Malnutrition and inflammation in peritoneal dialysis patients.

Background: Malnutrition, cardiovascular disease, and heightened inflammation are highly prevalent in dialysis patients, and major contributors to morbidity and mortality. We have investigated the inter-relationship between malnutrition and inflammation, and their impact on morbidity and mortality in peritoneal dialysis (PD) patients.

Method: We enrolled 63 PD patients beginning in November 2000, and measured C-reactive protein (CRP) and various nutritional markers, including prealbumin.

Relationship of bioelectrical impedance parameters to nutrition and survival in peritoneal dialysis patients.

Background: Malnutrition is highly prevalent in peritoneal dialysis (PD) patients and is associated with higher mortality in these patients. In this study, we have prospectively examined the relationship of bioimpedance indexes to the nutritional status and survival in PD patients.

Methods: We enrolled 48 PD patients beginning in November 2000.

Outcome of percutaneous endoscopic gastrostomy feeding in patients on peritoneal dialysis.

Protein malnutrition is now well established as an important contributory factor to the high mortality in peritoneal dialysis (PD) patients. Low dietary protein calorie intake is one of the factors leading to protein malnutrition. If PD patients develop difficulty eating, percutaneous endoscopic gastrostomy (PEG) feeding may prove beneficial in providing adequate nutrition.

Severe necrotizing mastopathy caused by calciphylaxis alleviated by total parathyroidectomy.

Calciphylaxis is a complication caused by secondary hyperparathyroidism in patients with chronic renal failure. These patients may present with clinical findings of ischemic necrosis involving the skin and muscle resulting in subsequent gangrene and vascular calcifications. We report a rare case of necrotizing mastopathy caused by calciphylaxis in a 70-year-old female with end-stage renal disease whose symptoms resolved with a total parathyroidectomy.

Reticulocyte hemoglobin content predicts functional iron deficiency in hemodialysis patients receiving rHuEPO.

Early detection of iron sufficiency at the level of the erythropoietic cell is necessary to optimize management of uremic anemia with recombinant human erythropoietin (rHuEPO). "Absolute" and "functional" iron deficiency are the most important factors causing resistance to administered rHuEPO. Transferrin saturation and serum ferritin measurements have been noted to be insensitive and inaccurate measures to detect functional iron deficiency.

Urinary red cell size: diagnostic value and determinants.

Urinary red blood cells (RBC) are usually small and morphologically abnormal in glomerular (GN) hematuria, and slightly enlarged and morphologically normal in nonglomerular (NG) hematuria. This study was performed to evaluate the diagnostic value of urinary red cell size and morphology and to investigate the mechanism of the alteration in cell size. In 34 consecutive patients with hematuria we examined the urinary RBC size distribution and mean corpuscular volume (MCV) by electronic sizing of suspensions of RBC in an isotonic medium and, in 28 cases, compared it with the presence of 50% or greater dysmorphia.

Cholesterol and lipid disturbances in renal disease: the natural history of uremic dyslipidemia and the impact of hemodialysis and continuous ambulatory peritoneal dialysis.

Lipid abnormalities have been postulated to contribute to renal insufficiency by a mechanism that is analogous to atherogenesis. The majority of patients treated for chronic renal failure die of cardiovascular complications. Lipid abnormalities in this group are thought to contribute to this high mortality.

Lipids in diabetic and nondiabetic hemodialysis and CAPD patients.

To examine the question of "accelerated atherogenesis" in ESRD patients, the authors conducted a lipid survey among their hemodialysis and CAPD populations and evaluated data relevant to the lipid and diabetic status of these groups. Interestingly, longer duration of hemodialysis in nondiabetic patients was associated with lower cholesterol but not HDL, which may reflect diminished cardiac risk and mortality in the long-term survivors. Diabetic patients showed lower HDL but no cholesterol change with longer duration on hemodialysis.