Variability of Serum Phosphate in Incident Hemodialysis Patients: Association with All-Cause Mortality.

Key Points: An increase in serum phosphate variability is an independent risk factor of mortality. The effects of a positive directional range (DR) is most pronounced in patients with high serum phosphate levels whereas the effects of a negative DR is most pronounced in patients with low serum phosphate and/or serum albumin.

Background: In maintenance hemodialysis (HD) patients, previous studies have shown that serum phosphate levels have a bidirectional relation to outcome.

Impact of fluid status and inflammation and their interaction on survival: a study in an international hemodialysis patient cohort.

In hemodialysis patients extracellular fluid overload is a predictor of all-cause and cardiovascular mortality, and a relation with inflammation has been reported in previous studies. The magnitude and nature of this interaction and the effects of moderate fluid overload and extracellular fluid depletion on survival are still unclear. We present the results of an international cohort study in 8883 hemodialysis patients from the European MONDO initiative database where, during a three-month baseline period, fluid status was assessed using bioimpedance and inflammation by C-reactive protein.

The Clinical Course of Minimal Change Nephrotic Syndrome With Onset in Adulthood or Late Adolescence: A Case Series.

Background: Few studies have examined the treatment and outcome of adult-onset minimal change nephrotic syndrome (MCNS). We retrospectively studied 125 patients who had MCNS with onset in either adulthood or late adolescence. Presenting characteristics, duration of initial treatment and response to treatment, relapse patterns, complications, and long-term outcome were studied.

Steroid use is associated with clinically irrelevant biopsies in patients with suspected giant cell arteritis.

Temporal artery biopsy (TAB) is the diagnostic gold standard for giant cell arteritis (GCA). GCA is treated by high-dose corticosteroids. In cases of high clinical suspicion, steroids may be administrated despite negative TAB, making TAB clinically irrelevant.

Moderate elevations of high-sensitivity cardiac troponin I and B-type natriuretic peptide in chronic hemodialysis patients are associated with mortality.

Background: Several biomarkers are associated with mortality in hemodialysis patients. In particular, elevated cardiac troponin T and B-type natriuretic peptide (BNP) are strong predictors of mortality; however, less is known about cardiac troponin I (cTnI). Elevated troponin I is detected in many hemodialysis patients, but the association of moderate elevations with mortality is unclear.

Prospective study on clinical effects of renal replacement therapy in treatment-resistant congestive heart failure.

Background/aims: Clinical outcome in cardiorenal syndrome (CRS) Type 2 and treatment with dialysis.

Methods: Prospective observational non-randomized study.

Results: Twenty-three patients were included, mean age 66±21 years.

Fluid state and blood pressure control: no differences between APD and CAPD.

The aim of this study was to compare fluid state, ambulatory blood pressure, and sodium removal in automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD). This observational, cross-sectional study comprised 20 APD and 24 CAPD patients with a mean duration on peritoneal dialysis of 30 ± 26 and 21 ± 23 months, respectively. Sixty-four percent of the patients were treated with icodextrin.

Quantification of free water transport during the peritoneal equilibration test.

Objective: Free water transport (FWT) can be calculated after a dwell of 1 hour with a 3.86% glucose solution using sodium kinetics (mini-PET, as developed by LaMilia et al.).

Inflammation, overhydration and cardiac biomarkers in haemodialysis patients: a longitudinal study.

Background: Inflammation, overhydration and elevated cardiac biomarkers are related to outcome in haemodialysis (HD) patients. Here, we explored the relationship between the body composition (BC), inflammation and cardiac biomarker concentrations in HD patients longitudinally.

Methods: A total of 44 HD patients were followed for 6 months.

Pregnancy in classic galactosemia despite undetectable anti-Müllerian hormone.

Objective: To report a pregnancy in a patient with classic galactosemia despite signs of no ovarian reserve to draw attention to the limited predictive value of ovarian reserve tests in these patients.

Design: Case report.

Setting: Secondary and tertiary care center.

Clinical effects of icodextrin in peritoneal dialysis.

Objective. This study reviews the relevant publications on the clinical effects of icodextrin in peritoneal dialysis (PD). Design.

Different treatment options in peritoneal dialysis.

Patients with end-stage renal disease (ESRD) are placed on dialysis while they await kidney transplantation. The mortality rate among patients with ESRD is high. This review outlines the importance of preservation of residual renal function (RRF) and supports the idea of the integrated care approach to uraemia where patients start on peritoneal dialysis (PD).

Pegylated interferon alfa-2a (40 kD) and ribavirin in haemodialysis patients with chronic hepatitis C.

Background: Chronic hepatitis C virus (HCV) infection is associated with liver dysfunction and hepatocellular carcinoma. In patients with normal kidney function, treatment with pegylated interferon (PEG-IFN) and ribavirin (RBV) frequently leads to eradication of HCV. Treatment in dialysis patients has long been controversial and until recently, the use of RBV was considered to be contra-indicated.

Peritoneal dialysis in patients with congestive heart failure.

Background: Peritoneal dialysis (PD) may be a useful technique in the treatment of patients with congestive heart failure, both with and without primary end-stage renal disease (ESRD).

Methods: In the treatment of patients with ESRD and congestive heart failure (CHF), PD has theoretical advantages compared with haemodialysis (HD), such as the absence of an arteriovenous fistula and the more gradual fluid removal. In cohort studies, the incidence of heart failure was less as compared with HD, however, randomized studies on this aspect are lacking.

Peritoneal sclerosis--aetiology, diagnosis, treatment and prevention.

Peritoneal selerosis (PS) is a rare, but potentially life-threatening complication in peritoneal dialysis (PD). The annual incidence increases with the duration of PD treatment and the mortality rate is high. Aetiology of PS is probably multifactorial and in most cases not exactly known.

Is there a competition between urine volume and peritoneal ultrafiltration in peritoneal dialysis patients?

Many peritoneal dialysis patients are overhydrated. Overhydration may lead to hypertension and left ventricular hypertrophy, and may be related to inflammation and malnutrition. The presence of overhydration is not always detected by clinical examination.

Influence of icodextrin on plasma and dialysate levels of N(epsilon)-(carboxymethyl)lysine and N(epsilon)-(carboxyethyl)lysine.

Rationale: Standard peritoneal glucose solutions may induce the formation of advanced glycation end products (AGEs). Preliminary data suggest that AGE formation may be less with the use of polyglucose solutions (icodextrin). Therefore, we investigated whether the use of icodextrin for the long dwell would result in a reduction in plasma and dialysate levels of the AGE products N(epsilon)-(carboxymethyl) lysine (CML) and N(epsilon)-(carboxyethyl) ysine (CEL).

Study on the relationship of serum fetuin-A concentration with aortic stiffness in patients on dialysis.

Background: An increase in aortic stiffness, as reflected by an increase in pulse wave velocity (PWV) or aortic augmentation index (AI) is an important predictor of cardiovascular mortality in dialysis patients. Dysregulation of calcification inhibitors, such as fetuin-A, is involved in vascular pathology in dialysis patients and fetuin-A is inversely related to mortality in dialysis patients. In this study, the relation between serum fetuin-A concentration and parameters of aortic stiffness was investigated in patients with end-stage renal disease.

Nepsilon-(carboxymethyl)lysine, Nepsilon-(carboxyethyl)lysine and vascular cell adhesion molecule-1 (VCAM-1) in relation to peritoneal glucose prescription and residual renal function; a study in peritoneal dialysis patients.

Background: Advanced glycation end products (AGEs) may contribute to peritoneal and cardiovascular damage in peritoneal dialysis (PD) patients, possibly in part by over-expression of vascular cell adhesion molecule-1 (VCAM-1). It has been suggested that peritoneal glucose load, oxidative stress, as well as the uraemic state itself may lead to an increased formation of AGEs. Aims of the present study were first to investigate the relation between residual glomerular filtration rate (rGFR), malondialdehyde (MDA) as a marker of lipid peroxidation, and peritoneal glucose prescription and absorption with serum levels of VCAM-1 and with the well characterized AGEs N(epsilon)-(carboxymethyl)lysine (CML) and N(epsilon)-(carboxyethyl)lysine (CEL), as well as with CML and CEL in peritoneal effluent.

Determinants of arterial distensibility in patients with renal failure.

Background: An increased stiffness of the arterial system is an adverse risk factor for the outcome in patients with renal disease. Few studies have focused on the determinants of an increased arterial stiffness in patients with renal failure. As the percentage of patients with renal failure secondary to vascular disease and/or diabetes mellitus is rapidly growing, and the underlying disease per se may also influence the arterial wall properties, it may also be of interest to study the arterial wall properties in relation to the etiology of kidney disease.

Influence of fluid status on techniques used to assess body composition in peritoneal dialysis patients.

Objective: A reliable assessment of nutritional state in peritoneal dialysis (PD) patients is of great importance. Nevertheless, techniques used to assess body composition in patients on PD may be affected by abnormalities in fluid status. The primary aim of the present study was to compare different techniques used to evaluate body composition and to assess the influence of fluid status on the assessment of body composition.