Determinants of haemodialysis access survival.

BACKGROUND: Vascular access patency is of vital importance for patients requiring haemodialysis. This analysis validates potential risk factors and benefits in patients undergoing vascular access procedures. PATIENTS AND METHODS: Vascular access procedures performed over a two-year period were retrospectively analysed. Clinical data and concomitant medication were retrieved from files as were surgical data following a standardized data capture sheet. Outcome parameters were primary (PP) and secondary patency (SP) as well as freedom from repeated revascularization. Minimal follow-up with functioning access was 679 days. RESULTS: During the observation period, 244 patients (mean age 62.2 +/- 0.9 years, 60.7 % male patients, 36.1 % pre-emptive, 31.1 % late referral) underwent vascular accesses procedures. PP and SP were 35.6 % and 45.6 %, respectively, at 540 days. Presence of diabetes mellitus was associated with decreased PP (OR: 0.6, 95 %-CI: 0.3 - 1.0) and SP (OR: 0.4, 95 %-CI: 0.2 - 0.7), whereas female gender was associated with lower SP (OR: 0.6, 95 %-CI: 0.3 - 0.9) and freedom from repeated revascularization rates (OR: 0.6, 95 %-CI: 0.3 - 1.0). In contrast, presence of hyperparathyreoidism was associated with higher SP (OR: 1.7, 95 %-CI: 1.0 - 3.0) and freedom from repeated revascularization (OR: 1.7, 95 %-CI: 1.0 - 3.0) rates. CONCLUSIONS: Haemodialysis access performs worst in patients with diabetes mellitus and in women. The benefit of hyperparathyroidism should be interpreted as hypothesis generating.

Leisure-time physical activity and aerobic fitness in African-American young adults.

This cross-sectional study identified the leisure-time physical activity (LTPA) and aerobic fitness levels of 189 African-American young adult college freshmen. LTPA was measured with the Lipid Research Clinics (LRC), Godin Leisure-Time Exercise, and the College Alumnus physical activity questionnaires. The Physical Activity Index (PAI), an index of walking, stair climbing, and recreational sports participation, was obtained from the College Alumnus questionnaire. Aerobic fitness was measured indirectly with the Cooper 12-Minute Walking/Running Test. More women (82%) than men (53%) were classified as inactive (strenuous exercise or labor < 3 days/week and much less active than peers) or low active (strenuous exercise or labor < 3 days/week and as active or more active than peers) on the LRC Questionnaire. The PAI scores were moderately low in men (1,521 +/- 1,634 kcal.week-1) and very low in women (706 +/- 868 kcal.week-1). The majority of men (71%) and women (82%) were classified as 'very poor' in aerobic fitness levels. Body mass index (BMI), a measure of body fatness, was classified as 'overweight' or 'obese' for 39% of men and 37% of women (BMI = 25.9 +/- 5.7 kg/m2), reflecting inactive LTPA habits. These findings are consistent with studies showing low LTPA in middle-age African-American adults. School and community-level interventions are recommended to increase LTPA and aerobic fitness in adolescent and young adult African-Americans.