Diabetic Ketoacidosis in End Stage Renal Failure Patient On Maintenance Dialysis – Key Challenges in Management

@#Diabetic ketoacidosis (DKA) is a medical emergency which requires prompt management to prevent mortality. Treatment is complicated in end stage renal failure (ESRF) patients due to their altered physiology in sugar metabolism and fluid haemodynamics. To date, there are only a few case reports illustrating the presentation and management of DKA in ESRF patients and a definite guideline on treatment of DKA in ESRF is seriously lacking. We report here a case of an ESRF patient on maintenance haemodialysis, who develops DKA due to missed insulin, and outline our successful treatment plan. We hope our reported case report research can further contribute to the knowledge of DKA management in ESRF.

Tratamiento de la hipercalemia en pacientes con enfermedad renal crónica en terapia dialítica / Treatment of hyperkaliemia in patients with chronic renal disease and dialytic therapy

Resumen: Debido a que la alteración electrolítica en la enfermedad renal crónica más importante es la hipercalemia, se realizó una revisión de la bibliografía respecto del tratamiento de la misma en pacientes con enfermedad renal crónica en terapia dialítica. Se analizaron artículos seleccionados en PubMed Central, EBSCO, Medlineplus, SciELO bajo el título hiperkalemia, hyperkalemia management, hyperkalemia treatment e hiperkalemia aguda y crónica (causa, epidemiología, métodos diagnósticos y métodos de tratamientos clásicos y actuales). Se analizaron diversos artículos de revisión y artículos de tratamiento en etapa prediálisis y en terapia dialítica; se analizaron los artículos que definieron la hipercalemia como la elevación mayor a 5 mEq/L en suero y que consideraron causa la excesiva ingesta de potasio, el desplazamiento extracelular y la alteración en la eliminación de potasio en los riñones, incluidas las manifestaciones clínicas y de laboratorio. Tambien se incluyó el análisis de artículos que asociaron la hipercalemia con la aparición de la insuficiencia renal, insuficiencia cardiaca y con la administración de medicamentos, incluidos los inhibidores del sistema renina angiotensina aldosterona, diuréticos ahorradores de potasio y antinflamatorios no esteroides. Las opciones de tratamiento de la hipercalemia en la enfermedad renal crónica continúan siendo limitadas a pesar del desarrollo de nuevos medicamentos, por lo que el objetivo del tratamiento en la hipercalemia aguda y crónica es revertir los efectos adversos principalmente en el corazón, desplazando el potasio a nivel intracelular, eliminando el potasio a nivel corporal, disminuyendo los síntomas y normalizando las concentraciones séricas del mismo.

Abstract Since the most important electrolytic alteration in chronic kidney disease is hyperkalemia, a review of the literature was conducted in the management of renal hyperkalemia in patients with chronic kidney disease and in dialysis therapy. Analysis of selected articles in PubMed Central, EBSCO, Medlineplus, SciELO under the title hyperkalemia, hyperkalemia management, hyperkalemia treatment and acute and chronic hyperkalemia (etiology, epidemiology, diagnostic methods and methods of classic and current treatments). Various review articles and treatment articles were analyzed in the pre-dialysis and dialysis stages. The articles that defined hyperkalemia as an elevation greater than 5 mEq/L in serum were analyzed and considered the etiology of excessive potassium intake, extracellular displacement and alteration in the elimination of potassium at the renal level, including clinical and laboratory manifestations. Also included was the analysis of articles that associated hyperkalemia with the development of renal failure, heart failure and with the use of drugs including renin angiotensin aldosterone system inhibitors, potassium-sparing diuretics and non-steroidal anti-inflammatory drugs. Treatment options for hyperkalemia in chronic kidney disease continue to be limited despite the development of new drugs, so the goal of treatment in both acute and chronic hyperkalemia is to reverse adverse effects primarily at the cardiac level, potassium at the intracellular level, eliminating the potassium at the corporal level, diminishing the symptoms and normalizing the serum concentrations of the same.

A Case Report of An End-Stage Renal Failure Patient with Peptic Ulcer Disease

@#A 64-year-old man with a background of chronic kidney disease (CKD) was admitted to hospital for symptoms of uraemia and was subsequently initiated on haemodialysis (HD). On day 13 of HD, he developed per rectal bleeding with a significant drop in his haemoglobin (Hb) level. Oesophagoduodenoscopy (OGD) was performed and showed several antral and duodenal ulcers. Colonoscopy was unremarkable. He was started on high-dose PPI and his Hb level remained stable with no recurrence of symptoms. This case report highlights the association between HD and the increased risk of developing peptic ulcer disease (PUD) in patients with end-stage renal failure. Abdominal symptoms are common in the primary care setting and it is crucial for family physicians to be able to recognise the red flags of PUD in this group of high-risk patients as timely referral and intervention reduces morbidity and mortality.

Fever with intradialytic pelvic pain: a case of iliopsoas abscess complicated with Methicillin-sensitive Staphylococcus Aureus bacteraemia in an end stage renal failure patient

Staphylococcus Aureus is a Gram-positive cocci bacteria which had been found to be the causative organism in over 88% of patients with primary iliopsoas abscess. We report the case of a 53-year-old diabetic woman with end-stage renal failure diagnosed with left iliopsoas abscess with a catheter-related infection. Computed tomogram (CT) of abdomen and pelvis revealed hypodense lesions of left psoas, iliacus and quadratus lumborum suggestive of psoas abscesses. In addition, osteomyelitis changes at left sacroiliac and hip joint were seen. At surgery, she was found to have abscess at the posterior psoas muscle where she underwent open surgery drainage and percutaneous drain was inserted. A high index of suspicion of iliopsoas abscess should be maintained among haemodialysis patients presenting with intradialytic pelvic and hip pain and treated with optimal antibiotics therapy with appropriate surgical intervention.

Effectiveness of Antihypertensive Drugs in Hypertensive Patients With End Stage Renal Failure

Hypertension has been identified as one of the causes for end stage renal failure (ESRF) and is likely to worsen kidney function. This retrospective study was carried out at a tertiary hospital in Malaysia with the objective of determining the effectiveness of combination antihypertensive drugs in hypertensive patients with ESRF admitted between 2006 and 2008. Patients with incomplete data and who were on monotherapy were excluded from this study. Although six different combinations gave significant reductions in systolic blood pressure (SBP) (13.38 ± 9.11 mmHg, p0.05) except for CCB-diuretics and BB-CCB-alpha blocker. The findings suggested better BP control with CCB-diuretic relative to other combinations used.

Outcome of Early Initiation of Peritoneal Dialysis in Patients with End-Stage Renal Failure

Recent studies reported that early initiation of hemodialysis may increase mortality. However, studies that assessed the influence of early initiation of peritoneal dialysis (PD) yielded controversial results. In the present study, we evaluated the prognosis of early initiation of PD on the various outcomes of end stage renal failure patients by using propensity-score matching methods. Incident PD patients (n = 491) who started PD at SNU Hospital were enrolled. The patients were divided into 'early starters (n = 244)' and 'late starters (n = 247)' on the basis of the estimated glomerular filtration rate (eGFR) at the start of dialysis. The calculated propensity-score was used for one-to-one matching. After propensity-score-based matching (n = 136, for each group), no significant differences were observed in terms of all-cause mortality (P = 0.17), technique failure (P = 0.62), cardiovascular event (P = 0.96) and composite event (P = 0.86) between the early and late starters. Stratification analysis in the propensity-score quartiles (n = 491) exhibited no trend toward better or poorer survival in terms of all-cause mortality. In conclusion, early commencement of PD does not reduce the mortality risk and other outcomes. Although the recent guidelines suggest that initiation of dialysis at higher eGFR, physicians should not determine the time to initiate PD therapy simply rely on the eGFR alone.

The epidemiology of end stage renal disease at a centre in Trinidad / Epidemiología de la fase terminal de la enfermedad renal en un centro de Trinidad

OBJECTIVE: The aim of this study is to estimate the trends in prevalence of end stage renal disease (ESRD) during the period 1999-2007 at one site in Trinidad, the Eric Williams Medical Sciences Complex (EWMSC), and to describe the epidemiological features, age, gender, ethnicity and co-morbidities associated with ESRD. DESIGN AND METHODS: A retrospective cohort study design was used. There was a count of patients on haemodialysis at the EWMSC centre from 1999 - 2007 in order to demonstrate trends in prevalence but more detailed data were collected and analysed for patients with ESRD attending the nephrology clinic between January 2002 and December 2007. The data that were collected from the patients' records included: demographic data (age, gender and ethnicity), medical history (diabetes mellitus, hypertension, end stage renal disease and autoimmune disorders), history of dialysis (type of vascular access, frequency of dialysis), mortality and its cause. RESULTS: Records of 81 patients were retrieved. Their age range was 10-79 years. The survey showed that patients most affected in the study population were: males, aged 50-59 years, who were hypertensive and/or diabetic and of African descent. CONCLUSIONS: In conclusion, we provide epidemiological evidence of ESRD and the associated contributing factors at one hospital in Trinidad.

OBJETIVO: El objetivo de este estudio es estimar las tendencias de la prevalencia de la enfermedad renal en fase terminal (ERFT) durante el periodo 1999-2007 en el Complejo de Ciencias Médicas Eric Williams, en Trinidad, y describir los rasgos epidemiológicos - edad, género, etnicidad - y co-morbilidades asociadas con la ERFT. DISEÑO Y MÉTODOS: Se usó un diseño de estudio de cohorte retrospectivo. Se llevó a cabo un análisis de todos los pacientes que asistieron a las clínicas de nefrología de EWMSC, de enero de 2002 a diciembre de 2007. Los datos recogidos de las historias clínicas de los pacientes al final del período de estudio incluyeron: datos demográficos (edad, género y etnicidad), historia médica (diabetes mellitus, hipertensión, enfermedad renal en fase terminal, trastornos autoinmunes), historia de diálisis (tipo de acceso vascular, frecuencia de diálisis), mortalidad y causa. RESULTADOS: Se obtuvieron las historias clínicas de 81 pacientes, cuya edad fluctuaba de 10 a 79 años. La encuesta mostró que los pacientes más afectados en la población del estudio fueron varones, de 50-59 años de edad, que eran hipertensos y/o diabéticos, de ascendencia africana. CONCLUSIONES: En conclusión, se ofrece evidencia epidemiológica de la ERFT en un hospital en Trinidad y se señalan los factores asociados que contribuyen a la enfermedad.

Simultaneous Bilateral Quadriceps Tendon Rupture in Patient with Chronic Renal Failure

Simultaneous bilateral spontaneous rupture of the quadriceps tendon is a very rare condition and only a few cases have been reported in the literature. The etiology is not clear yet. But it occurs infrequently in patients with chronic metabolic disorders. A 30-year-old female patient with simultaneous bilateral spontaneous quadriceps tendon rupture visited our hospital. She had chronic renal failure and her parathyroid hormone level was elevated due to parathyroid adenoma. We report a surgical repair of both quadriceps tendons of a patient with chronic renal failure as well as management of hyperparathyroidism.

Automated peritoneal dialysis in Brunei Darussalam

Introduction Chronic kidney disease in Brunei Darussalam is a growing problem. The number of patients reaching end stage kidney failure has increased dramatically in the last ten years. Currently, most are managed with haemodialysis while a smaller proportion is managed with continuous ambulatory peritoneal dialysis (CAPD). Automated peritoneal dialysis (APD) is a form of peritoneal dialysis and has been used in Brunei Darussalam since May 2008. Materials and Methods Eight patients participated in this prospective clinical trial. As all APD patients were previously on CAPD, comparisons are made between the outcomes of APD against CAPD. Results The median and mean age of APD patients were 42 and 45.5 ± 12.73 years respectively. After switching to APD, the serum haemoglobin and albumin improved from 10.56 ± 1.95 gm/L and 27.88 ± 7.71 gm/dL to 12.26 ± 1.82 gm/L and 33.63 ± 6.89 gm/dL respectively (p values <0.05). This corresponded to improvements in seven (87.5%) and six (75%) patients respectively in both parameters. Erythropoietin requirement was reduced in six (75%) patients, including three (37.5%) patients who were able to stop erythropoietin completely. There was no peritonitis encountered. All patients reported improved quality of life with better sleep, appetite and general well-being. Conclusions Our study showed that APD was as good as CAPD with improvement seen in both laboratory and quality of life parameters. There was also reduction in erythropoietin requirement. Based on these findings, we will actively encourage and promote APD usage as oppose to CAPD usage in our population.

Effectiveness of Topical Chia Seed Oil on Pruritus of End-stage Renal Disease (ESRD) Patients and Healthy Volunteers

BACKGROUND: Several studies have been performed to evaluate the efficacy of dietary n-3 fatty acid for patients with renal dysfunction. While about 40% to 80% of patients with end-stage renal disease (ESRD) complain about pruritus and xerosis, there are few reports on the effects of topical n-3 fatty acid on these symptoms. OBJECTIVE: In order to investigate the possible beneficial effects of topical n-3 fatty acid, oils extracted from chia (Salvia hispanica) seed were formulated into topical products, the effects of which were measured. METHODS: Five healthy volunteers having xerotic pruritus symptoms and 5 patients with pruritus caused by either ESRD or diabetes were involved in this study. A topical formulation containing 4% chia seed oils were applied for an 8-week duration. Subjective itching symptoms were assessed on a 6-point scale, as were other skin functions, namely transepidermal water loss and skin capacitance. RESULTS: After the 8 weeks of application, significant improvements in skin hydration, lichen simplex chronicus, and prurigo nodularis were observed in all patients. A similar improvement was also observed among healthy volunteers with xerotic pruritus. Improvement of epidermal permeability barrier function and skin hydration, represented by trans-epidermal water loss and skin capacitance, respectively, were also observed. No adverse effects were observed in all the tested patients and volunteers. CONCLUSION: Chia seed oil can be used as an adjuvant moisturizing agent for pruritic skin, including that of ESRD patients.

Sobrevida em hemodiálise crônica: estudo de uma coorte de 1009 pacientes em 25 anos / Survival in chronic hemodialysis: study of a cohort of 1009 patients in 25 years

Introdução: A maioria dos pacientes com doença renal crônica terminal depende de hemodiálise (HD) para a manutenção de sua vida. A análise dos fatores que influenciam na sobrevida pode auxiliar na busca contínua por melhores resultados. Métodos: Analisamos 1.009 pacientes tratados por HD crônica em três unidades de diálise de Santa Maria, RS, Brasil, durante 25 anos (1982-2007). Resultados: A sobrevida (método de Kaplan-Meier) em 1, 2 e 5 anos foi de 91% 84% e 64%, respectivamente. No modelo proporcional de Cox, tiveram influência estatisticamente significativa sobre o risco de mortalidade: idade ao iniciar HD (aumento de 4,5% por ano a mais; p=0,0001), presença de diabetes (aumento de 56%; p= 0,001) e ano de início da HD (redução de 5,2% por ano mais tarde; p+ 0,0001). A sobrevida foi significativamente melhor para pacientes que iniciaram HD de 1997 a 2007 do que para os que iniciaram de 1982 a 1996, tanto em diabéticos (54% versus 41% em 5 anos; p=0,01) como não diabéticos (72% versus 65% em 5 anos; p=0,045), embora, nestes, a idade tenha sido significativamente maior no período mais recente. Conclusões: A presença de diabete e cada ano a mais na idade determinaram risco significativamente aumentado. Cada ano subsequente do calendário trouxe um risco significativamente menor. Nos anos mais recentes, a melhora de sobrevida foi maior para pacientes diabéticos e idosos, sendo atribuída a avanços diagnósticos e terapêuticos e melhor qualidade global do programa dialítico.

Background: Most patients with endstage renal disease depends on hemodialysis (HD) for the maintenance of his life. Analysis of factors influencing survival may help in the continuing search for better results. Methods: We analyzed 1,009 patients treated with chronic HD at three dialysis units of Santa Maria, Brazil, during 25 years (1982-2007). Results: The survival (Kaplan-Meier) at 1, 2 and 5 years was 91% 84% and 64% respectively. In Cox proportional model, had significantly influenced the risk of mortality: age at starting HD (increase of 4.5% per year more, p = 0.0001), diabetes (56% increase, p = 0.001) and year of onset of HD (5.2% reduction a year later, p + 0.0001). Survival was significantly better for patients who started HD from 1997 to 2007 than for those who started from 1982 to 1996, both in diabetics (54% versus 41% in 5 years, p = 0.01) and nondiabetic patients (72% versus 65% in five years, p = 0.045), although in these, age was significantly higher in recent times. Conclusions: The presence of diabetes and each year in age led to significantly increased risk. Each year following the calendar brought a significantly lower risk. In recent years, improved survival was greater for diabetic and elderly, being attributed to diagnostic and therapeutic advances and improved overall quality of the dialysis program.

Fisiopatologia da hipertensão arterial em diálise: [revisão] / Pathophysiology of arterial hypertension in dialysis: [review]

A Insuficiência Renal Crônica tem se tornado cada vez mais prevalente no Brasil e no mundo. A hipertensão arterial e o Diabetes Mellitus se destacamcomo as principais doenças associadas ao seu aparecimento. Embora grandes avanços tenham sido conquistados no manuseio dessas doenças, aindanão é possível impedir que uma parcela desse grupo de pacientes evolua para a necessidade de terapia de substituição renal, diálise e/ou transplante.Apesar da melhora nas técnicas dialíticas, a mortalidade tem permanecido elevada, com destaque para as causas cardiovasculares, em que ahipertensão arterial representa importante fator de risco. Compreender a fisiopatologia da hipertensão nos pacientes em diálise faz-se necessário paradirecionar adequadamente o tratamento visando redução da morbidade e mortalidade. Esta revisão descreve mecanismos relacionados à hipertensãoem diálise com ênfase na retenção de sódio e água e as suas interações não apenas com o sistema renina-angiotensina-aldosterona, mas também como sistema nervoso autônomo simpático e outros de regulação pressórica cujo conhecimento pode auxiliar na prática nefrológica rotineira.

End stage renal failure has an increasing prevalence in Brazil and worldwide. Arterial hypertension and diabetes mellitus emerge as the leading diseasesassociated with its development. Despite larger advances in management of these two conditions, we are not able to refrain the progression of some ofthese patients to end stage renal disease and reduce the demand for dialysis or kidney transplant. Irrespective of the improvement in dialysis techniques,the mortality of end-stage renal disease patients remains elevated with cardiovascular diseases playing a pivotal role in this regard. Hypertension is animportant risk factor to this end-point. The understanding of the pathophysiology of hypertension in dialysis may be instrumental to an appropriate treatmentaiming to decrease the morbidity and mortality rates of these patients. This review describes mechanisms related to the development of hypertension indialysis with emphasis in sodium overload and its relationships with the renin-angiotensin-aldosterone system, sympathetic nervous system and othermechanisms of blood pressure regulation whose knowledge may help the quotidian working journey of many nephrologists.

Polymorphism of the ACE Gene in Dialysis Patients: Overexpression of DD Genotype in Type 2 Diabetic End-Stage Renal Failure Patients

The angiotensin-converting enzyme (ACE) gene DD homozygote has been suggested to be a significant risk factor for the progression of diabetic nephropathy. We analyzed clinical parameters and ACE genotype distribution between type 2 diabetic patients at the extremes of renal risk, i.e. an end-stage renal failure (ESRF) group (n = 103, group 1) who were on dialysis therapy due to progression of diabetic nephropathy, and a no progression group (n = 88, group 2) who had maintained normal renal function and normoalbuminuria for more than 15 years. There were no significant differences in age, sex, body mass index, HbA1c level, or lipid profiles between the two groups (p > 0.05). Group 1 had a significantly higher prevalence of hypertension [group 1: 82.5% (85/103) vs. group 2: 50.0% (44/88), p < 0.05] and diabetic retinopathy [group 1: 103/103 (100%) vs. group 2: 28/88 (31.8%), p < 0.05] than group 2. Daily urinary albumin excretion was also higher in group 1 than in group 2 [group 1: 2873 +/- 2176 mg/day vs. 12 +/- 7 g/day, p < 0.05]. The frequencies of the DD, ID, and II genotypes of the ACE gene in group 1 and group 2 were 26.2%, 47.6%, and 26.2%, and 7.9%, 57.9%, and 34.2%, respectively. The ACE genotype frequencies between the two groups were significantly different according to a chi-square test with Bonferroni's correction (p = 0.004). The presence of the DD genotype increased the risk of ESRF 4.286-fold compared to the II genotype [odds ratio 4.286, 95% CI 1.60- 11.42, p = 0.005]. The frequency of the D-allele was higher in both male and female patients in group 1 compared to group 2, but reached statistical significance only in males [male, group 1: 50.8% vs. group 2: 35.0%, p = 0.018, female, group 1: 48.8% vs. group 2: 39.5%, p = 0.231]. This study, although limited by sample size, showed that type 2 diabetic ESRF patients more frequently expressed the DD genotype. These findings may substantiate the previously noted relationship between the ACE DD genotype and the progression of diabetic nephropathy in Korean type 2 diabetic patients.

The determination of parathyroid hormone in the chronic renal failure and its clinical significances / 医学研究生学报

The secondary hyperparathyroidism is one of the complications of chronic renal failure (CRF) and end stage renal failure (ESRD), and becomes more serious with the development of the primary disease. Parathyroid hormone (PTH) is considered as one of the biomarks of the development of renal failure. The purpose of this article will expound the physiological effects of the PTH, the causes and clinical significances of PTH rising in CRF and ESRD patients, the determination of PTH level, and the relationships between the increase of PTH and the polymorphism of CYP2D6, GSTT1,GSTM1.

Effect of Hemodialysis on Taste Acuity in Patient with End-Stage Renal Disease / 대한신장학회잡지

In patients with end-stage renal disease, depressed taste acuity may often affect their food intake and causes malnutrition. We measured mean recognition thresholds for the four primary tastes before and after hemodialysis to evaluate the efficacy of hemodialysis on taste acuity and measured serum zinc concentrations to determine the relationship between taste acuity and zinc status in 21 patients undergoing hemodialysis. The results were as follows : 1) Mean taste recognition thresholds of sour(0.0034+/-0.0021 N), sweet(0.027+/-0.012 M), and salty(0.027+/-0.014 M) were significantly higher than those of controls(0.0012+/-0.0007 N, 0.016+/-0.008 M, and 0.015+/-0.008 M, respectively)(P<0.05). 2)After hemodialysis, mean taste recognition thresholds of sour(0.0014+/-0.0011 N), sweet(0.015+/-0.011 M), and salty(0.020+/-0.011 M) were significantly decreased(P<0.05) but were not different from those of controls. 3) The mean recognition threshold for bitter was not improved after hemodialysis and was not different from that of controls. 4) The serum zinc concentration of patients with chronic renal failure was not different from that of controls. Finally, the mean taste recognition thresholds for sour, sweet, and salty were decreased in patients with end-stage renal disease and were improved after hemodialysis. The mean taste recognition threshold for bitter was not improved after hemodialysis and was not different from that of controls.

Clinical usefulness of dipyridamole SPECT myocardial imaging in patients with end-stage renal disease / 대한내과학회지

BACKGROUND: Coronary artery disease(CAD) is a leading cause of death in patients with end-stage renal disease(ESRD). Current data concerning the role of dipyridamole SPECT myocardial imaging for the diagnosis of CAD in patients with ESRD vary according to authors. This study was performed to evaluate the usefulness of dipyridamole SPECT myocardial imaging and coronary angiography in diagnosing the CAD in patients with ESRD. METHODS: Sixty-three patients with ESRD underwent dipyridamole SPECT myocardial imaging and sixteen with positive myocardial imaging had selective coronary angiography. Controls were 73 patients with normal renal function who had dipyridamole SPECT myocardial imaging and coronary angiography because of chest pain or discomfort. The perfusion defect in myocardial images were defined as reversible or irreversible. Significant coronary artery disease was defined as one or more vessel disease with at least 50% stenosis on coronary angiography. The correlation between regional imaging defects and coronary stenoses in the corresponding vascular distribution was determined by the rule of a Van Train. RESULTS: Forty-nine of the patients had abnormal myocardial images (16 reversible, 6reversible + irreversible, 27 irreversible defects). Twenty six patients had a left anterior descending artery(LAD) defect, 13 a left circumflex artery(LCX) defect, 26 a right coronary artery(RCA) defect. There were no differences in age, sex, type and duration of dialysis, and associated atherogenic risk factors between patients with positive and negative myocardial imaging except for the durations of diabetes. Ten of the 16 patients, and thirty-nine of the 45 controls with positive myocardial imaging had a 50% or greater stenosis of one or more coronary arteries in coronary angiography. Therefore, the predictive value of positive SPECT in patients with ESRD was 63%, and that of controls was 87%. Of the 10 patients with stenotic lesions, 6 had double-, 3 single-, and 1 triple-vessel disease. Altogether, 7 diseased LCX , 6 RCA, and 5 LAD were found. In contrast, Of the 39 controls with angiographically significant stenotic lesions, 24 had single-, 9 double-, and 6 triple -vessel disease. Altogether, 27 diseased LAD, 17 LCX, and 16 RCA were found. There were no differences in age, sex, type and duration of dialysis, ST-T waves change, duration of ESRD, associated atherogenic risk factors, LV mass index and LVH between the patients with and without CAD except for the history of smoking. Three of 6 patients with false positive results of myocardial images had inferior perfusion defect and were on peritoneal dialysis. The pressure effects of peritoneal fluids on inferior perfusion defect were proven by a significant change of disappearance of inferior perfusion defect in myocardial images after complete drainge of the peritoneal fluids. And, the predictive value of positive SPECT differed between patients with and without false positive results of myocardial images (predictive value of positive SPECT 63% and 77%, respectively). CONCLUSION: Dipyridamole SPECT myocardial imaging appears to be an useful method for detection and exclusion of CAD in patients with ESRD and interpretation of dipyridamole SPECT myocardial imaging with inferior perfusion defect in patients with continuous ambulatory peritoneal dialysis needs more caution.

Angiotensin converting enzyme gene polymorphism in patients with end stage renal failure / 中华肾脏病杂志

Objective To evaluate the role of angiotensin-converting enzyme (ACE) gene polymorphism in the progression of renal diseases. Methods ACE gene polymorphism was analyzed in 77 patients with end stage renal failure (ESRF) and 150 normal control. Results The frequences of DD and DI genotype were significantly higher in ESRF patients than normal control (DD, 15.6% VS 6.0%, P

Effect of Interferon Alpha on Chronic Hepatitis C in Patients with Chronic Renal Failure and Renal Allograft Recipients / 대한이식학회지

Chronic hepatitis C is common complication in patients with end stage renal failure and relative contraindication to renal transplantation due to risk of progression. Although interferon alpha (IFN) treatment is proven to be effective in chronic hepatitis C with normal renal function, its effect on the treatment of chronic hepatitis C in dialysis patients and renal allograft recipients is not clear. We studied this study to evaluate the effect of IFN on chronic hepatitis C in patients with chronic renal failure and renal allograft recipients. Four dialysis patients and 2 renal allograft recipients were included in this study. The patients received IFN 3 million units three times a week for 6 months. All patients with showed normal levels of liver enzymes and seronegative conversion of HCV RNA. But seropositive conversion of HCV RNA was observed 1 dialysis patient after stopping of IFN treatment due to gross hematuria and epistaxis. Two dialysis patients had successful renal transplantation, and liver enzyme levels were normal and HCV RNA was negative after 2 months. In conclusion, IFN treatment is not only effective on the treatment of chronic hepatitis C in dialysis patients and renal allograft recipients but also may offer the potential of making transplantation a feasible option for chronic hepatitis C patients with end stage renal failure.

Role of Helocobacter pylori in Gastro-duodenl Mucosal Lesions in Patients with End-stage Renal Disease / 대한신장학회잡지

Helocobacter pylori(Hp) is thought to play an important role in the pathogenesis of active gastritis and other upper gastrointestinal mucosal lesions. Although upper gastrointestinal mucosal lesion have been one of the most common complication in patients with chronic renal failure. A few reports are available regarding the prevalence of H. pylori and its influence on the upper gastrointestinal tract. The objective of our study was to evaluate the prevalence of Hp in end-stage renal failure who were undergoing dialysis. The study population consisted of seventeen patients with upper gastrointestinal tract symptoms. Thirty-six patients without any known kidney disease were used control. Gastric mucosa and gastric juice were obtained endoscopically. Rapid urease test(CLO test) were used for the determination of Hp. Hp was observed in 35.3% of the dialysis group and 77.8% of the control. Gastroduodenal lesion in Hp positive dialysis patients included erosive gastritis, atrophic gastritis and superficial gastritis. In the dialysis group, ammonia concentration in gastric juice were higher in patients with Hp than in those without Hp (461.5+/-211.1 vs. 244.4+/-168.1microgram/mL, p< 0.05). Patients with end-stage renal failure who were undergoing dialysis were shown to have a low prevalence of Hp colonization. In the end-stage renal failure, Hp is associated with peptic ulcer and chronic active gastritis but its influence on the upper gastro- intestinal tract is milder than in those of normal renal function. Several factor including Hp may play a role in the pathogenesis of gastointestinal mucosal lesion.