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.

Association of residual urine output with mortality, quality of life, and inflammation in incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Study.

Background: Residual kidney function (RKF) is associated with improved survival in peritoneal dialysis patients, but its role in hemodialysis patients is less well known. Urine output may provide an estimate of RKF. The aim of our study is to determine the association of urine output with mortality, quality of life (QOL), and inflammation in incident hemodialysis patients.

Spoken language development in children following cochlear implantation.

Context: Cochlear implantation is a surgical alternative to traditional amplification (hearing aids) that can facilitate spoken language development in young children with severe to profound sensorineural hearing loss (SNHL).

Objective: To prospectively assess spoken language acquisition following cochlear implantation in young children.

Design, Setting, And Participants: Prospective, longitudinal, and multidimensional assessment of spoken language development over a 3-year period in children who underwent cochlear implantation before 5 years of age (n = 188) from 6 US centers and hearing children of similar ages (n = 97) from 2 preschools recruited between November 2002 and December 2004.

Inpatient hemodialysis initiation: reasons, risk factors and outcomes.

Background/aims: Inpatient initiation of chronic hemodialysis is considered undesirable because of cost and possible harms of hospitalization. We examined the patient characteristics and outcomes associated with inpatient initiation.

Methods: In a prospective cohort study of incident dialysis patients, the independent association of inpatient hemodialysis initiation with patient outcomes was assessed in multivariable analyses with adjustment for patient characteristics and propensity for inpatient initiation.

Correlates and outcomes of fatigue among incident dialysis patients.

Background & Objectives: Fatigue is a debilitating symptom experienced by patients undergoing dialysis, but there is only limited information on its prevalence and its association with patient outcomes. This study examines the correlates of self-reported fatigue at initiation of dialysis and after 1 yr and assesses the extent to which fatigue was associated with health-related quality of life and survival.

Design, Setting, Participants, & Measurements: A longitudinal cohort of 917 incident hemodialysis and peritoneal dialysis patients who completed the CHOICE Health Experience Questionnaire (CHEQ) participated in the study.

Peripheral vascular disease-related procedures in dialysis patients: predictors and prognosis.

Background And Objectives: Peripheral vascular disease (PVD) is prevalent among dialysis patients, and many dialysis patients undergo PVD-related procedures. We aimed to examine the risk factors for and prognosis after such procedures in the dialysis setting.

Design, Setting, Participants, & Measurements: In a national prospective cohort study of 1041 incident dialysis patients, we examined the factors that are associated with PVD procedures (lower extremity amputations and bypasses) after the start of dialysis.

Association of peritoneal dialysis clinic size with clinical outcomes.

Objective: Very few studies have addressed the relationship between number of peritoneal dialysis (PD) patients treated at a clinic (PD clinic size) and clinical outcomes. In a national prospective cohort study of incident PD patients (n = 236, from 26 clinics), we examined whether being treated at a larger PD clinic [>50 PD patients (n = 3 clinics) vs
Methods: Multivariable Cox models were used to assess relative hazards (RHs) for modality switches, cardiovascular events, cardiovascular deaths, and all-cause deaths by PD clinic size.

Cerebrovascular disease incidence, characteristics, and outcomes in patients initiating dialysis: the choices for healthy outcomes in caring for ESRD (CHOICE) study.

Background: Stroke is the third most common cause of cardiovascular disease death in patients on dialysis therapy; however, characteristics of cerebrovascular disease, including clinical subtypes and subsequent consequences, have not been well described.

Study Design: Prospective national cohort study, the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Study.

Settings & Participants: 1,041 incident dialysis patients treated in 81 clinics enrolled from October 1995 to July 1998, followed up until December 31, 2004.

Predicting behavior problems in deaf and hearing children: the influences of language, attention, and parent-child communication.

The development of language and communication may play an important role in the emergence of behavioral problems in young children, but they are rarely included in predictive models of behavioral development. In this study, cross-sectional relationships between language, attention, and behavior problems were examined using parent report, videotaped observations, and performance measures in a sample of 116 severely and profoundly deaf and 69 normally hearing children ages 1.5 to 5 years.

Timing, causes, predictors and prognosis of switching from peritoneal dialysis to hemodialysis: a prospective study.

Background: The use of peritoneal dialysis (PD) has declined in the United States over the past decade and technique failure is also reportedly higher in PD compared to hemodialysis (HD), but there are little data in the United States addressing the factors and outcomes associated with switching modalities from PD to HD.

Methods: In a prospective cohort study of 262 PD patients enrolled from 28 peritoneal dialysis clinics in 13 U.S.

MYH9 is associated with nondiabetic end-stage renal disease in African Americans.

As end-stage renal disease (ESRD) has a four times higher incidence in African Americans compared to European Americans, we hypothesized that susceptibility alleles for ESRD have a higher frequency in the West African than the European gene pool. We carried out a genome-wide admixture scan in 1,372 ESRD cases and 806 controls and found a highly significant association between excess African ancestry and nondiabetic ESRD (lod score = 5.70) but not diabetic ESRD (lod = 0.

The association of sudden cardiac death with inflammation and other traditional risk factors.

Despite the frequency of cardiovascular death in dialysis patients, few studies have prospectively measured sudden cardiac death in these individuals. Here, we sought to determine the frequency of sudden cardiac death and its association with inflammation and other risk factors among the CHOICE (Choices for Healthy Outcomes In Caring for ESRD) cohort of 1,041 incident dialysis patients. Sudden cardiac death was defined as that occurring outside of the hospital with an underlying cardiac cause from death certificate data.

Heparin-induced antibodies and cardiovascular risk in patients on dialysis.

The clinical relevance of heparin-induced antibodies (HIA) in the absence of thrombocytopenia remains to be defined. The aims of this study were (i) to determine the prevalence of HIA in patients treated by dialysis, (ii) to determine the prevalence of thrombocytopenia and heparin-induced thrombocytopenia (HIT), and (iii) to test whether HIA are associated with adverse outcomes. Sera from 740 patients treated by hemodialysis (HD, n=596) and peritoneal dialysis (PD, n=144) were tested for HIA (IgG, IgA or IgM) by masked investigators at approximately six months after enrolment in the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) study.

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.

Accuracy of patients' reports of comorbid disease and their association with mortality in ESRD.

Background: Patient awareness of chronic diseases is low. Unawareness may represent poor understanding of chronic illness and may be associated with poor outcomes in patients with end-stage renal disease (ESRD).

Study Design: Concurrent prospective national cohort study.

Phosphate levels and blood pressure in incident hemodialysis patients: a longitudinal study.

An elevated serum phosphate level in hemodialysis patients has been associated with mineral deposition in blood vessels. We studied a possible physiologic consequence of hyperphosphatemia by examining the relation between serum phosphate levels and blood pressure in 707 incident hemodialysis patients from 75 clinics who were enrolled in a prospective cohort study. We conducted cross-sectional and longitudinal multiple linear regression analyses, adjusting for demographics, medical history, and laboratory factors.

Serum phosphate levels and risk of infection in incident dialysis patients.

Background And Objectives: Hyperphosphatemia is highly prevalent in dialysis patients and may be associated with immune dysfunction. The association of serum phosphate level with infection remains largely unexamined.

Design, Setting, Participants, & Measurements: In an incident cohort of 1010 dialysis patients enrolled from 1995 to 1998 and treated in 80 US clinics, the association of phosphate level (low <3.

Surgical factors in pediatric cochlear implantation and their early effects on electrode activation and functional outcomes.

Objective: To assess the impact of surgical factors on electrode status and early communication outcomes in young children in the first 2 years of cochlear implantation.

Study Design: Prospective multicenter cohort study.

Setting: Six tertiary referral centers.

Assessing the use of speech and language measures in relation to parental perceptions of development after early cochlear implantation.

Objective: Clinicians and investigators use multiple outcome measures after early cochlear implantation (CI) to assess auditory skills, speech, and language effects. Are certain outcome measures better associated with optimal childhood development from the perspective of parents? We studied the association between several commonly used outcome instruments and a measure of parental perceptions of development to gain insight into how our clinical tests reflect parental perceptions of a child's developmental status.

Study Design: Cross-sectional analysis.

Tracking development of speech recognition: longitudinal data from hierarchical assessments in the Childhood Development after Cochlear Implantation Study.

Objective: To develop a speech recognition index that summarizes data collected through an array of age-appropriate hierarchical speech recognition tests in a longitudinal study.

Study Design: Prospective cohort.

Setting: Six tertiary referral centers in the Childhood Development after Cochlear Implantation (CDaCI) Study.

Electric charge requirements of pediatric cochlear implant recipients enrolled in the Childhood Development After Cochlear Implantation study.

Objective: To evaluate mapping characteristics of children with cochlear implants who are enrolled in the Childhood Development After Cochlear Implantation (CDACI) multicenter study.

Study Design: Longitudinal evaluation during 24 months of speech processor maps of children with cochlear implants prospectively enrolled in the study.

Setting: Six tertiary referral centers.

Third-generation parathyroid hormone assays and all-cause mortality in incident dialysis patients: the CHOICE study.

Background: There has been controversy about the utility of new third-generation parathyroid hormone (PTH) assays measuring only 1-84 PTH, with few large studies comparing second- and third-generation PTH measurements in patients with ESRD.

Methods: We measured 1-84 PTH ('biointact' or 'whole' PTH) and total PTH ('intact' PTH) in a national cohort of 515 incident dialysis patients from banked frozen EDTA plasma (median follow-up, 35 months) and examined the accuracy of estimating 1-84 PTH from total PTH and the associations of these levels with patient characteristics and mortality.

Results: The 1-84 PTH and total PTH levels were closely correlated.

Sleep quality and its correlates in the first year of dialysis.

Although sleep problems are thought to be prevalent among patients who undergo dialysis, there is only limited information on the determinants of sleep quality and the change in sleep quality during the first year of dialysis treatment. This report uses data from a national cohort study of incident hemodialysis and peritoneal dialysis patients to identify the correlates of sleep quality and to determine the extent to which sleep quality is related to patients' health-related quality of life and survival. This report includes 909 incident dialysis patients who responded to questions about sleep quality.

Temporal relation among depression symptoms, cardiovascular disease events, and mortality in end-stage renal disease: contribution of reverse causality.

Temporal relationships among depression, medical comorbidity, and death or cardiovascular disease (CVD) events are complex. Clarifying temporal relationships may enhance current insight regarding the nature of the association of depression with poor outcomes. The temporal relation of depression symptoms (DS; score < or = 52 on five-item Mental Health Index) assessed at 6-mo intervals for 2 yr to CVD event, all-cause death, cardiovascular disease deaths, and non-cardiovascular disease deaths was studied in 917 incident dialysis patients.