Serum sodium and mortality in a national peritoneal dialysis cohort.

Background: Sodium disarrays are common in peritoneal dialysis (PD) patients, and may be associated with adverse outcomes in this population. However, few studies of limited sample size have examined the association of serum sodium with mortality in PD patients, with inconsistent results. We hypothesized that both hypo- and hypernatremia are associated with higher death risk in a nationally representative cohort of US PD patients.

Serum Magnesium Levels and Hospitalization and Mortality in Incident Peritoneal Dialysis Patients: A Cohort Study.

Background: Prior studies have shown the association of low serum magnesium levels with adverse health outcomes in patients undergoing hemodialysis. There is a paucity of such studies in patients undergoing peritoneal dialysis (PD).

Study Design: Cohort study.

Residual Kidney Function Decline and Mortality in Incident Hemodialysis Patients.

In patients with ESRD, residual kidney function (RKF) contributes to achievement of adequate solute clearance. However, few studies have examined RKF in patients on hemodialysis. In a longitudinal cohort of 6538 patients who started maintenance hemodialysis over a 4-year period (January 2007 through December 2010) and had available renal urea clearance (CL) data at baseline and 1 year after hemodialysis initiation, we examined the association of annual change in renal CL rate with subsequent survival.

Mutational status of IDH1 in uveal melanoma.

Uveal (intraocular) melanoma is an uncommon malignancy that comprises a small percentage of all melanoma cases. While many uveal melanomas harbor mutations in the BRCA-Associated Protein 1 (BAP1) gene, the genetics of non-BAP1 associated tumors are not completely understood. Recent studies have shown that a small subset of non-uveal melanomas hold mutations in isocitrate dehydrogenase (IDH), but the mutational status of IDH in uveal melanoma is unclear.

Glycemic Control and Urinary Tract Infections in Women with Type 1 Diabetes: Results from the DCCT/EDIC.

Purpose: We examined the relationship between glycemic control and urinary tract infections in women with type 1 diabetes mellitus.

Materials And Methods: Women enrolled in the Epidemiology of Diabetes Interventions and Complications study, the observational followup of the Diabetes Control and Complications Trial, were surveyed to assess the rate of physician diagnosed urinary tract infections in the preceding 12 months. The relationship between glycated hemoglobin levels and number of urinary tract infections in the previous 12 months was assessed using a multivariable Poisson regression model.

Crowdsourced Data Indicate Widespread Multidrug Resistance in Skin Flora of Healthy Young Adults.

In a laboratory exercise for undergraduate biology majors, students plated bacteria from swabs of their facial skin under conditions that selected for coagulase-negative Staphylococcus; added disks containing the antibiotics penicillin, oxacillin, tetracycline, and erythromycin; and measured zones of inhibition. Students also recorded demographic and lifestyle variables and merged this information with similar data collected from 9,000 other students who had contributed to the database from 2003 to 2011. Minimum inhibitory concentration (MIC) testing performed at the Harborview Medical Center Microbiology Laboratory (Seattle, WA) indicated a high degree of accuracy for student-generated data; species identification with a matrix-assisted laser desorption ionization (MALDI) Biotyper revealed that over 88% of the cells analyzed by students were S.

Hidden Hypercalcemia and Mortality Risk in Incident Hemodialysis Patients.

Context: Neither uncorrected- nor albumin-corrected total calcium reliably predict ionized calcium in patients with end-stage renal disease. However, little is known about the consequences of inaccurate assessment of calcium concentration using total calcium.

Objective: We hypothesized that hidden hypercalcemia (ie, elevated ionized calcium with normal total calcium) and apparent hypercalcemia (ie, elevated ionized calcium with elevated total calcium) are both associated with increased mortality risk.

Incidence of Preoperative Deep Vein Thrombosis in Calcaneal Fractures.

Objectives: This study examined the incidence and risk factors of preoperative deep vein thrombosis (DVT) in patients presenting to an outpatient setting with an isolated calcaneal fracture.

Design: Retrospective chart review.

Setting: All patients included in the study presented to the treating surgeon at a Level I trauma center with isolated calcaneal fractures as an outpatient between 2005 and 2013.

The Evolving Ethics of Dialysis in the United States: A Principlist Bioethics Approach.

Throughout the history of dialysis, four bioethical principles - beneficence, nonmaleficence, autonomy and justice - have been weighted differently based upon changing forces of technologic innovation, resource limitation, and societal values. In the 1960s, a committee of lay people in Seattle attempted to fairly distribute a limited number of maintenance hemodialysis stations guided by considerations of justice. As technology advanced and dialysis was funded under an amendment to the Social Security Act in 1972, focus shifted to providing dialysis for all in need while balancing the burdens of treatment and quality of life, supported by the concepts of beneficence and nonmaleficence.

Incremental Hemodialysis, Residual Kidney Function, and Mortality Risk in Incident Dialysis Patients: A Cohort Study.

Background: Maintenance hemodialysis is typically prescribed thrice weekly irrespective of a patient's residual kidney function (RKF). We hypothesized that a less frequent schedule at hemodialysis therapy initiation is associated with greater preservation of RKF without compromising survival among patients with substantial RKF.

Study Design: A longitudinal cohort.

Predicting CPAP Use and Treatment Outcomes Using Composite Indices of Sleep Apnea Severity.

Study Objectives: Measures of baseline sleep apnea disease burden (apnea-hypopnea index, Epworth Sleepiness Scale) predict continuous positive airway pressure (CPAP) adherence, but composite indices of sleep apnea severity (Sleep Apnea Severity Index, Modified Sleep Apnea Severity Index) may be more robust measures of disease burden. We tested the relative prognostic ability of each measure of sleep apnea disease burden to predict subsequent CPAP adherence and subjective sleep outcomes.

Methods: Prospective cohort study at a tertiary academic sleep center.

Development of a Model of Interprofessional Shared Clinical Decision Making in the ICU: A Mixed-Methods Study.

Objectives: To develop a model to describe ICU interprofessional shared clinical decision making and the factors associated with its implementation.

Design: Ethnographic (observations and interviews) and survey designs.

Setting: Three ICUs (two in Israel and one in the United States).

Defining Unstageable Pressure Ulcers as Full-Thickness Wounds: Are These Wounds Being Misclassified?

Purpose: The purpose of this study was to describe the evolution of unstageable pressure ulcers (PUs) over time to determine if their healing trajectory is consistent with full- or partial-thickness wounds.

Design: Retrospective review of electronic medical record and a clinical PU database.

Subjects And Settings: Patients with hospital-acquired, unstageable PUs were evaluated.

Pre-dialysis serum sodium and mortality in a national incident hemodialysis cohort.

Background: A consistent association between low serum sodium measured at a single-point-in-time (baseline sodium) and higher mortality has been observed in hemodialysis patients. We hypothesized that both low and high time-varying sodium levels (sodium levels updated at quarterly intervals as a proxy of short-term exposure) are independently associated with higher death risk in hemodialysis patients.

Methods: We examined the association of baseline and time-varying pre-dialysis serum sodium levels with all-cause mortality among adult incident hemodialysis patients receiving care from a large national dialysis organization during January 2007-December 2011.

Urinary uromodulin, kidney function, and cardiovascular disease in elderly adults.

Urinary uromodulin (uUMOD) is the most common secreted tubular protein in healthy adults. However, the relationship between uUMOD and clinical outcomes is still unclear. Here we measured uUMOD in 192 participants of the Cardiovascular Health Study with over a 30% decline in estimated glomerular filtration rate (eGFR) over 9 years, 54 with incident end-stage renal disease (ESRD), and in a random subcohort of 958 participants.

Initial clinical presentation of children with acute and chronic versus acute subdural hemorrhage resulting from abusive head trauma.

OBJECT At presentation, children who have experienced abusive head trauma (AHT) often have subdural hemorrhage (SDH) that is acute, chronic, or both. Controversy exists whether the acute SDH associated with chronic SDH results from trauma or from spontaneous rebleeding. The authors compared the clinical presentations of children with AHT and acute SDH with those having acute and chronic SDH (acute/chronic SDH).

American Society of Nephrology Quiz and Questionnaire 2014: RRT.

The Nephrology Quiz and Questionnaire (NQ&Q) remains an extremely popular session for attendees of the Annual Kidney Week Meeting of the American Society of Nephrology (ASN). Once again, the conference hall was overflowing with audience members and eager quiz participants. Topics covered by the expert discussants included electrolyte and acid-base disorders, glomerular disease, end-stage renal disease/dialysis, and transplantation.

Evolving beyond the vicious triad: Differential mediation of traumatic coagulopathy by injury, shock, and resuscitation.

Background: A subset of trauma patients with critical injury present with coagulopathy, portending markedly worse outcomes. Clinical practice is evolving to treat the classical risk factors of hypothermia, hemodilution, and acidosis; however, coagulopathy persists even in the absence of these factors. We sought to determine the relative importance of injury- and shock-specific factors compared with resuscitation-associated factors in coagulopathy after trauma.

Care of the child with Ebola virus disease.

Objectives: To provide clinicians with practical considerations for care of children with Ebola virus disease in resource-rich settings.

Data Sources: Review of the published medical literature, World Health Organization and government documents, and expert opinion.

Data Synthesis: There are limited data regarding Ebola virus disease in children; however, reported case-fatality proportions in children are high.

The changing landscape of home dialysis in the United States.

Purpose Of Review: To discuss the changing landscape of home dialysis in the United States over the past decade, including recent research on clinical outcomes in patient undergoing peritoneal dialysis and home hemodialysis, and to describe the impact of recent payment reforms for patients with end-stage renal disease.

Recent Findings: Accumulating evidence supports the conclusion that clinical outcomes for patients treated with peritoneal dialysis or home hemodialysis are as good as or better than for patients treated with conventional in-center hemodialysis. The recent implementation of the Medicare-expanded prospective payment system for the care of end-stage renal disease patients has resulted in substantial growth in the utilization of peritoneal dialysis in the United States.

American Society of Nephrology Quiz and Questionnaire 2013: RRT.

The Nephrology Quiz and Questionnaire (NQ&Q) remains an extremely popular session for attendees of the Annual Meeting of the American Society of Nephrology. As in past years, the conference hall of the 2013 meeting was overflowing with interested audience members. Topics covered by expert discussants included electrolyte and acid-base disorders, glomerular disease, ESRD/dialysis, and transplantation.

Benchmarking outcomes in the critically injured burn patient.

Objective: To determine and compare outcomes with accepted benchmarks in burn care at 6 academic burn centers.

Background: Since the 1960s, US morbidity and mortality rates have declined tremendously for burn patients, likely related to improvements in surgical and critical care treatment. We describe the baseline patient characteristics and well-defined outcomes for major burn injuries.

Is early initiation of dialysis harmful?

Over the past two decades in the United States, there has been a inexorable increase in the mean estimated glomerular filtration rate (eGFR) at which patients are starting maintenance dialysis. Data from observational studies using eGFR derived from serum creatinine-based estimating equations has suggested that initiating dialysis at higher levels of kidney function may be associated with increased incidence of adverse clinical outcomes including mortality. At the same time, observational studies using time urinary clearances to measure eGFR have not demonstrated the same relationship, and instead of shown either no association between eGFR at dialysis initiation and subsequent outcomes, or increased survival with higher native renal clearances.