Effect of Age on the Association of Vascular Access Type with Mortality in a Cohort of Incident End-Stage Renal Disease Patients.

Background/aims: All hemodialysis (HD) patients are generally recommended to create a fistula first; but to create a mature arteriovenous fistula (AVF) can be challenging in elderly individuals. It is unclear if elderly incident HD patients derive a survival benefit from an AVF over an arteriovenous graft (AVG) or a tunneled central venous catheter (TDC).

Methods: We examined the association of vascular access type (AVF, AVG, and TDC with and without a maturing AVF/AVG at dialysis transition) at HD initiation with all-cause, cardiovascular (CV), and infection-related mortality in 46,786 US veterans using Cox models with adjustment for confounders.

Early Mortality Associated with Inpatient versus Outpatient Hemodialysis Initiation in a Large Cohort of US Veterans with Incident End-Stage Renal Disease.

Background: Mortality in the immediate post-hemodialysis transition period is extremely high. Many end-stage renal disease (ESRD) patients in the US start dialysis in an inpatient setting, but the characteristics of patients starting dialysis as inpatients, and the association of inpatient hemodialysis transition with mortality remain unclear.

Methods: We examined 48,261 US veterans who transitioned to hemodialysis between October 2007 and September 2011.

Activation of FGF-23 mediated vitamin D degradative pathways by cholecalciferol.

Context: The optimal circulating concentration of 25(OH) vitamin D is controversial.

Objective: The aim was to investigate if FGF-23 and 24,25(OH)2D can guide cholecalciferol replacement.

Design: Oral cholecalciferol (10,000 IU weekly) administered to subjects with 25(OH)D levels < 20 ηg/mL and eGFR > 60 mL/min/1.

Urinary albumin to osmolality ratio predicts 24-hour urine albumin excretion in diabetes mellitus.

Background: Urinary albumin to creatinine ratio (ACR) in a single urine sample has been proposed to provide an estimate of microalbuminuria by adjusting for variability in urine concentrations. We hypothesized that adjusting the urine albumin concentration of single-void specimens for actual urine osmolality (urinary albumin to osmolality ratio [AOR]) may provide a more accurate estimate of 24-hour urine albumin excretion rates (AERs).

Methods: Patients with diabetes mellitus (DM; n = 136) had urinary concentrations of albumin, glucose, and creatinine and osmolality measured on single-void samples, and albumin levels, on 24-hour samples.

Screening for microalbuminuria simplified by urine specific gravity.

Background: The albumin-to-creatinine ratio and the 24-hour urine collection to measure microalbuminuria are inconvenient and expensive. The newer rapid and less expensive dipstick methods for screening of microalbuminuria estimate only albumin and are subject to errors caused by variation in volume. We determined the relation between urine-specific gravity (Usg) and urine creatinine (Ucr) so that Ucr can be derived from Usg to correct for albumin concentration in the urine which is influenced by urine volume.