Anemia and survival in Thai hemodialysis patients: evidence from national registry data.

BACKGROUND: Anemia is a major contributor to morbidity and mortality in chronic dialysis patients. The K/DOQI guideline recommends the target hemoglobin of 11-12 g/dl (hematocrit of 33-36%). However the appropriate hematocrit level for Thai hemodialysis patients has been controversial. OBJECTIVE: To investigate the influence of anemia on mortality in Thai chronic hemodialysis patients who initiated their dialysis from 1999 through 2003. MATERIAL AND METHOD: The data from the Thailand Renal Replacement Therapy Registry who has conducted an annual report of chronic dialysis patients throughout Thailand since 1997 was used. Data of twice- and thrice-weekly hemodialysis patients who had recorded hematocrit from 1999 through 2003 were processed and confirmed before final analysis. Records of 3,211 hemodialysis patients from 301 centers were included. RESULT: The original kidney diseases were diabetes mellitus (31.5%) and hypertension (20.9%). Most patients received twice-weekly hemodialysis (86.3%). The mean hematocrit was 29.3 +/- 5.5%. Most patients (72.8%) had hematocrits of less than 33%. Kaplan-Meier analysis showed patients with hematocrit of ?33% or more had better survival than patients with hematocrits of less than 33% (p <0.01). Patients with hematocrits of less than 27, 27-29.9, 30-32.9 and 36% or more had mortality risks of 1.90 (95% CI: 1.31-2.76, p <0.01), 2.10 (95% CI: 1.42-3.09, p <0.01), 1.74 (95% CI: 1.18-2.56, p <0.01) and 1.174 (95% CI: 0.73-1.90, p = 0.51) respectively, compared to those with hematocrit of 33-35.9%. CONCLUSION: The best survival can be achieved in Thai patients with hematocrits of at least 33%.

Significance of antiphospholipid antibodies in lupus nephritis.

BACKGROUND: Some autoantibodies have been associated with lupus nephritis but the role of antiphospholipid antibodies (APA) is controversial. OBJECTIVE: The present study was to explore the role of APA by comparing demographic profiles and the presence of anticardiolipin antibody (aCL) and lupus anticoagulant (LA) in systemiclupus erythematosus 1 (SLE) patients with and without nephritis. MATERIAL AND METHOD: The cross-sectional study in a tertiary center was conducted in 77 SLE patients. All patients attended our renal or rheumatology clinics between June 2002 and December 2003. RESULTS: Sixty-three (82%) of the 77 SLE patients had nephritis. The prevalence of antiphospholipid syndrome (APS) was 10% (8 patients), positive aCL (IgG) was 26% (20 patients) and positive LA was 26% (20 patients). The receiver operating characteristic (ROC) method was applied to assess the significance of aCL in both nephritis and non-nephritis groups. Area under the ROC curve was 0.538 (95%CI 0.312-0.765), a cutoff value of 20.5 GPL had a sensitivity of 75% and a specificity of 53%. In univariate analysis, neither positivity for anticardiolipin antibody nor lupus anticoagulant was associated with lupus nephritis. Analyzed in only the lupus nephritis group, LA-positive lupus nephritis patients had higher systolic blood pressure (SBP) (133.7 vs 121.9 mmHg, p = 0.005), lower platelet count (209.8 vs 264.4 x 10(3)/microL, p = 0.02) and higher 24-hr urine protein excretion (2.6 vs 1.4 g, p = 0.02) than LA-negative lupus nephritis patients. Serum creatinine was higher in LA-positive lupus nephritis than LA-negative (233.0 vs 94.9 micromol/L), but did not reach statistical significance. CONCLUSION: APA are frequently seen in SLE patients, but not associated with lupus nephritis. However lupus anticoagulant tends to associate with lupus nephritis. Detection of LA in lupus nephritis patients could identify patients who had increased risk to develop bad renal outcomes (elevated SBP and 24-hr urine protein excretion).