Cardiac troponin-T in pre-end stage kidney disease.

BACKGROUND: Cardiac troponin T level (cTnT) is commonly increased in end stage chronic kidney disease (CKD) in the absence of acute myocardial infarction. There are few data available on serum cTnT concentration in patients with pre-end stage CKD. OBJECTIVE: To evaluate the correlation of cTnT level and severity of kidney disease in patients with CKD stage 3 and 4 and to evaluate whether there is a relationship between left ventricular mass index and cTnT level. MATERIAL AND METHOD: Patients (103) with CKD stage 3-4 between 26 and 85 years of age (mean 60.0 +/- 11.9) entered the present study. Serum cTnT determined using a third-generation electrochemiluminescent immunoassay on an Elecsys 2010 analyzer (Roche Diagnostics Ltd.). All patients underwent echocardiography. Left ventricular hypertrophy (LVH) was considered when LV mass index exceeded 125 g/m2. RESULTS: Overall, 28 patients (28.2%) had cTnT > 0.01 micro/L and two patients (1.8%) had cTnT > 0.1 microg/L cTnT concentration was commonly increased in more severe CKD (9 patients in stage 3 and 20 patients in stage 4). LVH was not associated with increased cTnT (p=0.105). CONCLUSION: The present study demonstrated that the elevated cTnT > 0.01 microg/L is relatively common in patients with CKD stage 3-4 who do not require dialysis treatment, however serum cTnT level above > 0.1 microg/L is uncommon in this population. Increased serum cTnT is associated with decreased renal clearance but not LVH.

The validity of A new practical quality of life measure in patients on renal replacement therapy.

OBJECTIVE: A new quality of life measure, apart of the National Health and Welfare 2003 survey, is a promising tool for outcome evaluation of clinical practice due to its brevity, validity, reliability, and providing easy interpretation against general population norm-based scores. The measure consisting of 9-items, and so called 9-item Thai Health status Assessment Instrument (9-THAI) was used to assess its validity and reliability in patients on renal replacement therapy (RRT). MATERIAL AND METHOD: Three hundred and two patients on RRT who visited Srinagarind Hospital from March to May 2005 were studied Convergent and divergent validity were assessed using SF-36 as the concurrent measure. Concurrent validity was also assessed using hematocrit level and hospitalization history in the last year as concurrent clinical measures. Test-retest reliability was studied by repeated measure within one 1 month. Responsiveness of 9-THAI was studied in patients who reported health improvement. RESULTS: Results of correlations between 9-THAI and SF-36 domains were as hypothesized 9-THAI scores were significantly correlated with hematocrit level and hospitalization history. The results confirmed the validity of 9-THAI for use as a quality of life measure. Intraclass correlation coefficients of 9-THAI scores in stable patients were satisfactory. Among patients on RRT who reported overall health improvement, 9-THAI scores significantly increased, thus adding further evidence of the responsiveness of 9-THAI. CONCLUSION: The 9-THAI is a valid and reliable generic health status measure that can be used as an ideal core in a battery of quality of life measures in clinical practice for patients on RRT.

Survival and technical failure in a large cohort of Thai CAPD patients.

OBJECTIVE: To evaluate patient and technique survival, and to analyze factors influencing survival in a large Thai CAPD program. MATERIAL AND METHOD: A single center, retrospective, observational cohort study was carried out to examine the baseline factors affecting patient and technique survival. RESULTS: From January 1995 to December 2005, 322 incident CAPD patients were recruited for study. One hundred and thirteen patients (35.1%) died during the study period of 7,706 patient-months. Median patient survival time was 46.4 months. The major cause of death was related to infection. In multivariate analysis, only age at enrollment and baseline serum albumin were strong risk factors of death. Median technique survival was 41.2 months. The major cause of technique failure was peritoneal dialysis related infection. History of peritonitis, baseline serum albumin, and dialysis commencement in recent era were technique failure predictors. A neutral effect of self and caregiver performer was observed in the present study. CONCLUSION: Patient survival in the presented institute is similar to that reported in Western countries. Age and baseline serum albumin were the strongest predictors of death.

Risk factors of first peritonitis episode in Thai CAPD patients.

BACKGROUND: Peritonitis is a major complication of continuous ambulatory peritoneal dialysis (CAPD) patients. Information on the specific risk of peritonitis is important in reducing this common complication. MATERIAL AND METHOD: A single center retrospective cohort study was done to assess time to first peritonitis event and risk factors in Thai CAPD population. RESULTS: Between January 1995 and December 2005, 322 incident CAPD patients were recruited for the present study. During the study period of 4,281 patient-months, 198 episodes of first peritonitis were recorded. The median peritonitis-free time was 13.7 months. A Cox regression model showed that an increase in level of baseline albumin and hematocrit by 1 g/dL and 1% would decrease risk of peritonitis by 27% and 3%, respectively (hazard ratio (95%CI): 0.73 (0.59-0.91) and 0.97 (0.94-1.00)). A neutral effect of self and caregiver performer was observed in the present study. CONCLUSION: The present study confirmed the susceptibility of hypoalbuminemia and anemia to peritonitis. Awareness of particular risk groups should be achieved to prevent peritonitis.

Bone mineral density among patients undergoing continuous ambulatory peritoneal dialysis (CAPD).

Apart from the conventional risks, low bone mineral density (BMD) is one of the risk factors for bone fracture. Interestingly, the incidence of bone fracture is highest among patients with chronic renal failure, but there is little data comparing the BMD of patients undergoing continuous ambulatory peritoneal dialysis (CAPD) with normal persons. The authors, therefore, compared the BMD between sex-, age- and bodyweight-matched CAPD patients and normal persons. The femoral neck, lumbar spine and total BMD were measured by dual energy X-ray absorptiometry in 62 CAPD patients and normal persons. In unadjusted analysis, femoral neck and total BMD in CAPD patients was significantly lower than normal controls in both men and women, while there was no significant difference at lumbar spine BMD between the two groups. The results were unchanged after adjusting for age, body weight and height (0.13 and 0.29 g/cm2, p < 0.001, for femoral and total BMD, respectively and 0.001 g/cm2, p = 0.96 for lumbar spine BMD). In conclusion, low BMD is already a major risk factor for hip fracture, and this risk is exacerbated by CAPD. BMD measurement should be incorporated into the routine care of CAPD patients in order to identify incipient osteoporosis, so that it may be treated to prevent fractures.