Efficacy of low-dose spironolactone on top of angiotensin receptor blockade in patients with glomerulonephritis

BACKGROUND: Previous studies have shown that aldosterone antagonists have a proteinuria-lowering effect in patients with proteinuria and progressive proteinuric disease not adequately controlled by the use of angiotensin receptor blockers (ARBs). Aldosterone antagonists, in combination with ARBs, might improve proteinuria in patients with glomerulonephritis (GN). METHODS: In the present retrospective study, we evaluated the proteinuria-lowering effect and drug safety of low-dose spironolactone (12.5 mg/day) in 42 patients with GN being treated with an ARB. RESULTS: Proteinuria decreased from a mean total-protein-to-creatinine (TP/Cr) ratio of 592.3 ± 42.0 mg/g at baseline to 335.6 ± 43.3 mg/g after three months of treatment with spironolactone (P < 0.001). After the initial three months, the mean TP/Cr ratio increased progressively at six, nine, and 12 months; however, it was still less than the baseline value (P = 0.001, < 0.001, and < 0.001, respectively). Although serum Cr levels increased significantly at three and nine months compared with baseline (P = 0.036 and 0.026, respectively), there was no time effect of treatment (P = 0.071). Serum potassium levels tended to increase with time (P = 0.118), whereas systolic and diastolic blood pressures decreased with time (P = 0.122 and 0.044, respectively). CONCLUSION: Low-dose spironolactone in combination with an ARB reduced proteinuria in patients with GN, which could represent a novel treatment option in individuals whose proteinuria is not optimally controlled by the use of ARBs alone.

Clinical utility of far-infrared therapy for improvement of vascular access blood flow and pain control in hemodialysis patients

BACKGROUND: Maintenance of a well-functioning vascular access and minimal needling pain are important goals for achieving adequate dialysis and improving the quality of life in hemodialysis (HD) patients. Far-infrared (FIR) therapy may improve endothelial function and increase access blood flow (Qa) and patency in HD patients. The aim of this study was to evaluate effects of FIR therapy on Qa and patency, and needling pain in HD patients. METHODS: This prospective clinical trial enrolled 25 outpatients who maintained HD with arteriovenous fistula. The other 25 patients were matched as control with age, sex, and diabetes. FIR therapy was administered for 40 minutes during HD 3 times/wk and continued for 12 months. The Qa was measured by the ultrasound dilution method, whereas pain was measured by a numeric rating scale at baseline, then once per month. RESULTS: One patient was transferred to another facility, and 7 patients stopped FIR therapy because of an increased body temperature and discomfort. FIR therapy improved the needling pain score from 4 to 2 after 1 year. FIR therapy increased the Qa by 3 months and maintained this change until 1 year, whereas control patients showed the decrease in Qa. The 1-year unassisted patency with FIR therapy was not significantly different from control. CONCLUSION: FIR therapy improved needling pain. Although FIR therapy improved Qa, the unassisted patency was not different compared with the control. A larger and multicenter study is needed to evaluate the effect of FIR therapy.

Fabry disease previously diagnosed as Henoch-Schonlein purpura

No abstract available.

Reanalysis of membranoproliferative glomerulonephritis patients according to the new classification: a multicenter study

BACKGROUND: All types of membranoproliferative glomerulonephritis (MPGN) are progressive diseases with poor prognoses. Recently, a newly proposed classification of these diseases separated them into immune complex- and complement- mediated diseases. We investigated the frequency of C3 glomerulonephritis among previously diagnosed MPGN patients. METHODS: We conducted a retrospective study of patients diagnosed with MPGN at three tertiary care institutions between 2001 and 2010. We investigated the incidence of complement-mediated disease among patients diagnosed with MPGN. Progressive renal dysfunction was defined as a 50% reduction in the glomerular filtration rate or the need for renal replacement therapy. RESULTS: Among the 3,294 renal biopsy patients, 77 (2.3%) were diagnosed with MPGN; 31 cases were excluded, of which seven were diagnosed with systemic lupus nephritis, and the others were not followed for a minimum of 12 months after biopsy. Based on the new classification, complement-mediated MPGN was diagnosed in two patients (4.3%); only one patient developed progressive renal dysfunction. Among the immune complex-mediated MPGN patients, 17 patients developed progressive renal dysfunction. Serum albumin and creatinine levels at the time of MPGN diagnosis were risk factors of renal deterioration, after adjusting for low C3 levels and nephrotic syndrome. CONCLUSION: Complement-mediated glomerulonephritis was present in 4.3% of patients previously diagnosed with MPGN.

Ferritin as a predictor of decline in residual renal function in peritoneal dialysis patients

BACKGROUND/AIMS: Aims: Inflammation is an important factor in renal injury. Ferritin, an inflammatory marker, is considered an independent predictor of rapid renal progression in patients with chronic kidney disease. However, the relationship between ferritin and residual renal function (RRF) in patients undergoing peritoneal dialysis (PD) remains unclear. METHODS: We reviewed the medical records of patients who started PD between June 2001 and March 2012 at Soonchunhyang University Bucheon Hospital, Korea. A total of 123 patients were enrolled in the study. At 1 month after the initiation of PD, RRF was determined by a 24-hour urine collection and measured every 6 months thereafter. Clinical and biochemical data at the time of the initial 24-hour urine collection were considered as baseline. RESULTS: The RRF reduction rate was significantly greater in patients with high ferritin (ferritin > or = 250 ng/mL) compared with those with low ferritin (ferritin < 250 ng/mL; -1.71 +/- 1.36 mL/min/yr/1.73 m2 vs. -0.84 +/- 1.63 mL/min/yr/1.73 m2, respectively; p = 0.007). Pearson correlation analysis revealed a significant negative correlation between the baseline serum ferritin level and the RRF reduction rate (r = -0.219, p = 0.015). Using multiple linear regression analysis and adjusting for other risk factors, baseline serum ferritin was an independent factor for the RRF reduction rate (beta = -0.002, p = 0.002). CONCLUSIONS: In this study we showed that a higher ferritin level was significantly associated with a more rapid RRF decline in patients undergoing PD.

Clinical Experience with Buttonhole Needling in a Single Hemodialysis Center / 대한내과학회지

BACKGROUND/AIMS: The buttonhole technique, in which needle insertion during cannulation is always into the same site, confers advantages including ease of cannulation, ease of achieving hemostasis, and reduced pain compared with rope-ladder needling. We introduced the buttonhole technique in hemodialysis patients experiencing pain during needling. None of the disadvantages associated with the buttonhole technique, such as infection or access events, were observed, due to the short duration of the study. METHODS: Patients undergoing buttonhole needling were observed prospectively. Data were collected on the following parameters: infectious complications, hospitalizations and access events. We compared buttonhole and rope-ladder needling using baseline data. RESULTS: A total of 48 patients (34 males; mean age = 49.4 +/- 13.8 years) were enrolled. Seven patients were excluded: in three patients, the buttonhole technique failed to form a tract, three others underwent kidney transplantation, and one was lost to follow-up. The remaining 41 patients were followed for 15.7 +/- 4.7 months. Thirteen patients suffered infections, as follows: local infections (n = 5), pneumonia (n = 3), bacteremia (n = 2), cellulitis (n = 1), osteomyelitis (n = 1), and liver abscess (n = 1). There were no significant differences between the rope-ladder and buttonhole needling techniques in rates of infection, hospitalization or vascular access events. CONCLUSIONS: The infection rate and access event frequency associated with buttonhole needling did not differ in relation to that of rope-ladder needling.

Clinical Experience with Buttonhole Needling in a Single Hemodialysis Center / 대한내과학회지

BACKGROUND/AIMS: The buttonhole technique, in which needle insertion during cannulation is always into the same site, confers advantages including ease of cannulation, ease of achieving hemostasis, and reduced pain compared with rope-ladder needling. We introduced the buttonhole technique in hemodialysis patients experiencing pain during needling. None of the disadvantages associated with the buttonhole technique, such as infection or access events, were observed, due to the short duration of the study. METHODS: Patients undergoing buttonhole needling were observed prospectively. Data were collected on the following parameters: infectious complications, hospitalizations and access events. We compared buttonhole and rope-ladder needling using baseline data. RESULTS: A total of 48 patients (34 males; mean age = 49.4 +/- 13.8 years) were enrolled. Seven patients were excluded: in three patients, the buttonhole technique failed to form a tract, three others underwent kidney transplantation, and one was lost to follow-up. The remaining 41 patients were followed for 15.7 +/- 4.7 months. Thirteen patients suffered infections, as follows: local infections (n = 5), pneumonia (n = 3), bacteremia (n = 2), cellulitis (n = 1), osteomyelitis (n = 1), and liver abscess (n = 1). There were no significant differences between the rope-ladder and buttonhole needling techniques in rates of infection, hospitalization or vascular access events. CONCLUSIONS: The infection rate and access event frequency associated with buttonhole needling did not differ in relation to that of rope-ladder needling.

Ischemic monomelic neuropathy: a rare complication after vascular access formation

No abstract available.

Clinical Aspects of Peritonitis in Peritoneal Dialysis Patient: A Single Center Experience

OBJECTIVE: Peritonitis is one of major complication of peritoneal dialysis. It is the most important reason for removal of peritoneal catheter, death, or converting to hemodialysis. There is a debate that peritonitis decreases residual renal function. Thus, the authors carried out a study to grasp the prognosis of peritonitis which affects residual renal function (RRF) and assessed the risk factors of its clinical course. METHODS: Among 245 patients who had been on peritoneal dialysis in Soonchunhyang University Bucheon Hospital from April 2001 to March 2012, the author selected 91 patients who had kept on peritoneal dialysis for more than 3 months and experienced more than one episode of peritonitis. The medical records and laboratory findings were reviewed. RESULTS: During the average period of 36.3+/-22.8 months of peritoneal dialysis, total of 182 episodes of peritonitis developed in 91 study subjects. Among them, the 15 cases (8.2%) did not improve despite of intraperitoneal antibiotics and peritoneal catheter was subsequently removed. Eight patients were dead because of peritonitis related complications. The lactic dehydrogenase (LDH) level of peritoneal fluid at the third day of treatment had a significant correlation with peritonitis treatment failure (odds ratio [OR], 1.079; P=0.009) and death (OR, 1.071; P=0.049), respectively. The RRF after peritonitis became significantly low (P=0.011) compared to before peritonitis. But the slopes of declining rate of RRF were not different between before and after peritonitis (P=0.932). CONCLUSION: The LDH level of peritoneal fluid at the third day of treatment was correlated with treatment failure or death. The declining rate of RRF was not affected after peritonitis.

Features of atherosclerosis in hemodialysis patients

BACKGROUND: Cardiovascular disease is the main cause of mortality in dialysis patients. Carotid intima-media thickness (CIMT) is used as a surrogate marker of early atherosclerosis. Atherosclerosis can cause vascular access failure.The purpose of this study was to define the clinical features of atherosclerosis in hemodialysis patients based on CIMT and to define the relationship between CIMT and access failure. METHODS: In this cross-sectional study, the CIMT of 60 patients on hemodialysis was examined using B-mode Doppler ultrasonography between May 2012 and November 2012. Carotid atherosclerosis was defined as a CIMT> or =0.9 mm or the incidence of atherosclerotic plaques. RESULTS: The patients' mean age was 54.5+/-10.6 years, and 60% of the patients were male. The CIMT was 0.81+/-0.47 mm (range, 0.35-2.50 mm).The group with atherosclerosis was characterized by older age compared with those without atherosclerosis. Patients with atherosclerosis showed much shorter durations of access patency than their counterparts in the nonatherosclerosis group (hazard ratio, 2.822; 95% confidence interval, 1.113-7.156; P=0.029). Moreover, being overweight was associated with a 2.47-fold (95% confidence interval,1.101-5.548) increased primary access failure. CONCLUSION: This study shows that atherosclerosis is associated with older age. Patients who are overweight and have atherosclerosis may have shortened access patency.

Rapid Decrease of Intact Parathyroid Hormone Could Be a Predictor of Better Response to Cinacalcet in Hemodialysis Patients

PURPOSE: Cinacalcet is effective for treating refractory secondary hyperparathyroidism (SHPT), but little is known about the response rates and clinical factors influencing the response. MATERIALS AND METHODS: A prospective, single-arm, multi-center study was performed for 24 weeks. Cinacalcet was administered to patients with intact parathyroid hormone (iPTH) level greater than 300 pg/mL. Cinacalcet was started at a dose of 25 mg daily and titrated until 100 mg to achieve a serum iPTH level <300 pg/mL (primary end point). Early response to cinacalcet was defined as a decrease of iPTH more than 50% within one month. RESULTS: Fifty-seven patients were examined. Based on the magnitude of iPTH decrease, patients were divided into responder (n=47, 82.5%) and non-responder (n=10, 17.5%) groups. Among the responders, 38 achieved the primary end point, whereas 9 patients showed a reduction in serum iPTH of 30% or more, but did not reach the primary end point. Compared to non-responders, responders were significantly older (p=0.026), female (p=0.041), and diabetics (p<0.001). Additionally, early response was observed more frequently in the responders (30/47, 63.8%), of whom the majority (27/30, 90.0%) achieved the primary end point. Multivariate analysis showed that lower baseline iPTH levels [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.93-0.99], the presence of diabetes (OR 46.45, CI 1.92-1125.6) and early response (OR 21.54, CI 2.94-157.7) were significant clinical factors affecting achievement of iPTH target. CONCLUSION: Cinacalcet was effective in most hemodialysis patients with refractory SHPT. The presence of an early response was closely associated with the achievement of target levels of iPTH.

Clinical Utility of the Buttonhole Technique Using Biohole(TM) in Hemodialysis Patients / 대한내과학회지

BACKGROUND/AIMS: Buttonhole cannulation has been popular because it provides an easy puncture, is less painful, and requires less time for hemostasis. However, the technique requires a skilled staff and a long time to form the tract. A new buttonhole technique using Biohole(TM), which shortens the time needed for tract formation, has been introduced in Europe, North America, and Japan. METHODS: We prepared a cannulation tract using the buttonhole technique and Biohole(TM) over a two-week period and compared the 12-week outcomes between patients who underwent the rope-ladder versus buttonhole techniques. RESULTS: The 40 patients (27 males) had a mean age of 49.1 +/- 14.2 years. Thirteen and 27 patients were cannulated with the rope-ladder and buttonhole techniques, respectively. Patients who underwent the buttonhole technique had more initial pain than did those who received the rope-ladder technique (p = 0.044). The Biohole(TM) procedure improved puncture pain (5.6 vs. 3.4, p = 0.003) and shortened hemostasis time (1.8 vs. 1.3, p = 0.001). Over a two-week period, patients using Biohole(TM) experienced dislocation (20.8%), bleeding at peg sites (8.6%), and pain during peg change (2.4%). Over the 12 week study period, patients who underwent the buttonhole technique had insignificantly less pain than did those who received the rope-ladder technique (p = 0.088), but the former had less bleeding time than the latter (p = 0.000). One patient who received the buttonhole technique experienced one episode of infection (p = 0.327). CONCLUSIONS: The new buttonhole technique using Biohole(TM) is safe and useful in the short term. A long-term, larger, multicenter study is required to confirm these results.

A Case of Parathyroid Carcinoma in a Patient with Stage 3 Chronic Kidney Disease / 대한내과학회지

Parathyroid carcinoma is a rare disease in patients with primary hyperparathyroidism. We experienced a case of parathyroid carcinoma presenting with hyperparathyroidism. A 62-year-old male patient had hypercalcemia, chronic kidney disease, and an elevated parathyroid hormone level for at least 3 months. An ultrasonogram and parathyroid scan did not show parathyroid neoplasm. He underwent left hemithyroidectomy and parathyroidectomy. Biopsy revealed a parathyroid carcinoma. His azotemia and hypercalcemia improved after surgery.

Validation of the Oxford Classification of IgA Nephropathy: A Single-Center Study in Korean Adults

BACKGROUND/AIMS: The recently published Oxford classification of IgA nephropathy (IgAN) proposed a split system for histological grading, based on prognostic pathological features. This new classification system must be validated in a variety of cohorts. We investigated whether these pathological features were applicable to an adult Korean population. METHODS: In total, 69 adult Korean patients with IgAN were analyzed using the Oxford classification system at Soonchunhyang University Hospital, Seoul, Korea. All cases were categorized according to Lee's classification. Renal biopsies from all patients were scored by a pathologist who was blinded to the clinical data for pathological variables. Inclusion criteria were age greater than 18 years and at least 36 months of follow-up. We excluded cases with secondary IgAN, diabetic nephropathy combined other glomerulopathies, less than 36 months of follow-up, and those that progressed rapidly. RESULTS: The median age of the patients was 34 years (range, 27 to 45). Mean arterial blood pressure was 97 +/- 10 mmHg at the time of biopsy. The median follow-up period was 85 months (range, 60 to 114). Kaplan-Meier analysis showed significant prognostic predictions for M, E, and T lesions. A Cox proportional hazard regression analysis also revealed prognostic predictions for E and T lesions. CONCLUSIONS: Using the Oxford classification in IgAN, E, and T lesions predicted renal outcome in Korean adults after taking clinical variables into account.

Impact of initial blood flow on outcomes of vascular access in hemodialysis patients

BACKGROUND: Direct access flow measurements are considered the most useful surveillance method for significant stenosis, and ultrasound dilution has become the most popular and validated technique. The goal of this study was to evaluate access flow (Qa) at the time of first cannulation and its relationship to the survival of vascular access in Korean hemodialysis patients. METHODS: We conducted a prospective observational study from May 2004 to June 2011. We enrolled 60 patients (36 men) who underwent the first access operation between January 2004 and December 2005 and were followed-up for surveillance. RESULTS: Maturation failure occurred in nine patients (15%). Mean time to first use was 1.8+/-1.2 months after surgery. The patients were followed-up for a mean of 50.5+/-25.9 months. There were 25 deaths and six kidney transplants in patients with a functioning access. The total percutaneous transluminal angioplasty incidence was 50 in 27 patients (0.14/access-year). The initial Qa was 757.5+/-476.4 mL/minute. First cannulation time was not significantly correlated with initial Qa (r=0.234, P=0.075). A total of 22 of the 60 patients (36.7%) had an initial Qa<500 mL/minute. Maturation failure, initial Qa<500 mL/minute, and the use of antiplatelet agents were risk factors for poor primary patency. Diabetic status and use of a graft were risk factors for low cumulative patency. CONCLUSION: An initial Qa<500 mL/minute is a risk factor for poor primary patency, while an initial Qa<500 mL/minute is not a risk factor for low cumulative patency or mortality.

Mortality Predictors in Patients Treated with Continuous Renal Replacement / 대한신장학회지

PURPOSE: Acute kidney injury (AKI) is a frequent condition with a high mortality rate that requires continuous renal replacement therapy (CRRT). We evaluated the Simplified Acute Physiology Score 3 (SAPS 3) and Acute Physiology and Chronic Health Evaluation II (APACHE II) score, determined at the start of CRRT, for predicting mortality in AKI. METHODS: We retrospectively analyzed the demographic, clinical, and laboratory data of 89 patients with AKI or acute-on-chronic kidney disease who received CRRT between September 2006 and September 2009. We calculated the SAPS 3 and APACHE II score at the start of CRRT. RESULTS: The average age of the 89 patients was 64.4+/-13.9 (17-92) years. Fifty-nine (66.3%) were male. Eighteen (20.2%) patients had chronic kidney disease and 30 (33.7%) had diabetes. The overall mortality was 75.3%. The average SAPS 3 was 89.4+/-14.9 and the average APACHE II score was 28.4+/-5.2. The SAPS 3 was higher in non-survivors than survivors (p=0.038). Infection was more common in non-survivors (p=0.036). There were no significant differences between the two groups for other conditions. The variables influencing mortality on univariate analysis were SAPS 3 and presence of infection. The area under the receiver-operating characteristic curve for SAPS 3 was 0.69 (95% CI. 0.54-0.83). At a SAPS 3 of 84, the sensitivity for predicting mortality was 71.6% and the specificity was 69.2%. CONCLUSION: The SAPS 3 determined before starting CRRT could be a predictor of hospital mortality in patients with AKI.

Infective Endocarditis with Cerebral Infarction in a Hemodialysis Patient with Failed Renal Allograft / 대한신장학회지

Infective endocarditis is a dreaded complication in dialysis or kidney transplantation patients, with high morbidity and mortality. Despite the improved early survival of the transplanted kidney with new immunosuppressive agents, the number of patients returning to dialysis after a failed renal allograft is increasing. There is no consensus on the optimal management of immunosuppression in patients with a failed allograft. Continued immunosuppression is associated with infection, and the rapid discontinuation of immunosuppression may lead to acute rejection. Therefore, it is important to taper the immunosuppression properly in patients with a failed renal allograft. We report on a hemodialysis patient with a failed renal allograft who had a cerebral infarction following infective endocarditis. The patient was treated successfully with antibiotics and valve replacement.

The Anti-Inflammatory Effects of Statin in 5/6 Nephrectomized Rats / 대한내과학회지

BACKGROUND/AIMS: In a previous study, statin therapy reduced proteinuria and ameliorated the progression of chronic kidney disease. However, in patients with chronic renal failure (CRF), the beneficial effect of statin therapy on the preservation of renal function has not been determined. Thus, we determined the effect of rosuvastatin on CRF. METHODS: Male Sprague-Dawley rats (6 weeks old) were subjected to 5/6 nephrectomy. Six weeks after the procedure, the rats were divided into control and rosuvastatin-treated groups. Body weight and blood/urine biochemical parameters were measured 6 weeks after 5/6 nephrectomy and 8 weeks after the start of rosuvastatin treatment. Remnant kidneys were harvested at 6 (n = 4) and 14 (n = 8) weeks after 5/6 nephrectomy. RESULTS: During rosuvastatin treatment, changes in body weight and serum total and low-density lipoprotein cholesterol did not differ significantly between the control and rosuvastatin-treated groups. Although serum creatinine and proteinuria increased in both groups, the differences were not significant (p = 0.24 and 0.77, respectively). Immunohistochemical staining, enzyme-linked immunosorbent assays, and western blotting showed that the expression of transforming growth factor-beta1 and intracellular adhesion molecule-1 were reduced in the rosuvastatin-treated group. CONCLUSIONS: Long-term statin treatment may attenuate the inflammatory process in the progression of renal failure.

The Anti-Inflammatory Effects of Statin in 5/6 Nephrectomized Rats / 대한내과학회지

BACKGROUND/AIMS: In a previous study, statin therapy reduced proteinuria and ameliorated the progression of chronic kidney disease. However, in patients with chronic renal failure (CRF), the beneficial effect of statin therapy on the preservation of renal function has not been determined. Thus, we determined the effect of rosuvastatin on CRF. METHODS: Male Sprague-Dawley rats (6 weeks old) were subjected to 5/6 nephrectomy. Six weeks after the procedure, the rats were divided into control and rosuvastatin-treated groups. Body weight and blood/urine biochemical parameters were measured 6 weeks after 5/6 nephrectomy and 8 weeks after the start of rosuvastatin treatment. Remnant kidneys were harvested at 6 (n = 4) and 14 (n = 8) weeks after 5/6 nephrectomy. RESULTS: During rosuvastatin treatment, changes in body weight and serum total and low-density lipoprotein cholesterol did not differ significantly between the control and rosuvastatin-treated groups. Although serum creatinine and proteinuria increased in both groups, the differences were not significant (p = 0.24 and 0.77, respectively). Immunohistochemical staining, enzyme-linked immunosorbent assays, and western blotting showed that the expression of transforming growth factor-beta1 and intracellular adhesion molecule-1 were reduced in the rosuvastatin-treated group. CONCLUSIONS: Long-term statin treatment may attenuate the inflammatory process in the progression of renal failure.

Prevalence of Helicobacter pylori Infection on Peptic Ulcer in Dialysis Patients in One Center / 대한신장학회지

PURPOSE: Patients with chronic renal failure tend to have an increased incidence of peptic ulcer disease. Helicobacter pylori (H. pylori) infection is generally found to be the major cause of peptic ulcer disease. There are a few studies about the association between H. pylori and peptic ulcer disease in dialysis patients. In this retrospective study, we investigated the relationship between H. pylori and peptic ulcer disease in dialysis patients. METHODS: The participants enrolled in this study were hemodialysis (HD) or peritoneal dialysis (PD) patients in the period from February 2001 to March 2010, who had been diagnosed as having a peptic ulcer. The presence of H.pylori was identified by at least one of the following: the rapid urease test, the urea breath test or histologic findings. RESULTS: A total of 132 patients (100 HD and 32 PD patients) were enrolled. The mean age and duration of dialysis were 56.5+/-14.8 years and 27.6+/-45.3 months, respectively. The prevalence of H. pylori-positive patients amongst those with peptic ulcer disease was 43.1% (57/132). H. pylori-positive prevalence was 48.1% (38/79) in gastric ulcer patients, and 33.3% (11/33) in duodenal ulcer patients, but this difference was not significant (p=0.21). There were no significant differences in age, causes of chronic renal failure or dialysis method between the H. pylori-positive and H. pylori-negative groups. However, the duration of dialysis was significantly longer in the H. pylori-negative group (16.6+/-34.1 vs. 36.0+/-50.8 months, p=0.01). Furthermore, as the duration of dialysis increased, the prevalence of H. pylori infection decreased (p=0.004). CONCLUSION: There was little association between H. pylori and peptic ulcer disease in dialysis patients. Long-term dialysis appeared to decrease the prevalence of H. pylori infection in peptic ulcer disease.