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Introduction: Transplant centers hesitate to transplant patients with cognitive impairment. It is unclear if pre‐kidney transplant (KT) cognitive screening can predict post‐KT cognitive function. Methods: We evaluated pre‐ to post‐KT cognitive function with the Montreal Cognitive Assessment (MoCA) in a cohort of 108 patients. We used an adjusted logistic regression model to assess pre‐ to post‐KT changes in cognitive status (continuous variable) and a linear mixed model to assess changes in MoCA scores (categorical variable) pre‐ to post‐ KT. Results: The average pre‐ and post‐KT MoCA scores were 25.3 ± 3.0 and 26.4 ± 2.8, respectively. Final pre‐KT score did not predict post‐KT cognitive status (OR = 1.08; 95% CI:.92–1.26; P =.35). 32% of the patients with a final pre‐KT score ≥26 had at least one post‐KT score < 26. Conversely, 61% of the patients with a final pre‐KT score < 26 had at least one post KT score ≥26. In the linear mixed model analysis, the final pre‐KT score was associated with a small, clinically insignificant (β =.34; 95% CI:.19–.49; P <.001) effect on the post‐KT score. Conclusion: A low pre‐KT MoCA score is not a strong independent predictor of post‐KT cognitive function and should not preclude patients from receiving a KT. [ABSTRACT FROM AUTHOR]

Background/Objectives: Non‐steroidal anti‐inflammatory drugs (NSAIDs) can cause kidney injury, especially in older adults. However, previously reported associations between NSAID use and kidney health outcomes are inconsistent and limited by reliance on serum creatinine‐based GFR estimates. This analysis investigated the association of NSAID use with kidney damage in older adults using multiple kidney health measures. Design: Cross‐sectional and longitudinal analyses. Setting: Multicenter, community‐based cohort. Participants: Two thousand nine hundred and ninty nine older adults in the Health ABC Study. A subcohort (n = 500) was randomly selected for additional biomarker measurements. Exposure: Prescription and over‐the‐counter NSAID use ascertained by self‐report. Measurements: Baseline estimated glomerular filtration rate (eGFR) by cystatin C (cysC), urine albumin‐to‐creatinine ratio (ACR), kidney injury molecule‐1 (KIM‐1), and interleukin‐18 (IL‐18) were measured in 2,999 participants; alpha‐1 microglobulin (α1m), neutrophil gelatinase‐associated lipocalin (NGAL), propeptide type III procollagen (PIIINP), and uromodulin (UMOD) were measured in 500 participants. GFR was estimated three times over 10 years and expressed as percent change per year. Results: Participants had a mean age of 74 years, 51% were female, and 41% African‐American. No eGFR differences were detected between NSAID users (n = 655) and non‐users (n = 2,344) at baseline (72 ml/min/1.73 m2 in both groups). Compared to non‐users, NSAID users had lower adjusted odds of having ACR greater than 30 mg/g (0.67; 95% confidence interval (CI) = 0.51–0.89) and lower mean urine IL‐18 concentration at baseline (−11%; 95% CI = −4% to −18%), but similar mean KIM‐1 (5%; 95% CI = −5% to 14%). No significant differences in baseline concentrations of the remaining urine biomarkers were detected. NSAID users and non‐users did not differ significantly in the rate of eGFR decline (−2.2% vs ‐2.3% per year). Conclusion: Self‐reported NSAID use was not associated with kidney dysfunction or injury based on multiple measures, raising the possibility of NSAID use without kidney harm in ambulatory older adults. More research is needed to define safe patterns of NSAID consumption. [ABSTRACT FROM AUTHOR]

Objectives: Fibroblast growth factor (FGF)‐23 is a key regulator of mineral metabolism and has been linked with left ventricular hypertrophy in animal models. Most existing epidemiologic studies evaluated a C‐terminal FGF23 assay which measures both the intact (active) hormone and inactive fragments. The relationship of intact FGF23 with cause‐specific mortality is unknown. Design: Prospective analyses of data from Health, Aging, & Body Composition (HABC) study. Setting: Community‐living adults aged 70 to 79 years with longitudinal follow up. [ABSTRACT FROM AUTHOR]

Trichodysplasia spinulosa (TS) is a rare skin condition caused by trichodysplasia spinulosa‐associated polyomavirus (TSPyV). It affects immunosuppressed patients, and <50 cases have been reported. The majority of these cases are seen in solid organ transplant recipients. TS often poses a diagnostic and therapeutic challenge because of its rarity and resemblance with other skin conditions. Several forms of treatment are usually tried prior to establishing a definitive diagnosis. Oral valganciclovir and topical cidofovir have been found to give the best results and hence are the most commonly used agents once the diagnosis is established. Here, we present two cases with a review of literature of TS in solid organ transplant recipients, focusing on time to develop the condition post‐transplant, immunosuppression regimen used, and treatment initiated both before and after a definitive diagnosis. [ABSTRACT FROM AUTHOR]

Aims: Diuretic resistance is common in acute decompensated heart failure (ADHF). When loop diuretic monotherapy is ineffective, thiazides are often recommended as adjunctive therapy, but these agents have many side effects and are associated with worsened survival. In contrast, sodium glucose cotransporter 2 inhibitors (SGLT‐2i's), initially developed as glucose‐lowering medications for type 2 diabetes, improve heart failure outcomes. A candidate contributory mechanism for this benefit is their diuretic effects. We sought to describe the safety and efficacy of SGLT‐2i's as loop diuretic adjuvants in ADHF. Methods and results: We retrospectively analysed patients who received adjuvant SGLT‐2i therapy between August 2016 and June 2018 at Yale‐New Haven Hospital. Thirty‐one patients comprised the cohort, 58% of whom had type 2 diabetes. Compared with the 24 h prior to SGLT‐2i initiation, average weight loss improved (1.0 ± 2.2 kg, P = 0.03 at Day 1; 1.7 ± 4.9 kg, P = 0.08 at Day 2; and 2.1 ± 5.6 kg, P = 0.06 at Day 3), as did urine output (3.7 ± 2.0 L, P = 0.002 at Day 1; 3.4 ± 1.7 L, P = 0.02 at Day 2; and 3.1 ± 1.7 L, P = 0.02 at Day 3) while loop diuretic dosing remaining stable. Creatinine remained unchanged during the 3 days after initiation, as did blood pressure and the incidence of hypokalaemia (P = NS for all). Conclusions: In this cohort of patients with ADHF, SGLT‐2i's improved weight loss, urine output, and diuretic efficiency without worsening of creatinine, potassium, or blood pressure. Further study of SGLT‐2i's as a loop diuretic adjuvant is warranted. [ABSTRACT FROM AUTHOR]

Uromodulin is released into serum (sUMOD) and urine (uUMOD) exclusively by renal tubular cells. Both sUMOD and uUMOD are correlated with estimated glomerular filtration rate (eGFR), and associated with mortality and cardiovascular disease (CVD). However, no study to our knowledge has measured both sUMOD and uUMOD in the same population, thus the relationship of sUMOD with uUMOD with one another, and their respective correlates have not been evaluated simultaneously. We evaluated the correlations of sUMOD, uUMOD with eGFR in a random sub‐cohort (n = 933) of the Cardiovascular Health Study and their associations with demographic and laboratory parameters and CVD risk factors using multi‐variable linear regression analysis. The mean age of the cohort was 78 years, 40% were male and 15% were Black. The mean sUMOD level was 127 ng/mL, uUMOD was 30 500 ng/mL and eGFR was 63 mL/min/1.73 m2. Correlation between sUMOD and uUMOD, adjusted for eGFR was moderate (r = 0.27 [95% confidence interval = 0.21‐0.33]). The correlation of eGFR with sUMOD (r = 0.44 [0.39‐0.49]) was stronger than with uUMOD (r = 0.21 [0.15‐0.27]). In multi‐variable analysis adjusting sUMOD for uUMOD and vice versa, sUMOD was independently associated with eGFR (β = 1.3 [1.1‐1.6]), log2 C‐reactive protein (β = −4.2 [−6.8 to −1.6]) and male sex (β = −13.6 [−22.7 to −4.5]). In contrast, male sex was associated with higher uUMOD (β = 3700 [400‐7000]), while diabetes (β = −6400 [−10 600 to −2100]) and hypertension (−4300 [−7500 to −1100]) were associated with lower uUMOD levels. We conclude that sUMOD is more strongly associated with eGFR compared with uUMOD. Correlates of sUMOD and uUMOD differ substantially, suggesting that apical and basolateral secretion may be differentially regulated. SUMMARY AT A GLANCE: Although both serum and urine uromodulin levels are correlated directly with eGFR, it is unclear which is better. In this study, serum uromodulin is more strongly associated with eGFR than urine uromodulin. In addition, correlates of serum and urine uromodulin differ, thus they may be differentially regulated to a certain extent. [ABSTRACT FROM AUTHOR]

The appropriate blood pressure (BP) target for dialysis patients remains controversial. Although there have been remarkable advances in this area in the general population, extrapolation of these data to dialysis patients is not possible. Observational studies in dialysis patients suggest that low BP is associated with worse outcomes. However, this is likely a result of confounding, considering that among dialysis patients with fewer cardiovascular comorbidities and longer survival, a more linear relationship exists between BP and mortality. Use of home BP measurements and ambulatory blood pressure monitoring (ABPM) measurements are more useful from a prognostic standpoint than in-center predialysis BP measurements. Large clinical trial data are, however, lacking and firm recommendations on BP targets for dialysis patients are not possible. [ABSTRACT FROM AUTHOR]

Pericarditis and pericardial effusions are not uncommon in patients with end-stage renal disease (ESRD). Etiologies include those found in the general population along with two entities unique to patients with kidney disease, namely uremic and dialysis-associated pericarditis. Uremic pericarditis has been arbitrarily defined as pericarditis that develops before or within 8 weeks of initiation of dialysis, while dialysis-associated pericarditis is used to define pericarditis in patients on dialysis for more than 8 weeks. Retention of uremic toxins is likely a major contributor to uremic and dialysis-associated pericarditis although their exact cause is not known. Indeed, whether they are actually distinct entities is uncertain. Symptoms and signs of pericarditis differ in patients with ESRD compared to the non-ESRD population. Management has not been well studied and ranges from initiation and intensification of dialysis to percutaneous or open drainage for large effusions. This review covers the literature on this topic but emphasizes that most of the data are old and of relatively poor quality, and therefore additional research is needed. [ABSTRACT FROM AUTHOR]

Objectives To evaluate whether fibroblast growth factor 23 ( FGF-23) is related to frailty and to characterize the nature of their joint association with mortality. Design Cross-sectional analysis for frailty and longitudinal cohort analysis for mortality. Setting Cardiovascular Health Study. Participants Community-dwelling individuals (N = 2,977; mean age 77.9 ± 4.7, 40% male, 83% white). Measurements The predictor was serum FGF-23 concentration (C-terminal enzyme-linked immunosorbent assay), and the outcomes were frailty status (determined according to frailty phenotype criteria of weight loss, weakness, exhaustion, slowness, and low physical activity) and mortality. Multinomial logistic regression was used to assess the cross-sectional association between FGF-23 and frailty and prefrailty, adjusting for demographic characteristics, cardiovascular disease and risk factors, and kidney markers. Proportional hazards Cox proportional hazards regression was used to assess the association between FGF-23, frailty, and all-cause mortality. Results Mean estimated glomerular filtration rate ( eGFR) was 64 ± 17 mL/min per 1.73 m2. Median FGF-23 was 70.3 RU/mL (interquartile range 53.4-99.2); 52% were prefrail, and 13% were frail. After multivariate adjustment, each doubling in FGF-23 concentration was associated with 38% (95% confidence interval (CI) = 17-62%) higher odds of frailty than of nonfrailty and 16% (95% CI = 3-30%) higher odds of prefrailty. FGF-23 (hazard ratio ( HR) = 1.16, 95% CI = 1.10-1.23) and frailty (HR = 1.82, 95% CI = 1.57-2.12) were independently associated with mortality, but neither association was meaningfully attenuated when adjusted for the other. Conclusion In a large cohort of older adults, higher FGF-23 was independently associated with prevalent frailty and prefrailty. FGF-23 and frailty were independent and additive risk factors for mortality. FGF-23 may be a marker for functional outcomes. [ABSTRACT FROM AUTHOR]

Objectives To evaluate and compare the associations between microvascular and macrovascular abnormalities and cognitive and physical function Design Cross-sectional analysis of the Cardiovascular Health Study (1998-1999). Setting Community. Participants Individuals with available data on three or more of five microvascular abnormalities (brain, retina, kidney) and three or more of six macrovascular abnormalities (brain, carotid artery, heart, peripheral artery) (N = 2,452; mean age 79.5). Measurements Standardized composite scores derived from three cognitive tests (Modified Mini-Mental State Examination, Digit-Symbol Substitution Test, Trail-Making Test ( TMT)) and three physical tests (gait speed, grip strength, 5-time sit to stand) Results Participants with high microvascular and macrovascular burden had worse cognitive (mean score difference = −0.30, 95% confidence interval ( CI) = −0.37 to −0.24) and physical (mean score difference = −0.32, 95% CI = −0.38 to −0.26) function than those with low microvascular and macrovascular burden. Individuals with high microvascular burden alone had similarly lower scores than those with high macrovascular burden alone (cognitive function: −0.16, 95% CI = −0.24 to −0.08 vs −0.13, 95% CI = −0.20 to −0.06; physical function: −0.15, 95% CI = −0.22 to −0.08 vs −0.12, 95% CI = −0.18 to −0.06). Psychomotor speed and working memory, assessed using the TMT, were only impaired in the presence of high microvascular burden. Of the 11 vascular abnormalities considered, white matter hyperintensity, cystatin C-based glomerular filtration rate, large brain infarct, and ankle-arm index were independently associated with cognitive and physical function. Conclusion Microvascular and macrovascular abnormalities assessed using noninvasive tests of the brain, kidney, and peripheral artery were independently associated with poor cognitive and physical function in older adults. Future research should evaluate the usefulness of these tests in prognostication. [ABSTRACT FROM AUTHOR]

Although cognitive impairment is common in hemodialysis patients, the etiology of and risk factors for its development remain unclear. Fibroblast growth factor 23 ( FGF-23) levels are elevated in hemodialysis patients and are associated with increased mortality and left ventricular hypertrophy. Despite FGF-23 being found within the brain, there are no prior studies assessing whether FGF-23 levels are associated with cognitive performance. We measured FGF-23 in 263 prevalent hemodialysis patients in whom comprehensive neurocognitive testing was also performed. The cross-sectional association between patient characteristics and FGF-23 levels was assessed. Principal factor analysis was used to derive two factors from cognitive test scores, representing memory and executive function, which carried a mean of 0 and a standard deviation of 1. Multivariable linear regression adjusting for age, sex, education status, and other relevant covariates was used to explore the relationship between FGF-23 and each factor. Mean age was 63 years, 46% were women and 22% were African American. The median FGF-23 level was 3098 RU/mL. Younger age, lower prevalence of diabetes, longer dialysis vintage, and higher calcium and phosphorus were independently associated with higher FGF-23 levels. Higher FGF-23 was independently associated with a lower memory score (per doubling of FGF-23, β = −0.08 SD [95% confidence interval, CI: −0.16, −0.01]) and highest quartile vs. lowest quartile (β = −0.42 SD [−0.82, −0.02]). There was no definite association of FGF 23 with executive function when examined as a continuous variable (β = −0.03 SD [−0.10, 0.04]); however, there was a trend in the quartile analysis (β = −0.28 SD [−0.63, 0.07], P = 0.13, for 4th quartile vs. 1st quartile). FGF-23 was associated with worse performance on a composite memory score, including after adjustment for measures of mineral metabolism. High FGF-23 levels in hemodialysis patients may contribute to cognitive impairment. [ABSTRACT FROM AUTHOR]

There are few reports on the relationship of blood pressure with cognitive function in maintenance dialysis patients. The Cognition and Dialysis Study is an ongoing investigation of cognitive function and its risk factors in six Boston area hemodialysis units. In this analysis, we evaluated the relationship between different domains of cognitive function with systolic and diastolic blood pressure, pulse pressure, and intradialytic changes in systolic blood pressure, using univariate and multivariable linear regression models adjusted for age, sex, race, education, and primary cause of end-stage renal disease. Among 314 participants, mean age was 63 years; 47% were female, 22% were African American, and 48% had diabetes. The mean ( SD) of systolic blood pressure, diastolic blood pressure, pulse pressure, and intradialytic change in systolic blood pressure were 141 (21), 73 (12), 68 (15), and −10 (24) mm Hg, respectively. In univariate analyses, the performance on cognitive tests primarily assessing executive function and processing speeds was worse among participants with lower diastolic blood pressure and higher pulse pressure. These relationships were not statistically significant, however, in multivariable analyses. There was no association between cognitive function and systolic blood pressure or intradialytic change in systolic blood pressure in either univariate or multivariable analyses. We found no association between different measures of blood pressure and cognitive function in cross-sectional analysis. Longitudinal studies are needed to confirm these results. [ABSTRACT FROM AUTHOR]

Objectives To examine the association between kidney function and all-cause mortality in octogenarians. Design Retrospective analysis of prospectively collected data. Setting Community. Participants Serum creatinine and cystatin C were measured in 1,053 Cardiovascular Health Study ( CHS) All Stars participants. Measurements Estimated glomerular filtration rate (e GFR) was determined using the Chronic Kidney Disease Epidemiology Collaboration creatinine (e GFRCR) and cystatin C one-variable (e GFRCYS) equations. The association between quintiles of kidney function and all-cause mortality was analyzed using unadjusted and adjusted Cox proportional hazards models. Results Mean age of the participants was 85, 64% were female, 66% had hypertension, 14% had diabetes mellitus, and 39% had prevalent cardiovascular disease. There were 154 deaths over a median follow-up of 2.6 years. The association between e GFRCR and all-cause mortality was U-shaped. In comparison with the reference quintile (64-75 mL/min per 1.73 m2), the highest (≥75 mL/min per 1.73 m2) and lowest (≤43 mL/min per 1.73 m2) quintiles of e GFRCR were independently associated with mortality (hazard ratio (HR) = 2.49, 95% confidence interval (CI) = 1.36-4.55; HR = 2.28, 95% CI = 1.26-4.10, respectively). The association between e GFRCYS and all-cause mortality was linear in those with e GFRCYS of less than 60 mL/min per 1.73 m2, and in the multivariate analyses, the lowest quintile of e GFRCYS (<52 mL/min per 1.73 m2) was significantly associated with mortality (HR = 2.04, 95% CI = 1.12-3.71) compared with the highest quintile (>0.88 mL/min per 1.73 m2). Conclusion Moderate reduction in kidney function is a risk factor for all-cause mortality in octogenarians. The association between e GFRCR and all-cause mortality differed from that observed with e GFRCYS; the relationship was U-shaped for e GFRCR, whereas the risk was primarily present in the lowest quintile for e GFRCYS. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is a growing public health problem. The incidence of kidney failure is rising in all age groups but particularly in older adults. Individuals in all stages of CKD are at higher risk for development of cognitive impairment and this may be a major determinant in their quality of life. Furthermore, cognitive impairment is associated with an increased risk of death in dialysis patients. Cerebrovascular disease is a strong risk factor for development of cognitive impairment and vascular disease is a more likely cause of cognitive impairment than Alzheimer’s disease in patients with CKD. Both traditional and nontraditional vascular risk factors are more common in CKD and dialysis patients may also be at risk for cognitive impairment via nonvascular risk factors and the hemodialysis procedure itself. Unfortunately, because risk factors for cognitive impairment in CKD have not been thoroughly ascertained, evaluation of potential treatments has been limited. Given the high prevalence of cognitive impairment in all stages of CKD, additional studies are needed to evaluate potential risk factors and treatments in this vulnerable population. [ABSTRACT FROM AUTHOR]

Given the high burden of atherosclerotic cardiovascular disease in dialysis patients, we hypothesized that cognitive testing would reveal subtle abnormalities in subcortical brain function, a measure frequently associated with cerebrovascular disease. Detailed neurocognitive testing was performed in 25 hemodialysis patients. All patients had Mini-Mental State Examination (MMSE) scores >24 and had no history of cerebrovascular disease. Where appropriate, scores were normalized for age, gender, and education. One-sample t tests were used to compare differences in cognitive function between dialysis patients and normative data. The mean age was 57 years, and the mean MMSE was 27.5. Fourteen subjects (56%) were females, and 15 white (60%). Results of the North American Adult Reading Test, a measure of verbal intelligence, were comparable with the general population. Similarly, measures of cortical function, namely retention and recognition scores from the Word List Learning subtest of the Wechsler Memory Scale-III, were preserved when compared with normative data where reference = 10. Significant deficits were seen on tests assessing subcortical function: scores (mean±standard deviation) for block design, and symbol coding subtests of the Wechsler Adult Intelligence Scale-III were 7.0±1.7 and 7.7±3.1, respectively (p<0.001 for both comparisons with normative data). Similarly, adjusted scores on the trails A and B tests were 40.5±8.3 and 41.8±11.3, respectively (p<0.001 for both comparisons with normative data where reference= 50). These results suggest that, despite relatively normal MMSE scores, mild cognitive impairment may be prevalent in hemodialysis patients. The pattern of cognitive dysfunction is primarily subcortical in nature. [ABSTRACT FROM AUTHOR]

Background Micronutrient status can affect cognitive function in the elderly; however, there is much to learn about the precise effects. Understanding mediating factors by which micronutrient status affects cognitive function would contribute to elders' quality of life and their ability to remain in the home. Objectives The Nutrition, Aging, and Memory in Elders (NAME) Study is designed to advance the current level of knowledge by investigating potential mediating factors by which micronutrient status contributes to cognitive impairment and central nervous system abnormalities in the elderly. NAME targets homebound elders because they are understudied and particularly at risk for poor nutritional status. Methods Subjects are community-based elders aged 60 and older, recruited through area Aging Services Access Points. The NAME core data include demographics; neuropsychological testing and activities of daily living measures; food frequency, health and behavioral questionnaires; anthropometrics; gene status; plasma micronutrients, homocysteine, and other blood determinants. A neurological examination, psychiatric examination, and brain MRI and volumetric measurements are obtained from a sub-sample. Results Preliminary data from first 300 subjects are reported. These data show that the NAME protocol is feasible and that the enrolled subjects are racially diverse, at-risk, and had similar basic demographics to the population from which they were drawn. Conclusion The goal of the NAME study is to evaluate novel relationships between nutritional factors and cognitive impairment. These data may provide important information on potential new therapeutic strategies and supplementation standards for the elderly to maintain cognitive function and potentially reduce the public health costs of dementia. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

There is no widely accepted definition of intradialytic hypertension. Arbitrary clinical definitions have included an increase in blood pressure during or immediately after hemodialysis, a rise in blood pressure during the second or third hour of dialysis, and an increase in blood pressure that is resistant to ultrafiltration. To date, no studies have evaluated the prevalence and prognostic importance of intradialytic hypertension. The pathogenesis of intradialytic hypertension is complex and is due in part to extracellular fluid volume expansion, increased cardiac output, activation of the renin-angiotensin system and the sympathetic nervous system, increased circulating vasoactive substances resulting in peripheral vasoconstriction, erythropoietin use, and fluctuations in electrolytes and removal of antihypertensive medications during the dialysis procedure. Management strategies of intradialytic hypertension are based on expert opinion using the pathophysiologic principles described above. We conclude that additional epidemiologic, basic science, and interventional studies are needed to further elucidate the prevalence, prognostic importance, pathophysiology, and potential treatment of intradialytic hypertension. [ABSTRACT FROM AUTHOR]

Individuals with chronic kidney disease (CKD) are at increased risk for the development and progression of cardiovascular disease (CVD). The increased risk is due to a higher prevalence of both traditional risk factors as well as nontraditional risk factors. In this review we focus on individuals at all stages of CKD and discuss modifiable traditional risk factors, namely hypertension, dyslipidemia, diabetes mellitus and poor glycemic control, smoking, and physical inactivity. The prevalence of each risk factor and its relationship with CVD is described. Treatment recommendations are provided using evidence available from populations with CKD or evidence extrapolated from the general population when there are insufficient data on individuals with CKD. [ABSTRACT FROM AUTHOR]

Studies the cardiovascular risk factors in dialysis patients. Epidemiological analysis; Mortality risk in dialysis patients; Diagnosis of coronary artery disease.

Dialysis patients have a high prevalence of both structural brain abnormalities and cognitive impairment. The pathogenesis of the structural brain abnormalities and cognitive impairment as well the relationship between the two is however less clear. In this editorial, we question whether the hemodialysis procedure itself may be partly responsible for the structural abnormalities noted on imaging studies as well as for the cognitive impairment. We invoke several mechanisms whereby the procedure itself may 'hurt' the brain including rapid changes in blood pressure, microembolization, microbleeds, and cerebral edema. We then summarize research questions whose answers may help move the field forward. [ABSTRACT FROM AUTHOR]

Presents views on the means of reducing cardiac death rate in dialysis patients in the U.S. Examination of risk factors on earlier stages of kidney disease; Beneficial effect of target hemoglobin on asymptomatic hemodialysis patients; Calcification of coronary vessels on dialysis patients.

Focuses on the treatment methods for subclavian vein stenosis in hemodialysis patients in the United States. Complications of subclavian vein stenosis; Discussion of each access method; Preference of stenting over other methods.

Focuses on the long-term performance and complications of the Tesio twin catheter system for hemodialysis access. Risks of subclavian stenosis and thrombosis; Rate of infection in the placement of the catheter; Use of urokinase in sufficient amount to fill the catheter.