End Stage Renal Disease

Diabetic muscle infarction (DMI) is a rare, long-term complication of poorly controlled diabetes (typically of type I). DMI was first described in 1965 and more than 100 cases have been reported thereafter in the English literature. Usually, there is a coexistence with concomitant nephropathy, neuropathy, and retinopathy. The etiology remains uncertain, but appears to be attributable to diabetic microangiopathy and hypercoagulability and is believed that hypoxia-reperfusion injury is involved. DMI presents with sudden onset of pain associated with a tender mass in the thigh in most instances. The diagnosis is based on magnetic resonance imaging, which is not specific but highly indicative. Treatment is conservative with relapses occurring in 50% of the patients, but not necessarily in the same muscle group. We describe a case of DMI that occurred 4 months after simultaneous kidney and pancreas transplantation in one patient with type I diabetes mellitus and end-stage renal disease.

Results: Early postoperative mortality (in the first 30 days) was 3.4% (n = 1). The overall estimated Kaplan–Meier survival was 56.7% at 36 months, 46.7% at 60 months, and 43.3% at 96 months. HD program was discontinued for two patients after renal transplantation in the ...

Protracted hypocalcemia is the most common complication after parathyroidectomy for secondary hyperparathyroidism. Several parameters have been identified to predict the degree of postoperative hypocalcemia. The purpose of this study was to determine whether there were any factors associated with prolonged hospitalization in these patients. A total of 81 consecutive patients with end-stage renal disease and advanced secondary hyperparathyroidism who underwent parathyroidectomy between January 2004 and December 2006 were studied. The postoperative calcium infusion protocol and discharge criteria were standardized. Clinical variables were compared between patients with a shorter or longer postoperative stay. The mean postoperative hospital stay was 5.6 days. Preoperative alkaline phosphatase levels were significantly higher in patients with a longer stay (p=0.035). In a linear regression model, the postoperative length of stay was moderately but significantly correlated with preoperat...

Accurate information on prevalence and status of blood pressure control among US hemodialysis patients is lacking. We have surveyed the status of blood pressure control in 649 hemodialysis patients (89.8% black) from 10 dialysis units in Mississippi. Our results show a hypertension prevalence of 72% (hypertension defined as mean arterial pressure prior to dialysis session ≥114 mm Hg). This mean arterial pressure did not differ among black patients compared with white patients (P = 0.51). The majority of hypertensive patients (80%) had elevation of both systolic and diastolic blood pressure. Isolated systolic hypertension was present in only 20% of hypertensive patients and was not different between black and white patients (P = 0.10). Three hundred eighty-one patients (58.7% of the total population and 81.5% of the hypertensive patients) were receiving antihypertensives. Age was the only significant factor that correlated with blood pressure: older patients (>65 years) had lower blood pressure (P < 0.0001). Race, time on dialysis, etiology of end-stage renal disease, adequacy of dialysis, and several excess volume parameters had no influence on the blood pressure level. Treated hypertensive patients had a predialysis mean blood pressure only 3 mm Hg less than the untreated hypertensive patients. No differences were found among four classes of antihypertensives with regard to the degree of blood pressure control. Patients with hypertension requiring more than one antihypertensive did not achieve a lower blood pressure than the untreated patients. There was no correlation between use of antihypertensives and the magnitude of decrease in blood pressure after dialysis. Our results document the high prevalence and resistant nature of hypertension in the hemodialysis population. It also casts doubt on the effectiveness of our current methods of treatment. Excess volume may not be as important in these patients as once thought.

To compare hospital costs of Aboriginal and non-Aboriginal patients having haemodialysis treatment and forecast the future treatment cost. The costs of patients with HD in the &quot;Top End&quot; of Australia&#39;s Northern Territory were estimated for the financial years 1996/97 and 1997/98 using a hospital costing model. We used an Autoregression Integrated Moving Average model to predict future demand. 165 patients (101 Aboriginal and 64 non-Aboriginal) were treated at a total cost of $12.4 million in this two-year period. These 165 patients represented 0.7% of inpatients, 8.8% of total inpatient costs and 31.6% of total inpatient episodes of care in the Top End region. $9.5 million (77%) was spent on routine haemodialysis treatment and $2.9m (23%) on other hospitalisations. The average cost per routine haemodialysis treatment over the two-year period was $527, or $78 600 per patient treatment year. Hospitalisations for comorbidities occurred in 86% of Aboriginal and 39% of non-A...

The proper measures for assessing quality of life (QOL) in patients with chronic kidney disease (CKD) remain unclear. QOL measures are subjective or objective, functional or satisfaction-based, and generic or disease-specific. Treatment of end-stage renal disease with transplantation and treatment of anemia with erythropoietin in patients with CKD have been associated with dramatic improvements of QOL. Other factors such as age, ethnic or national background, stage of CKD, modality of dialytic therapy, exercise interventions, sleep disturbances, pain, erectile dysfunction, patient satisfaction with care, depressive affect, symptom burden, and perception of intrusiveness of illness may be associated with differential perception of QOL. Recent studies showed an association between assessment of QOL and morbidity and mortality in end-stage renal disease patients, suggesting the measures do matter. Further studies are necessary in patients with early stages of CKD and in children. QOL m...

To determine the possible association between anemia and clinical and echocardiographic cardiac disease, a cohort of 432 end-stage renal disease patients (261 on hemodialysis and 171 on peritoneal dialysis) who started dialysis therapy between 1982 and 1991 were followed prospectively for an average of 41 months. Baseline demographic, clinical, and echocardiographic assessments were performed, as well as monthly serial clinical and laboratory tests while the patients were on dialysis therapy. The mean (+/-SD) hemoglobin level during dialysis therapy was 8.8 +/- 1.5 g/dL. After adjusting for age, diabetes, and ischemic heart disease, as well as for blood pressure and serum albumin levels measured serially, each 1 g/dL decrease in mean hemoglobin was independently associated with the presence of left ventricular dilatation on repeat echocardiogram (odds ratio, 1.46; P = 0.018) and the development of de novo (relative risk [RR] = 1.28; P = 0.018) and recurrent (RR = 1.20; P = 0.046) cardiac failure. In addition, each 1 g/dL decrease in the mean hemoglobin level was independently associated with mortality while the patients were on dialysis therapy (RR = 1.14; P = 0.024). Anemia had no independent association with the development of ischemic heart disease while the patients were on dialysis therapy. Anemia, an easily reversible feature of end-stage renal disease, is an independent risk factor for clinical and echocardiographic cardiac disease, as well as mortality in end-stage renal disease patients.

Depressive symptoms are common among patients with end-stage renal disease (ESRD). In order to better understand what factors influence these symptoms, we examined the impact of illness and treatment cognitions on emotional adjustment and the influence of dialysis modality (hospital- vs. home-based dialysis) on this relationship. A cross-sectional sample of 145 ESRD patients on four different dialysis modalities [hospital hemodialysis (HD), n=52; home HD, n=25; continuous ambulatory peritoneal dialysis (CAPD), n=45; automated PD (APD), n=23] completed the Illness Perceptions Questionnaire, the Illness Effects Questionnaire, the Treatment Effects Questionnaire, and the Beck Depression Inventory. Measures of ESRD severity/comorbidity and biochemistry were also collected. Perceptions of treatment disruptiveness and attributions to poor medical care were significantly greater in CAPD. Home-based treatments were not found to confer an emotional adjustment advantage compared to hospital HD. There were marked differences across home-based modalities, with n=22 (44.4%) CAPD meeting the clinical cutoff of depression (≧16) vs. n=6 (26.1%) in APD and n=2 (8%) in home HD. After adjusting for case-mix differences, the mean levels of depressed mood remained significantly higher in CAPD patients compared to APD and home HD (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.01). On multiple regression analysis, 42.5% of the variance in depression was explained by the End-Stage Renal Severity Index, dialysis modality, perceived treatment disruptiveness, and beliefs about illness consequences and the extent to which the illness could be controlled. The findings suggest that the benefits of self-care are not uniformly manifested across dialysis modalities and that patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; cognitions are important determinants of depressed mood with implications for future research and clinical practice.

1. Among end-stage renal disease (ESRD) patients on hemodialysis, death from withdrawal from life-sustaining dialysis is increasingly common. The present study&#x27;s objective was to examine depression as a potential risk factor for hemodialysis withdrawal. Two hundred forty ESRD hemodialysis (133 male and 107 female) patients were followed for an average of 4 years after depression symptom assessment. Of these, 18% withdrew from dialysis. Using multivariate survival analysis and after controlling for the effects of age ...

Patient–professional communication is a critically important element of effective chronic illness care. However, the dynamics of health care communication in supporting self-care management and effective coping with various chronic diseases is not well understood. The present study examined health care communication from the perspective of 38 patients with four distinct chronic conditions: end-stage renal disease (ESRD), non-insulin dependent diabetes mellitus (NIDDM), multiple sclerosis (MS), and fibromyalgia (FM). Analysis revealed the dimensions of courtesy, respect, and engagement to be inherent in communication priorities across conditions. However, distinct “disease worlds” among and between these chronic conditions illuminated salient differences within these dimensions, thereby illustrating the way in which relevant variables such as legitimacy, the availability of conventional treatments, and lifestyle implications shape the meaning of health care communication. The findings enlarge upon patient-centered approaches to health care communication and inform further analysis of the interactional dynamics associated with chronic conditions.

The majority of patients with end stage renal disease (ESRD) have only limited knowledge of their condition. Various studies of the benefits of patient education programs have shown that educated patients have a reduced incidence of emergency dialysis compared with uneducated patients. The risk of end stage renal disease (ESRD) is increased among individuals with low income and in low income communities. Low socioeconomic status has been shown to be associated with an increased risk of end-stage renal disease on dialysis and mortality. This study was performed on 277 patients undergoing hemodialysis at 2 dialysis centers in Nellore (Andhra Pradesh). Data was collected on educational qualification and income through interview method and compared with Subjective Global Assessment. At baseline SGA scores 4.6% illiterateswere under well nourished, 54% were in mild to moderate nourishment and 41.2% were in severe malnutrition. After 6 months SGA scores 6.9% were under well nourished, 58.8% were in mild to moderate nourishment and 34.4% were under severe malnourishment. Under the category of degree +Pgat baseline SGA scores 4.3% were under well nourished, 58.6% were mild to moderate nourishment and 36.9% were severe malnutrition. After 6 months SGA scores 13% were under well nourished, 50% were under mild to moderate nourishment, 36.9% were under severe malnutrition. There is significant association in pre and post SGA scores based on income. Neither basic education nor acquired education (knowledge about the disease) did not show any influence on the nutritional status. However income of the family has shown a favorable effect on nutritional status.

Objective: Assess the reliability and validity of the Thai translation of the CHOICE Health Experience Questionnaire (CHEQ), which is the English-language questionnaire, developed specifically for End-stage-renal disease (ESRD) patients. The CHEQ comprised of two parts, nine general domains of SF-36 (physical function, role-physical, bodily pain, mental health, role-emotional, social function, vitality, general health, and report transition) and 16 dialysis specific domains of the CHEQ (role-physical, mental health, general health, freedom, travel restriction, cognitive function, financial function, restriction diet and fluids, recreation, work, body image, symptoms, sex, sleep, access, and quality of life). Material and method: The authors translated the CHEQ questionnaire into Thai and confirmed the accuracy by back translation. Pilot study sample was 10 Thai ESRD patients. Then the CHEQ (Thai) was applied to 110 Thai ESRD patients. Twenty-three patients had chronic peritoneal dialysis patients and 87 were chronic intermittent hemodialysis patients. Statistical analysis included descriptive statistics, Mann-Whitney U test, Student's t-test, and Cronbach's alpha. Results: Construct validity was satisfactory with the significant difference less than 0.001 between the low and high group. The reliability coefficient for the Cronbach's alpha of the total scale of the CHEQ (Thai) was 0.98. The Cronbach 's alphas were greater than 0.7 for all domains, range from 0.58 to 0.92, except the social function and quality of life domain (alpha = 0.66 and 0.575). Conclusion: The CHEQ (Thai) is reliable and valid for assessment of Thai ESRD patients receiving chronic dialysis. Its properties are similar to those reported in the original version.