Non-descriptive and convenient labels are uninformative and unfairly project blame onto patients.The language clinicians use in the Electronic Medical Record,research,and clinical settings shapes biases and subsequent...Non-descriptive and convenient labels are uninformative and unfairly project blame onto patients.The language clinicians use in the Electronic Medical Record,research,and clinical settings shapes biases and subsequent behaviors of all providers involved in the enterprise of transplantation.Terminology such as noncompliant and nonadherent serve as a reason for waitlist inactivation and limit access to life-saving transplantation.These labels fail to capture all the circum-stances surrounding a patient’s inability to follow their care regimen,trivialize social determinants of health variables,and bring unsubstantiated subjectivity into decisions regarding organ allocation.Furthermore,insufficient Medicare coverage has forced patients to ration or stop taking medication,leading to allograft failure and their subsequent diagnosis of noncompliant.We argue that perpetuating non-descriptive language adds little substantive information,in-creases subjectivity to the organ allocation process,and plays a major role in reduced access to transplantation.For patients with existing barriers to care,such as racial/ethnic minorities,these effects may be even more drastic.Transplant committees must ensure thorough documentation to correctly encapsulate the entirety of a patient’s position and give voice to an already vulnerable population.展开更多
The structure and function of brain networks have been altered in patients with end-stage renal disease(ESRD).Manifold regularization(MR)only considers the pairing relationship between two brain regions and cannot rep...The structure and function of brain networks have been altered in patients with end-stage renal disease(ESRD).Manifold regularization(MR)only considers the pairing relationship between two brain regions and cannot represent functional interactions or higher-order relationships between multiple brain regions.To solve this issue,we developed a method to construct a dynamic brain functional network(DBFN)based on dynamic hypergraph MR(DHMR)and applied it to the classification of ESRD associated with mild cognitive impairment(ESRDaMCI).The construction of DBFN with Pearson’s correlation(PC)was transformed into an optimization model.Node convolution and hyperedge convolution superposition were adopted to dynamically modify the hypergraph structure,and then got the dynamic hypergraph to form the manifold regular terms of the dynamic hypergraph.The DHMR and L_(1) norm regularization were introduced into the PC-based optimization model to obtain the final DHMR-based DBFN(DDBFN).Experiment results demonstrated the validity of the DDBFN method by comparing the classification results with several related brain functional network construction methods.Our work not only improves better classification performance but also reveals the discriminative regions of ESRDaMCI,providing a reference for clinical research and auxiliary diagnosis of concomitant cognitive impairments.展开更多
Purpose: In this study, we aimed to discuss the laparoscopic cholecystectomy in patients with end stage renal disease compared to the general population. Materials and Methods: We retrospectively evaluated a group of ...Purpose: In this study, we aimed to discuss the laparoscopic cholecystectomy in patients with end stage renal disease compared to the general population. Materials and Methods: We retrospectively evaluated a group of patients with (n = 45) and without (n = 90) end-stage renal disease undergoing laparoscopic cholecystectomy. The groups were compared in terms of length of surgery;duration of hospitalization after surgery;use of blood derivatives;mortality rates;and perioperative, postoperative, and postdischarge complications. Results: Patients with end-stage renal disease exhibited a higher frequency of associated diseases;lower hemoglobin levels;and elevated alkaline phosphatase, blood urea nitrogen, and creatinine values. Statistically significant differences were found between the two groups regarding length of surgery (83.6 ± 14.88 vs. 71.7 ± 11.42 minutes;p p p = 0.011), postoperative (p p = 0.011) rates. Among all patients with end-stage renal disease, 12 (26.7%) were converted to an open procedure (p < 0.001). Conclusion: Despite higher complication rates of laparoscopic cholecystectomy in end-stage renal disease patients, laparoscopic cholecystectomy could be performed safely in patients with end-stage renal disease with low levels of complications and no associated mortality.展开更多
BACKGROUND The estimation of left ventricular ejection fraction(LVEF)by 2D echocardiography(2D-ECHO)is the most used tool to assess LV systolic function(LVSF).Global longitudinal strain(GLS)has recently been suggested...BACKGROUND The estimation of left ventricular ejection fraction(LVEF)by 2D echocardiography(2D-ECHO)is the most used tool to assess LV systolic function(LVSF).Global longitudinal strain(GLS)has recently been suggested as a superior method for several evaluations.This study explored the association and prevalence of LV systolic dysfunction(LVSD)by using these methods in patients with end-stage renal disease(ESRD)and severe hyperparathyroidism(SHPTH);both associated with cardiovascular events(CEs).AIM To evaluate the myocardial function in patients with ESRD and SHPTH by using the GLS and LVEF measured through conventional 2D-ECHO.METHODS In 62 patients with ESRD and SHPTH,asymptomatic,and without a history of CEs,LVSF was evaluated by 2D-ECHO,obtaining the EF,by the Simpson biplane method,and GLS by speckle tracking.RESULTS The total patients with ESRD had a preserved LVEF(>50%)but abnormal GLS(<13.55%).Additionally,multivariate analysis showed an independent association of GLS and serum parathyroid hormone(PTH),LV mass index,and hemoglobin.Also,PTH was independently associated with lateral e'wave and tricuspid regurgitation velocity.CONCLUSION In patients with SHPTH linked to ESRD,the use of GLS by 2D-ECHO is a more sensitive tool than LVEF for detecting LVSD.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
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
Background: Although the radial artery (RA) is mostly selected for the creating of arterio-venous fistula (AVF) in end-stage renal disease patients (ESRDP), it still represents a suitable site to simply assess systemi...Background: Although the radial artery (RA) is mostly selected for the creating of arterio-venous fistula (AVF) in end-stage renal disease patients (ESRDP), it still represents a suitable site to simply assess systemic calcification. Our goal of this study was to research the RA before the arteriovenous fistula creation in ESRDP and evaluate the risk factor determinants. Material and Methods: The RA has been determined to estimate vascular calcification in 67 ESRDPs on dialysis by doppler ultrasonography (USG). If there was any pathologic conditions, direct examination of the forehand soft tissue roentgenograms as a simply method was made. Preoperative spectral Doppler sonography measured radial artery peak systolic velocity during tight fist clenching for 3 minutes and after fist relaxation. Vessel diameters and peak systolic velocity were assessed for predictive value based on subsequent fistula adequacy. RA calcification was scored from Grade 0 which was defined as no calcification to Grade 4 which was described as severe calcification from proximal to distal end of RA. Results: Doppler USG has shown that the major or minor RA calcification was detected in 11 patients (16.5%). In these patients, direct roentgenogram also demonstrated RA calcific disease. Total and LDL cholesterol levels, gender and smoking status have no influence on calcification scores. When the dialysis periods are concerned, there was no correlation with the RA calcification. Serum calcium and phosphate levels, rather than calcium-phosphate products, and age were correlated with high calcification scores. The highest prevalence of RA calcification was also found in diabetic group. Conclusion: Our data indicate that RA calcification is highly prevalent among ESRDP, with the highest prevalence among diabetics. The RA was used as an A-V fistual creation in ESRDPs, which may be risky since the calcification percentage is higher. Therefore, a simple roentgenographic survey may help to identify patients with severe calcified RA. Because our roengenographyc results were correlated with doppler USG, it can be used to determine RA calcific disease before the arteriovenous fistula creation.展开更多
In 2015, 634387 million people(9% of the world's population) resided in Latin America(LA), with half of those populating Brazil and Mexico. The LA Dialysis and Transplant Registry was initiated in 1991, with the a...In 2015, 634387 million people(9% of the world's population) resided in Latin America(LA), with half of those populating Brazil and Mexico. The LA Dialysis and Transplant Registry was initiated in 1991, with the aim of collecting data on renal replacement therapy(RRT) from the 20 LA-affiliated countries. Since then, the Registry has revealed a trend of increasing prevalence and incidence of end-stage kidney disease on RRT, which is ongoing and is correlated with gross national income, life expectancy at birth, and percentage of population that is older than 65 years. In addition, the rate of kidney transplantation has increased yearly, with > 70% being performed from deceased donors. According to the numbers reported for 2013, the rates of prevalence, incidence and transplantation were(in patients per million population) 669, 149 and 19.4, respectively. Hemodialysis was the treatment of choice(90%), and 43% of the patients undergoing this treatment was located in Brazil; in contrast, peritoneal dialysis prevailed in Costa Rica, El Salvador and Guatemala. To date, the Registry remains the only source of RRT data available to healthcare authorities in many LA countries. It not only serves to promote knowledge regarding epidemiology of end-stage renal disease and the related RRT but also for training of nephrologists and renal researchers, to improve understanding and clinical application of dialysis and transplantation services. In LA, accessibility to RRT is still limited and it remains necessary to develop effective programs that will reduce risk factors, promote early diagnosis and treatment of chronic kidney disease, and strengthen transplantation programs.展开更多
Over recent years,the nomenclature of non-alcoholic fatty liver disease has undergone significant changes.Indeed,in 2020,an expert consensus panel proposed the term“Metabolic(dysfunction)associated fatty liver diseas...Over recent years,the nomenclature of non-alcoholic fatty liver disease has undergone significant changes.Indeed,in 2020,an expert consensus panel proposed the term“Metabolic(dysfunction)associated fatty liver disease”(MAFLD)to underscore the close association of fatty liver with metabolic abnormalities,thereby highlighting the cardiometabolic risks(such as metabolic syndrome,type 2 diabetes,insulin resistance,and cardiovascular disease)faced by these patients since childhood.More recently,this term has been further replaced with metabolic associated steatotic liver disease.It is worth noting that emerging evidence not only supports a close and independent association of MAFLD with chronic kidney disease in adults but also indicates its interplay with metabolic impairments.However,comparable pediatric data remain limited.Given the progressive and chronic nature of both diseases and their prognostic cardiometabolic implications,this editorial aims to provide a pediatric perspective on the intriguing relationship between MAFLD and renal function in childhood.展开更多
Frailty and sarcopenia are frequently observed in patients with end-stage liver disease.Frailty is a complex condition that arises from deteriorations across various physiological systems,including the musculoskeletal...Frailty and sarcopenia are frequently observed in patients with end-stage liver disease.Frailty is a complex condition that arises from deteriorations across various physiological systems,including the musculoskeletal,cardiovascular,and immune systems,resulting in a reduced ability of the body to withstand stressors.This condition is associated with declined resilience and increased vulnerability to negative outcomes,including disability,hospitalization,and mortality.In cirrhotic patients,frailty is influenced by multiple factors,such as hyperammonemia,hormonal imbalance,malnutrition,ascites,hepatic encephalopathy,and alcohol intake.Assessing frailty is crucial in predicting morbidity and mortality in cirrhotic patients.It can aid in making critical decisions regarding patients’eligibility for critical care and transplantation.This,in turn,can guide the development of an individualized treatment plan for each patient with cirrhosis,with a focus on prioritizing exercise,proper nutrition,and appropriate treatment of hepatic complications as the primary lines of treatment.In this review,we aim to explore the topic of frailty in liver diseases,with a particular emphasis on pathophysiology,clinical assessment,and discuss strategies for preventing frailty through effective treatment of hepatic complications.Furthermore,we explore novel assessment and management strategies that have emerged in recent years,including the use of wearable technology and telemedicine.展开更多
Background and Aims:Patients with chronic hepatitis C (CHC) and end-stage renal disease (ESRD) who are dialysisdependent form a unique group,in which safety,tolerability and efficacy of sofosbuvir (SOF)-based direct-a...Background and Aims:Patients with chronic hepatitis C (CHC) and end-stage renal disease (ESRD) who are dialysisdependent form a unique group,in which safety,tolerability and efficacy of sofosbuvir (SOF)-based direct-acting antivirals (DAAs) need further evaluation.Methods:We performed a retrospective analysis of 14 patients with CHC and ESRD on dialysis who received 15 courses of SOF-based therapy.We evaluated dose escalation to standard-dose SOF in this proof-of-principle experience.Results:Sustained virological response (defined as undetectable viral load at 12 weeks,SVR-12) was achieved in 13 out of the 15 (86.7%) treatment courses.Seven (46.6%) patients received reduced half dose as conservative proof-of-principal to mitigate potential toxicity.In 13 out of 15 treatment courses,patients completed the designated treatment duration.One patient was treated twice and developed SVR-12 with the retreatment.One patient was lost to follow-up and counted as a non-responder.Premature discontinuations were not due to DAA-related adverse effects.There were no reports of severe adverse effects or drug interactions.Conclusion:We treated CHC patients with ESRD using dose escalation to standard-dose SOF in this proof-of-principle experience and achieved SVR rates comparable to general population.展开更多
文摘Non-descriptive and convenient labels are uninformative and unfairly project blame onto patients.The language clinicians use in the Electronic Medical Record,research,and clinical settings shapes biases and subsequent behaviors of all providers involved in the enterprise of transplantation.Terminology such as noncompliant and nonadherent serve as a reason for waitlist inactivation and limit access to life-saving transplantation.These labels fail to capture all the circum-stances surrounding a patient’s inability to follow their care regimen,trivialize social determinants of health variables,and bring unsubstantiated subjectivity into decisions regarding organ allocation.Furthermore,insufficient Medicare coverage has forced patients to ration or stop taking medication,leading to allograft failure and their subsequent diagnosis of noncompliant.We argue that perpetuating non-descriptive language adds little substantive information,in-creases subjectivity to the organ allocation process,and plays a major role in reduced access to transplantation.For patients with existing barriers to care,such as racial/ethnic minorities,these effects may be even more drastic.Transplant committees must ensure thorough documentation to correctly encapsulate the entirety of a patient’s position and give voice to an already vulnerable population.
基金supported by the National Natural Science Foundation of China (No.51877013),(ZJ),(http://www.nsfc.gov.cn/)the Jiangsu Provincial Key Research and Development Program (No.BE2021636),(ZJ),(http://kxjst.jiangsu.gov.cn/)+1 种基金the Science and Technology Project of Changzhou City (No.CE20205056),(ZJ),(http://kjj.changzhou.gov.cn/)by Qing Lan Project of Jiangsu Province (no specific grant number),(ZJ),(http://jyt.jiangsu.gov.cn/).
文摘The structure and function of brain networks have been altered in patients with end-stage renal disease(ESRD).Manifold regularization(MR)only considers the pairing relationship between two brain regions and cannot represent functional interactions or higher-order relationships between multiple brain regions.To solve this issue,we developed a method to construct a dynamic brain functional network(DBFN)based on dynamic hypergraph MR(DHMR)and applied it to the classification of ESRD associated with mild cognitive impairment(ESRDaMCI).The construction of DBFN with Pearson’s correlation(PC)was transformed into an optimization model.Node convolution and hyperedge convolution superposition were adopted to dynamically modify the hypergraph structure,and then got the dynamic hypergraph to form the manifold regular terms of the dynamic hypergraph.The DHMR and L_(1) norm regularization were introduced into the PC-based optimization model to obtain the final DHMR-based DBFN(DDBFN).Experiment results demonstrated the validity of the DDBFN method by comparing the classification results with several related brain functional network construction methods.Our work not only improves better classification performance but also reveals the discriminative regions of ESRDaMCI,providing a reference for clinical research and auxiliary diagnosis of concomitant cognitive impairments.
文摘Purpose: In this study, we aimed to discuss the laparoscopic cholecystectomy in patients with end stage renal disease compared to the general population. Materials and Methods: We retrospectively evaluated a group of patients with (n = 45) and without (n = 90) end-stage renal disease undergoing laparoscopic cholecystectomy. The groups were compared in terms of length of surgery;duration of hospitalization after surgery;use of blood derivatives;mortality rates;and perioperative, postoperative, and postdischarge complications. Results: Patients with end-stage renal disease exhibited a higher frequency of associated diseases;lower hemoglobin levels;and elevated alkaline phosphatase, blood urea nitrogen, and creatinine values. Statistically significant differences were found between the two groups regarding length of surgery (83.6 ± 14.88 vs. 71.7 ± 11.42 minutes;p p p = 0.011), postoperative (p p = 0.011) rates. Among all patients with end-stage renal disease, 12 (26.7%) were converted to an open procedure (p < 0.001). Conclusion: Despite higher complication rates of laparoscopic cholecystectomy in end-stage renal disease patients, laparoscopic cholecystectomy could be performed safely in patients with end-stage renal disease with low levels of complications and no associated mortality.
基金Supported by the Secretaría de Investigación y Posgrado of the Instituto Politécnico Nacionalthe Comisión de Operación y Fomento de Actividades Académicas of the Instituto Politécnico Nacionalthe Consejo Nacional de Ciencia y Tecnología
文摘BACKGROUND The estimation of left ventricular ejection fraction(LVEF)by 2D echocardiography(2D-ECHO)is the most used tool to assess LV systolic function(LVSF).Global longitudinal strain(GLS)has recently been suggested as a superior method for several evaluations.This study explored the association and prevalence of LV systolic dysfunction(LVSD)by using these methods in patients with end-stage renal disease(ESRD)and severe hyperparathyroidism(SHPTH);both associated with cardiovascular events(CEs).AIM To evaluate the myocardial function in patients with ESRD and SHPTH by using the GLS and LVEF measured through conventional 2D-ECHO.METHODS In 62 patients with ESRD and SHPTH,asymptomatic,and without a history of CEs,LVSF was evaluated by 2D-ECHO,obtaining the EF,by the Simpson biplane method,and GLS by speckle tracking.RESULTS The total patients with ESRD had a preserved LVEF(>50%)but abnormal GLS(<13.55%).Additionally,multivariate analysis showed an independent association of GLS and serum parathyroid hormone(PTH),LV mass index,and hemoglobin.Also,PTH was independently associated with lateral e'wave and tricuspid regurgitation velocity.CONCLUSION In patients with SHPTH linked to ESRD,the use of GLS by 2D-ECHO is a more sensitive tool than LVEF for detecting LVSD.
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.
文摘Background: Although the radial artery (RA) is mostly selected for the creating of arterio-venous fistula (AVF) in end-stage renal disease patients (ESRDP), it still represents a suitable site to simply assess systemic calcification. Our goal of this study was to research the RA before the arteriovenous fistula creation in ESRDP and evaluate the risk factor determinants. Material and Methods: The RA has been determined to estimate vascular calcification in 67 ESRDPs on dialysis by doppler ultrasonography (USG). If there was any pathologic conditions, direct examination of the forehand soft tissue roentgenograms as a simply method was made. Preoperative spectral Doppler sonography measured radial artery peak systolic velocity during tight fist clenching for 3 minutes and after fist relaxation. Vessel diameters and peak systolic velocity were assessed for predictive value based on subsequent fistula adequacy. RA calcification was scored from Grade 0 which was defined as no calcification to Grade 4 which was described as severe calcification from proximal to distal end of RA. Results: Doppler USG has shown that the major or minor RA calcification was detected in 11 patients (16.5%). In these patients, direct roentgenogram also demonstrated RA calcific disease. Total and LDL cholesterol levels, gender and smoking status have no influence on calcification scores. When the dialysis periods are concerned, there was no correlation with the RA calcification. Serum calcium and phosphate levels, rather than calcium-phosphate products, and age were correlated with high calcification scores. The highest prevalence of RA calcification was also found in diabetic group. Conclusion: Our data indicate that RA calcification is highly prevalent among ESRDP, with the highest prevalence among diabetics. The RA was used as an A-V fistual creation in ESRDPs, which may be risky since the calcification percentage is higher. Therefore, a simple roentgenographic survey may help to identify patients with severe calcified RA. Because our roengenographyc results were correlated with doppler USG, it can be used to determine RA calcific disease before the arteriovenous fistula creation.
文摘In 2015, 634387 million people(9% of the world's population) resided in Latin America(LA), with half of those populating Brazil and Mexico. The LA Dialysis and Transplant Registry was initiated in 1991, with the aim of collecting data on renal replacement therapy(RRT) from the 20 LA-affiliated countries. Since then, the Registry has revealed a trend of increasing prevalence and incidence of end-stage kidney disease on RRT, which is ongoing and is correlated with gross national income, life expectancy at birth, and percentage of population that is older than 65 years. In addition, the rate of kidney transplantation has increased yearly, with > 70% being performed from deceased donors. According to the numbers reported for 2013, the rates of prevalence, incidence and transplantation were(in patients per million population) 669, 149 and 19.4, respectively. Hemodialysis was the treatment of choice(90%), and 43% of the patients undergoing this treatment was located in Brazil; in contrast, peritoneal dialysis prevailed in Costa Rica, El Salvador and Guatemala. To date, the Registry remains the only source of RRT data available to healthcare authorities in many LA countries. It not only serves to promote knowledge regarding epidemiology of end-stage renal disease and the related RRT but also for training of nephrologists and renal researchers, to improve understanding and clinical application of dialysis and transplantation services. In LA, accessibility to RRT is still limited and it remains necessary to develop effective programs that will reduce risk factors, promote early diagnosis and treatment of chronic kidney disease, and strengthen transplantation programs.
文摘Over recent years,the nomenclature of non-alcoholic fatty liver disease has undergone significant changes.Indeed,in 2020,an expert consensus panel proposed the term“Metabolic(dysfunction)associated fatty liver disease”(MAFLD)to underscore the close association of fatty liver with metabolic abnormalities,thereby highlighting the cardiometabolic risks(such as metabolic syndrome,type 2 diabetes,insulin resistance,and cardiovascular disease)faced by these patients since childhood.More recently,this term has been further replaced with metabolic associated steatotic liver disease.It is worth noting that emerging evidence not only supports a close and independent association of MAFLD with chronic kidney disease in adults but also indicates its interplay with metabolic impairments.However,comparable pediatric data remain limited.Given the progressive and chronic nature of both diseases and their prognostic cardiometabolic implications,this editorial aims to provide a pediatric perspective on the intriguing relationship between MAFLD and renal function in childhood.
文摘Frailty and sarcopenia are frequently observed in patients with end-stage liver disease.Frailty is a complex condition that arises from deteriorations across various physiological systems,including the musculoskeletal,cardiovascular,and immune systems,resulting in a reduced ability of the body to withstand stressors.This condition is associated with declined resilience and increased vulnerability to negative outcomes,including disability,hospitalization,and mortality.In cirrhotic patients,frailty is influenced by multiple factors,such as hyperammonemia,hormonal imbalance,malnutrition,ascites,hepatic encephalopathy,and alcohol intake.Assessing frailty is crucial in predicting morbidity and mortality in cirrhotic patients.It can aid in making critical decisions regarding patients’eligibility for critical care and transplantation.This,in turn,can guide the development of an individualized treatment plan for each patient with cirrhosis,with a focus on prioritizing exercise,proper nutrition,and appropriate treatment of hepatic complications as the primary lines of treatment.In this review,we aim to explore the topic of frailty in liver diseases,with a particular emphasis on pathophysiology,clinical assessment,and discuss strategies for preventing frailty through effective treatment of hepatic complications.Furthermore,we explore novel assessment and management strategies that have emerged in recent years,including the use of wearable technology and telemedicine.
文摘Background and Aims:Patients with chronic hepatitis C (CHC) and end-stage renal disease (ESRD) who are dialysisdependent form a unique group,in which safety,tolerability and efficacy of sofosbuvir (SOF)-based direct-acting antivirals (DAAs) need further evaluation.Methods:We performed a retrospective analysis of 14 patients with CHC and ESRD on dialysis who received 15 courses of SOF-based therapy.We evaluated dose escalation to standard-dose SOF in this proof-of-principle experience.Results:Sustained virological response (defined as undetectable viral load at 12 weeks,SVR-12) was achieved in 13 out of the 15 (86.7%) treatment courses.Seven (46.6%) patients received reduced half dose as conservative proof-of-principal to mitigate potential toxicity.In 13 out of 15 treatment courses,patients completed the designated treatment duration.One patient was treated twice and developed SVR-12 with the retreatment.One patient was lost to follow-up and counted as a non-responder.Premature discontinuations were not due to DAA-related adverse effects.There were no reports of severe adverse effects or drug interactions.Conclusion:We treated CHC patients with ESRD using dose escalation to standard-dose SOF in this proof-of-principle experience and achieved SVR rates comparable to general population.
