Current Issue : January - March Volume : 2014 Issue Number : 1 Articles : 9 Articles
Background: There is a paucity of information about the views of dialysis nurses towards dialysis modality\r\nselection, yet nurses often have the most direct contact time with patients. We conducted a survey to better\r\nunderstand nurses� attitudes and perceptions, and hypothesized that nurses with different areas of expertise\r\nwould have differences in opinions.\r\nMethods: We administered an electronic survey to all dialysis/predialysis nurses (n = 129) at a large, tertiary care\r\ncenter. The survey included questions about preferred therapy - in-center hemodialysis (CHD), versus home dialysis\r\n(home hemodialysis and peritoneal dialysis) and ideal modality mix. Responses were compared between nurses\r\nwith home dialysis and CHD experience.\r\nResults: The survey response rate was 69%. Both nursing groups ranked patient caregivers and dialysis nurses as\r\nhaving the least impact on patient modality selection. For most patient characteristics (including age > 70 years and\r\npresence of multiple chronic illnesses), CHD nurses felt that CHD was somewhat or strongly preferred, while home\r\ndialysis nurses preferred a home modality (p < 0.001 for all characteristics studied). Similar differences in responses\r\nwere noted for patient/system factors such as patient survival, cost to patients and nursing job security. Compared\r\nto CHD nurses, a higher proportion of home dialysis nurses felt that CHD was over-utilized (85% versus 58%,\r\np = 0.024).\r\nConclusion: Dialysis nurses have prevailing views about modality selection that are strongly determined by their\r\narea of experience and expertise....
Background: Acute kidney injury occurs commonly in hospitalized patients and is associated with significant\r\nmorbidity and mortality. Although renal ultrasound is often performed, its clinical utility in determining of the cause\r\nof acute kidney injury, particularly the detection of urinary tract obstruction, is not established.\r\nMethods: Retrospective cohort study of all adult inpatients that underwent renal ultrasound for acute kidney injury\r\nover a 3-year period at a large university teaching hospital. The frequency of renal ultrasound abnormalities and\r\nclinical characteristics that predicted the finding of urinary tract obstruction was determined.\r\nResults: Over the 3-year period, 1471 renal ultrasounds were performed of which 55% (810) were for evaluation of\r\nacute kidney injury. Renal ultrasound was normal in 62% (500 of 810) of patients. Hydronephrosis was detected in\r\nonly 5% (42 of 810) of studies and in only 2.3% (19 of 810) of the cases was obstructive uropathy considered the\r\ncause of acute kidney injury. The majority of these patients (14 of 19) had a medical history suggestive of urinary\r\ntract obstruction. Less than 1% of patients (5 of 810) had urinary tract obstruction on ultrasound without a\r\nsuggestive medical history. Most other ultrasound findings were incidental and did not establish an etiology for the\r\nacute kidney injury.\r\nConclusions: Renal ultrasound for evaluation of acute kidney injury is indicated if there is medical history\r\nsuggestive of urinary tract obstruction. Otherwise, renal ultrasound is unlikely to yield useful results and should be\r\nused more selectively based on patients� medical history....
Background: Enhanced external counterpulsation (EECP) enhances coronary perfusion and reduces left ventricular\r\nafterload. However, the role of EECP on renal function in cardiac patients is unknown. Our aim was to assess renal\r\nfunction determined by serum cystatin C in cardiac patients before and after EECP treatment.\r\nMethods: A prospective observational longitudinal study was conducted in order to evaluate renal function using\r\nserum cystatin C (Cys C) and estimated glomerular filtration rate (GFR) after 35 sessions of EECP treatment in 30\r\npatients with chronic stable angina and/or heart failure. The median (IQR) time for follow-up period after starting\r\nEECP treatment was 16 (10ââ?¬â??24) months.\r\nResults: Cys C significantly declined from 1.00 (0.78-1.31) to 0.94 (0.77-1.27) mg/L (p < 0.001) and estimated GFR\r\nincreased from 70.47 (43.88-89.41) to 76.27 (49.02-91.46) mL/min/1.73 m2 (p = 0.006) after EECP treatment. Subgroup\r\nanalysis showed that patients with baseline GFR <60 mL/min/1.73 m2 or NT-proBNP >125 pg/mL had a significant\r\ndecrease in Cys C when compared to other groups (p < 0.01).\r\nConclusions: The study demonstrated that EECP could improve long-term renal function in cardiac patients\r\nespecially in cases with declined renal function or with high NT-proBNP....
Background: Responsiveness to erythropoiesis-stimulating agents (ESAs) varies widely among dialysis patients. ESA\r\nresistance has been associated with mortality in hemodialysis (HD) patients, but in peritoneal dialysis (PD) patients\r\ndata is limited. Therefore we assessed the relation between ESA resistance in both HD and PD patients.\r\nMethods: NECOSAD is a Dutch multi-center prospective cohort study of incident dialysis patients who started\r\ndialysis between January 1997 and January 2007. ESA resistance was defined as hemoglobin level < 11 g/dL with an\r\nabove median ESA dose (i.e. 8,000 units/week in HD and 4,000 units/week in PD patients). Unadjusted and adjusted\r\nCox regression analysis for all-cause 5-year mortality was performed for HD and PD patients separately.\r\nResults: 1013 HD and 461 PD patients were included in the analysis. ESA resistant HD patients had an adjusted\r\nhazard ratio of 1.37 (95% CI 1.04-1.80) and ESA resistant PD patients had an adjusted hazard ratio of 2.41 (1.27-4.57)\r\nas compared to patients with a good response.\r\nConclusions: ESA resistance, as defined by categories of ESA and Hb, is associated with increased mortality in both\r\nHD and PD patients. The effect of ESA resistance, ESA dose and hemoglobin are closely related and the exact\r\nmechanism remains unclear. Our results strengthen the need to investigate and treat causes of ESA resistance not\r\nonly in HD, but also in PD patients....
Background: Hepatitis C virus (HCV) infection and chronic kidney disease (CKD) have high prevalences in Taiwan\r\nand worldwide, but the role of HCV infection in causing CKD remains uncertain. This cohort study aimed to explore\r\nthis association.\r\nMethods: This nationwide cohort study examined the association of HCV with CKD by analysis of sampled claims\r\ndata from Taiwan National Health Insurance Research Database from 1998 to 2004. ICD-9 diagnosis codes were\r\nused to identify diseases. We extracted data of 3182 subjects who had newly identified HCV infection and no\r\ntraditional CKD risk factors and data of randomly selected 12728 matched HCV-uninfected control subjects. Each\r\nsubject was tracked for 6 years from the index date to identify incident CKD cases. Cox proportional hazard\r\nregression was used to determine the risk of CKD in the HCV-infected and control groups.\r\nResults: The mean follow-up durations were 5.88 years and 5.92 years for the HCV-infected and control groups,\r\nrespectively. Among the sample of 15910 subjects, 251 subjects (1.6%) developed CKD during the 6-year follow-up\r\nperiod, 64 subjects (2.0%) from the HCV-infected group and 187 subjects (1.5%) from the control group. The incidence\r\nrate of CKD was significantly higher in the HCV-infected group than in the control group (3.42 vs. 2.48 per 1000\r\nperson-years, p = 0.02). Multivariate analysis indicated that the HCV-infected group had significantly greater risk for CKD\r\n(adjusted hazard ratio: 1.75, 95% CI: 1.25-2.43, p = 0.0009). This relationship also held for a comparison of HCV-infected\r\nand HCV-uninfected subjects who were younger than 70 years and had none of traditional CKD risk factors.\r\nConclusions: HCV infection is associated with increased risk for CKD beyond the well-known traditional CKD risk factors.\r\nHCV patients should be informed of their increased risk for development of CKD and should be more closely monitored...
Background: The aim of this study was to evaluate whether a high baseline level of high-sensitivity C-reactive\r\nprotein (hs-CRP) or changes in the level predicts the risk of peritonitis in patients on continuous ambulatory\r\nperitoneal dialysis (CAPD).\r\nMethods: A prospective, cross-sectional, caseââ?¬â??control study was conducted in a single hospital-based PD unit. A\r\ntotal of 327 patients were included in the study. Serum hs-CRP was measured annually for 2 years. Patients were\r\ndivided into 4 groups according to the changes in annual hs-CRP levels (at baseline and at 1 year intervals): group\r\n1 (from <5 mg/L to <5 mg/L, n = 171), group 2 (from <5 mg/L to =5 mg/L, n = 45), group 3 (from =5 mg/L to <5\r\nmg/L, n = 45), and group 4 (from =5 mg/L to =5 mg/L, n = 80). Demographics, biochemistry results, PD adequacy\r\nindices, and peritonitis risk were compared between the groups.\r\nResults: The initial serum albumin level was similar in the 4 groups (p = 0.12). There was a negative linear\r\ncorrelation between the serial albumin change (?alb) and serial hs-CRP change (?hs-CRP; r = -0.154, p = 0.005). The\r\nhazard ratio (HR) for peritonitis was significantly higher in group 2 (HR = 1, reference) than in group 4 (HR = 0.401,\r\n95% CI 0.209 - 0.769). Group 2 had a greater serum albumin decline rate (?alb: ââ?¬â??3% Ã?± 9%) and hs-CRP elevation\r\nrate (?hs-CRP: 835% Ã?± 1232%) compared to those for the other groups.\r\nConclusions: A progressive increase in the hs-CRP level was associated with a corresponding decline in the serum\r\nalbumin level. Progressive rather than persistently high levels of serum hs-CRP predicted peritonitis risk in CAPD patients....
Background: In the general population, reported levels of oxidative stress and antioxidant potential seem to vary.\r\nThe aim of this study was to investigate the levels of oxidant status markers in relation to estimated glomerular\r\nfiltration rate (eGFR) and albuminuria in Japanese population.\r\nMethods: Data were analyzed from 8335 individuals who underwent a general health screening test. For the\r\nestimation of albuminuria, urinary albumin-to-creatinine ratio (UAER) was calculated. Oxidant status was determined\r\nby assessing derivatives of reactive oxygen metabolites (d-ROMs) and biological antioxidant potential (BAP).\r\nResults: After adjusting for age, high blood pressure, depressor agent use, CRP, smoking status, multivariate logistic\r\nregression analysis showed that the lowest eGFR quartile was associated negatively with the top d-ROM quartile in\r\nmen (odds ratio 0.78 [95% CI 0.62-0.98, P = 0.034]) and the highest UAER was associated with the top d-ROM in\r\nmen (odds ratio 1.68) [95% CI 1.35-2.10, P < 0.001]. In addition, both the first eGFR quartile and the fourth UAER\r\nquartile showed significant positive association with low BAP levels in men, but not in women.\r\nConclusions: Among men who underwent general health screening, lower eGFR and increased albuminuria was\r\nnegatively and positively, respectively, associated with higher oxidative stress levels, whereas both conditions were\r\npositively associated with lower antioxidant potential levels....
The burden of chronic kidney disease (CKD) is substantial and is associated with poor health outcomes including\r\nincrease hospitalizations and premature deaths, as well as considerable health care cost. In recognition of this\r\nmounting public health problem, the U.S. Centers for Disease Control and Prevention and their collaborators\r\ncreated a national CKD surveillance system. This commentary introduces the national CKD surveillance system and\r\ndiscusses some of its potential uses...
Background: Vitamin D insufficiency is associated with proteinuria and could be a risk factor for end-stage renal\r\ndisease (ESRD). However, few studies have examined the significance of vitamin D insufficiency as a contributing\r\nfactor for the development of ESRD in the Asian chronic kidney disease (CKD) population.\r\nMethods: Authors examined the relationship between vitamin D status and the staging of CKD using data from an\r\noutpatient clinic-based screening in 2,895 Thai CKD patients. Serum levels of 25-hydroxyvitamin D were analyzed\r\naccording to CKD stages. Vitamin D deficiency and insufficiency were defined as a serum 25-hydroxyvitamin D\r\nconcentration < 10 ng/mL and 10ââ?¬â??30 ng/mL, respectively.\r\nResults: The mean (SD) 25-hydroxyvitamin D levels were significantly lower according to severity of renal\r\nimpairment (CKD stage 3a: 27.84Ã?±14.03 ng/mL, CKD stage 3b: 25.86Ã?±11.14 ng/mL, CKD stage 4: 24.09Ã?±11.65 and\r\nCKD stage 5: 20.82Ã?±9.86 ng/mL, p<0.001). The prevalence of vitamin D deficiency/insufficiency was from CKD stage\r\n3a, 3b, 4 to 5, 66.6%, 70.9%, 74.6%, and 84.7% (p<0.001). The odds ratio (95% CI) of vitamin D insufficiency/\r\ndeficiency (serum 25-hydroxyvitamin D = 30 ng/mL) and vitamin D deficiency (serum 25-hydroxyvitamin D < 10\r\nng/mL) for developing ESRD, after adjustment for age, gender, hemoglobin, serum albumin, calcium, phosphate\r\nand alkaline phosphatase were 2.19 (95% CI 1.07 to 4.48) and 16.76 (95% CI 4.89 to 57.49), respectively.\r\nConclusion: This study demonstrates that 25-hydroxyvitamin D insufficiency and deficiency are more common and\r\nassociated with the level of kidney function in the Thai CKD population especially advanced stage of CKD....
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