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Overseas kidney transplantation has often been reported to have unsatisfactory outcomes. This study aims to compare post-transplantation outcomes between overseas and domestic kidney transplant (KT) recipients in Taiwan. The Taiwanese National Health Insurance Research Database was used to identify 310 domestic and 643 overseas KT recipients, who survived for longer than 1 month after the transplantation, in a cohort of 45 453 chronic haemodialysis patients in 1997-2002. Cox proportional hazards models were used to assess risks of mortality and graft failure. The 1, 3 and 5 year survival rates for domestic KT recipients were 96.5%, 93.3% and 91.6%, respectively, while those for overseas KT recipients were 94.9%, 87.9% and 77.1%, respectively ( P = 0.015). For the overseas group, those who received a KT before 2001 had significantly higher hazard ratios of mortality and graft failure (2.85 and 1.71, respectively). However, for those receiving a KT in 2001-2002, no significant outcome difference could be found between overseas and domestic recipients. The risk disparity between overseas and domestic KT recipients is mainly attributable to when the transplantation was performed. In attempting to dissuade potential recipients from organ trafficking, merely emphasizing the previously acknowledged poor outcomes no longer suffices as a valid reason. In this paper, Hsu and colleagues from Taiwan analyze the outcome of kidney transplantation performed overseas in two time periods, before and after 2001, and show the outcome of kidney transplants performed outside Taiwan after 2001 are comparable to those performed in Taiwan. The implication of this paper is that emphasis on poor mortality and graft outcome from 'transplant tourism' is less sustainable than before and new strategies to deter this will need to be developed. [ABSTRACT FROM AUTHOR]

SUMMARY: Clinically relevant renal lesions in rheumatoid arthritis (RA) are not common. More often renal involvement is related to complications of therapy than the disease itself. The most common forms of primary renal disease in RA are membranous glomerulonephropathy and a pure mesangial proliferative glomerulonephritis. Some studies have described the association between crescentic glomerulonephritis (crescentic GN) and RA, but they were all found to be perinuclear antineutrophil cytoplasmic antibody (p-ANCA) positive. However, RA associated with ANCA negative pauci-immue crescentic GN has not been reported. This is a case report of a 37-year-old female with RA who initially presented with general oedema and acute deterioration of renal function. The renal biopsy revealed ANCA negative pauci-immune crescentic GN. The patient was treated with steroid pulse and plasmapheresis, but not cyclophosphamide because of severe urosepsis. Despite the use of aggressive therapy, her renal function was not improved and she underwent maintenance haemodialysis thereafter. Because ANCA negative crescentic GN may occur in RA patients without frank systemic vasculitis, but with severe clinical manifestation, a heightened suspicion for a relatively ‘silent’ crescentic GN would have led to the correct diagnosis and appropriate treatment. [ABSTRACT FROM AUTHOR]

In this investigation, we tried to find the incidence and characteristics of tuberculosis (TB) in dialysis patients previously found only in a small number of cases. We collected the cases of newly diagnosed TB patients in Taiwan during 1997. Simultaneously, all dialysis patients were collected and matched with the TB cases to identify the dialysis patients who had also contracted TB. The annual incidence of the dialysis population was 493.4/100,000, 6.9 times that of the general population (71.1/100,000). The annual incidence for the male dialysis population was 573.3, the incidence was 479.2 for the female dialysis population. The incidence for the general population was 97.1 and 43.7/100,000, respectively. Although the 1-year mortality rate due to TB (1.7 vs. 1.9%, p > 0.05) was similar in both populations, the non-TB mortality was much higher in the dialysis population than that in the general population (25.6 vs. 11.1%, p < 0.05). Finally, the 1-year mortality rate of dialysis patients with TB is 3.3 times higher than that in dialysis patients without TB (27.3 vs. 8.3%, p < 0.05). The findings suggest that uremia modifies the behavior of TB, jeopardizes female and younger dialysis patients, poses a higher risk of extrapulmonary dissemination, and predicts a higher overall mortality.Copyright © 2001 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Binding of the anion-exchange inhibitor ³H2-labeled 4,4'-diisothiocyano-2,2'-stilbene disulfonic acid (DIDS) to highly purified luminal and basolateral beef kidney tubular membranes was characterized. Specific binding of [³H2]DIDS is present in both luminal and basolateral membranes. Scatchard analysis revealed a Kd for [³H2]DIDS of 5.5 µM and 19.3 µM and a maximal number of binding sites of 10.9 nmol and 31.7 nmol DIDS/mg protein in basolateral and luminal membranes, respectively. To assess the role of this putative anion exchanger on transport we measured 35SO4 uptake by luminal and basolateral membranes. In both luminal and basolateral membranes sulfate uptake was significantly greater in the presence of an outward-directed el gradient, OH gradient or HCO3 gradient than in the absence of these gradients. There was an early anion-dependent sulfate uptake of five to ten times the equilibrium uptake at 60 min. The sulfate taken in could be released by lysis of the vesicles indicating true uptake and not binding of sulfate. No significant difference in SO4 uptake was found in the presence and in the absence of valinomycin, indicating that the anion exchanger is electroneutral. The anion-dependent sulfate uptake was completely inhibited by either DIDS or furosemide in both luminal and basolateral membranes. Dixon analysis of HCO3-dependent SO4 uptake by luminal membranes in the presence of different concentrations of DIDS revealed a Ki for DIDS of 20 µM. The similar values of the Kd for [³H2]DIDS binding and the Ki for DIDS inhibition of SOn uptake might suggest an association between DIDS binding and the inhibition of SO4 transport. In addition, an inward-directed Na gradient stimulated sulfate uptake in luminal but not in basolateral membranes. The Na-dependent sulfate uptake in luminal membranes was also inhibited by DIDS. We conclude that, in addition to the well-known Na-dependent sulfate uptake in luminal membranes, there exists an anion exchanger in both basolateral and luminal membranes capable of sulfate transport. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor that focuses on lesser sac abscess induced relapsing peritonitis in a continuous ambulatory peritoneal dialysis Patient, published in the December 2002 issue of the medical journal "Nephron."

The article describes the case of a 52-year-old man with diabetic nephropathy-related end-stage renal disease (ESRD), with liver cirrhosis caused by chronic hepatitis B, who presented with fever and pain with redness over the dorsum of his bilateral feet for two days. Laboratory tests showed a higher leukocyte count and elevated serum levels. Immunocompromised patients with mild skin lesions may still suffer from an infection of the ecthyma gangrenosum-related soft tissue.

The article discusses the case of a 20-year-old Chinese male with bilateral flank pain and general malaise. Pale conjunctiva and bilateral palpalable flank mass were seen in physical examination, while an impairment of renal function was shown in laboratory evaluation. He underwent allogenic haematopoietic stem-cell transplantation due to very high risk of disease recurrence. He was diagnosed with cantaloupe-like kidney, which is a rare form of early infiltration of renal interstitium.

Presents a letter to the editor replying to comments made on the authors' article, published in the periodical "Kidney International," concerning the impact of dialysis on endogenous acylcarnitine levels in chronic hemodialysis patients.

The article describes the case of a 43-year-old man who presented with a two-week history of foamy urine, progressive oedema of his lower limbs, ascites and a 28-pound weight gain, diagnosed with chylous ascites, with hypoalbuminaemia-associated bowel oedema with resultant lacteal leakage or malabsorption offered as a speculative explanation.

A letter to the editor is presented regarding the function of continuous renal replacement therapy (CRRT) device with extracorporeal membrane oxygenation (ECMO) circuit in the 2010 issue.

Background. Incident and prevalent (I&P) rates in dialysis end-stage renal disease (ESRD) patients in Taiwan increased rapidly following the launch of National Health Insurance (NHI) in 1995. Our aim was to explore the impact of NHI on the status and trends of ESRD epidemiology in Taiwan. Methods. This study was conducted using retrospective cohort analysis of data collected from the Taiwan national dialysis registry. Results. From 1990 to 2001, I&P rates of ESRD patients increased 2.6 times from 126 to 331 per million populations (pmp) and 3.46 times from 382 to 1322 pmp, respectively. Increasing ESRD was seen in patients who were middle-aged, elderly and who had diabetic nephropathy as their primary renal disease. The mean age of I&P patients increased by 7.2 years and 7.1 years, respectively. All of these parameters increased markedly in 1995, the year of NHI implementation. First-year mortality decreased to 7.8 per 1000 patient-months in 1994, and then increased to 18.0 in 2001. The cumulative survival rate of the elderly subgroup (age >65) in the incident 1990–1994 cohort was greater than in the 1995–1999 cohort. These data indicated that NHI implementation significantly influenced the inflow and the mortality of ESRD patients. Conclusion. In addition to presenting ESRD epidemiology in Taiwan, this study demonstrated that NHI implementation stimulated the growth of treated ESRD populations. Preventive plans mounted against chronic kidney diseases will be essential to reduce the growth of ESRD patient numbers and consequent economic burdens. [ABSTRACT FROM AUTHOR]

Background. Taiwan has the worlds highest incidence and second highest prevalence of end-stage renal disease (ESRD), particularly in older age groups. However, the transition from chronic kidney disease (CKD) to death or ESRD remains unclear. This study aimed to investigate the impact of late-stage CKD on all-cause and cause-specific mortality by identifying the CKD population. Methods. This was an observational cohort study (n = 35 529), mean age 75.7 years (SD = 5.3), of participants in the Elderly Health Examination Program (EHEP) in Kaohsiung City, Taiwan, between 2002 and 2004. Estimated glomerular filtration rate (eGFR) was calculated by the simplified modified diet in renal disease equation. Proportional hazard ratios (HR) of mortality associated with late-stage CKD were assessed by Cox regression. Results. The crude prevalence rate of CKD stages 3–5 was 39.4%; 1840 participants (5.18%) died within 2-year follow-up, a mortality rate of 20.3 per 1000 person-years overall and 16.4 per 1000 person-years in the reference group. Higher HR for all-cause and cause-specific mortality were found in the groups with decreased eGFR. Compared with the reference group (eGFR > 60 mL/min/1.73 m2), adjusted HR for all-cause mortality were 1.5, 2.1 and 2.6 for groups with eGFR 30–44, 15–29 and P P Conclusion. Late-stage CKD is a significant risk factor for mortality, especially due to cardiovascular and renal diseases, in elderly Taiwanese. Given the higher prevalence rate of late-stage CKD in the study area, CKD patient mortality was relatively lower, which might reflect underestimation of renal function for patients at early stages of CKD, or partly explain the high ESRD population. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor commenting on an article published in the periodical "Kidney International," concerning changes in the composition of carnitines in hemodialysis patients.

Presents a letter to the editor about the treatment of idiopathic membranous nephropathy.

A case study of a 74 year old man developing adynamic ileus post insertion of peritonial dialysis catheter for the management of his end-stage renal disease, is presented. Reportedly, after undergoing catheterization his postoperative progress was normal. However, on the second day he complained of nausea, abdominal distention with dull pain. Abdomen computed tomography (CT) revealed bladder perforation due to catheter. Patient recovered fully from the complication after removal of catheter.

A letter to the editor is presented in response to the article "Thiazolidinediones provide better renoprotection than insulin in an obese, hypertensive type II diabetic rat model," by S. Ohtomo and colleagues, in a 2007 issue, is presented.

Presents a letter to the editor commenting on an article published in the periodical "Kidney International," concerning the association between postprocedural drop in hematocrit and contrast-induced nephropathy.

A response from Ho-Han Wu and colleagues to a letter to the editor on their article related to the perforation of urinary bladder after implantation of a peritoneal dialysis (PD) catheter, is presented.

Objective: The prevalence of type 2 diabetes, often leading to diabetic nephropathy, has increased globally, especially in Asia. Irbesartan treatment delays the progression of kidney disease at the early (microalbuminuria) and late (proteinuria) stages of nephropathy in hypertensive type 2 diabetics. This treatment has proven to be cost-effective in Western countries. This study assessed the cost-effectiveness of early irbesartan treatment in Asian settings. Methods: An existing lifetime model was reprogrammed in Microsoft Excel to compare irbesartan started at an early stage to irbesartan or amlodipine started at a late stage, and standard treatments from a health-care perspective in China, Malaysia, Thailand, South Korea, and Taiwan. The main effectiveness parameters were incidences of end-stage renal disease, time in dialysis, and life expectancy. All costs were converted to 2004 US$ using official purchasing power parity. Local data were obtained for costs, transplantation,dialysis, and mortality rates. Probabilities regarding disease progression after treatment with the investigated drugs were extracted from two published clinical trials. A probabilistic sensitivity analysis was performed. Results: Early use of irbesartan yielded the largest clinical and economic benefits reducing need for dialysis by 61% to 63% versus the standard treatment, total costs by 9% (Thailand) to 42% (Taiwan), and increasing life expectancy by 0.31 to 0.48 years. Early irbesartan had a 66% (Thailand) to 95% (Taiwan) probability of being dominant over late irbesartan. Conclusion: Although the absolute results varied in different settings, reflecting differences in epidemiology, management, and costs, early irbesartan treatment was a cost-effective alternative in the Asian settings. [ABSTRACT FROM AUTHOR]

Examines the impact of recombinant human erythropoietin on patients with renal anemia. Causes of iron deficiency; Problems of iron status in chronic renal failure patients; Reduction of morbidity and mortality in dialysis patients.

The article offers information on an old woman who has been on hemodialysis due to kidney failure and is presented with tongue abnormalities which is considered to be amyloidosis.

The article presents a case of 66-year-old woman with a 15-year history of type II diabetes and hypertension in the U.S. She was accordingly clinically euvolemis without a history of diuretic use. According to the article, uncontrolled diabetes is accompanied by serious hypertriglyceridemia, which can result in pseudohyponatremia