRD) but little is known about its epidemiology and clinical outcomes in this setting. This scoping review seeks to investigate the characteristics, clinical features, diagnostic evaluation, management and outcomes of DMI among people with ESRD. Electronic database (Pub Med/MEDLINE, CINAHL, SCOPUS and and EMBASE) searches were conducted for ("diabetic muscle infarction" or "diabetic myonecrosis") and("chronic kidney disease" or "renal impairment" or "dialysis" or "renal replacement therapy" or "kidney transplant ") from January 1980 to June 2017. Relevant cases from reviewed bibliographies in reports retrieved were also included. Data were extracted in a standardized form. A total of 24 publications with 41 patients who have ESRD were included. The mean age at the time of presentation with DMI was 44.2 years. Type 2 diabetes was present in 53.7% of patients while type 1 in 41.5%. In this cohort, 60.1% were receiving hemodialysis, 21% on peritoneal dialysis and 12.2% had kidney transplantation. The proximal lower limb musculature was the most commonly affected site. Muscle pain and swelling were the most frequent manifestation on presentation. Magnetic resonance imaging (MRI) provided the most specific findings for DMI. Laboratory investigation findings are usually non-specific. Non-surgical therapy is usually used in the management of DMI. Short-term prognosis of DMI is good but recurrence occurred in 43.9%. DMI is an uncommon complication in patients with diabetes mellitus, including those affected by ESRD. In comparison with unselected patients with DMI, the characteristics and outcomes of those with ESRD are generally similar. DMI may also occur inkidney transplant recipients, including pancreas-kidney transplantation. MRI is the most useful diagnostic investigation. Non-surgical treatment involving analgesia, optimization of glycemic control and initial bed rest can help to improve recovery rate. However, recurrence of DMI is relatively frequent.展开更多
AIM To investigate the prevalence and association of Helicobacter pylori(H. pylori) with end-stage renal disease(ESRD).METHODS SA comprehensive literature search was completed from inception until October 2016. Studie...AIM To investigate the prevalence and association of Helicobacter pylori(H. pylori) with end-stage renal disease(ESRD).METHODS SA comprehensive literature search was completed from inception until October 2016. Studies that reported prevalence, relative risks, odd ratios, hazard ratios or standardized incidence ratio of H. pylori among ESRD patients were included. Participants without H. pylori were used as comparators to assess the association between H. pylori infection and ESRD. Pooled risk ratios and 95%CI was calculated using a random-effect model. Adjusted point estimates from each study were combined by the generic inverse variance method of DerS imonian and Laird.RESULTS Of 4546 relevant studies, thirty-seven observational studies met all inclusion criteria. Thirty-five crosssectional studies were included in the analyses to assess the prevalence and association of H. pylori with ESRD. The estimated prevalence of H. pylori among ESRD patients was 44%(95%CI: 40%-49%). The pooled RR of H. pylori in patients with ESRD was 0.77(95%CI: 0.59-1.00) when compared with the patients without ESRD. Subgroup analysis showed significantly reduced risk of H. pylori in adult ESRD patients with pooled RR of 0.71(95%CI: 0.55-0.94). The data on the risk of ESRD in patients with H. pylori were limited. Two cohort studies were included to assess the risk of ESRD in patients with H. pylori. The pooled risk RR of ESRD in patients with H. pylori was 0.61(95%CI: 0.03-12.20).CONCLUSION The estimated prevalence of H. pylori in ESRD patients is 44%. Our meta-analysis demonstrates a decreased risk of H. pylori in adult ESRD patients.展开更多
We aimed to explore the prevalence of Fabry disease in Thai patients who were diagnosed with end-stage renal disease(ESRD) of an unknown origin.Venous blood samples were collected from ESRD patients for biochemical an...We aimed to explore the prevalence of Fabry disease in Thai patients who were diagnosed with end-stage renal disease(ESRD) of an unknown origin.Venous blood samples were collected from ESRD patients for biochemical and molecular studies.Alpha-galactosidase A(a-GAL A) screening was performed from dried-blood spots using fluorometry.Molecular confirmation was performed using DNA sequencing of the GLA gene.A total of 142 male and female patients were included in this study.Ten patients(7.04%) exhibited a significant decrease in a-GAL A activity.There were no definitive pathogenic mutations observed in the molecular study.However,four patients revealed a novel nucleotide variant at c.l-10 C>T,which was identified as a benign variant following screening in the normal population.In conclusion,the a-GAL A assay utilizing dried-blood spots revealed a significant false positive rate.There was no definitive Fabry disease confirmed in Thai patients diagnosed with ESRD of unknown etiology.展开更多
AIM To determine the impact of allopurinol non-adherence as a proxy for uncontrolled disease on primary prevention of end-stage renal disease(ESRD).METHODS A cohort of 2752 patients with gout diagnosis was reconstruct...AIM To determine the impact of allopurinol non-adherence as a proxy for uncontrolled disease on primary prevention of end-stage renal disease(ESRD).METHODS A cohort of 2752 patients with gout diagnosis was reconstructed using the Québec Régie de l'assurance maladie du Québec and MedE cho administrative databases.Eligible patients were new users of allopurinol,aged 45-85,with a diagnosis of hypertension,and treated with an antihypertensive drug between 1997 and 2007.RESULTS Major risk factor for ESRD onset was chronic kidney disease at stages 1 to 3 [rate ratio(RR) = 8.00;95% confidence interval(CI):3.16-22.3 and the severity of hypertension(≥ 3 vs < 3 antihypertensives)] was a trending risk factor as a crude estimate(RR = 1.94;95%CI:0.68-5.51).Of 341 patients,cases(n = 22) and controls(n = 319),high adherence level(≥ 80%) to allopurinol therapy,compared with lower adherence level(< 80%),was associated with a lower rate of ESRD onset(RR = 0.35;95%CI:0.13-0.91).CONCLUSION Gout control seem to be associated with a significantdecreased risk of ESRD onset in hypertensive populations,further research should be conducted confirming this potential associated risk.展开更多
This study adapted a statistical probabilistic anatomical map of the brain for single photon emission computed tomography images of depressive end-stage renal disease patients. This research aimed to investigate the r...This study adapted a statistical probabilistic anatomical map of the brain for single photon emission computed tomography images of depressive end-stage renal disease patients. This research aimed to investigate the relationship between symptom clusters, disease severity, and cerebral blood flow. Twenty-seven patients (16 males, 11 females) with stages 4 and 5 end-stage renal disease were enrolled, along with 25 healthy controls. All patients underwent depressive mood assessment and brain single photon emission computed tomography. The statistical probabilistic anatomical map images were used to calculate the brain single photon emission computed tomography counts. Asymmetric index was acquired and Pearson correlation analysis was performed to analyze the correlation between symptom factors, severity, and regional cerebral blood flow. The depression factors of the Hamilton Depression Rating Scale showed a negative correlation with cerebral blood flow in the left amygdale. The insomnia factor showed negative correlations with cerebral blood flow in the left amygdala, right superior frontal gyrus, right middle frontal gyrus, and left middle frontal gyrus. The anxiety factor showed a positive correlation with cerebral glucose metabolism in the cerebellar vermis and a negative correlation with cerebral glucose metabolism in the left globus pallidus, right inferior frontal gyrus, both temporal poles, and left parahippocampus. The overall depression severity (total scores of Hamilton Depression Rating Scale) was negatively correlated with the statistical probabilistic anatomical map results in the left amygdala and right inferior frontal gyrus. In conclusion, our results demonstrated that the disease severity and extent of cerebral blood flow quantified by a probabilistic brain atlas was related to various brain areas in terms of the overall severity and symptom factors in end-stage renal disease patients.展开更多
End-stage renal disease(ESRD) patients have a defective T-cell-mediated immune system which is related to excessive premature ageing of the T-cell compartment.This is likely to be caused by the uremia-associated pro-i...End-stage renal disease(ESRD) patients have a defective T-cell-mediated immune system which is related to excessive premature ageing of the T-cell compartment.This is likely to be caused by the uremia-associated pro-inflammatory milieu,created by loss of renal function.Therefore,ESRD patients are highly susceptible for infections,have an increased risk for virus-associated cancers,respond poorly to vaccination and have an increased risk for atherosclerotic diseases.Three ageing parameters can be used to assess an immunological T-cell age.First,thymic output can be determined by assessing the T-cell receptor excision circlescontent together with CD31 expression within the naive T cells.Second,the telomere length of T cells and third the T-cell differentiation status are also indicators of T-cell ageing.Analyses based on these parameters in ESRD patients revealed that the immunological T-cell age is increased by on average 20 years compared to the chronological age.After kidney transplantation(KTx) the aged T-cell phenotype persists although the pro-inflammatory milieu is diminished.This might be explained by epigenetic modifications at hematopoietic stem cells level.Assessment of an immunological T-cell age could be an important tool to identify KTx recipients who are at risk for allograft rejection or to prevent over-immunosuppression.展开更多
文摘BACKGROUND Since the beginning of corona virus disease 2019(COVID-19)pandemic,there has been a widespread use of remdesivir in adults and children.There is little known information about its outcomes in patients with end stage renal disease who are on dialysis.AIM To assess the clinical outcomes with use of remdesivir in adult patients with end stage kidney failure on hemodialysis.METHODS A retrospective,multicenter study was conducted on patients with end stage renal disease on hemodialysis that were discharged after treatment for COVID-19 between April 1,2020 and December 31,2020.Primary endpoints were oxygen requirements,time to mortality and escalation of care needing mechanical ventilation.RESULTS A total of 45 patients were included in the study.Twenty patients received remdesivir,and 25 patients did not receive remdesivir.Most patients were caucasian,females with diabetes mellitus and hypertension being the commonest comorbidities.There was a trend towards reduced oxygen requirement(beta=-25.93,X^(2)(1)=6.65,P=0.0099,probability of requiring mechanical ventilation(beta=-28.52,X^(2)(1)=22.98,P<0.0001)and mortality(beta=-5.03,X^(2)(1)=7.41,P=0.0065)in patients that received remdesivir compared to the control group.CONCLUSION Larger studies are justified to study the effects of remdesivir in this high-risk population with end stage kidney disease on dialysis.
文摘Castleman's disease(CD), also known as angiofolicular lymph node hyperplasia, is a rare heterogenous group of lymphoproliferative disorders. Histologically, it can be classified as hyaline vascular type, plasma cell type, or mixed type. Clinically two different subtypes of the CD are present: Unicentric and multicentric. Unicentric CD is generally asymptomatic and associated with hyaline vascular type, and its diagnoses depend on the localized lymphadenopathy on examination or imaging studies. However, multicentric CD presents with generalized lymphadenopathy and systemic symptoms including malaise, fever, night sweats, weight loss, and it is associated with the plasma cell type and mix type. Herein, we report a patient with unicentric CD of the plasma cell type without systemic symptoms, who developed end stage renal failure caused by amyloidosis 6 years after onset of CD.
文摘Background: Nowadays cardiovascular diseases remain as the single most common cause of death in chronic dialysis patients;the aim of this study was to evaluate the effects of two different regimens of dialysis potassium removal in patients with a tendency to develop arrhythmias during haemodialysis (HD). Methods and Materials: There were 88 (36 men and 52 women) end stage renal disease (ESRD) patients recruited for the study. They received regular haemodialysis three times per week at the haemodialysis units of a university medical centre (Golestan hospital) during year 2011. We compared the arrhythmogenic effects of two dialysis techniques. Results: There was a tendency in the HD solution with constant (3 mEq/l) K for premature ventricular complex (PVC) appearance in to be reduced as compared with constant (2 mEq/l) K in the time of dialysis period, although this reduction was not statistically significant(P = 0.09). There was a significant reduction in SVC in the HD solution with constant (3 mEq/l) K as compared with constant (2 mEq/l) K. Discussion: In conclusion, the use of a model of intra-HD potassium that is more close to potassium serum concentration of ESRD patients can reduce the arrhythmogenic effect of HD in patients on regular HD treatment.
文摘Neurotoxicity is an infrequent adverse reaction to iodinated contrast agents. Contrast induced neurotoxicity following coronary angiogram is very rare. Renal disease is a risk factor for contrast induced neurotoxicity. We report a case of contrast induced neurotoxicity following coronary angiogram and intervention using Iohexol(Omnipaque 350) in an end stage renal disease patient on peritoneal dialysis who had prior exposure to iodinated contrast without any adverse reaction. Hemodialysis had to be initiated for rapid removal of the contrast agent with subsequent complete resolution of neurological deficits. This case highlights the need for interventionalists to be aware of an important adverse reaction to iodinated contrast agents, especially in individuals with renal dysfunction, and that neurotoxicity is a possibility even with prior uneventful exposures. The role and timing of hemodialysis in contrast induced neurotoxicity in patients with chronic kidney disease and in those without chronic kidney disease needs further deliberation.
文摘AIM:To understand factors associated with quality of life(QOL),examine types of QOL instruments,and determine need for further improvements in QOL assessment.METHODS:The method used databases(Pubmed,Google scholar) and a bibliographic search using key words QOL,end stage renal disease,Hemodialysis,Peritoneal dialysis,instruments to measure QOL,patients and qualitative/quantitative analysis published during 1990 to June 2014.Each article was assessed for sample size,demographics of participants,study design and type of QOL instruments used.We used WHO definition of QOL.RESULTS:For this review,109 articles were screened,out of which 65 articles were selected.Out of 65 articles,there were 19 reports/reviews and 12 questionnaire manuals.Of the 34 studies,82% were quantitative while only 18% were qualitative.QOL instruments measured several phenomenon such as physical/psychological health,effects and burdens of kidney disease,social support etc.those are associated with QOL.Few studies looked at spiritual beliefs,cultural beliefs,personal concerns,as per the WHO definition.Telemedicine and Palliative care have now been successfully used however QOL instruments seldom addressed those in the articles reviewed.Also noticed wasthat longitudinal studies were rarely conducted.Existing QOL instruments only partially measure QOL.This may limit validity of predictive power of QOL.CONCLUSION:Culture and disease specific QOL instruments that assess patients' objective and subjective experiences covering most aspects of QOL are urgently needed.
文摘End stage renal disease (ESRD),with a prevalence in China of about 200-250 cases per million,is one of the major diseases that seriously threaten human health and cause poverty.Recently,with the advancement of healthcare system reform in China,basic medical insurance now covers over 95％ of urban and rural residents,and a high-reimbursement system for the catastrophic diseases including ESRD has been established.The improvement of healthcare policy calls on the medical community to strengthen healthcare service capability for severe illness,establish standardized pathways for prevention,diagnosis,treatment and rehabilitation according to disease spectrum and characteristics of Chinese population,organize multicenter clinical trials,promote the research and development of medical equipments,devices and drugs,and achieve the overall progress of China's healthcare industry finally.So to say,we are now facing the unprecedented opportunities and challenges as well.
文摘AIM To estimate the risk of end-stage renal disease(ESRD)in patients with inflammatory bowel disease(IBD).METHODS From January 2010 to December 2013, patients with Crohn's disease(CD) and ulcerative colitis(UC) were identified, based on both the International Classification of Diseases, 10 th revision(ICD-10) and the rare,intractable disease registration program codes from the National Health Insurance(NHI) database in South Korea. We compared 38812 patients with IBD to ageand sex-matched non-IBD controls with a ratio of 1:3.Patients newly diagnosed with ESRD were identified with the ICD-10 code.RESULTS During a mean follow-up of 4.9 years, ESRD was detected in 79(0.2%) patients with IBD and 166(0.1%)controls. The incidence of ESRD in patients with IBD was0.42 per 1000 person-years. Patients with IBD had a significantly higher risk of ESRD than controls [adjusted hazard ratio(HR) = 3.03; 95% confidence interval(CI):1.77-5.20; P < 0.001]. The incidences(per 1000 personyears)of ESRD were 0.51 in patients with CD and 0.13 in controls, respectively(adjusted HR = 6.33; 95%CI:2.75-14.56; P < 0.001). In contrast, the incidence of ESRD was similar between the UC and control groups(0.37 vs 0.37 per 1000 person-years; adjusted HR = 2.01;95%CI: 0.90-4.51; P = 0.089).CONCLUSION The risk of ESRD was elevated in patients with CD, but not UC. Patients with CD should be monitored carefully for signs of renal insufficiency.
文摘The diagnosis of extra-pulmonary tuberculosis(TB) seems relatively difficult due to the absence of specific symptoms and signs in patients on peritoneal dialysis or hemodialysis.We report four cases of extra-pulmonary tuberculosis on dialysis,with two cases on peritoneal dialysis and two cases on hemodialysis.The presentations,therapy,and outcomes of TB infection in these patients were reviewed.Otherwise,the English literature published in the PubMed database associating extra-pulmonary tuberculosis on dialysis over the last three decades is reviewed.A total of 61 studies containing 70 cases were included.The most common primary disease was diabetic nephropathy(22.86%,16/70).The peritoneum(31.42%,22/70),bone(21.42%,15/70),and lymph node(20%,14/70) were the most frequently infected.Single organ infection was common(90%,63/70).Fever(58.57%,41/70),pain(35.71%,25/70),and enlarged lymph node(20%,14/70) were the most common symptoms.Biopsy(67.14%,47/70) and culture(40%,28/70) provided most reliable methods for clear diagnosis of tuberculosis.The combined treatment of isoniazid,rifampicin,pyrazinamide,and ethambutol(44.29%,31/70) was the most common therapy.The majority of patients improved(82.86%,58/70);however,12 cases got worse(17.14%),with 10 of them dying(14.29%).Physicians should be aware of the non-specific symptoms and location of infection,and consider tuberculosis in their differential diagnoses in dialysis patients presenting with symptoms such as fever,pain,and weight loss.
文摘End stage renal disease (ESRD) and cardiovascular disease are induced by arteriosclerosis (AS). The latest investigation shows that AS is a special inflammatory state. The constant inflammation,which has been defined as a micro inflammatory state is related to the decline of renal function and blood purification, but not the result of infections caused by external pathogenic microorganisms or internal opportunistic pathogenic microorganisms. We investigated the mechanism of interleukin-10 (IL-10) gene-1082 A/G protection effect to keep ESRD patients away from micro inflammation and AS. METHODS Patients Eight hundred and seventy ESRD patients were randomly chosen, 437 were male and 433 were female. Five hundred patients were treated with hemodialysis and the dialytic time ranged from 1 to 114 months. Normal control group consisted of 1000 healthy persons, 500 were male and 500 were female.
文摘AIM To determine if end-stage renal disease (ESRD) is a risk factor for post endoscopic retrograde cholangio-pancreatography (ERCP) adverse events (AEs). METHODS We performed a retrospective cohort study using the Nationwide Inpatient Sample (NIS) 2011-2013. We identified adult patients who underwent ERCP using the International Classification of Diseases 9^(th) Revision (ICD-9-CM). Included patients were divided into three groups: ESRD, chronic kidney disease (CKD), and control. The primary outcome was post-ERCP AEs including pancreatitis, bleeding, and perforation determined based on specific ICD-9-CM codes. Secondary outcomes were length of hospital stay, in-hospital mortality, and admission cost. AEs and mortality were compared using multivariate logistic regression analysis.RESULTS There were 492175 discharges that underwent ERCP during the 3 years. The ESRD and CKD groups contained 7347 and 39403 hospitalizations respectively, whereas the control group had 445424 hospitalizations. Post-ERCP pancreatitis (PEP) was significantly higher in the ESRD group (8.3%) compared to the control group (4.6%) with adjusted odd ratio (aOR) = 1.7 (95% CI: 1.4-2.1, ~aP < 0.001). ESRD was associated with significantly higher ERCP-related bleeding (5.1%) compared to the control group 1.5% (aOR = 1.86, 95%CI: 1.4-2.4, ~aP < 0.001). ESRD had increased hospital mortality 7.1% vs 1.15% in the control OR = 6.6 (95%CI: 5.3-8.2, ~aP < 0.001), longer hospital stay with adjusted mean difference (aMD) = 5.9 d (95% CI: 5.0-6.7 d, ~aP < 0.001) and higher hospitalization charges aMD = $+82064 (95%CI: $68221-$95906, ~aP < 0.001). CONCLUSION ESRD is a risk factor for post-ERCP AEs and is associated with higher hospital mortality. Careful selection and close monitoring is warranted to improve outcomes.
文摘Diabetic muscle infarction(DMI) refers to spontaneous ischemic necrosis of skeletal muscle among people with diabetes mellitus, unrelated to arterial occlusion. People with DMI may have coexisting end-stage renal disease(ESRD) but little is known about its epidemiology and clinical outcomes in this setting. This scoping review seeks to investigate the characteristics, clinical features, diagnostic evaluation, management and outcomes of DMI among people with ESRD. Electronic database (Pub Med/MEDLINE, CINAHL, SCOPUS and and EMBASE) searches were conducted for ("diabetic muscle infarction" or "diabetic myonecrosis") and("chronic kidney disease" or "renal impairment" or "dialysis" or "renal replacement therapy" or "kidney transplant ") from January 1980 to June 2017. Relevant cases from reviewed bibliographies in reports retrieved were also included. Data were extracted in a standardized form. A total of 24 publications with 41 patients who have ESRD were included. The mean age at the time of presentation with DMI was 44.2 years. Type 2 diabetes was present in 53.7% of patients while type 1 in 41.5%. In this cohort, 60.1% were receiving hemodialysis, 21% on peritoneal dialysis and 12.2% had kidney transplantation. The proximal lower limb musculature was the most commonly affected site. Muscle pain and swelling were the most frequent manifestation on presentation. Magnetic resonance imaging (MRI) provided the most specific findings for DMI. Laboratory investigation findings are usually non-specific. Non-surgical therapy is usually used in the management of DMI. Short-term prognosis of DMI is good but recurrence occurred in 43.9%. DMI is an uncommon complication in patients with diabetes mellitus, including those affected by ESRD. In comparison with unselected patients with DMI, the characteristics and outcomes of those with ESRD are generally similar. DMI may also occur inkidney transplant recipients, including pancreas-kidney transplantation. MRI is the most useful diagnostic investigation. Non-surgical treatment involving analgesia, optimization of glycemic control and initial bed rest can help to improve recovery rate. However, recurrence of DMI is relatively frequent.
文摘AIM To investigate the prevalence and association of Helicobacter pylori(H. pylori) with end-stage renal disease(ESRD).METHODS SA comprehensive literature search was completed from inception until October 2016. Studies that reported prevalence, relative risks, odd ratios, hazard ratios or standardized incidence ratio of H. pylori among ESRD patients were included. Participants without H. pylori were used as comparators to assess the association between H. pylori infection and ESRD. Pooled risk ratios and 95%CI was calculated using a random-effect model. Adjusted point estimates from each study were combined by the generic inverse variance method of DerS imonian and Laird.RESULTS Of 4546 relevant studies, thirty-seven observational studies met all inclusion criteria. Thirty-five crosssectional studies were included in the analyses to assess the prevalence and association of H. pylori with ESRD. The estimated prevalence of H. pylori among ESRD patients was 44%(95%CI: 40%-49%). The pooled RR of H. pylori in patients with ESRD was 0.77(95%CI: 0.59-1.00) when compared with the patients without ESRD. Subgroup analysis showed significantly reduced risk of H. pylori in adult ESRD patients with pooled RR of 0.71(95%CI: 0.55-0.94). The data on the risk of ESRD in patients with H. pylori were limited. Two cohort studies were included to assess the risk of ESRD in patients with H. pylori. The pooled risk RR of ESRD in patients with H. pylori was 0.61(95%CI: 0.03-12.20).CONCLUSION The estimated prevalence of H. pylori in ESRD patients is 44%. Our meta-analysis demonstrates a decreased risk of H. pylori in adult ESRD patients.
文摘We aimed to explore the prevalence of Fabry disease in Thai patients who were diagnosed with end-stage renal disease(ESRD) of an unknown origin.Venous blood samples were collected from ESRD patients for biochemical and molecular studies.Alpha-galactosidase A(a-GAL A) screening was performed from dried-blood spots using fluorometry.Molecular confirmation was performed using DNA sequencing of the GLA gene.A total of 142 male and female patients were included in this study.Ten patients(7.04%) exhibited a significant decrease in a-GAL A activity.There were no definitive pathogenic mutations observed in the molecular study.However,four patients revealed a novel nucleotide variant at c.l-10 C>T,which was identified as a benign variant following screening in the normal population.In conclusion,the a-GAL A assay utilizing dried-blood spots revealed a significant false positive rate.There was no definitive Fabry disease confirmed in Thai patients diagnosed with ESRD of unknown etiology.
文摘AIM To determine the impact of allopurinol non-adherence as a proxy for uncontrolled disease on primary prevention of end-stage renal disease(ESRD).METHODS A cohort of 2752 patients with gout diagnosis was reconstructed using the Québec Régie de l'assurance maladie du Québec and MedE cho administrative databases.Eligible patients were new users of allopurinol,aged 45-85,with a diagnosis of hypertension,and treated with an antihypertensive drug between 1997 and 2007.RESULTS Major risk factor for ESRD onset was chronic kidney disease at stages 1 to 3 [rate ratio(RR) = 8.00;95% confidence interval(CI):3.16-22.3 and the severity of hypertension(≥ 3 vs < 3 antihypertensives)] was a trending risk factor as a crude estimate(RR = 1.94;95%CI:0.68-5.51).Of 341 patients,cases(n = 22) and controls(n = 319),high adherence level(≥ 80%) to allopurinol therapy,compared with lower adherence level(< 80%),was associated with a lower rate of ESRD onset(RR = 0.35;95%CI:0.13-0.91).CONCLUSION Gout control seem to be associated with a significantdecreased risk of ESRD onset in hypertensive populations,further research should be conducted confirming this potential associated risk.
基金support of the Pusan National University Research Grant for 2 years
文摘This study adapted a statistical probabilistic anatomical map of the brain for single photon emission computed tomography images of depressive end-stage renal disease patients. This research aimed to investigate the relationship between symptom clusters, disease severity, and cerebral blood flow. Twenty-seven patients (16 males, 11 females) with stages 4 and 5 end-stage renal disease were enrolled, along with 25 healthy controls. All patients underwent depressive mood assessment and brain single photon emission computed tomography. The statistical probabilistic anatomical map images were used to calculate the brain single photon emission computed tomography counts. Asymmetric index was acquired and Pearson correlation analysis was performed to analyze the correlation between symptom factors, severity, and regional cerebral blood flow. The depression factors of the Hamilton Depression Rating Scale showed a negative correlation with cerebral blood flow in the left amygdale. The insomnia factor showed negative correlations with cerebral blood flow in the left amygdala, right superior frontal gyrus, right middle frontal gyrus, and left middle frontal gyrus. The anxiety factor showed a positive correlation with cerebral glucose metabolism in the cerebellar vermis and a negative correlation with cerebral glucose metabolism in the left globus pallidus, right inferior frontal gyrus, both temporal poles, and left parahippocampus. The overall depression severity (total scores of Hamilton Depression Rating Scale) was negatively correlated with the statistical probabilistic anatomical map results in the left amygdala and right inferior frontal gyrus. In conclusion, our results demonstrated that the disease severity and extent of cerebral blood flow quantified by a probabilistic brain atlas was related to various brain areas in terms of the overall severity and symptom factors in end-stage renal disease patients.
文摘End-stage renal disease(ESRD) patients have a defective T-cell-mediated immune system which is related to excessive premature ageing of the T-cell compartment.This is likely to be caused by the uremia-associated pro-inflammatory milieu,created by loss of renal function.Therefore,ESRD patients are highly susceptible for infections,have an increased risk for virus-associated cancers,respond poorly to vaccination and have an increased risk for atherosclerotic diseases.Three ageing parameters can be used to assess an immunological T-cell age.First,thymic output can be determined by assessing the T-cell receptor excision circlescontent together with CD31 expression within the naive T cells.Second,the telomere length of T cells and third the T-cell differentiation status are also indicators of T-cell ageing.Analyses based on these parameters in ESRD patients revealed that the immunological T-cell age is increased by on average 20 years compared to the chronological age.After kidney transplantation(KTx) the aged T-cell phenotype persists although the pro-inflammatory milieu is diminished.This might be explained by epigenetic modifications at hematopoietic stem cells level.Assessment of an immunological T-cell age could be an important tool to identify KTx recipients who are at risk for allograft rejection or to prevent over-immunosuppression.
