Dialysis "no-shows" on saturdays: implications of the weekly hemodialysis schedules on nonadherence and outcomes.

BACKGROUND: The prevalence of skipped hemodialysis or no-show is higher among African Americans, younger Sages, smokers and illicit drug users. The effect of the weekly hemodialysis treatment schedules (Mondays, Wednesdays, Fridays (MWF); or Tuesdays, Thursdays, Saturdays (TTS)] on adherence is unknown. METHODS: Our hemodialysis patients were prospectively monitored for compliance over a 12-month duration. Regression analyses were employed for associations between variables and outcomes. RESULTS: A total of 114 African-American patients-mean age 55 +/- 14 and 53% male--were surveyed. Compared to the MWF, the TTS patients had higher rates of no show (2.4% vs. 1.7%, p = NS); shortened hemodialysis time (30% vs. 26%, p = NS); cocaine use (18% vs. 8%, p = 0.09); higher interdialytic weight gain 14.3 +/- 1.8 kg vs. 3.4 +/-1.3 kg, p = 0.005); prolonged length of hospital stay (9 +/- 12 days vs. 4 +/- 5 days, p = 0.02); and higher mortality (16% vs. 8%, p = NS). Compared to other days of the week, the Saturday no-show rate was significantly higher: 31% vs. 13%, 15%, 16%, 17%, 8%, Monday through Friday, respectively. Length of hospital stay correlated with no show (R2 = 0.4, p < 0.0001), while early termination was associated with smoking, cocaine use, female gender, TTS schedule, low serum albumin, hematocrit and adequacy of dialysis (Kt/V) (R2 = 0.6, p = 0.009). CONCLUSIONS: The TTS-scheduled hemodialysis patients are less adherent, and have higher morbidity than the MWF Spatients and a predilection for skipping on Saturdays.

Association of C-reactive protein with surrogate measures of insulin resistance among nondiabetic US from National Health and Nutrition Examination Survey 1999-2002.

BACKGROUND: Increased C-reactive protein (CRP) concentration and insulin resistance (IR) are associated with increased rates of adverse cardiovascular events. We sought to examine the relationship of CRP with surrogate measures of IR among nondiabetic adults in the US. METHODS: We conducted analyses using data from the National Health and Nutrition Examination Survey 1999-2002. We analyzed a nationally representative sample of 2514 men and nonpregnant women age > or = 20 years who were non-Hispanic white, non-Hispanic black, or Mexican American. RESULTS: After adjustment for age, sex, race/ethnicity, smoking status, systolic blood pressure, and serum concentrations of HDL cholesterol, LDL cholesterol, and triglyceride, CRP was significantly associated with 10 IR measures (all P values <0.01). The strength of the association attenuated after further adjustment for waist circumference (change in adjusted regression coefficients ranging from 60.0% to 75.1%). The association of CRP with each IR surrogate was similar (standardized regression coefficient ranges from 0.06 to 0.09). The association of CRP (>3 vs <1 mg/L) with the homeostasis model for assessment of IR (> or = 75th vs <75th percentile) was statistically significant among people with a body mass index > or = 30 kg/m(2) (odds ratio, 2.6; 95% CI, 1.3-5.1) or with a body mass index <25 kg/m(2) (odds ratio, 2.5; 95% CI, 1.5-4.2). CONCLUSIONS: CRP was significantly associated with the surrogate measures of IR among nondiabetic adults. Obesity may play an important role in the association of CRP with IR in this nationally representative sample.

Proinflammatory cytokines and the hypermetabolism of children with sickle cell disease.

Sickle cell anemia (HbSS) includes chronic inflammation, but the origin is unclear. We hypothesized that in stable HbSS patients the inflammation was associated with hypermetabolism. We compared selected hypermetabolic and key immunomodulator indicators in HbSS versus control children and examined associations between measures of hypermetabolism and inflammation. Twelve fasting asymptomatic HbSS children 6-12 years and 9 controls matched for age, gender and fat mass (FM) were studied. Proportional reticulocyte count (retic%) and resting energy expenditure (REE) represented hypermetabolism, and C-reactive protein (CRP) indicated inflammation. Proinflammatory cytokines tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6), chemokine monocyte chemoattractant protein-1 (MCP-1), and energy balance cytokine leptin were measured. Methods were indirect calorimetry, enzyme-linked immunosorbent assay, and radioimmunoassay. Statistical analysis included simple correlation and regression analysis. REE (51 +/- 6 vs. 43 +/- 12 kcal/kg per fat-free mass (FFM), mean +/- SD), retic% (12 +/- 4 vs. 0.7 +/- 0.3%), CRP (5 +/- 3 vs. 0.3 +/- 0.4 mg/liter), and IL-6 (71 +/- 40 vs. 20 +/- 7 pg/ml) were significantly higher for HbSS than controls (P < 0.05). Conversely, leptin (0.1 +/- 0.1 vs. 2 +/- 1 microg/liter per kgFM) and MCP-1 (34 +/- 5 vs. 41 +/- 4 pg/ml) were significantly lower for the HbSS subjects (P < 0.01). TNF-alpha was not significantly different. There were no significant associations between REE or retic% and any cytokine measured. However, CRP was significantly associated with REE in HbSS (r = 0.8, P = 0.003) and an important predictor of REE/FFM. We provide new evidence for low circulating levels of inflammatory chemokine MCP-1 in stable HbSS children, confirm mostly low cytokine levels, inflammation, and hypermetabolism and demonstrate association of hypermetabolism with inflammation via CRP but not via cytokines.