Residual kidney function in nocturnal vs conventional haemodialysis patients: a prospective observational study.

BACKGROUND: Residual kidney function (RKF) provides substantial volume and solute clearance even after dialysis initiation. Preservation of RKF is associated with improved outcomes including mortality in patients on both peritoneal and haemodialysis (HD). Factors predicting RKF loss are unclear, including HD modality. Nocturnal haemodialysis (NHD) may result in less aggressive fluid and solute shifts, however, retrospective data suggests frequent NHD may accelerate RKF decline. The aim of the study was to determine if decline in RKF differs between patients undergoing conventional haemodialysis (CHD) versus NHD. METHODS: A prospective observational study of incident HD patients was undertaken comparing patients undertaking CHD (4-5 h, 3 days/week) and NHD (8 h, 3-5 nights/week). Change in RKF was measured by urea and creatinine clearance (48-h interdialytic urine collection) and glomerular filtration rate (GFR) (Cr51-EDTA nuclear scan) at initiation of dialysis (baseline) and 12 months. RESULTS: A total of 18 incident HD patients were recruited (8 CHD, 10 NHD). Three patients withdrew after baseline (n = 15). Baseline RKF was similar between groups with mean nuclear GFR of 13.3 ± 4.1 mL/min in the CHD cohort vs 13.5 ± 4.6 mL/min in the NHD group (p = 0.89). Baseline urine volume was 2399 ± 950 mLs and 2794 ± 1662 mLs in the CHD and NHD, respectively (p = 0.57). Nuclear GFR declined from time 0 to 12 months to 9.3 ± 2.5 mL/min and 10.4 ± 4.3 mL/min in the CHD and NHD, respectively (p = 0.52). There was a significant decline in 48-h urine volume over 12 months with a mean volume of 1943 ± 1087.0 mLs in the CHD compared to 601.7 ± 315.3 mLs in the NHD (p = 0.01). No significant difference was found in other measures of RKF between groups over 12 months. CONCLUSION: This small prospective cohort study found that the loss of residual urine volume was greater in the NHD vs the CHD cohort but there was no difference in other measures of RKF.

Alcohol use among young adults presenting to the emergency department.

OBJECTIVES: To determine the prevalence of young ED patients at risk from hazardous alcohol consumption, to identify high-risk patient subgroups and evaluate the feasibility of use of the Alcohol Use Disorders Identification Test (AUDIT) in this setting. METHODS: We undertook a cross-sectional survey of 336 ED patients aged 18-30 years, inclusive. All were breathalysed prior to self-administering the AUDIT. A 'positive' AUDIT score (> or = 8) defined hazardous alcohol consumption. AUDIT scores were correlated with sex and trauma diagnosis. RESULTS: One hundred and thirty-one (39.0%, 95% confidence interval [CI] 33.8-44.5) patients were classified as AUDIT-positive. Men were significantly more likely to be AUDIT-positive (49% vs 23%, P < 0.001) and had significantly higher total AUDIT scores (P < 0.001) than women. Trauma patients were significantly more likely to be AUDIT-positive (P < 0.001) and had significantly higher AUDIT scores than non-trauma patients (P < 0.001). Of the six patients who recorded a positive breath alcohol reading, all were AUDIT-positive. One hundred (76.3%, 95% CI 68.0-83.1) AUDIT-positive patients did not report others being concerned about their drinking or had not been given advice to cut down. CONCLUSION: It is feasible to use the AUDIT screening tool in the ED to identify those at risk from hazardous drinking. In our ED there is a high prevalence of hazardous alcohol consumption in young adult patients, many of whom have not previously received advice to cut down on their drinking.