Is dialysis modality a factor in survival of patients with ESRD and HIV-associated nephropathy?

BACKGROUND: Human immunodeficiency virus (HIV)-associated nephropathy (HIVAN), characterized by a fulminant form of focal segmental glomerulosclerosis, has become the third leading cause of end-stage renal disease (ESRD) in young African Americans. There is a theoretical possibility that hemodialysis (HD) therapy in these patients may enhance HIV replication through the activation of white blood cells and release of such cytokines as tumor necrosis factor-alpha, interleukin-1, and interleukin-6, which have been found to increase HIV replication in vitro. We therefore determined whether dialysis modality is a factor in the survival of patients with HIVAN and ESRD. METHODS: Information regarding dialysis modality was available for 6,053 of 6,166 patients with ESRD and HIVAN who started dialysis therapy in the United States from December 1995 to December 1999 by using the US Renal Data System database. RESULTS: Eighty-nine percent were black. Eighty-eight percent underwent HD, and 12%, peritoneal dialysis (PD). On Cox-proportional hazard analysis, after adjusting for demographic variables and year of dialysis therapy initiation, there was no difference in survival between the different modalities (PD versus HD: hazard ratio, 1.01; 95% confidence interval, 0.91 to 1.13). In addition, on censoring patients at the time of first dialysis modality switch, no difference in survival was found between PD and HD. CONCLUSION: We conclude that patients with HIVAN and ESRD should be given an option to choose dialysis modality because it is not a factor in predicting survival.

Cuffed-catheter-related Lemierre syndrome.

Sepsis is a common problem in patients who have cuffed catheters for hemodialysis. Line sepsis, however, has not often been associated with septic thrombophlebitis as seen in Lemierre syndrome. Thrombophlebitis of a central vein associated with catheter placement is extremely rare and when encountered is known to affect the femoral or the subclavian vein. Thrombophlebitis of the internal jugular vein after hemodialysis catheter placement has not been reported. We present the case of a woman with line sepsis who developed Lemierre syndrome, a serious complication of which the medical community should be aware. Lemierre syndrome requires a high index of suspicion for diagnosis and can have a fatal outcome if not treated with appropriate antibiotics.