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Peritoneal dialysis (PD) is one of the options for renal replacement therapy (RRT) in the end stage renal disease (ESRD) patients. Compared to hemodialysis (HD), patients on PD experience a greater sense of well-being, an improved steady state in terms of extracellular fluid volume shifts and hemodynamics and it is preferred method for patients with problematic vascular access, bleeding tendencies, heart failure and elderly patients. In order to perform PD, a tunneled catheter should be placed through the abdominal wall and into peritoneal space, with positioning of the catheter within the most dependent portion of pelvis. Currently, there are several techniques available for PD catheter placement: open surgery, laparoscopic and percutaneous. We present for the first time in our country a case of 65 year old male patient to whom percutaneous onsite insertion of peritoneal catheter was performed. The idea is to emphasize that sometimes this should be a method of choice for RRT, especially in patients where general anesthesia should be avoid. Compared to other methods, percutaneous insertion is a simple procedure with no need for general anesthesia, and the benefits of quick recovery, earlier ambulation, and less delay in catheter placement. [ABSTRACT FROM AUTHOR]

Background: We aimed to determine the effects of systemic therapy with autologous adipose tissue derived mesenchymal stem cells (AD-MSCs) on different parameters of peritoneal function and inflammation in peritoneal dialysis (PD) patients. Methods: We enrolled nine PD patients with ultrafiltration failure (UFF). Patients received 1.2 ± 0.1 x 106 cell/kg of AD-MSCs via cubital vein and were then followed for six months at time points of baseline, 3, 6, 12, 16 and 24 weeks after infusion. UNIPET was performed for assessment of peritoneal characteristics at baseline and weeks 12 and 24. Systemic and peritoneal levels of tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), IL-2 and CA125 (by ELISA) and gene expression levels of transforming growth factor beta (TGF-β), smooth muscle actin (α-SMA) and fibroblast-specific protein-1 (FSP-1) in PD effluent derived cells (by quantitative real-time PCR) were measured at baseline and weeks 3, 6, 12, 16 and 24. Results: Slight improvement was observed in the following UF capacity indices: free water transport (FWT, 32%), ultrafiltration - small pore (UFSP, 18%), ultrafiltration total (UFT, 25%), osmotic conductance to glucose (OCG, 25%), D/P creatinine (0.75 to 0.70), and Dt/D0 glucose (0.23 to 0.26). There was a slight increase in systemic and peritoneal levels of CA125 and a slight decrease in gene expression levels of TGF-β, α-SMA and FSP-1 that was more prominent at week 12 and vanished by the end of the study. Conclusion: Our results for the first time showed the potential of MSCs for treatment of peritoneal damage in a clinical trial. Our results could be regarded as hypothesis suggestion and will need confirmation in future studies. [ABSTRACT FROM AUTHOR]

Objective: Continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) are main modalities for end stage renal disease (ESRD) patients, and those have been covered by National Health Insurance (NHI) scheme since 2014 in Indonesia. This study aims to update the cost-effectiveness model of CAPD versus HD in Indonesia setting. Results: Compared to HD, CAPD provides good value for money among ESRD patients in Indonesia. Using societal perspective, the total costs were IDR 1,348,612,118 (USD 95,504) and IDR 1,368,447,750 (USD 96,908), for CAPD and HD, respectively. The QALY was slightly different between two modalities, 4.79 for CAPD versus 4.22 for HD. The incremental cost-effectiveness ratio (ICER) yields savings of IDR 34,723,527/QALY (USD 2460). [ABSTRACT FROM AUTHOR]

Background: Right ventricular dysfunction is a major cause of heart failure and mortality in end‐stage renal disease patients. Scarce data is available regarding the comparison of echocardiographic right ventricular function in end‐stage renal disease patients on hemodialysis (HD) and peritoneal dialysis (PD). The aim of the study was to evaluate the long‐term impacts of different dialysis modalities on right ventricular function assessed by conventional echocardiography, in end‐stage renal disease patients with preserved left ventricular function. Methods: The study included 120 patients grouped as follows: PD (n = 40), HD with arterio‐venous fistula (n = 40), and healthy control subjects (n = 40). Conventional echocardiography was performed on all patients. A classification of right ventricular function was defined in HD patients by using tricuspid annular plane systolic excursion (TAPSE), right ventricular myocardial performance index (RV‐MPI), fractional area change (FAC), and tricuspid lateral annulus systolic velocity (Sa) values. Correlation analysis was performed by using the right ventricular dysfunction score, clinical, and echocardiographic parameters. Results: The mean age of the study population was 51.9 ± 13.1 years and 47.5% were females. TAPSE and Sa velocity were found to be significantly lower and RV‐MPI was significantly higher in patients undergoing HD, compared with control and PD patients. Logistic regression analysis showed that HD treatment was an independent risk factor for developing right ventricular dysfunction. Conclusion: RV function was impaired in patients undergoing HD compared with patients on PD. [ABSTRACT FROM AUTHOR]

Albumin (HSA) is a multifunctional protein and due to its free Cys34 thiol group, represents a main source of free thiols in the circulation. This property of HSA, combined with its ability to sequester redox active Cu(II) ions, makes HSA a dominant circulatory antioxidant. End stage kidney disease (ESRD) is a condition accompanied by elevated oxidative stress. The aim of the present study was to examine changes in the antioxidative capacity of HSA and Cu(II) binding affinity in patients on peritoneal dialysis (PD), and relate it to the Cys34 thiol group content and other structural changes of this molecule. HSA molecules are modified in ESRD patients subjected to PD, having significantly lower thiol group and bound Cu(II) content, reduced antioxidant capacity, an increased content of advanced glycation end-products and altered conformation. Also, Cu(II) binding capacity of HSA in these patients is impaired, since a significant portion of the high-affinity metal-binding site is unable to interact with Cu(II). Taking into account that the concentration of Cu(II) in the circulation of ESRD patients is much higher than in healthy persons and that Cu(II) binding capacity of HSA in these patients is significantly impaired, HSA may be considered as a novel circulatory pro-oxidant, thus exacerbating oxidative stress. [Display omitted] • Albumin molecules are modified in PD patients. • Albumin has impaired antioxidant properties and increased content of AGEs. • Cu(II) binding capacity of albumin in PD patients is impaired. • Albumin may be considered as a novel pro-oxidant in PD. [ABSTRACT FROM AUTHOR]

Introduction. Kidney transplantation is the treatment of choice in the majority of end-stage renal disease (ESRD) patients. However, most of the incident ESRD patients are not given the necessary information regarding kidney transplantation. The aim of this study was to evaluate awareness and knowledge about kidney transplantation in ESRD patients who were on dialysis. Methods. In this cross-sectional study, a total of 300 ESRD patients who underwent hemodialysis or peritoneal dialysis and could be eligible for kidney transplant, were included. A questionnaire with 15 multiple choice questions (MCQs) was designed to collect the data. SPSS version 16 was used for data analysis and a P value less than .05 was considered statistically significant. Results. Two hundred thirty-four patients participated in the study (response rate of 78%). Among them 58.1% were male with the mean age (SD) of 52.5 (12.1) years. The majority of the patients (94.0%) were on hemodialysis. About 87.6% wanted to receive kidney transplant; but despite the desire of the patients, this method was initially offered to about 11.5 % of the patients as a possible method of renal replacement therapy. Patients who had desire to receive kidney transplantation were significantly younger, male, married, employed, and had high level of education (P < .05). Conclusion. Although most of the patients wanted to receive a kidney transplant, it was initially offered to a small population. Age, gender, marital status, employment condition, and level of education were significant factors for the patient's tendency to receive a kidney transplant. [ABSTRACT FROM AUTHOR]

Introduction: Cardiovascular complications are considered as the main cause of mortality in patients with End-Stage Renal Disease (ESRD). Cardiovascular Disease (CVD) includes disorders of the Left Ventricular Hypertrophy (LVH) of the heart which is the most frequent cardiac alteration in ESRD. Galectin-3 (GAL-3), a ß-galactoside-binding protein has been proposed to be a new clinical biomarker that reflects cardiac fibrosis in patients with Heart Failure (HF). Aim: To evaluate the relationship between GAL-3 and biochemical parameters in Peritoneal Dialysis (PD) patients with and without LVH. Materials and Methods: This cross-sectional study enrolled 45 patients (25 women and 20 men) with ESRD who were categorised as having CVD with (n=12) or without (n=33) LVH. Demographic, biochemical and clinical characteristics of 45 patients were analysed. The relationship of plasma GAL-3 levels was analysed with the biochemical parameters for both the groups of patients. For comparison between groups, Student unpaired t-test was used for the data of normal distribution while Mann-Whitney test was used for data of non- Gaussian distribution. Pearson's correlation test was performed to examine various correlations. Results: Significantly high number (83.3%) of female patients were observed in ESRD with LVH. The groups did not differ significantly in their demographic, and biochemical and clinical parameters. There was significant increase in Left Ventricular End-Diastolic Diameters (LVEDD), Left Ventricular (LV) mass and LV mass index in patients with LVH as compared to the patients without LVH. The levels of GAL-3 showed slight increase (91±23.98 ng/mL) levels in LVH patients as compared to the patients without LVH (83.68±32.8 ng/mL). Exponential positive correlation between serum levels of GAL-3 and creatinine in all ESRD patients (r2=0.5488, p=0.0002). GAL-3 also showed positive correlations with urea (r=0.3825, p=0.011) as well as and uric acid (r=0.347, p=0.021) for ESRD patients without LVH. However, GAL-3 showed no association with uric acid and urea (r=0.04487, p=0.896; r=0.2383, p=0.48) in ESRD patients with LVH. Conclusion: GAL-3 positively correlated to the biochemical parameters in ESRD patients. Patients with LVH only showed positive correlation between GAL-3 and creatinine. Moreover, GAL-3 could not be used as the biomarker because it did not correlate with established diagnostic parameter like LV mass and LV mass index. Hence, in this study GAL-3 is not a potential clinical biomarker for the progression of cardiovascular complications in ESRD patients. Overall, these data reflect the need for further investigation of GAL-3 to HF in patients with ESRD. [ABSTRACT FROM AUTHOR]

Background: Some observational studies indicate an association of 25-hydroxy vitamin D (25(OH)D) insufficiency and atherogenic cholesterol concentrations. The aim of this study was to investigate relationship between 25(OH)D concentrations and lipid parameters in end stage renal disease (ESRD) patients, separately for predialysis, hemodialysis and peritoneal dialysis patients. Methods: We have adjusted 25(OH)D concentrations for seasonal variability with cosi nor ana lysis, and performed all further analysis using these corrected 25(0 H)D concentrations. Concentrations of 25(OH)Dand the lipid parameters were determined in 214 ESRD patients and 50 control group participants. The analysis included the measurement of 25(OH)D by HPLC, apolipoprotein (Apo) Al, ApoB and Lp(a) by nephelometry, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG) by spectrophotometry and manually calculated ApoB/ApoAl and LDL-C/HDL-C ratio. Results: ESRD patients with adjusted 25(OH)D concentrations of ž 50 nmol/L had significantly higher TC (P = 0.005) and ApoAl (P = 0.049). Significantly higher HDL- C (P = 0.011) and ApoAl (P = 0.020) were found in hemodialysis patients with the 25(OH)D concentrations of > 50 nmol/L. The other analyzed lipid parameters differed significantly between predialysis, hemodialysis and peritoneal dialysis patients with 25(OH)D concentrations of < 50 nmol/L. Conclusions: Our study indicate the significant relationship between 25(OH)D repletion and optimal concentrations of lipid parameters in ESRD patients. Further research is necessary to explain whether joint evaluation of vitamin D status and lipid abnormalities could improve cardiovascular outcome in ESRD patients. [ABSTRACT FROM AUTHOR]

Globally, home dialysis prevalence has been declining relative to the increase in end stage renal disease and renal replacement therapy. The goal of this study was to identify international perceptions and practices. A web-based questionnaire was disseminated to nephrology nurses in 30 home dialysis-prevalent nations. Global telehealth use was low (23%), contrasting with 83% respondents agreeing telehealth would improve care. Only 31% of all programs enabled patient training outside of normal working hours (e.g., nights and weekends), and 31% of all program patients had some cost reimbursement, with a significant difference between U.S. and non-U.S. programs (U.S. 11%, non-U.S. 59%, 2 = 93.6, p < 0.0001). Significant differences in the need for monthly clinic visits (U.S. 72%, non-US 44%, 2 = 83.7, p < 0.0001) were also found. Telehealth provision and patient training flexibility is limited, and patient cost reimbursement is low. Increased telehealth, patient cost reimbursement, and flexible training models may promote home dialysis growth. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the level of end-stage renal disease (ESRD) knowledge among patients on peritoneal dialysis and haemodialysis and test associations between the level of their ESRD knowledge with sociodemographic and clinical variables. An in-centre cross-sectional study was conducted on a randomly selected 178 dialysis (57 peritoneal dialysis and 121 haemodialysis) patients receiving renal care at Rimba Dialysis Centre, Brunei, of which 50.6% (n=90) were females and 49.4% (n=88) were males. A validated, structured 10-Item ESRD knowledge questionnaire (with score scale of 0-10; and classified as <5 limited, 5-7 moderate, and 7-10 substantial knowledge) was self-administered by the respondents to assess their ESRD knowledge. Additional sociodemographic information was collected, and clinical variables were extracted from their dialysis records. The mean age of the respondents was 50.1 (SD=13.57) years. The mean knowledge score of the patients was 5.84 (SD=2.29), indicating moderate knowledge among ESRD patients on dialysis. Higher educational attainment (P<0.001), higher income (P=0.041), longer duration on dialysis (P=0.008), and dialysis initiation at a younger age (P=0.001) were significantly associated with better ESRD knowledge. On the other hand, the type of dialysis modality (P=0.117), age (P=0.106), employment status (P=0.662), marital status (P=0.187), dietary restrictions; potassium and phosphate (P=0.182), systolic blood pressure (P=0.172), diastolic blood pressure (P=0.062), intra-dialytic weight gain (P=0.592) and dialysis adequacy (P=0.977) were not associated with ESRD knowledge. Most patients, especially those with low income and education status demonstrated limited knowledge regarding ESRD and treatment, suggesting the need for educational interventions. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency and pattern of dyslipidemia in pediatric patients with end stage renal disease presenting in a tertiary care hospital. Study Design: Cross-sectional, observational study. Place and Duration of Study: The Children's hospital and the Institute of Child Health Lahore, from Sep 2016 to Nov 2017. Material and Methods: Children aged 5-15 years, of either gender and diagnosed with end stage renal disease were selected for the study. All the patients were undergoing renal replacement therapy in the form of hemodialysis and/or continuous ambulatory peritoneal dialysis. The serum levels of total cholesterol, triglycerides, high density lipoprotein, low density lipoprotein and very low density lipoprotein were measured. Results: There were 138 patients in the study with mean age 11.24 ± 2.37 years and male to female ratio 2.5:1. The mean ± SD values of total serum cholesterol, triglycerides, and low density lipoprotein were found to be 174.0 ± 54.1, 241.2 ± 142.4 and 95.2 ± 49.0 mg/dl respectively. The frequency of abnormally high levels of total serum cholesterol, triglycerides, and low density lipoprotein were found to be 21.7%, 84.8% and 19.6% respectively. The lipid profile of patients on peritoneal dialysis was markedly elevated as compared to that of patients on maintenance hemodialysis (p-value ≤0.05). Conclusion: Majority of pediatric patients with end stage renal disease had suffered from dyslipidemia especially raised serum triglycerides. Timely identification of abnormal lipid levels and appropriate management is expected to help reduce cardiovascular morbidity and mortality associated with dyslipidemia in these pediatric patients. Moreover, lipid profile of patients on peritoneal dialysis was more deranged than those on hemodialysis. [ABSTRACT FROM AUTHOR]

Objective: Using mesenchymal stem cells (MSCs) is regarded as a new therapeutic approach for improving fibrotic diseases. The aim of this study to evaluate the feasibility and safety of systemic infusion of autologous adipose tissue-derived MSCs (AD-MSCs) in peritoneal dialysis (PD) patients with expected peritoneal fibrosis. Materials and Methods: This study was a prospective, open-label, non-randomized, placebo-free, phase I clinical trial. Case group consisted of nine eligible renal failure patients with more than two years of history of being on PD. Autologous AD-MSCs were obtained through lipoaspiration and expanded under good manufacturing practice conditions. Patients received 1.2 ± 0.1×106 cell/kg of AD-MSCs via cubital vein and then were followed for six months at time points of baseline, and then 3 weeks, 6 weeks, 12 weeks, 16 weeks and 24 weeks after infusion. Clinical, biochemical and peritoneal equilibration test (PET) were performed to assess the safety and probable change in peritoneal solute transport parameters. Results: No serious adverse events and no catheter-related complications were found in the participants. 14 minor reported adverse events were self-limited or subsided after supportive treatment. One patient developed an episode of peritonitis and another patient experienced exit site infection, which did not appear to be related to the procedure. A significant decrease in the rate of solute transport across peritoneal membrane was detected by PET (D/P cr=0.77 vs. 0.73, P=0.02). Conclusion: This study, for the first time, showed the feasibility and safety of AD-MSCs in PD patients and the potentials for positive changes in solute transport. Further studies with larger samples, longer follow-up, and randomized blind control groups to elucidate the most effective route, frequency and dose of MSCs administration, are necessary (Registration Number: IRCT2015052415841N2). [ABSTRACT FROM AUTHOR]

Background It is not clear on which level of estimated glomerular filtration rate to start dialysis until now. Objective To compare between patient groups according to estimated glomerular filtration rate at dialysis initiation. Methods Eighty-seven Patients are selected randomly from a list of patients admitted for dialysis (Hemodialysis or Peritoneal dialysis) at Northern General Hospital - Sheffield Kidney Institute from 1st of January to 31st of December 2000. Patients have been categorized into two groups. First group includes 45 patients started dialysis with glomerular filtration rate less than 5 ml/min/1.73m². Second group includes 42 patients started dialysis with glomerular filtration rate from 5-10 ml/min/1.73m². Patients have been followed up for five years retrospectively until 31st December 2005. Results The study showed males are the predominant gender. White Caucasian patients are majority of patients. The mean age is 56 years. About half of patients are middle aged (45-65 years) and are overweight or obese. This study shows no difference between patients who started dialysis early (estimated glomerular filtration rate 5-10 ml/min/1.73m²) versus late (estimated glomerular filtration rate below 5 ml/min/1.73m²) in term of mortality and morbidity throughout five years of follow up. Conclusion This study showed no justification to decide on time to initiate dialysis based solely on estimated glomerular filtration rate level. [ABSTRACT FROM AUTHOR]

Objective: To explore the effects of peritoneal dialysis (PD) and hemodialysis (HD) on calcium-phosphorus metabolism and micro inflammatory state in patients with end-stage renal disease (ESRD). Results: 94 patients with ESRD who were treated in our hospital fromJanuary 2016 to February 2017 were selected as the subjects, the patients were divided into PDgroup (47 cases) and HD group (47 cases) by random number table, the PD group were treated with ambulatory continuous PD treatment, the HD group were treated with HD, after 6 months treatment, the levels of serumcalcium, phosphorus metabolism and micro inflammation were compared between the two groups, the incidence of complications in the two groups was also counted. After 6 months treatment, the serum calcium levels of the two groups increased significantly, serum phosphorus levels decreased significantly (P<0.05), but there was no significant difference between the HD group and the PD group (P>0.05). After 6 months treatment, the levels of serum c-reactive protein (CRP) in two groups were significantly increased, and the HD group was higher than the PD group, the differences were statistically significant (P<0.05). After 6 months treatment, the level of procalcitonin (PCT) was lower than that at before treatment, the difference was statistically significant (P<0.05), but there was no significant difference between the HD group and the PD group (P>0.05). The incidence of infection and hypoproteinemia in PD group were higher than that in HD group, and the incidence of hypertension, arrhythmia andcongestive heart failure in HDgroup were higher than that inPDgroup, the differenceswere statisticallysignificant (P<0.05). Conclusion: The PD and HD treatment both can improve the metabolismof calcium and phosphorus in patients with ESRD, but both of them will aggravate the micro inflammatory reaction, and HD has more influence on the micro inflammatory state of the patients. [ABSTRACT FROM AUTHOR]

Objective:To compare the effect of hemodialysis and peritoneal dialysis on the prognosis and safety of patients with end-stage renal disease (ESRD). Methods:246 patients with dialysis in our hospital from January 2010 to April 2016 were selected and divided into two groups: hemodialysis group and peritoneal dialysis group, the survival and incidence of complications were compared between the two groups. Results:The causes of death in both groups were heart failure, gastrointestinal bleeding, severe infection, cerebral infarction, and the fatality rate and cause of death showed no statistically significant difference (P>0.05). The 1-year, 3-year and 5-year survival rates of ESRD patients in the peritoneal dialysis group were significantly higher than those of the hemodialysis group (P<0.05), no statistical difference was found in the 7-year survival rate between two groups (P>0.05). For the first time in over 60 years of age in patients with end-stage renal disease, the 1-year, 3-year, 5-year and 7-year survival rates were significantly lower than those of the hemodialysis group(P<0.05). The incidence of heart failure, arteriovenous fistula occlusion of hemodialysis group were higher than those of the peritoneal dialysis group (P<0.05), the incidence of peritonitis in peritoneal dialysis group was higher than that of the hemodialysis group (P<0.05), the total complication rate in the hemodialysis group was higher than that of the peritoneal dialysis group (P<0.05). Conclusion:Hemodialysis and peritoneal dialysis had their own advantages and disadvantages, we should choose the mode of dialysis for patients with end-stage renal disease, reduce the complications, improve the quality of life and the survival rate. [ABSTRACT FROM AUTHOR]

Patients receiving care for the management of end stage renal disease require transport to nephrology practice settings and treatment centers for hemodialysis and peritoneal dialysis. This type of transportation, defined as non-emergency medical transportation, has long presented a challenge for patients, families, and healthcare providers. This article explores the current and projected statistics and trends for chronic kidney disease, transportation challenges faced by patients and nephrology healthcare providers, and examples of successful transportation services and programs. Implications for practice with a focus placed on the importance of an interprofessional approach are described. [ABSTRACT FROM AUTHOR]

This study measured the prevalence of depression in 39 patients on hemodialysis and peritoneal dialysis in two urban outpatient facilities in the southeastern United States. Additionally, it evaluated the number of patients who sought and scheduled a mental health evaluation after screening and education. The prevalence of mild to severely depressed individuals among participants in this study was 36%, affirming previous findings of depressive symptoms in the ESRD population. Results suggest that patients with ESRD are at a higher risk for depression than the general population. The effects of depression may exacerbate ESRD symptoms, affect treatment adherence, and increase hospitalizations and morbidity. It is likely that screening, diagnosing, and treating depression will be associated with improvement in quality and quantity of life. The practicality of using the screening procedure may improve the detection of depression in this population. However, only a fraction of identified patients in this study pursued further mental health evaluation within the 45-day period. Continued research is needed to identify barriers to seeking mental health consultation and treatment in this community. [ABSTRACT FROM AUTHOR]

Aim There is little information on the relationship between uric acid (UA) and residual renal function (RRF) in continuous ambulatory peritoneal dialysis (CAPD). The aim of this research is to study the influence of UA on RRF decline in CAPD patients. Methods A retrospective observational cohort study of 304 patients who started CAPD without anuria between 2001 and 2010 was conducted at a single medical center. The outcomes measured in the study included the rate of RRF decline and anuria. A multiple ordinal logistic regression model with backward elimination was conducted to determine the independent factors of the slope of RRF decline. A Cox proportional hazard model was conducted to determine the independent variables of time to anuria. Results The average rate of RRF decline was −0.12 ± 0.22 mL/min per month. Multivariate analysis showed that lower UA group (<0.372 mmol/L), higher UA group (≧0.421 mmol/L), male gender, diabetes mellitus (DM), the use of calcium channel blocker (CCB), and RRF at baseline were linked positively with the rate of RRF decline; on the other hand, independence in dialysate exchanges and BUN were negatively associated with the risk of RRF decline. In addition, male gender, DM, diuretics, and CCB were associated with a higher risk of progression to anuria, whereas 24-h urine amount at baseline conferred a protective role in the development of anuria. Conclusions A U-shaped relationship was found between UA levels and the rate of RRF decline in patients on CAPD, with a faster decline rate in those of higher and lower UA groups. [ABSTRACT FROM AUTHOR]

Peritoneal dialysis (PD) offers the healthiest way for starting renal replacement therapy (RRT) in End Stage Renal Disease patients, however exposes long-term PD patients to a dangerous complication named encapsulating peritoneal sclerosis (EPS). In this study, we searched for possible risk factors of EPS. Data were collected from two PD centers covering period 1995–2012 and comprised 464 patients. Control group defined as PD patients stayed on PD >42 month (n = 122), and case group was 12 confirmed EPS patients. Associations were analyzed using linear regression analysis. Prevalence and incidence of EPS were 2.59% and 8.9% with an incidence of 0.7% patient-years, respectively. The age at start of PD in EPS patients (32.75 ± 10.8 year) was significantly lower compared with control group (49.61 ± 16.18 year,p = .0001). The mean duration of PD in EPS and control group were 2494.4 ± 940.9 and 1890.2 ± 598.8 days (p = .002). Control group had 145 episodes of peritonitis during total duration of 7686 patient months (peritonitis rate of 1/53). This was 1/26 with a total 38 episodes of peritonitis during the total duration of 997 patient months (p = .01) for EPS group. In regression analysis, PD duration, age at PD start and duration of Ultrafiltration failure (UFF) were associated with EPS. Longer time being on PD, younger age, and higher UFF duration were the risk factors for EPS development. [ABSTRACT FROM AUTHOR]

Home dialysis offers many advantages over in-center dialysis, but peritoneal dialysis and home hemodialysis are infrequently used. To better understand why, a survey of dialysis healthcare professionals (N = 273) in the United States was conducted to assess their knowledge, perceptions, and beliefs about home dialysis modalities. Most survey respondents demonstrated a lack of knowledge about home dialysis and perceived many barriers to home therapy, which may affect patient modality choice; however, 90% of respondents stated they would choose home dialysis for themselves if they required dialysis. Additional staff education may help reduce misperceptions, address knowledge gaps, and subsequently, increase use of home modalities. [ABSTRACT FROM AUTHOR]

BackgroundUltrafiltration (UF) failure mostly contributes to technical failure in peritoneal dialysis (PD) patients, and one of its responsible factors is peritoneal angiogenesis. Resveratrol has been proposed to have an angiogenesis-ameliorating effect on tumor patients. We hypothesizetrans-resveratrol has beneficial effects on angiogenesis-related markers in PD patients.MethodsIn this prospective, randomized, and double-blind trial, 72 patients were randomly assigned to 12-week treatment of low-dose or high-dose (150 or 450 mg/d) trans-resveratrol or a placebo. Visits were scheduled at 0, 4, 8, and 12 weeks after treatment. Clinical indices including 24-hour UF volume, UF rate, 24-hour urine volume, residual renal function, and dialysis adequacy (kt/v) were measured. Angiogenesis markers including vascular endothelial growth factor (VEGF), fetal liver kinase-1 (Flk-1), angiopoietin-2 (Ang-2), tyrosine kinase 2 (Tie-2), and thrombospondin-1 (Tsp-1) in peritoneal effluent were also assessed by enzyme-linked immunosorbent assay.ResultsFinally, 64 out of 72 patients were analyzed, 18 in the high-dose group, 22 in the low-dose group, and 24 in the placebo group. Over the 12-week period, patients in the high-dose group [mean change from baseline (95% CI): 171.4 (141.3-201.5) (mL),p = 0.003 (Net UF); 11.3(10.5-12.1) (mL/h),p = 0.02 (UF rate)] or the low-dose group [mean change from baseline (95% CI: 98.1 (49.5-146.7) (mL),p = 0.007 (Net UF); 6.5 (4.4-8.6) (mL/h),p = 0.04 (UF rate)] versus the placebo group had a significantly greater improvement in mean net UF volume and UF rate. The appearance rates of VEGF, Flk-1, and Ang-2 were more significantly reduced (appearance rates of Tie-2 and Tsp-1 increased) in the high-dose group versus the placebo group, but not in the low-dose group.ConclusionSupplementation with trans-resveratrol is beneficial to improve ultrafiltration in PD patients, and high-dose supplementation may improve ultrafiltration by ameliorating angiogenesis induced by conventional lactate-buffered PD solutions. [ABSTRACT FROM PUBLISHER]

Pediatric patients with end stage renal disease (ESRD) are not as prevalent as adults with ESRD, but the numbers are increasing each year. Medical management is the same for pediatric patients as it is with adults with ESRD: hemodialysis, peritoneal dialysis, no therapy, or transplantation. Among most pediatric nephrology centers, the goal for patients is to achieve transplantation. [ABSTRACT FROM AUTHOR]

Background: High cost of maintenance hemodialysis (HD) and continuous ambulatory peritoneal dialysis (PD) in India has made renal replacement therapy out of reach of many patients with end stage renal disease (ESRD). Repeated puncture PD although inferior to HD biochemically, is easily and freely available across Rajasthan, India, and is simple to perform, and does not require sophisticated machines, thus making it an attractive option for dialysis for ESRD. Aim: To analyze the outcomes of periodic PD in patients with ESRD requiring dialysis support. Subjects and Methods: A prospective study analyzing the data of patients who underwent PD between August 2010 and January 2013 in Sawai Man Singh Hospital, Jaipur, India was conducted. Patients were divided into three groups based on the time period between first and second session of PD. Detailed demographic and clinical data during the study period were collected along with PD related complications. The main outcome studied was technique survival 1 year post initiation of PD. Results: 234 patients received an initial session of PD, of which 174 had a good response and were included in the study. 19 patients received the second PD within 7 days of first (Group 1), 45 patients within 8-14 days (Group 2) and 110 patients within 15-21 days (Group 3). The overall 1 year technique survival was 68.4% (91/133), with a rate of 50% (5/10), 56.8% (21/37), and 75.6% (65/86) for Group 1, Group 2, and Group 3, respectively. The time duration between first and second PD proved to be reliable indicator of the subsequent response, with a technique survival rate significantly lower in Group 1 patients compared to Groups 2 and 3 (P = 0.04). Median dialysis free days were 11, 16 and 21 days in Group 1, Group 2, and Group 3, respectively. Peritonitis rate observed was 2.1% (49/2261) during the study period. Conclusion: Periodic PD is a simple, safe and cheap procedure, which can be considered as used as a palliative measure in terminal uremia in underprivileged areas. [ABSTRACT FROM AUTHOR]

Background: Serial interferon-gamma-release-assay (IGRA) result can show variance due to within-subject variation and difference in host immune status, and may be affected by latent tuberculosis infection (LTBI) treatment. We aimed to know the changes in QFT-IT (QuantiFERON-TB Gold In-Tube) results measured at a 4 month interval in end stage renal disease patients and whether these changes were influenced by dialysis method or LTBI treatment.Methods: We prospectively performed serial QFT-IT tests at 4 month interval in 93 end stage renal disease (ESRD) patients on HD (hemodialysis) or PD (peritoneal dialysis). LTBI treatment was given to 18 of 39 patients with initial positive QFT-IT result. Agreement between the two results was estimated for all 93 patients and reversion rates were estimated among the 39 patients with initial positive QFT-IT.Results: Positive QFT-IT at the first and 2(nd) tests were 41.9 and 34.4 %, respectively. The concordance rate between baseline QFT-IT and 2(nd) QFT in 93 ESRD patients was excellent (90.3 %, kappa = 0.80, p < 0.001). Agreement between the first QFT-IT and 2(nd) QFT-IT in HD (95.3 %, kappa = 0.91, p < 0.001) was higher than in PD patients (86.0 %, kappa = 0.69, p < 0.001). Among all ESRD patients, the odds of reversion of QFT-IT was not different in those who were, or were not treated for LTBI [odds ratio = 2.3 (0.5-11.4), p = 0.43].Conclusions: In a group of 93 dialyzed ESRD patients 8.6 % showed reversion of initial positive QFT to negative within 4 months. Reversion seemed not to be associated with LTBI treatment. Further study with larger numbers of patients is needed to investigate the variation of QFT-IT tests in dialyzed ESRD patients. [ABSTRACT FROM AUTHOR]

Aim: The number of patients with end-stage renal disease (ESRD) has shown a consistent rise in India in recent years. Continuous ambulatory peritoneal dialysis (CAPD) remains one of the safe and effective forms of treatment. In this study, we have tried to assess the effectiveness of field block technique for analgesia during catheter placement surgery until 24 h postoperatively, also, if it can obviate the need for general anesthesia in these high-risk patients. Materials and Methods: We studied 52 ESRD patients from 2010 to 2012 who were posted for CAPD catheterization in the Department of Urology, Care Hospital, Hyderabad, India. Under ultrasound guidance, "unilateral posterior" and "unilateral subcostal" transversus abdominis plane block anesthesia were given for the placement of CAPD catheter. Patient's intra-operative pain and post-operative pain were recorded with visual analog scores (VAS) and analyzed. Results: All patients in our study belonged to American Society of Anesthesiologists category 2 or 3 with multiple co-morbidities. 41 out of 52 patients required no supplemental analgesia during the procedure; 8 patients needed additional infiltration of local anesthetic during skin incisions. Three patients required supplemental analgesia and were considered as failure. A VAS of two was noted in 30 patients and 1 in 19 Patients. No Patient had significant pain 24 h post operatively. No local complication was noted in any patient. Conclusion: CAPD Catheterization under regional field block remains safe and effective options for ESRD patients. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) is the most important cause of morbidity and mortality in patients with end stage renal disease (ESRD). Apelin expressed in endothelial and other tissues including brain and kidney is an adipocytokine defined recently and is emerging an important mediator of cardiovascular homeostasis. The aim of this study was to test whether apelin levels might be associated with carotid artery atherosclerosis and left ventricular mass index (LVMI) in peritoneal dialysis patients. Patients and methods: Fifty peritoneal dialysis patients (25 female, mean age 41.4 ± 11.9 years, mean dialysis vintage 65.0 ± 35.4 months) and 18 healthy individuals (9 female, mean age 41.7 ± 6.8 years) were included in this cross-sectional study. Serum apelin 12 levels, echocardiographic findings and carotid intima media thickness (CIMT) were recorded as well as clinical and laboratory data. Results: There were no differences between the patient and the control groups with regard to demographic characteristics. In patient group, LVMI, CIMT, CRP and apelin levels were elevated compared to control group. However there was no association between apelin, LVMI and CIMT. There was a positive correlation between apelin and CRP, which was not statistically significant. When patients were divided into two groups according to the mean serum apelin levels, LVMI, CIMT and CRP were higher in the high apelin group but this difference did not reach statistical significance. Conclusion: We observed an increased inflammation and CVD risk in peritoneal dialysis patients. However, serum apelin levels seem not to be associated with cardiovascular risk in this group of patients. [ABSTRACT FROM AUTHOR]

The article discusses research done on safety issues in home dialysis. It references the study "Safety Issues in Home Dialysis" by A. Peters published in the 2014 issue. It cites the factors that nephrology nurses must consider when initiating a home dialysis therapy. It mentions the important role of an early home visit in the success of home dialysis therapy. The unique aspects of home therapy for patients are also discussed.

Background: We aimed here to investigate hydration status by echocardiography in end stage renal disease (ESRD) patients. Methods: 25 ESRD patients [15 males; mean age: 54.0±16.6 years; 13 hemodialysis; 12 peritoneal dialysis] were considered eligible for this study. We also examined 29 healthy volunteers as a control group (17 males; mean age: 46.5±12.8 years). Body composition analysis using the bioimpedance spectroscopy technique was performed for volume overload diagnosis. The ratio of extracellular water (ECW) to height was used as volume indices. The aortic elastic parameters were calculated by echocardiography. A correlation analyses was performed between the ratio of ECW to height indicating the volume overload and the aortic elastic parameters e.g. Aortic strain (AS), Aortic distensibility (AD) and Aortic stiffness index (ASI). Results: The ratio of ECW to height that indicates volume overload in ESRD patients was considerably higher than that in the control group (10.25±1.98 L/m vs 8.66±1.22 L/m, p=0.001). There was a negative correlation between the ratio of ECW to height and AS and AD and a positive correlation between the ratio of ECW to height and ASI. Conclusion: Given the importance of the diagnosis and follow up of volume overload, the results show that aortic elasticity measurements, being easy to perform and replicate, can be used for this purpose. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Sleep disturbances are common among uremic patients; however, limited data are available on predictors of sleep quality in this population. We assessed sleep quality in patients on hemodialysis (HD) and peritoneal dialysis (PD) and investigated predictors related to sleep quality. Methods: Patients on maintenance HD and PD were consecutively included from two medical centers in Isfahan city (Iran). They completed the Pittsburgh sleep quality index (PSQI) and hospital anxiety and depression scale. Laboratory tests were done for iron state, kidney function, and electrolytes. Univariate and multivariate analyses were performed to find predictors of sleep quality. Results: About 90 patients were evaluated (53 males, age = 54.2 ± 15.2 years, disease duration = 5.3 ± 4.5 years). Poor sleep quality was frequent in 86.6% of the cases in each group of HD and PD patients. Patients on HD had poorer sleep quality in terms of total PSQI scores and two dimensions of sleep latency and sleep efficiency (P < 0.05). Anxiety (β = 0.232, P = 0.027), depression (β = 0.317, P = 0.004), and being on HD (β = 2.095, P = 0.009) were independent predictors of overall poor sleep quality. Conclusions: Poor sleep quality is highly frequent in patients on maintenance dialysis and mood disorders and being on HD are predictive factors. Further studies are required for better understanding of risk factors associated with poor sleep quality and thus possible treatments in these patients. [ABSTRACT FROM AUTHOR]

In 1975 Matas and co-workers were the first in the world literature to show an increased risk of malignant tumor occurrence in the group of hemodialyzed patients and kidney transplant recipients. The report is an analysis of world literature fromthe last 35 years in reference to epidemiology as well as the profile of screening tests and diagnostic methods related to malignant tumors in the population with end stage renal disease, especially hemodialyzed patient [ABSTRACT FROM AUTHOR]

Introduction: This chapter describes the characteristics of adult patients starting renal replacement therapy (RRT) in the UK in 2010 and the incidence rates for RRT in Primary Care Trusts and Health Boards (PCT/HBs) in the UK. Methods: The basic demographics and clinical characteristics are reported on patients starting RRT from all UK renal centres. Presentation time, defined as time between first being seen by a nephrologist and start of RRT, was also studied. Age and gender standardised ratios for incidence rates in PCT/HBs were also calculated. Results: In 2010, the incidence rates in the UK and England were similar to 2009 at 107 per million population (pmp). The incidence rate fell in Scotland (from 104 pmp to 95 pmp), increased in Northern Ireland (from 88 pmp to 101 pmp) and Wales (from 120 pmp to 128 pmp). There were wide variations between PCT/HBs in standardised incidence ratios. The median age of all incident patients was 64.9 years (IQR 51.0, 75.2). For transplant centres this was 63.1 years (IQR 49.7, 74.2) and for non-transplanting centres 66.5 years (IQR 52.9, 76.0). The median age for non-Whites was 57.1 years. Diabetic renal disease remained the single most common cause of renal failure (24%). By 90 days, 68.3% of patients were on haemodialysis, 18.1% on peritoneal dialysis, 7.7% had had a transplant and 5.9% had died or stopped treatment. The mean eGFR at the start of RRT was 8.7 ml/ min/1.73 m2 which was similar to the previous three years. Late presentation (<90 days) fell from 28.2% in 2005 to 20.6% in 2010. There was no relationship between social deprivation and presentation pattern. Conclusions: Incidence rates have plateaued in England over the last five years. They have fallen in Scotland and fallen and then risen again in Northern Ireland and Wales. Wales continued to have the highest incidence rate of the countries making up the UK. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Introduction: This chapter describes the characteristics of adult patients on renal replacement therapy (RRT) in the UK in 2010. Methods: Data were electronically collected from all 72 renal centres within the UK. Cross-sectional and longitudinal analyses were performed to describe the demographics of prevalent RRT patients in 2010 at centre and national level. Age and gender standardised ratios for prevalence rates per million population per year were calculated. Results: There were 50,965 adult patients receiving RRT in the UK on 31st December 2010. The UK prevalence of RRT (including paediatric patients) was 832 pmp. This represented an annual increase in prevalent numbers of approximately 4% although there was significant variation between centres and regions. From 2009 to 2010 there was a 1.5% increase in the number of patients on haemodialysis (HD), a 3.2% fall in peritoneal dialysis (PD) patients and a 5.4% increase in patients with a functioning transplant. The number of patients receiving home HD has increased 23% since 2009. Median RRT vintage was 5.6 years. The median age was 57.9 years (HD 66.3 years, PD 61.7 years and transplant 51.2 years) compared to 55 years in 2000. Prevalence rates in males exceeded those in females. The most common identifiable renal diagnosis was biopsyproven glomerulonephritis (16.0%), followed by diabetes (14.9%). Transplantation was the most common treatment modality (48%), HD in 44% and PD 8%. Conclusions: The HD and transplant population continued to expand whilst the PD population contracted. There were national, regional and dialysis centre level variations in prevalence rates. Prevalent patients were on average 4 years older than 10 years ago. This has implications for service planning and ensuring equity of care for RRT patients. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Aims: To describe the demographics of the paediatric RRT population under the age of 16 years in the UK and to analyse changes in demography with time. Methods: Data were collected from all 13 paediatric renal centres within the UK. A series of cross-sectional and longitudinal analyses were performed to describe the demographics of prevalent paediatric RRT patients. Results: A total of 870 children and young people under 18 with ERF were receiving treatment at paediatric nephrology centres in 2010. At the census date, 76.7% had a functioning transplant, 14.3% were receiving peritoneal dialysis (PD) and 9.0% were receiving haemodialysis (HD). In patients aged <16 years the prevalence of ERF was 59.3 pmarp and the incidence 8.1 pmarp. Analysis of trends over the last 15 years shows that both incidence and prevalence are increasing with the most marked increases in children aged 12-16 years and in ethnic minority groups. A third of the patients have one or more reported comorbidities. At transfer to adult services, 84.9% of patients had a functioning renal transplant. Conclusions: The data provided in this report show increasing trends over 15 years in the incidence and prevalence of established renal failure. This is important for the planning of the provision of care for children needing renal replacement therapy. The inclusion this year of an analysis of the patients transferring to adult services may assist in developing care pathways for this vulnerable group. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: The UK Renal Association (RA) and National Institute for Health and Clinical Excellence (NICE) have published clinical practice guidelines which include recommendations for management of anaemia in established renal failure. Aim: To determine the extent to which the guidelines for anaemia management are met in the UK. Methods: Quarterly data were obtained regarding haemoglobin (Hb) and factors that influence Hb from renal centres in England, Wales, Northern Ireland (EWNI) and the Scottish Renal Registry for the incident and prevalent renal replacement therapy (RRT) cohorts for 2010. Results: In the UK, in 2010 53.6% of patients commenced dialysis therapy with Hb &ges;10.0 g/dl (median Hb 10.1 g/dl). The median Hb of haemodialysis (HD) patients was 11.5 g/dl with an interquartile range (IQR) of 10.5-12.3 g/dl. Of HD patients 84.6% had Hb &ges;10.0 g/dl. The median Hb of peritoneal dialysis (PD) patients in the UK was 11.6 g/dl (IQR 10.6-12.5 g/dl). Of UK PD patients, 87.2% had Hb &ges;10.0 g/dl. The median ferritin in HD patients in EWNI was 444 μg/L (IQR 299-635) and 96% of HD patients had a ferritin &ges;100 μg/L. The median ferritin in PD patients was 264 μg/L (IQR 148-426) with 86% of PD patients having a ferritin &ges;100 μg/L. In EWNI the mean Erythropoietin Stimulating Agent (ESA) dose was higher for HD than PD patients (9,020 vs. 6,202 IU/week). Conclusions: Of prevalent HD patients, 52.7% had Hb &ges;10 and ≤12 g/dl. Of prevalent PD patients, 54.3% had Hb 10.5-12.5 g/dl. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article presents the case study of 56-year-old female with type 2 diabetes and end stage renal disease (ESRD). The patient had a 3-month history of increasingly painful, firm, red to brown nodules bilaterally in her distal extremities, increasing in size and number. Various tests confirmed the diagnosis of calcific uremic arteriolopathy (CUA). The patient was with IP sodium thiosulfate. The article also discusses several review studies dealing with treatment and diagnosis of CUA.

Background: The UK Renal Association (RA) and National Institute for Health and Clinical Excellence (NICE) have published Clinical Practice Guidelines which include recommendations for management of anaemia in established renal failure. Aims: To determine the extent to which the guidelines for anaemia management are met in the UK. Methods: Quarterly data were obtained regarding haemoglobin (Hb) and factors that influence Hb from renal centres in England, Wales, Northern Ireland (EWNI) and the Scottish Renal Registry for the incident and prevalent renal replacement therapy (RRT) cohorts for 2009. Results: In the UK, in 2009 55% of patients commenced dialysis therapy with Hb x10.0 g/dl (median Hb 10.2 g/dl). The median Hb of haemodialysis (HD) patients was 11.6 g/dl with an interquartile range (IQR) of 10.6 – 12.4 g/dl. Of HD patients 85% had Hb ≧10.0 g/dl. The median Hb of peritoneal dialysis (PD) patients in the UK was 11.7 g/dl (IQR 10.7–12.6 g/dl). Of UK PD patients, 88% had Hb ≧10.0 g/dl. The median ferritin in HD patients in EWNI was 441 mg/L (IQR 289–629) and 96% of HD patients had a ferritin ≧100 mg/L. The median ferritin in PD patients was 249 mg/L (IQR 142–412) with 86% of PD patients having a ferritin 5100 mg/L. In EWNI the mean Erythropoietin Stimulating Agent (ESA) dose was higher for HD than PD patients (9,507 vs. 6,212 IU/week). Conclusions: In 2009, 56% of prevalent HD patients had a Hb ≧10.5 and ≤12.5 g/dl compared with 54% in 2008 and 53% in 2007. Fifty-four percent of prevalent PD patients had a Hb ≧10.5 and ≤12.5 g/dl compared to 55% in 2008. [ABSTRACT FROM AUTHOR]

Introduction: This chapter describes the characteristics of adult patients on renal replacement therapy (RRT) in the UK in 2009. The prevalence rates per million population (pmp) were calculated for Primary Care Trusts in England, Health and Social Care Areas in Northern Ireland, Local Health Boards in Wales and Health Boards in Scotland. These areas will be referred to in this report as ‘PCT/HBs’. Methods: Data were electronically collected from all 72 renal centres within the UK. A series of cross-sectional and longitudinal analyses were performed to describe the demographics of prevalent RRT patients in 2009 at centre and national level. Age and gender standardised ratios for prevalence rates in PCT/HBs were calculated. Results: There were 49,080 adult patients receiving RRT in the UK on 31st December 2009, equating to a UK prevalence of 794 pmp. This represented an annual increase in prevalent numbers of approximately 3.2% although there was significant variation between centres and PCT/HB areas. The growth rate from 2008 to 2009 for prevalent patients by treatment modality in the UK was 4.2% for haemodialysis (HD), a fall of 7.2% for peritoneal dialysis (PD) and a growth of 4.4% with a functioning transplant. There has been a slow but steady decline in the proportion of PD patients from 2000 onwards. Median RRT vintage was 5.4 years. The median age of prevalent patients was 57.7 years (HD 65.9 years, PD 61.2 years and transplant 50.8 years). For all ages, prevalence rates in males exceeded those in females: peaks for males were in the 75–79 years age group at 2,632 pmp and for females in the 70–74 years age group at 1,445 pmp. The most common identifiable renal diagnosis was biopsy-proven glomerulonephritis (16.0%), followed by diabetes (14.7%). Transplantation was the most common treatment modality (48%), HD in 44% and PD 8%. However, HD was increasingly common with increasing age and transplantation less common. Conclusions: The HD and transplant population continued to expand whilst the PD population contracted. There were national, regional and dialysis centre level variations in prevalence rates. This has implications for service planning and ensuring equity of care for RRT patients. [ABSTRACT FROM AUTHOR]

Introduction: RRT incidence rates and the proportion of patients using a home dialysis modality (peritoneal or home haemodialysis) varies widely between centres and persists even after area differences in age, ethnicity and social deprivation structure are taken into account. A nationwide survey was undertaken to identify possible drivers of this variation. Methods: A systematic literature review followed by a two-stage Delphi consensus technique was employed to identify renal centre characteristics and practice patterns that may be important in determining either RRT incidence or home modality usage. Results: All 72 (100%) of UK adult renal centres responded. Questions about staffing numbers, interface with primary care, interface with other secondary care sites, capacity within the HD programme, constituents of pre-dialysis education programmes, conservative management programmes, range of treatments available, dialysis access and training and physician attitudes to home modalities were included. Conclusions: There was wide variation in practice patterns and centre characteristics across the UK. Overall, physician enthusiasm for home dialysis modalities was greater than the actual usage of home dialysis. [ABSTRACT FROM AUTHOR]

Introduction: This chapter describes the characteristics of adult patients starting renal replacement therapy (RRT) in the UK in 2009 and the acceptance rates for RRT in Primary Care Trusts and Health Boards (PCT/HBs) in the UK. Methods: The basic demographics and clinical characteristics are reported on patients starting RRT from all UK renal centres. Late presentation, defined as time between first being seen by a nephrologist and start of RRT being <90 days was also studied. Age and gender standardised ratios for acceptance rates in PCT/HBs were calculated. Results: In 2009, the incidence rate in the UK and England was 109 per million population (pmp). Acceptance rates in Scotland (104 pmp), Northern Ireland (88 pmp) and Wales (120 pmp) had all fallen although Wales still remained the country with the highest acceptance rate. There were wide variations between PCT/HBs with respect to the standardised ratios. The median age of all incident patients was 64.8 years (IQR 50.8, 75.1). For transplant centres this was 63.0 years (IQR 49.0, 74.2) and for non-transplanting centres 66.3 years (IQR 52.6, 75.9). The median age for non-Whites was 57.1 years. Diabetic renal disease remained the single most common cause of renal failure (25%). By 90 days, 69.1% of patients were on haemodialysis, 17.7% on peritoneal dialysis, 6.7% had had a transplant and 6.5% had died or stopped treatment. The mean eGFR at the start of RRT was 8.6 ml/min/1.73 m2 which was similar to the previous two years. Late presentation (<90 days) has fallen from 27% in 2004 to 19% in 2009. There was no relationship between social deprivation and presentation pattern. Conclusions: Acceptance rates have fallen in Northern Ireland, Scotland and Wales whilst they have plateaued in England over the last four years. Wales continued to have the highest acceptance rate of the countries making up the UK. [ABSTRACT FROM AUTHOR]

Introduction: This chapter describes the characteristics of adult patients on renal replacement therapy (RRT) in the UK in 2008 and the prevalence rate per million population (pmp) in Primary Care Trusts and local authorities (Council Areas or District Councils) (PCT/LAs) were calculated. Methods: Complete data were electronically collected from all 72 renal centres within the UK. A series of cross-sectional and longitudinal analyses were performed to describe the demographics of prevalent RRT patients in 2008 at centre and national level in the UK. Age and gender standardised ratios of actual to expected for prevalence rates in PCT/LAs were calculated. Results: There were 47,525 adult patients receiving RRT in the UK on 31/12/2008, equating to a UK prevalence of 774 pmp. This represents an annual increase in prevalence of approximately 4.4% although there was significant variation between PCT/LA areas. The pmp growth rate from 2007 to 2008 for prevalent patients by treatment modality in the UK was 5.9% for haemodialysis (HD), a fall of 9.2% for peritoneal dialysis (PD) and growth of 4.6% with a functioning transplant. Over the long term (1982–2007), the steady growth in transplant prevalent numbers was maintained at 4%. There was a slow but steady decline in PD patient numbers from 1999 onwards. Median RRT vintage was 5.3 years. The median age of prevalent patients was 57.3 years (HD 65.5 years, PD 61.0 years and transplant 50.4 years). For all ages, prevalence rates in males exceeded those in females peaking in the 75–79 years age group at 2,582 pmp for males and 70–74 years age group at 1,408 pmp for females. The most common identifiable renal diagnosis was biopsy-proven glomerulonephritis (16.0%), followed by diabetes (14.1%). Transplantation was the most common treatment modality (47%) followed closely by HD (43%). However, HD was increasingly common with increasing older age at the expense of transplantation. Conclusions: The HD and transplant population continued to expand whilst the PD population contracted. There was national, regional and dialysis centre level variation in prevalence rates. This has implications for service planning and ensuring equity of care for RRT patients. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Introduction: This chapter describes the characteristics of adult patients starting renal replacement therapy (RRT) in the UK in 2008 and the acceptance rates for RRT in Primary Care Trusts and Local Authorities (PCT/LAs) in the UK. Methods: The basic demographics and clinical characteristics are reported on patients starting RRT from all UK renal centres. Late referral, defined as time between first being seen by a nephrologist and start of RRT being <90 days was also studied. Age and gender standardised ratios for acceptance rate in PCT/LAs were calculated. Results: In 2008, the acceptance rate in the UK was 108 per million population (pmp). Acceptance rates in Scotland (103 pmp), Northern Ireland (97 pmp) and Wales (117 pmp) have all fallen although Wales still remains the country with the highest acceptance rate. There were wide variations between PCT/LAs with respect to the standardised ratios, which were lower in more PCT/LAs in the North West and South East of England and higher in London, the West Midlands, Scotland, Northern Ireland, and Wales. The median age of all incident patients was 64.1 years and for non-Whites 56.1 years. Diabetic renal disease remains the single most common cause of renal failure (24%). By 90 days, 67.7% of patients were on haemodialysis, 19.8% on peritoneal dialysis, 5.9% had had a transplant and 6.6% had died or had stopped treatment. By 90 days, 77.4% of all dialysis patients were on HD. The geometric mean eGFR at the start of RRT was 8.6 ml/min/ 1.73 m2 which was similar to the eGFR of those starting in 2007. The incidence of late presentation (<90 days) has fallen from 28% in 2003 to 22% in 2008. There was no relationship between social deprivation and referral pattern. Conclusions: Acceptance rates have fallen in Northern Ireland, Scotland and Wales whilst they have plateaued in England over the last three years. Wales continued to have the highest acceptance rate of the countries making up the UK. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Introduction: These analyses examine survival from the start of renal replacement therapy (RRT), based on the total incident UK RRT population reported to the UK Renal Registry, including the 19% who started on PD and the 5% who received a pre-emptive transplant. Survival of prevalent patients and changes in survival between 1997 and 2007 are also reported. Methods: Survival was calculated for both incident and prevalent patients on RRT and compared between the UK countries after adjustment for age. Survival of incident patients (starting RRT during 2007) was calculated both from the start of RRT and amongst the cohort who survived at least 90 days after RRT, and both with and without censoring at transplantation. Both the Kaplan–Meier and Cox adjusted models were used to calculate survival. Causes of death were analysed for both groups. Relative risk of death was calculated compared with the general UK population. Results: The 2007 unadjusted 1 year after 90 day survival for patients starting RRT was 86.2%. In incident 18–64 year olds the unadjusted 1 year survival had risen from 85.9% in 1997 to 92.4% in 2007 and for those aged >65 it had risen from 63.8% to 74.9%. The age-adjusted survival (adjusted to age 60) of prevalent dialysis patients rose from 85% in 2000 to 89% in 2007. Diabetic prevalent patient survival rose from 76.5% in 2000 to 83.0% in 2007. The age-standardised mortality ratio for prevalent RRT patients compared with the general population was 28.6 at age 30 years (and was lower than in the 1998–2001 cohort in all age groups up to 45–49) and 4.6 at age 80 years. In the prevalent RRT dialysis population, cardiovascular disease accounted for 29% of deaths, infection 17% and treatment withdrawal 14%. Of deaths, 26% were recorded as uncertain. Treatment withdrawal was a more frequent cause of death in patients aged >65 at start than in younger patients. The median life years remaining for a 25–29 year old on RRT was 20 years and 5 years for a 70 year old. Conclusions: Incident 2007 and prevalent 2008 patient survival on RRT in all the UK countries for all age ranges and also for patients with diabetes continued to improve. The relative risk of death on RRT compared with the general population has fallen since 2001. Death rates on dialysis in the UK remained lower than when compared with a similar aged population on dialysis in the USA. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: A preliminary review of the UK Renal Registry (UKRR) pre-RRT study data revealed results suggesting that, for some patients, the date of start of renal replacement therapy (RRT), as reported to the UKRR, was incorrect and often significantly later than the true date of start. A more detailed study then aimed to validate a set of criteria to identify patients with an incorrect start date. Methods: Pre-RRT laboratory data were electronically extracted from 8,810 incident RRT patients from 9 UK renal centres. Any patient with a low urea (<15 mmol/L) at the start of RRT or with a substantial improvement in kidney function (either a fall in urea >10 mmol/L or rise in eGFR >2 ml/ min/1.73 m) within the two months prior to RRT were considered to potentially have an incorrect date of start. In 4 selected centres, the electronic patient records of all patients fl‚agged were reviewed to validate these criteria. Results: Of 8,810 patients, 1,616 (18.3%) were fl‚agged by the identification criteria as having a potentially incorrect date of start of RRT, although a single centre accounted for 41% of the total flagged cohort. Of these flagged patients, 61.7% had been assigned an incorrect date of start of haemodialysis (HD), 5.7% had evidence of acute RRT being given before the reported date of start of HD and 9.2% had evidence of starting peritoneal dialysis exchanges prior to the reported date of start. Of those flagged, 10.7% had a correct date of start of RRT. Conclusions: Accurate reporting of RRT episodes is vital for the analysis of time dependent studies such as survival or time to transplantation. A proportion of patients starting RRT were assigned an incorrect start date. In order to improve the accuracy of this reporting the UK Renal Registry must work with renal centres and clinical staff on improving data input for the start of RRT. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: International comparisons between renal registries are important to highlight epidemiological and practice differences in RRT provision between countries. This report aims to compare the rates of RRT incidence and prevalence in the UK with a number of different countries. Methods: Data from 19 countries or regions between 2003 and 2007 from four international renal registries were analysed. Rates of RRT incidence, prevalence, transplantation and dialysis modality were compared. A crude mortality rate for each country was calculated. Results: Despite continued growth, the UK ranked 16th highest in incidence rate and 15th in prevalence rate in 2007. This may partly be related to successful primary care preventing stage 5 CKD. The UK had the 8th fastest rate of increase in RRT prevalence of 18 countries (4.2%/ year). The age profile of UK RRT patients was comparable with other countries. The UK had the 6th highest use of home dialysis therapies. The UK has the 8th highest incidence and 9th highest prevalence rate of kidney transplantation of 16 countries. Conclusion: Meeting the growing demand for RRT is a problem for all countries that choose to offer it. The UK continues to provide for growth in demand for RRT. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Cardiovascular morbidity and mortality are common in end stage renal disease (ESRD) patients. There is scarce data on carotid and bulb intima-media thickness (IMT-C and IMT-B) as an early marker of atherosclerosis and related factors in children on hemodialysis (HD) and peritoneal dialysis (PD). Since we did not have enough information about our patients, this study was carried on all ESRD children (hemodialysis and peritoneal dialysis) in a referral center. Data was collected from 16 ESRD children under 18 years with seven patients on PD and nine on HD. Lab tests and biochemical parameters including serum von Willebrand factor (vWF), homocystein, apo lipoprotein A, apo lipoprotein B and quantitative CRP were measured in fasting patients just before initiating dialysis. IMT-C and IMT-B were measured by gray scale ultrasound using 7.5 MHZ probe. The mean of age was 12.76 ± 4.5 years. The mean duration of dialysis in HD and PD patients were not significantly different; 11.88 ± 3.25 months and 10.14 ± 2.4 months respectively. Mean of systolic blood pressure in HD group was significantly higher than PD group, 135.55 ± 25.54 mmHg versus 121.42 ± 12.14 mmHg, P < 0.05. Significant differences among all following parameters in ESRD patients, with normal laboratory values, were clarified: cholesterol, triglycerides, apo A, apo B, quantitative CRP, VWF, homocystein and IMT-C. However, we could not demonstrate any difference between IMT-B in case and control group. After adjusting for age, partial correlation showed significant correlation between IMT-C and following factors: N-PTH and serum alkaline phosphatase. Longitudinal studies with large size samples are needed to clarify the contributing factors with intima-media thickness in ESRD children. [ABSTRACT FROM AUTHOR]

The article describes a case study of an older adult patient with end stage renal disease (ESRD) who is managed by a family nurse practitioner (FNP) and a nephrologist. Topics discussed include challenges for the elderly patient on dialysis, how a FNP primary care provider (PCP) provides primary care in collaboration with a nephrologist and renal care team, and how FNP PCP can educate patients during a dialysis modality change.

Background. Uric acid (UA) is known to play a pathogenic role in chronic kidney disease (CKD). However, its effect in end-stage renal disease (ESRD) has not yet been elucidated. We explored the prevalence of hyperuricaemia and the relationship between UA and residual renal function (RRF) in peritoneal dialysis (PD) patients. [ABSTRACT FROM PUBLISHER]

Endothelial dysfunction (ED) is an important factor in the pathogenesis of atherosclerosis, which is the major cause of mortality and morbidity in ESRD patients. Endothelium exerts a number of vasoprotective effects, such as vasodilatation, suppression of smooth muscle cell growth, and inhibition of inflammatory responses impairment of endothelial functions can leads to vascular dysfunction. This study involved 25 ESRD patients on regular hemodialysis (HD) (group 1), 15 ESRD patients on intermittent peritoneal dialysis (PD) (group 2) and 20 healthy control subjects (group 3). For all groups complete medical history and thorough examination, biochemical Laboratory tests including renal function tests, calcium, phosphorus, intact PTH and Echocardiography. Endothelial function was assessed by Flow mediated dilatation of the brachial artery (FMD) evaluated non-invasively by B-mode ultrasonography. Comparison of FMD of brachial artery shows significant difference between hemodialysis group and control ( p < 0.001), peritoneal dialysis group and control group ( p < 0.001), and between hemodialysis and peritoneal dialysis group ( p < 0.001). Multiple regression test for brachial artery flow mediated dilatation shows significant correlations with age ( p < 0001), serum LDL ( p = 0.04), hematocrit value ( p < 0.001), serum PTH ( P = 0.01) and presence of DM ( p = 0.009). No correlation is found with duration of dialysis ( p = 0.57), total cholesterol ( p = 0.62), serum triglyceride ( p = 0.10) nor with calcium phosphorus products ( p = 0.08). Endothelial function is impaired in ESRD patients. PD patients had more endothelial dysfunction when compared to HD patients. ED is independently affected by age, LDL, PTH, hematocrit and presence of diabetes mellitus. The main correctable factors affecting ED are Hematocrit, PTH, and LDL. [ABSTRACT FROM AUTHOR]

The incidence of end-stage renal disease (ESRD) is increasing and patients receiving renal replacement therapy including hemodialysis, peritoneal dialysis or renal transplantation will comprise an enlarging segment of the dental patient population. Renal replacement therapy can affect periodontal tissues including gingival hyperplasia in immune suppressed renal transplantation patients and increased levels of plaque, calculus and gingival inflammation and possible increased prevalence and severity of destructive periodontal diseases in ESRD patients on dialysis maintenance therapy. Also, the presence of undiagnosed periodontitis may have significant effects on the medical management of the ESRD patient. Periodontitis has been found to contribute to systemic inflammatory burden including the elevation of C-reactive protein (CRP) in the general population. Atherosclerotic complications including myocardial infarction and stroke are the primary causes of mortality in the ESRD population and, in contrast to that of the general population, the best predictor of all cause and cardiac death in this population is CRP. Consequently, periodontitis may be a covert but treatable source of systemic inflammation in the ESRD population. The objective of this review was to explore the interaction between chronic renal disease, renal replacement therapy and periodontal diseases based upon the results of studies published within the last decade. [ABSTRACT FROM AUTHOR]

Objectives: This study tested whether continuous ambulatory peritoneal dialysis (CAPD) changes free or phospholipid-bound choline concentrations in serum or peritoneal dialysis fluid of patients with end stage renal disease (ESRD).Design and methods: Serum and dialysate choline and phospholipid-bound choline were measured before, during and after 6 h CAPD.Results: Serum choline concentrations were higher in patients with ESRD compared with age-matched controls. CAPD lowered serum choline concentrations significantly although it did not influence phospholipid-bound choline. Choline accumulated in the dialysate, reaching 28.4 ± 2.7 μM in children and 18.2 ± 1.4 μM in adults, during six hours CAPD; phospholipid-bound choline increased to 22.9 ± 2.5 μM and 10.8 ± 1.4 μM in children and adults, respectively. The total daily loss of choline into the dialysate was 181 ± 20 μmoles in children and 260 ± 18 μmoles in adults.Conclusion: CAPD causes a substantial loss of choline into peritoneal dialysates and reduces serum choline concentrations significantly. [Copyright &y& Elsevier]