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Hemodialysis has improved the morbidity and mortality associated with end stage renal disease. In India, hemodialysis prescription is empiric, which leads to complications related to under-dialysis. Hence, adequacy of hemodialysis in Indian setting was analyzed in this study. A total of 50 patients on twice per week hemodialysis were assessed for 1 month. The number of sessions meeting standards laid out by Kidney Diseases Outcome Quality Initiatives (KDOQI) guidelines were calculated. They were divided into two groups: one in whom dialysis was monitored and session length enhanced to meet the minimum standard Kt/V of 2 and second control group; where Kt/V was not monitored. Hemoglobin (Hb) levels, albumin levels, mean arterial pressure and World Health Organization (WHO) quality of life (QoL) score were compared in the two groups after 6 months. Only 28% of hemodialysis sessions were adequate as per KDOQI guidelines. There was significant improvement in Hb levels (1.47 vs. 0.15 g/dl), mean arterial pressure levels (15.2 vs. 3.16 mm Hg), serum albumin levels (0.82 vs. 0.11 g/dl) and WHO QoL score (17.2 vs. 2.24) in study group as compared to control group. Standard Kt/V can be used as an important tool to modify twice weekly dialysis sessions to provide better QoL to the patients. However, studies with larger sample size are required to conclusively prove our results. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease is a progressive and irreversible loss of renal function. Anemia is one of the main complications of end-stage renal disease (ESRD) which is linked closely with other complications of the disease. The primary therapy for anemia in these patients is erythropoietin (EPO). The goal of this study was to find the effect of Vitamin D administration in addition to the appropriate dose of EPO in ESRD patients with Vitamin D deficiency. Materials and Methods: This was a double-blind clinical trial on 64 ESRD patients undergoing hemodialysis in Amin and Noor Hospitals of Isfahan, Iran. The patients were divided into two groups of control and intervention. The intervention group was given Vitamin D supplements and the control group received placebo. The required dose of EPO to reach the target hemoglobin (Hb) was measured and statistically analyzed. Results: A total number of 32 females and 32 males were included in this study. All the patients in the treatment group were aged between 18 and 76 and the patients in the control group were aged between 21 and 76 years old. There was a significant statistical relationship between Vitamin D administration and the required dose of EPO in both groups (P = 0.013). However, there was no correlation between the concentration of Hb and serum Vitamin D levels. Conclusion: Based on the main finding of this study, the relationship between Vitamin D administration and required dose of EPO seems that the predicted dose of Vitamin D prescribing strategy in Kidney Disease Outcomes Quality Initiative guidelines is not adequate to achieve normal serum Vitamin D in ESRD patients. [ABSTRACT FROM AUTHOR]

We evaluated whether polymorphisms in interleukin (IL‑1) gene cluster (IL‑1 alpha [IL‑1A], IL‑1 beta [IL‑1B], and IL‑1 receptor antagonist [IL‑1RN]) are associated with end stage renal disease (ESRD). A total of 258 ESRD patients and 569 ethnicity matched controls were examined for IL‑1 gene cluster. These were genotyped for five single‑nucleotide gene polymorphisms in the IL‑1A, IL‑1B and IL‑1RN genes and a variable number of tandem repeats (VNTR) in the IL‑1RN. The IL‑1B − 3953 and IL‑1RN + 8006 polymorphism frequencies were significantly different between the two groups. At IL‑1B, the T allele of − 3953C/T was increased among ESRD (P = 0.0001). A logistic regression model demonstrated that two repeat (240 base pair [bp]) of the IL‑1Ra VNTR polymorphism was associated with ESRD (P = 0.0001). The C/C/C/C/C/1 haplotype was more prevalent in ESRD = 0.007). No linkage disequilibrium (LD) was observed between six loci of IL‑1 gene. We further conducted a meta‑analysis of existing studies and found that there is a strong association of IL‑1 RN VNTR 86 bp repeat polymorphism with susceptibility to ESRD (odds ratio = 2.04, 95% confidence interval = 1.48-2.82; P = 0.000). IL‑1B − 5887, +8006 and the IL‑1RN VNTR polymorphisms have been implicated as potential risk factors for ESRD. The meta‑analysis showed a strong association of IL‑1RN 86 bp VNTR polymorphism with susceptibility to ESRD. [ABSTRACT FROM AUTHOR]

The cost of managing end stage renal disease (ESRD) is prohibitive in Nigeria and the burden is solely borne by patients and their relatives. Despite increasing number of dialysis centers in urban areas, actual utilization of such facilities is very low. It is unclear if the outcomes of these patients have improved in recent times. We evaluated pattern of hemodialysis (HD) performance and outcome among ESRD patients. A 5-year prospective cross-sectional study of all ESRD patients on HD was undertaken. The final outcomes included duration on maintenance dialysis, death from inability to sustain dialysis, absconded, confirmed deaths within or outside health facility or referral for kidney transplant. A total of 540 (54%) of 976 cases of ESRD commenced HD, out of which 7 (1.3%) eventually had live-related kidney transplant in India. The male to female ratio was 2:1 with male and female mean ages of 43 ± 17 and 36 ± 16 years respectively. There was a progressive annual increase in the number of ESRD patients. The commonest underlying renal disorder was chronic glomerulonephritis. The mean HD session duration was 8.11 ± 5.4 hours, while the mean duration of stay on HD was 8.72 ± 1.0 weeks. In conclusion, ESRD is common and is being increasingly recognized. Financial constraint and late presentation are major contributory factors to poor outcomes despite the widespread availability of HD facilities. Therefore, effort should be geared towards aggressive strategies for early detection and treatment. Government commitment in terms of funding and/or subsidy for patient with ESRD is advocated. [ABSTRACT FROM AUTHOR]

Despite decades of research, a full understanding of chronic kidney disease (CKD)-end stage renal disease (ESRD) progression remains elusive. The common consensus is a predictable, linear, progressive and time-dependent decline of CKD to ESRD. Acute kidney injury (AKI) on CKD is usually assumed to be transient, with recovery as the expected outcome. AKI-ESRD association in current nephrology literature is blamed on the so-called "residual confounding." We had previously described a relationship between AKI events and rapid onset yet irreversible ESRD happening in a continuum in a high-risk CKD cohort. However, the contribution of the syndrome of rapid onset-ESRD (SORO-ESRD) to incident United States ESRD population remained conjectural. In this retrospective analysis, we analyzed serum creatinine trajectories of the last 100 consecutive ESRD patients in 4 Mayo Clinic chronic hemodialysis units to determine the incidence of SORO-ESRD. Excluding 9 patients, 31 (34%) patients, including two renal transplant recipients, had SORO-ESRD: 18 males and 13 females age 72 (range 50-92) years. Precipitating AKI followed pneumonia (8), acutely decompensated heart failure (7), pyelonephritis (4), post-operative (5), sepsis (3), contrast-induced nephropathy (2), and others (2). Time to dialysis was shortest following surgical procedures. Concurrent renin angiotensin aldosterone system blockade was higher with SORO-ESRD - 23% versus 5%, P = 0.0113. In conclusion, SORO-ESRD is not uncommon among the incident general US ESRD population. The implications for ESRD care planning, AV-fistula-first programs, general CKD care and any associations with renal ageing/senescence warrant further study. [ABSTRACT FROM AUTHOR]

Chronic infection known to be a predisposing factor for the development of atherosclerosis. Several studies have found a possible role of Helicobacter pylori in the pathogenesis of atherosclerosis. The aim of this study was to investigate the presence of H. pylori in atherosclerotic plaques in iliac arteries in 25 end stage renal disease (ESRD) patients undergoing kidney transplantation. Esophagogastroduodenoscopy was performed in all patients before transplantation. Biopsy specimens obtained from gastric antrum were sent for pathologic evaluation. Gastric H. pylori infection was confirmed by microscopic assessment and rapid urease test. Arterial specimens were obtained from iliac arteries during kidney transplantation. Presence of H. pylori DNA in atherosclerotic plaques and healthy vessel samples was evaluated by the polymerase chain reaction (PCR). The mean age of patients was 44.1 ± 22.6 years. Risk factors in patients with atherosclerosis were hypertension (68%), diabetes mellitus (20%), hyperlipidemia (20%), positive family history (16%). Atherosclerotic plaques were found in 21 (84%) patients. PCR analysis did not detect H. pylori in any case. There was a significant relationship of atherosclerosis with hypertension (P = 0.006) but not with diabetes mellitus and hyperlipidemia (P = 0.5). There was no significant relationship between atherosclerosis and gastric H. pylori infection (P = 0.6). This study revealed no association between the presence of H. pylori as a pathogen of vessel walls and atherosclerosis in ESRD. [ABSTRACT FROM AUTHOR]