Depression in end-stage renal disease patients: a critical review.

Depression is the most common psychological disorder in end-stage renal disease (ESRD) patients with a prevalence rate as high as 20% to 25% by some contemporary estimates. There are several studies linking depression with mortality in ESRD, making early diagnosis and treatment essential. The mechanisms linking depression with survival in ESRD patients are unclear but may be related to treatment compliance, improvement in nutritional parameters, increased perception of social support, and modulation of the immune system.

Elevated plasma concentrations of IL-6 and elevated APACHE II score predict acute kidney injury in patients with severe sepsis.

Acute kidney injury (AKI) is common in critically ill patients with severe sepsis (SS), and the predictors of AKI in this population have not been well characterized. The study group was the placebo group of the Prospective Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) data set. PROWESS is a prospective, randomized, controlled study of the use of drotrecogin alpha (activated) for the treatment of SS.

Chronic nephropathies of cocaine and heroin abuse: a critical review.

Renal disease in cocaine and heroin users is associated with the nephrotic syndrome, acute glomerulonephritis, amyloidosis, interstitial nephritis, and rhabdomyolysis. The pathophysiologic basis of cocaine-related renal injury involves renal hemodynamic changes, glomerular matrix synthesis and degradation, and oxidative stress and induction of renal atherogenesis. Heroin is the most commonly abused opiate in the United States.

Pain, sleep disturbance, and quality of life in patients with chronic kidney disease.

Background And Objectives: Few studies have assessed sleep disturbances or perception of pain in patients with early-stage chronic kidney disease. It was hypothesized that perception of pain and sleep disturbance would increase with chronic kidney disease stage, that pain and sleep disturbance would correlate with psychosocial variables, and that there would be a higher prevalence of pain and sleep disturbances in patients with chronic kidney disease compared with general medical patients.

Design, Setting, Participants, & Measurements: A total of 92 predialysis patients with chronic kidney disease and 61 general medical outpatients were evaluated using the Beck Depression Inventory, Illness Effects Questionnaire, Multidimensional Scale of Perceived Social Support, Satisfaction with Life Scale, Karnofsky Scale, Pittsburgh Sleep Questionnaire, and McGill Pain questionnaire.

Renal provider recognition of symptoms in patients on maintenance hemodialysis.

Background And Objectives: Although several studies have found that the burden of symptoms in patients who are on maintenance hemodialysis is substantial, little is known about renal providers' awareness of these symptoms. The aim of this study was to assess renal provider recognition of symptoms and their severity in hemodialysis patients.

Design, Setting, Participants, & Measurements: The Dialysis Symptom Index, a 30-item measure of symptoms and their severity, was administered to patients during a routine hemodialysis session.

Depression and anxiety in urban hemodialysis patients.

Depression is well established as a prevalent mental health problem for people with ESRD and is associated with morbidity and mortality. However, depression in this population remains difficult to assess and is undertreated. Current estimates suggest a 20 to 30% prevalence of depression that meets diagnostic criteria in this population.

Nutritional status, psychological issues and survival in hemodialysis patients.

There is a high prevalence of protein-energy malnutrition in the end-stage renal disease population. There are a number of causes of malnutrition in hemodialysis patients, which can often be directly linked to the uremic state. Laboratory measures including albumin, prealbumin, and serum cholesterol, as well as anthropometric measures, have been used to assess malnutrition in this patient population.

Genome-wide scans for diabetic nephropathy and albuminuria in multiethnic populations: the family investigation of nephropathy and diabetes (FIND).

The Family Investigation of Nephropathy and Diabetes (FIND) was initiated to map genes underlying susceptibility to diabetic nephropathy. A total of 11 centers participated under a single collection protocol to recruit large numbers of diabetic sibling pairs concordant and discordant for diabetic nephropathy. We report the findings from the first-phase genetic analyses in 1,227 participants from 378 pedigrees of European-American, African-American, Mexican-American, and American Indian descent recruited from eight centers.

Depression in end-stage renal disease hemodialysis patients.

Depression has been identified as a complicating comorbid diagnosis in a variety of medical conditions, including end-stage renal disease (ESRD). Despite this, the psychological health of hemodialysis patients is understudied. The purpose of this paper is to review the research and issues involved in the assessment of depression and its sequelae in ESRD.

Associations of race with depression and symptoms in patients on maintenance haemodialysis.

Background: Although studies have shown that African American haemodialysis patients report better overall quality of life than Whites, racial differences in depression and symptom burden remain less well characterized. The aim of this study was to compare these domains between African American and White patients on chronic haemodialysis.

Methods: We surveyed African American and White maintenance haemodialysis patients.

Trends in treatment and outcomes of survival of adolescents initiating end-stage renal disease care in the United States of America.

This study characterizes treatment and outcome trends of adolescent patients initiating renal replacement therapy in the USA from 1978 to 2002. This is a retrospective analysis of data from the US Renal Data System (USRDS) of incident end-stage renal disease (ESRD) patients, ages 12 years through 19 years, initiating renal replacement therapy between 1978 and 2002. Survival analyses were conducted from either the first date of kidney failure or date of transplantation until death or 31 December 2002.

Non-contrast-enhanced computerized tomography and analgesic-related kidney disease: report of the national analgesic nephropathy study.

Previous studies suggested that the non-contrast-enhanced computerized tomography (CT) scan is a highly reliable tool for the diagnosis of analgesic-associated renal disease. However, this issue has not been addressed in the US population. A total of 221 incident patients with ESRD from different regions of the United States underwent a helical CT scan and detailed questioning about drug history.

Hemodialysis timing, survival, and cardiovascular outcomes in the Hemodialysis (HEMO) Study.

Background: The timing of medical therapies has been shown to influence the outcomes and side effects of treatments for disease. This report examines the extent to which hemodialysis treatment time of day was associated with cardiovascular mortality and morbidity and all-cause mortality in a secondary analysis of the Hemodialysis Study.

Methods: Dialysis start time defined dialysis shift: morning beginning between 0400 and 0930 hours (n = 822); midday, between 0930 and 1530 hours (n = 851); and evening, between 1530 and 2200 hours (n = 172).

Incidence and mortality of acute renal failure in Medicare beneficiaries, 1992 to 2001.

This study's objective was to determine the incidence and mortality of acute renal failure (ARF) in Medicare beneficiaries. Data were from hospitalized Medicare beneficiaries (5,403,015 discharges) between 1992 and 2001 from the 5% sample of Medicare claims. For 1992 to 2001, the overall incidence rate of ARF was 23.

Quality of life in patients with chronic kidney disease: focus on end-stage renal disease treated with hemodialysis.

The proper measures for assessing quality of life (QOL) in patients with chronic kidney disease (CKD) remain unclear. QOL measures are subjective or objective, functional or satisfaction-based, and generic or disease-specific. Treatment of end-stage renal disease with transplantation and treatment of anemia with erythropoietin in patients with CKD have been associated with dramatic improvements of QOL.

The role of ultrasound in renal insufficiency: the essentials.

Sonography is the best screening modality to evaluate patients presenting with renal insufficiency. Ultrasound findings can be normal in patients with renal disease, especially in prerenal azotemia and acute parenchymal renal disease. Echogenic kidneys indicate the presence of parenchymal renal disease; the kidneys may be of a normal size or enlarged.

New-onset gout after kidney transplantation: incidence, risk factors and implications.

Background: Although cyclosporine use has been associated with an increased risk of new-onset gout after renal transplantation, the incidence and risk factors for new-onset gout have not been reported in the era of modern immunosuppression.

Methods: We conducted a retrospective cohort study of Medicare primary renal transplant patients reported in the United States Renal Data System (USRDS), using Medicare claims data to determine the incidence of new-onset gout. Cox regression analysis was used to calculate adjusted hazard ratios (AHR) for cyclosporine (including separate analysis of Neoral) compared directly with tacrolimus, for the risk of new-onset gout, adjusted for baseline demographic factors and posttransplant renal function.

Identifying critically ill patients at high risk for developing acute renal failure: a pilot study.

Background: Acute renal failure (ARF) occurs commonly in the intensive care unit (ICU), but predicting which patients will develop ARF is difficult. We set out to determine which risk factors would predict the development of ARF in critically ill patients who are admitted to the ICU without ARF.

Methods: From August 2002 to April 2003, we enrolled medical-surgical ICU admissions into a cohort using a sampling tool based on their risk factor (RF) profile.

Associations of metabolic syndrome with inflammation in CKD: results From the Third National Health and Nutrition Examination Survey (NHANES III).

Background: Although metabolic syndrome is associated with inflammation in the general population, it is unknown whether similar associations exist in patients with chronic kidney disease.

Methods: +7 cross-sectional associations of metabolic syndrome and its component conditions (diabetes, hypertension, hypertriglyceridemia, abdominal obesity, and low high-density lipoprotein cholesterol level) with inflammation (C-reactive protein level > 3 mg/L) were examined by using logistic regression models in groups with high (>90 mL/min/1.73 m2 [>1.