Clinical Characteristics and Survival Analysis of Elderly Patients Undergoing Continuous Ambulatory Peritoneal Dialysis / 대한신장학회지

PURPOSE: The increased prevalence and incidence of end-stage renal disease in the elderly is a worldwide phenomenon. We investigated the survival rate, technical success, cause of death and the predictors of death in patients starting peritoneal dialysis over 65 years of age. METHODS: We analyzed 67 patients; 37 were in the elderly group (>65 years of age) and 30 in the control group (45-64 years of age) that started peritoneal dialysis between January 1995 and June 2006. Clinical characteristics and laboratory findings at the beginning of dialysis and 6 months later were retrospectively analyzed. In addition, the survival rate and independent predictors of survival were analyzed. RESULTS: The prevalence of complication was not different in the two groups. However, leakage of dialysate was more common in the elderly group. The duration of patient survival, serum albumin levels and BMI were lower in the elderly group. The multivariate analysis showed that age, presence of diabetes, initial albumin level, and residual renal function was associated with patient survival, gender, age, initial albumin level, and the prevalence of peritonitis affected the technical success rate. CONCLUSION: Among elderly patients, leakage was more prevalent compared to the younger patients and the most common cause of death was cardiovascular disease. The presence of diabetes, a low serum albumin and BMI, and residual renal function were associated with the duration of survival

Relationship between serum brain natriuretic peptide and heart function in patients with chronic kidney disease

BACKGROUND/AIMS: Brain natriuretic peptide (BNP) levels are known to be elevated in patients with chronic kidney disease (CKD) and normal heart function. Therefore, the present study was performed to examine the effectiveness of BNP level in diagnosing heart failure in patients with CKD and to determine its effects on survival rate and prognosis. METHODS: A total of 182 patients with CKD who visited the hospital due to dyspnea of NYHA class II were included in the study. BNP levels were measured and echocardiography was performed to divide the subjects into groups with and without heart failure. Their BNP levels, clinical courses, and survival rates were analyzed retrospectively. RESULTS: When BNP level was > or =858.5 pg/mL in CKD patients, heart failure could be diagnosed with sensitivity and specificity of 77% and 72%, respectively. Survival rate of the group with BNP levels of > or =858.8 pg/mL was significantly lower than that of the group with BNP level below this threshold (p=0.012) and multivariate analysis showed that BNP level, age, and sex affected survival rate in the group with BNP level > or =858.8 pg/mL. CONCLUSIONS: BNP levels of patients with CKD showed a positive correlation with creatinine levels, and the critical point of BNP level for diagnosis of heart failure was 858.5 pg/mL. As the survival rate in patients with BNP level above the critical point was significantly low, this level was a useful indicator for predicting their prognosis. Care should be taken in interpreting BNP level because patients with stage 5 CKD may show a high concentration of BNP without heart failure.

Clinical Characteristics of Alcoholic Ketoacidosis in Patients with Chronic Alcoholic Ingestion / 대한신장학회잡지

BACKGROUND:Alcoholic ketoacidosis is a common disorder observed in chronic alcoholics with metabolic acidosis but there were only several reports. This study was undertaken to evaluate the clinical characteristics of alcoholic ketoacidosis and to identify prognostic factors that could affect survival of patients. METHODS:We retrospectively evaluated the clinical characteristics and prognostic factors in 66 patients who were diagnosed with alcoholic ketoacidosis. RESULTS: There were 57 men and 9 women and their mean age was 48.6 years. Duration of alcohol intake was 20+/-12 years. The amount of daily alcohol intake was 129+/-68 g. Alcohol drinking patterns such as duration and the amount of daily alcohol consumption did not differ significantly between the non-survivors the and survivors. On laboratory testing, the levels of creatinine, pCO2, leukocyte count, total bilirubin, creatinine, creatine kinase and lactate dehydrogenase were significantly higher in the non-survivors than in the survivors (respectively, p=0.044; p=0.003; p=0.001; p=0.011; p=0.007; p=0.018). The levels of hemoglobin, total protein, albumin and calcium were significantly lower in the non-survivors than in the survivors (respectively, p=0.003; p=0.022; p=0.001; p= 0.001). Combined conditions on admission were acute renal failure (36/66), alcoholic hepatitis (29/66), gastritis (21/66), rhabdomyolysis (15/66), alcohol withdrawal syndrome (15/66), infections (15/66) and pancreatitis (10/66). Mortality rate was 22.7% (15/66) and common causes of death were uncontrolled acidosis, sepsis and gastrointestinal bleeding. CONCLUSION: The general conditions, ability of respiratory compensation, renal function and the severity of liver disease on admission were associated with mortality in patients with alcoholic ketoacidosis.