[Show abstract][Hide abstract] ABSTRACT: The average prevalence of hepatitis C virus (HCV) infection in renal transplant recipients is 10%. Studies of these patients with HCV infection usually focuses on long-term graft survival and patient survival. Studies of the correlation between HCV infection and bone mineral density (BMD) in renal transplant patients are limited. The aim of this study was to investigate whether HCV infection is a risk factor for BMD change during a short follow-up period.
Seventy-six renal transplant recipients underwent 2 separate dual-energy X-ray absorptiometry (DXA) scans during a mean period of 14 months. Fifteen patients were HCV infection. First bone mineral density (BMD) at the lumbar spine, hip, and femoral neck was determined using dual-energy X-ray absorptiometry (DXA) between September 2008 and March 2009. After that, 34 patients took alendronate sodium 70 mg per week. Subgroups risk factors analysis was also performed into with or without alendronate. Immunosuppressive agents, bisphosphonates, patient characteristics, and biochemical factors were analyzed to identify associations with BMD.
After 14 months, in 76 patients, BMD of the lumbar spine had significantly increased (from 0.9 g/cm(2) to 0.92 g/cm(2), p<0.001), whereas BMD of the hip and femoral neck had not. Multiple linear regression analysis showed that HCV infection was negatively associated with BMD change in the lumbar spine ( β : -0.247, 95% CI, -0.035 to -0.002; p = 0.028). Moreover, in subgroup analysis, among 42 patients without alendronate, multiple linear regression analysis showed HCV infection was a risk factor for adverse BMD change of the lumbar spine ( β : -0.371, 95% CI, -0.043 to -0.003; p = 0.023).
HCV infection in renal transplant recipients was a negative risk factor for BMD change in the lumbar spine. Moreover, alendronate may be able to reverse the negative effect of HCV infection on bone in renal transplant recipients.
PLoS ONE 05/2013; 8(5):e63263. DOI:10.1371/journal.pone.0063263 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Peritoneal dialysis (PD) is characterized by a slow continuous removal of solutes. Traditionally, dialysis adequacy is quantified by referring to the kinetics of urea nitrogen (UN) and creatinine (Cr) clearance. The efficacy of middle molecular substances and protein-bound solutes as markers for peritoneal dialysis adequacy is not clear. The aim of this cross-sectional study was to investigate correlations between the clearance of indoxyl sulfate (IS), p-cresyl sulfate (PCS), UN, and Cr in the peritoneum and kidneys and to compare the overall clearances of IS and PCS between non-anuric and anuric groups in PD patients. We recruited a total of 175 patients who had been undergoing continuous ambulatory PD (CAPD) or automated PD (APD) for at least 4 months. We measured total IS and PCS concentrations in serum, dialysate, and urine samples. Free IS and PCS concentrations were measured in all serum samples. IS and PCS clearances via both kidney and peritoneum were measured. The mean concentration of IS in the urine samples was 9.2-fold higher than that in the dialysate samples, and concentration of PCS in the urine samples was 8.5-fold higher than that in the dialysate samples. Peritoneal UN and Cr clearances were not correlated with peritoneal PCS clearance (P > 0.05) but were mildly correlated with peritoneal IS clearance. The peritoneal IS and PCS clearances in the different peritoneal equilibration test groups were similar. The renal UN and Cr clearances were strongly correlated with renal PCS and IS clearances (P > 0.89, P < 0.001). In addition, non-anuric patients showed better elimination of total PCS (10.3 mg/day [range, 1.6-19.8] vs. 5.2 mg/day [range, 0-14]; P < 0.001] and IS (37.9 mg/day [range, 25.6-56.7] vs. 24.8 mg/day [range, 17.1-41.6]; P < 0.001) than anuric patients. This cross-sectional study showed that peritoneal clearance of water-soluble solutes is not correlated with that of PCS but is mildly correlated with that of IS. However, the renal clearances of IS and PCS show strong positive correlation with the renal clearances of UN and Cr. This study confirms the important role of residual renal function in the removal of protein-bound uremic toxins.
Therapeutic apheresis and dialysis: official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 08/2012; 16(4):361-7. DOI:10.1111/j.1744-9987.2012.01068.x · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Patients undergoing continuous ambulatory peritoneal dialysis (CAPD) are at an increased risk of peritonitis following colonoscopy with or without polypectomy. Guidelines for peritoneal dialysis patients recommend administration of prophylactic antibiotics and drainage of the abdomen before colonoscopy. In this report, we describe a 53-year-old woman on CAPD who underwent colonoscopy with polypectomy and developed peritonitis within 24 hours. She presented with severe abdominal pain, typical rebounding tenderness, and turbid dialysate containing increased white blood cells with a predominance of neutrophils. A culture of the patient's peritoneal fluid grew polymicrobial species including Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis. She was treated with intraperitoneal and intravenous administration of combination antibiotics, and she fully recovered within 3 weeks. We suggest that nephrologists and endoscopists should be familiar with the risks and follow the guidelines to prevent such complications in CAPD patients. If peritonitis occurs, medical therapy with antibiotics should be considered before surgical intervention for catheter salvage.
Internal Medicine 07/2012; 51(14):1841-3. DOI:10.2169/internalmedicine.51.7485 · 0.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Myelomatous pleural effusion is an unusual clinical condition associated with poor outcomes. We report a case with myelomatous pleural effusion upon the presentation of the disease. The patient had multiple risk factors for inferior prognosis of multiple myeloma, including old age, immunoglobulin D (IgD) isotype, high lactate dehydrogenase, C-reactive protein, beta2-microglogulin levels, and a high myeloma cell burden in the bone marrow. The myeloma cells in both bone marrow and pleural effusion had characteristic features of plasmablasts, including gigantic size, large and eccentrically placed nuclei, fine cytoplasm, and prominent nucleoli. Immunophenotypical analysis showed the plasmablastic cells in the pleural effusion were positive for surface CD38, cytoplasmic immunoglobulin, both kappa and lambda light chains but negative for surface CD19 or CD79a. Our experience suggests that the diagnosis of myelomatous pleural effusion should be made with clinical alertness and careful cytological examination, preferably supplemented by immunophenotypical analysis.
[Show abstract][Hide abstract] ABSTRACT: Cardiothoracic ratio (CTR) is associated with left ventricular mass, left ventricular systolic dysfunction and mortality in patients with hypertension or chronic cardiovascular disease. The clinical significance of CTR in non-diabetic maintenance hemodialysis (MHD) patients remains unclear.
468 non-diabetic MHD patients were enrolled. Geographic, hematological, biochemical and dialysis-related data were obtained. The patients were analyzed for nutritional and inflammatory markers as well as CTR. All patients were followed up for 2 years to investigate the risks for mortality.
Chi-square analysis showed that the incidence of malnutrition and inflammation was significantly higher in patients with CTR >60% than in patients with CTR <or=60%. CTR positively correlated with high-sensitivity C-reactive protein (hsCRP) levels but negatively correlated with albumin levels. 29 patients (6.2%) had expired by the end of the study. Cox multivariate analysis revealed that CTR significantly predicts both all-cause and cardiovascular-cause 2-year mortality in non-diabetic MHD patients.
CTR is an indicator of inflammation and nutritional status in non-diabetic MHD patients and can predict 2-year mortality in these patients. The analytical results of this study support continued efforts to reduce CTR and treat underlying causes in patients with CTR >50%.
Kidney and Blood Pressure Research 04/2008; 31(3):143-51. DOI:10.1159/000127388 · 2.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Arterial stiffness as determined by brachial-ankle pulse wave velocity (baPWV) has been demonstrated to predict cardiovascular events or mortality in patients with end-stage renal disease. Peritoneal function and residual renal function (RRF) both are important for patients undergoing peritoneal dialysis (PD). No association has yet been established between arterial stiffness, and RRF and peritoneal function in patients undergoing PD.
146 PD patients received PD lasting over 4 months. baPWV was determined using an automated, non-invasive, waveform analysis device.
This retrospective study revealed independent correlations between baPWV and mean arterial pressure, age, status of diabetes mellitus and RRF as well as an inverse correlation with body mass index.
This retrospective study showed that arterial stiffness is independently correlated with RRF. Interestingly, peritoneal function test is not associated with baPWV value.
[Show abstract][Hide abstract] ABSTRACT: Brachial-ankle pulse wave velocity (baPWV), a non-invasive waveform analysis, is a useful tool for the vascular evaluation of arterial stiffness. Increased baPWV values have been found increased in patients with arterial stiffness. The aim of this study was to investigate retrospectively the association between arterial stiffness and the common medications used in peritoneal dialysis patients.
In all, 116 peritoneal dialysis patients (35 males and 81 females) received peritoneal dialysis for more than four months. Patients who had dialysis-related peritonitis or other infection within six months prior to this study, inflammation disease, fasting serum sugar >or=126 mg/dL, and/or use of oral hypoglycemic agents or insulin injections were excluded. The medications that were enrolled in our study were calcium-containing phosphate binders, vitamin-B complex, folic acid, and antihypertensive medications. baPWV was determined using an automated, non-invasive, waveform analysis device.
In a step-wise multiple linear regression analysis, baPWV correlated independently with systolic blood pressure (t = 8.4, p < 0.001) and age (t = 5.5, p < 0.001), and inversely correlated with body mass index (t = -3.19, p = 0.002) and the use of angiotensin II receptor antagonists (t = -2.35, p = 0.021).
In this retrospective study of peritoneal dialysis patients, we found that angiotensin II receptor antagonists (ARBs) in peritoneal dialysis patients may be an independent factor for arterial stiffness. Hence, we suggest that compared with other antihypertensive drugs, ARBs may be a good choice for lowering arterial stiffness in PD patients. However, further studies on the optimal treatment of arterial stiffness in peritoneal dialysis patients are warranted.
[Show abstract][Hide abstract] ABSTRACT: Chronic inflammation and malnutrition relate to increased risks for cardiovascular death. This study compared fasting glucose levels (FGL) and impaired fasting glucose (IFG) with malnutrition and inflammation in nondiabetic maintenance hemodialysis (MHD) patients to investigate the adverse affects and risks for mortality. In total, 693 MHD patients were enrolled in this study and followed up for 1 yr. Geographic, hematologic, biochemical, and dialysis-related data were collected. According to 1997 and 2003 definitions, all patients were classified into three groups: Diabetic, nondiabetic with IFG, and nondiabetic with normal FGL. More diabetic and nondiabetic with IFG group patients were malnourished (chi(2) = 24.55, P < 0.0001) and had inflammatory changes (chi(2) = 9.32, P = 0.0095) than those with normal FGL. The IFG group had higher high-sensitivity C-reactive protein and ferritin and lower serum albumin, creatinine levels, and normalized protein catabolic rate than the normal FGL group. Age and parameters of nutrition and inflammation were associated with FGL. Stepwise multiple regression analysis demonstrated that FGL were negatively associated with serum albumin (P = 0.0026) and positively correlated with Log high-sensitivity C-reactive protein (P = 0.0004) in nondiabetic MHD patients. In addition, after 1 yr of follow-up, Cox multivariate analysis demonstrated that, after adjustment for other significant related factors, FGL (relative risk 1.049; 95% confidence interval 1.007 to 1.093; P = 0.0232) or presence of IFG (relative risk 3.798; 95% confidence interval 1.168 to 12.344; P = 0.0265) was a significant risk factor for 1-yr all-cause mortality of these patients. On the basis of these findings, basal FGL or presence of IFG, a preventive and treatable status, plays an important role in inflammation, malnutrition, and short-term mortality of nondiabetic MHD patients.
Journal of the American Society of Nephrology 09/2007; 18(8):2385-91. DOI:10.1681/ASN.2006121409 · 9.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Peritonitis is a serious complication in peritoneal dialysis (PD) patients; however, the clinical outcome of culture-negative peritonitis (CNP) is controversial. This retrospective study of CNP attempts to resolve this controversy. In 813 episodes of peritonitis, 202 episodes of CNP in 152 PD patients were reviewed. Two different methods of effluent culture were utilized during the study period. The incidence of CNP was lower with 50 ml centrifugation culture than 10 ml direct inoculation culture (20.7% vs. 35.7%; p < 0.05). The overall cure rate of CNP was greater than 80% of patients receiving cefamezine and gentamicin as initial therapy. Relapse within 30 days after completion of treatment happened in 9.6% of cases, and antibiotic therapy failed in 8.1% of CNP cases. In comparison with cured patients, patients with relapse or treatment failure are older (62.0 +/- 15.0 years vs. 54.3 +/- 15.3 years; p = 0.007) and have a higher rate of abdominal pain (91.4% vs. 69.3%; p = 0.007) and greater need for salvage therapy (54.3 % vs. 11.0%; p < 0.001). A history of antibiotic use or peritonitis within 30 days before onset of CNP was noted in 23.3% and 12.5% of cases, respectively, but was not associated with clinical outcome. The clinical outcome of CNP was benign in this study. Older age, abdominal pain, and need for salvage therapy were associated with an increased risk for relapse and treatment failure in CNP cases. Moreover, 50 ml centrifugation culture method was better than 10 ml direct inoculation culture in reducing the incidence of CNP.
[Show abstract][Hide abstract] ABSTRACT: Atherosclerotic vascular change affecting the lower extremities is the most common peripheral vascular disease. Ankle-brachial index (ABI) and toe-brachial index (TBI) are common, non-invasive diagnostic tests for atherosclerosis in the lower extremities. Peritoneum is a vascular-based structure. The use of glucose-based hyperosmolar solutions for PD patients results in a significant increase in blood glucose load and can be considered atherogenic. The association between ABI or TBI values and peritoneal function in patients undergoing peritoneal dialysis remains unclear. We presumed that the risk factors for atherosclerosis in large and small vessels may differ.
A total of 146 peritoneal dialysis patients, 41 males and 105 females (119 without diabetes and 27 with diabetes), received peritoneal dialysis for more than four months. Patients who had dialysis-related peritonitis within six months prior to this study were excluded. The ABI or TBI was determined using an automated, non-invasive, waveform analysis device.
The ABI value correlated positively with mean arterial pressure and TBI value. The TBI value correlated positively with ABI value and inversely with fasting serum glucose and serum total cholesterol concentrations. Peritoneal function was not correlated with ABI or TBI.
This cross-sectional study demonstrated that risk factors in peritoneal dialysis patients for atherosclerosis in large vessels and small vessels differed. Interestingly, peritoneal function test is not associated with ABI or TBI value. However, further investigation of the association between ABI or TBI value and cardiovascular events is required for this patient group.
[Show abstract][Hide abstract] ABSTRACT: Aortic dissection is a life-threatening illness requiring early diagnosis and treatment. Uncommon early presentations mimicking various illnesses can delay diagnosis. This case study describes a 44-year-old woman with type B aortic dissection initially presenting as acute pyelonephritis (APN). Early clinical manifestations were sudden onset of left flank pain, fever, hematuria and pyuria, and following admission, severe abdominal pain, nausea, vomiting, reduced urine output and renal function deterioration. Abdominal computed tomography showed type B aortic dissection complicated with a small bowel infarct, ischemic ascending colon and left renal infarct. Emergency surgical interventions of small bowel resection, ileoduodenostomy and cholecystectomy were performed; a second laparotomy was subsequently performed for anastomosis leakage. The patient died due to septic shock with multiorgan failure. Aortic dissection initially mimicking APN is rare. Accurate early diagnosis of aortic dissection with indeterminate presentation is crucial. Early surgical intervention for visceral organ ischemia is important to preventing morbidity and mortality.
Journal of nephrology 05/2006; 19(3):341-5. · 1.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hepatitis B virus (HBV) is endemic in Taiwan. Transplantation followed by long-term immunosuppressive medications may precipitate HBV reactivation. Interference of hepatitis C virus (HCV) with HBV gene expression and replication has been confirmed in many studies involving non-transplant populations. This study investigates the incidence of HBV reactivation following renal transplantation and compares the clinical outcome, especially the liver outcome, of patients with or without HCV co-infection.
Fifty-one of 512 renal transplant recipients were positive for hepatitis B surface antigen before surgery, and were followed for 81.6+/-7.5 (4-120) months. Seventeen of 51 patients acquired HCV before transplantation and six patients acquired HCV after renal transplantation.
At the end of this assessment, we had 28 patients who suffered HBV reactivation and another 23 patients who suffered no HBV reactivation. Initially, we found a significant difference of HCV carriage (P<0.05) between patients with (seven out of 28 or 25%) or without (21 out of 23 or 91.3%) HBV reactivation. Further inspection showed that 21 of the 28 patients without HCV co-infection and seven of the 23 patients with HCV co-infection suffered HBV reactivation. After comparison, we found a lower incidence of HBV reactivation in patients with HCV co-infection than in patients without HCV co-infection (P<0.05). In contrast to the latter, we found that patients with HCV co-infection suffering HBV reactivation tended to have a late onset of HBV reactivation (P<0.05). Otherwise, there was no difference in hepatitis severity, in terms of peak alanine aminotransferase, total bilirubin levels and hepatitis reactivation-related death, between these two groups of patients. Finally, a multivariable analysis also revealed that HCV carriage was indeed an independent variable leading to the reduced incidence of HBV reactivation in patients with HCV co-infection.
HCV might affect the reactivation of HBV by decreasing the incidence or delaying the onset of HBV reactivation in renal transplant recipients carrying both HBV and HCV.
[Show abstract][Hide abstract] ABSTRACT: We describe the case of a female with xanthogranulomatous pyelonephritis and malacoplakia of the bladder, presenting with recurrent urinary tract infection and renal mass. The genitourinary tract should be explored to evaluate the coexistence of these two diseases. Nephrectomy and bladder mass resection is warranted to maintain sterile urine. This case represents an unusual instance of the synchronic appearance of xanthogranulomatous pyelonephritis and malacoplakia of the bladder, implying a common pathogenesis for two related diseases from a different histological spectrum, in which the urinary obstruction serves as a promoting factor for the stepwise transformation of morphogenesis.
Journal of nephrology 03/2006; 19(2):222-4. · 1.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Candida parapsilosis is the most prevalent pathogen of fungal peritonitis in peritoneal dialysis (PD). The difference between C. parapsilosis peritonitis and other C. species for clinical outcomes and treatment responses to fungal peritonitis remains unclear. This retrospective study of fungal peritonitis attempts to answer that question. A total 22 patients with fungal peritonitis in 762 PD patients were enrolled in this study. The mean age of the 22 patients, 9 males and 13 females, was 54.7 +/- 12.5 years with a mean PD duration of 39.7 +/- 33.4 months. Candida species accounted for 86% (19 cases) of fungal peritonitis and 41% (9 cases) were C. parapsilosis. Thirteen (59%) patients received fluconazole as monotherapy; others received either amphotericin B alone or in combination with fluconazole. Catheters were removed for all patients. The mean duration from peritonitis onset to catheter removal was 5.8 +/- 4.1 days. Eleven (50%) patients developed severe complications, with abscess formation or persistent peritonitis after catheter removal. C. parapsilosis peritonitis had a higher complication rate than other Candida species (78% versus 20%, p = 0.012). In patients who received fluconazole as monotherapy, the rate of severe complications of C. parapsilosis peritonitis was statistically higher than those of other Candida species (100% versus 29%, p = 0.013). Because of different severity and prognosis, C. parapsilosis peritonitis in PD patients should be treated more aggressively than other Candida species.
[Show abstract][Hide abstract] ABSTRACT: Controversy still persists regarding the impact of HCV infection on renal transplant recipients. This study aimed to evaluate the effect of anti-HCV antibody status on patients and grafts of renal transplants at a single center.
We examined 299 first cadaveric renal transplants performed between July 1981 and May 2000 at our hospital, including 129 patients with anti-HCV antibody positive (HCV+ group) and 170 patients with anti-HCV antibody negative (HCV- group). The HBsAg of the 299 patients were all negative throughout the follow-up period. Causes of graft failure and patient death were analyzed. Patient and graft cumulative survival were compared between HCV+ and HCV- groups. Multivariate analysis with Cox proportional hazard model were calculated for risk hazards of outcome.
Overall cumulative patient survival was 97.72, 85.63 and 71.31% at 1, 10, and 15 yr, respectively, in the HCV+ group, compared with 95.02, 67.85 and 59.83% at 1, 10 and 15 yr, respectively, in the HCV- group (p = 0.014). The major cause of patient death in both groups was infection with 26.67% in HCV+ group and 60.87% in HCV- group. Cumulative graft survival in the HCV+ group revealed 92.26, 55.97 and 26.16% at 1, 10 and 15 yr, respectively, compared with 88.07, 58.34 and 58.32% at 1, 10 and 15 yr, respectively, in the HCV- group (p = 0.700). The major cause of graft failure was chronic allograft dysfunction (56.82%) in HCV+ group, and patient death (32.43%) in the HCV- group. Multivariate analysis of patient survival revealed anti-HCV antibody+ had lesser risk hazard (aRR: 0.30, p = 0.002), chronic hepatitis had higher risk hazard (aRR: 1.90, p = 0.135), male recipient had higher risk hazard (aRR: 2.18, p = 0.051), and older recipients (age >55) also had higher risk hazard (aRR: 4.21, p = 0.063). Analysis of graft survival revealed only older donors (age >35) had higher risk hazard (aRR: 1.90, p = 0.081).
The study revealed that patients with anti-HCV antibody had higher incidence of chronic hepatitis, chronic allograft dysfunction and post-transplantation nephrotic syndrome. Graft survival tended lower in the very long time. However, patients with anti-HCV antibodies had better patient survival when compared with patients without HCV antibodies up to 15 yr follow up. Patients of hepatitis C group without clinical chronic hepatitis was associated with best patient survival.
[Show abstract][Hide abstract] ABSTRACT: Patients with systemic lupus erythematosus (SLE) have an increased risk for malignancy and end-stage renal disease itself might further augment the risk. Treating uremic patients with cervical cancer by cisplatin-based chemotherapy combined with radiation is hampered by the reduced renal excretion of cisplatin. Doxorubicin, a potential radiosensitizer with an established effect on carcinomas that arise in the ovary, uterine cervix and endometrium, might be applied in these cases. We describe a 36-year-old woman, who had a 9-year history of SLE and was maintained on dialysis, and who developed severe drug reaction manifesting as fever, skin rash and exfoliative dermatitis with positive lupus band test after infusion of pegylated liposomal doxorubicin therapy for advanced cervical cancer. These skin manifestations improved after i.v. methylprednisolone pulse therapy.
[Show abstract][Hide abstract] ABSTRACT: This article reports the unexpected discovery of IgA nephropathy in a 26-year-old Chinese woman 1.5 years after the onset of idiopathic dermatomyositis. The patient was taking immunosuppressive agents, prednisolone 25 mg and azathioprine 75 mg daily. Glomerulonephritis associated with idiopathic polymyositis/dermatomyositis is rare. A review of the medical literature indicates that the most common pattern seen in idiopathic polymyositis is mesangial proliferative glomerulonephritis. However, both membranous and mesangial proliferative glomerulonephritis are often seen in idiopathic dermatomyositis. It is still not clear, however, whether the humorally- mediated immune process in dermatomyositis and the cell-mediated immune process in polymyositis can explain the different patterns of occurrence of glomerular lesions in these two closely related disease entities.
Journal of nephrology 01/2003; 16(1):148-53. · 1.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the influence of early nephrology referral on clinical outcome in type II diabetes mellitus patients on maintenance peritoneal dialysis (PD).
This is a retrospective study in a single University Hospital in Taiwan.
This study analyzed the type II diabetic patients entering our PD program from February 1988 to June 2000. Patients that were presented to a nephrologist more than 6 months before starting dialysis were defined as early referrals (ER). Patients were considered late referrals (LR) if they were transferred to the nephrology department within 6 months before initial dialysis.
Patient survival and technique survival curves were derived from Kaplan-Meier analysis and were compared using the Cox-Mantel log rank test. Covariates were analyzed with Cox proportional hazards model.
52 type II diabetic patients were enrolled in this study: 16 in the ER group and 36 in the LR group. Patient survival was better in the ER group than in the LR group [relative risks [exp(coef)] 0.42; 95% confidence interval 0.152-0.666; p < 0.05]. The improved survival in the ER group was independent of age at dialysis, good glycemic control, and residual renal function, as indicated in the multivariate analysis with stepwise regression by Cox proportional hazards model. The ER group was also associated with better technique survival.
These results suggest that early nephrology referral before initiating dialysis is associated with improved long-term clinical outcome in type II diabetics on maintenance PD.
Peritoneal dialysis international: journal of the International Society for Peritoneal Dialysis 01/2003; 23(1):39-45. · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Muscle cramp is a common complication of haemodialysis. The exact mechanism of this complication is still unknown. Many approaches have been used to relieve the muscle cramping but have had variable effects. One of the possible mechanisms of haemodialysis-associated muscle cramps (HAMC) is the disturbance of muscle energy metabolism. Creatine monohydrate can enhance muscle metabolism. We evaluated the clinical effect of creatine monohydrate on HAMC.
Ten patients with frequent muscle cramps during haemodialysis were randomly selected into two groups, control and placebo. In a double-blind manner, 12 mg of creatine monohydrate or placebo was given to each patient before each dialysis session for 4 weeks. The incidence of muscle cramp during haemodialysis was compared between the two groups. Dialysis adequacy, haemodynamic status, and side-effects were also evaluated. We continued to observe and compare the patients during a 4-week washout period to verify the effect of creatine monohydrate.
The frequency of symptomatic muscle cramps decreased by 60% in the creatine monohydrate treatment group (6.2+/-0.8 vs 2.6+/-1.8 times/4 weeks, P<0.05) during the treatment period. This decreasing incidence of muscle cramps disappeared in the washout period in the creatine group (6.6+/-1.1 times/4 weeks). There was no difference in the incidence of muscle cramps in the placebo group. The haematocrit, Kt/V, serum albumin, and haemodynamics remained unchanged in both groups during the treatment and washout periods. Serum creatinine increased slightly after creatine monohydrate treatment (10.7+/-3.2 vs 12.4+/-3.2 mg/dl, P<0.05). No adverse effect was found in either group during the treatment and washout periods.
These data suggest that creatine monohydrate can reduce the incidence of HAMC and that it may be a safe agent.
[Show abstract][Hide abstract] ABSTRACT: A 55-year-old woman presented with Guillain-Barré syndrome, nephrotic syndrome and multiple tubular dysfunction under occupational exposure to an organic solvent, which contained acetone as the principal solvent. In this case, the onset of the nephrotic syndrome and tubular dysfunction coincided with the development of the neurological manifestation. Renal biopsy demonstrated minimal change glomerulopathy with moderate tubulointerstitial nephritis. Several clearance tests that evaluated tubular transport functions revealed multiple tubular defects (including the Na(+)-K(+)-Cl(-) cotransporter of thick ascending limb and distal proton pump). The simultaneous occurrence of Guillain-Barré and nephrotic syndrome has previously been reported. However, both minimal glomerulopathy with multiple tubular dysfunction and progressive peripheral neuropathy under occupational exposure to an organic solvent remain unreported. Herein, we presented a rare association of minimal change nephrotic syndrome, tubular dysfunction with Guillain-Barré syndrome under the risk of exposure to an acetone-based cleansing solution; the case raises our concerns about possible chronic nephrotoxic or neurotoxic effects of common chemical organic solvents.
American Journal of Nephrology 10/2002; 22(5-6):560-5. DOI:10.1159/000065268 · 2.67 Impact Factor