Inflammatory markers and risk of cerebrovascular events in patients initiating dialysis.

Background And Objectives: Stroke remains a leading cause of morbidity and mortality for patients on dialysis; however, its risk factors in this population and measures to prevent it are not well understood.

Design, Setting, Participants, & Measurements: We investigated whether inflammation was associated with cerebrovascular events in a national US cohort of 1041 incident dialysis patients enrolled from October 1995 to June 1998 and followed until January 31, 2004. Incident cerebrovascular events were defined as nonfatal (hospitalized stroke, carotid endarterectomy) and fatal (stroke death) events after dialysis initiation.

Lipoprotein(a) level as a predictor of cardiovascular disease and small apoliprotein(a) isoforms in dialysis patients: assay-related differences are important.

Background: Lipoprotein(a) assays sensitive to apolipoprotein(a) size may underestimate associations of lipoprotein(a) with cardiovascular disease (CVD) and low molecular weight (LMW) apolipoprotein(a) isoforms. This study among 629 dialysis patients compares the value of two lipoprotein(a) assays in predicting CVD events and small isoforms.

Methods: Lipoprotein(a) level was measured by an apolipoprotein(a) size-insensitive ELISA and apolipoprotein(a) size-sensitive immunoturbidometric (IT) assay; and apolipoprotein(a) size by Western blot.

Novel and traditional cardiovascular risk factors for peripheral arterial disease in incident-dialysis patients.

Peripheral arterial disease (PAD), which threatens limb viability and patient survival, is increasing in frequency in the dialysis population, but associated risk factors remain poorly defined. We conducted a cross-sectional analysis of the association of novel and traditional cardiovascular risk factors with PAD in incident-dialysis patients enrolled in the CHOICE study by application of multivariate logistic-regression models with adjustment for confounders. Risk factors were determined by interview, record review, and laboratory analysis of frozen specimens.

Agreement of self-reported comorbid conditions with medical and physician reports varied by disease among end-stage renal disease patients.

Objective: To compare self-report of eight diseases with review of medical records and physician reports.

Study Design And Setting: In a cohort of 965 incident end-stage renal disease (ESRD) patients (Choices for Healthy Outcomes in Caring for End-stage renal disease study), data on existing medical conditions were obtained from medical record abstraction, physician report (CMS Form 2728), and self-report in a baseline questionnaire. We evaluated agreement with kappa statistics (k) and sensitivity of self-report.

Nephrotic range proteinuria and CD4 count as noninvasive indicators of HIV-associated nephropathy.

Purpose: Human immunodeficiency virus (HIV)-associated nephropathy is a common and serious cause of progressive renal insufficiency in patients with HIV, frequently presenting with nephrotic range proteinuria. The purpose of this study is to document the histopathologic diagnoses seen in HIV-positive patients with and without nephrotic range proteinuria and to evaluate the predictive value of both nephrotic range proteinuria and CD4 count in diagnosing HIV-associated nephropathy.

Methods: We performed a cross-sectional, single-center study of all 107 HIV-positive patients who had both a renal biopsy and urine protein measurement between 1995 and 2002.

Mild vs severe pulmonary hypertension before heart transplantation: different effects on posttransplantation pulmonary hypertension and mortality.

Background: Pulmonary hypertension (PH) is common in severe heart failure, but the effect of mild PH on posttransplantation PH and survival after heart transplantation has not been well described.

Methods: This cohort study examined preoperative and postoperative hemodynamics in 172 heart transplant recipients at Johns Hopkins Hospital followed for up to 15.1 years.

High lipoprotein(a) levels and small apolipoprotein(a) size prospectively predict cardiovascular events in dialysis patients.

Lipoprotein(a) [Lp(a)] levels are increased in dialysis patients, suggesting that they may play a role in the elevated atherosclerotic cardiovascular disease (ASCVD) risk in this population. Few prospective studies of Lp(a) level, apolipoprotein(a) [apo(a)] size, and ASCVD have been performed in the dialysis population. An inception cohort of 833 incident dialysis patients were followed prospectively.

Sonography as a predictor of human immunodeficiency virus-associated nephropathy.

Objective: To determine whether renal sonography can be used to predict the pathologic diagnosis of human immunodeficiency virus-associated nephropathy.

Methods: This cross-sectional study evaluated 87 human immunodeficiency virus-positive patients who underwent both kidney biopsy and renal sonography after referral to the Johns Hopkins Renal Clinic from January 1995 to July 2002. Using a standardized measure of echogenicity, an independent blinded radiologist reviewed the original sonographic images.

Association between cholesterol level and mortality in dialysis patients: role of inflammation and malnutrition.

Context: Total cholesterol level is inversely associated with mortality in dialysis patients, a group at high risk of cardiovascular disease (CVD). This paradox may be explained by systemic inflammation and/or malnutrition, which are associated with lower cholesterol levels and higher mortality.

Objective: To determine the relationship between cholesterol level and outcome in patients undergoing dialysis, accounting for inflammation and malnutrition.

Lipoprotein(a) and prevalent cardiovascular disease in a dialysis population: The Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study.

Background: Levels of lipoprotein(a) [Lp(a)], an atherogenic lipoprotein, are elevated in patients with end-stage renal disease and inversely related to the size of apolipoprotein(a) [apo(a)], a glycoprotein bound to Lp(a). We studied the association of Lp(a) level and apo(a) size with prevalent atherosclerotic cardiovascular disease (ASCVD) in 871 incident dialysis patients (261 blacks, 565 whites, 45 other).

Methods: Lp(a) was measured by an apo(a) size-independent enzyme-linked immunoassay; and apo(a) size was measured by sodium dodecyl sulfate-agarose gel electrophoresis.

The relationship between treatment objectives and practice patterns in the management of urinary tract infections.

Objective: To describe physicians' goals when treating uncomplicated urinary tract infections (UTIs) and the relationship between goals and practice patterns.

Study Design: Analysis of survey results.

Population: Primary care physicians.

Small apolipoprotein(a) size predicts mortality in end-stage renal disease: The CHOICE study.

Background: The high mortality rate in end-stage renal disease has engendered interest in nontraditional atherosclerotic cardiovascular disease (ASCVD) risk factors that are more prevalent in end-stage renal disease, such as elevated lipoprotein(a) [Lp(a)] levels. Previous studies suggest that high Lp(a) levels and small apolipoprotein(a) [apo(a)] isoform size are associated with ASCVD, but none have investigated the relationship between Lp(a) level, apo(a) size, and mortality.

Methods And Results: An inception cohort of 864 incident dialysis patients was followed prospectively.

Traditional cardiovascular disease risk factors in dialysis patients compared with the general population: the CHOICE Study.

Although atherosclerotic cardiovascular disease (ASCVD) risk in end-stage renal disease (ESRD) is 5 to 30 times that of the general population, few data exist comparing ASCVD risk factors among new dialysis patients to the general population. This cross-sectional study of 1041 dialysis patients describes the prevalence of ASCVD risk factors at the beginning of ESRD compared with estimates of ASCVD risk factors in the adult US population derived from the Third National Health and Nutrition Examination (NHANES III). CHOICE Study participants had a high prevalence of diabetes (54%), hypertension (96%), left ventricular hypertrophy by electrocardiogram (EKG) criteria (22%), low physical activity (80%), hypertriglyceridemia (36%), and low HDL cholesterol (33%).

Race-specific association of lipoprotein(a) with vascular access interventions in hemodialysis patients: the CHOICE Study.

Background: Elevated serum levels of lipoprotein(a) [Lp(a)] and low molecular weight apolipoprotein(a) [apo(a)] isoforms are associated with atherothrombotic disease in the general population and in patients with kidney failure. Lp(a) may be more atherothrombotic in whites than in blacks. Data on the relation of Lp(a) and apo(a) isoform size to hemodialysis vascular access complications are limited.

Validation of comorbid conditions on the end-stage renal disease medical evidence report: the CHOICE study. Choices for Healthy Outcomes in Caring for ESRD.

Since 1995, the Medical Evidence Report for end-stage renal disease (Form 2728) has been used nationally to collect information on comorbid conditions. To date, these data have not been validated. A national cross-sectional study of 1005 incident dialysis patients (734 hemodialysis and 271 peritoneal dialysis) enrolled between October 1995 and June 1998 was conducted using clinical data to validate 17 comorbid conditions on Form 2728.