Prevalence of silent kidney disease in Hong Kong: the screening for Hong Kong Asymptomatic Renal Population and Evaluation (SHARE) program.

BACKGROUND: End-stage renal disease (ESRD) is epidemic worldwide. In Hong Kong, the annual incidence of ESRD has risen from 100 pmp (per million population) in 1996 to 140 pmp in 2003. SHARE (Screening for Hong Kong Asymptomatic Renal Population and Evaluation program) is a population-based screening program aimed at identifying the prevalence of unrecognized renal disease in asymptomatic individuals, allowing further evaluation and disease-modifying interventions. METHODS: From November to December 2003, SHARE was conducted in several large residential communities in Hong Kong. The screening tool included a questionnaire documenting demographics and history or family history of diabetes mellitus (DM), hypertension (HT), and chronic kidney disease (CKD), together with on-site measurements of blood pressure (BP) and urine dipstick for protein, blood, and glucose. RESULTS: There were a total of 1811 participants. One thousand two hundred and one subjects were entered into the final analysis. Among the 1201 who were apparently "healthy" (asymptomatic and without history of DM, HT, or CKD), the prevalence of positive (> or =1+) urine dipstick for protein, glucose, blood, protein or blood, any urine abnormality, and HT (BP> or =140/90) was 3.2%, 1.7%, 13.8%, 16%, 17.4%, and 8.7%, respectively. Thirty three percent of the age over 60 years old group had either hypertension or urine abnormalities, compared with 24.0% in the 41- to 60-year-old group and 9.7% in the 20- to 40-year-old group. Having a family history of diabetes or hypertension increases the risk of having urine abnormalities, while a family history of hypertension also increases the risk of high blood pressure. CONCLUSION: It is concluded that subclinical abnormalities in urinalysis or BP readings are prevalent across all age groups in the adult population. An effective screening program at the primary care level that identifies these subjects for further evaluation is warranted, and the public in Hong Kong should be educated toward the significance of such findings in order to have regular health check for asymptomatic renal diseases.

A report with consensus statements of the International Society of Nephrology 2004 Consensus Workshop on Prevention of Progression of Renal Disease, Hong Kong, June 29, 2004.

This report summarizes the discussions of the International Society of Nephrology (ISN) 2004 Consensus Workshop on Prevention of Progression of Renal Disease, which was held in Hong Kong on June 29, 2004. Three key areas were discussed during the workshop: (1) screening for chronic kidney disease; (2) evaluation and estimating progression of chronic kidney disease; and (3) measures to prevent the progression of chronic kidney disease. Fifteen consensus statements were made in these three areas, as endorsed by the participants of the workshop. The ISN can make use of and take reference to these statements in formulating its policy for tackling chronic kidney disease, a disease with significant global impact.

Acute renal impairment in coronavirus-associated severe acute respiratory syndrome.

BACKGROUND: Severe acute respiratory syndrome (SARS) is a newly emerged infection from a novel coronavirus (SARS-CoV). Apart from fever and respiratory complications, acute renal impairment has been observed in some patients with SARS. Herein, we describe the clinical, pathologic, and laboratory features of the acute renal impairment complicating this new viral infection. METHODS: We conducted a retrospective analysis of the plasma creatinine concentration and other clinical parameters of the 536 SARS patients with normal plasma creatinine at first clinical presentation, admitted to two regional hospitals following a major outbreak in Hong Kong in March 2003. Kidney tissues from seven other patients with postmortem examinations were studied by light microscopy and electron microscopy. RESULTS: Among these 536 patients with SARS, 36 (6.7%) developed acute renal impairment occurring at a median duration of 20 days (range 5-48 days) after the onset of viral infection despite a normal plasma creatinine level at first clinical presentation. The acute renal impairment reflected the different prerenal and renal factors that exerted renal insult occurring in the context of multiorgan failure. Eventually, 33 SARS patients (91.7%) with acute renal impairment died. The mortality rate was significantly higher among patients with SARS and acute renal impairment compared with those with SARS and no renal impairment (91.7% vs. 8.8%) (P < 0.0001). Renal tissues revealed predominantly acute tubular necrosis with no evidence of glomerular pathology. The adjusted relative risk of mortality associated with the development of acute renal impairment was 4.057 (P < 0.001). By multivariate analysis, acute respiratory distress syndrome and age were the most significant independent risk factors predicting the development of acute renal impairment in SARS. CONCLUSION: Acute renal impairment is uncommon in SARS but carries a high mortality. The acute renal impairment is likely to be related to multi-organ failure rather than the kidney tropism of the virus. The development of acute renal impairment is an important negative prognostic indicator for survival with SARS.

Solute removal index correlates more with equilibrated Kt/V than with single pool Kt/V in haemodialysis patients.

BACKGROUND AND AIMS: Solute removal index (SRI) is an adequacy index that estimates haemodialysis dose based on urea removal in the spent dialysate. We examined the SRI, single pool Kt/V (spKt/V) and equilibrated Kt/V (eKt/V) in two groups of chronic haemodialysis patients; group A, 25 patients received haemodialysis twice weekly and group B, 11 patients received haemodialysis thrice weekly. METHOD AND RESULTS: The Ing's partial dialysate collection method was used for spent dialysate collection. The SRI values of the first and second dialysis sessions in a week in group A were 68.7 +/- 4.7 and 69.7 +/- 4.1%, respectively, while that of the first, mid-week and third dialysis sessions in a week in group B were 56.5 +/- 5.3, 55.8 +/- 5.4 and 57.5 +/- 6.2%, respectively. The correlation coefficients (r) between SRI and spKt/V in the first and second dialysis sessions in a week in group A were 0.90 (P < 0.01) and 0.95 (P < 0.01), respectively, and that in the first, mid-week and third sessions for group B were 0.96 (P < 0.01), 0.94 (P < 0.01) and 0.91 (P < 0.01), respectively. The r values between SRI and eKt/V in the first and second sessions for group A were 0.97 (P < 0.01) and 0.99 (P < 0.01), respectively, and that in the first, mid-week and third sessions for group B were 0.98 (P < 0.01), 0.97 (P < 0.01) and 0.98 (P < 0.01), respectively. Therefore, the correlation between SRI and eKt/V (r values approaching one) was better than that between SRI and spKt/V in all dialysis sessions in a week for both group A and B patients. CONCLUSION: We conclude that the SRI, an index based on dialysate urea removal, correlates more with equilibrated Kt/V (an index that accounted for postdialysis urea rebound) than with single pool Kt/V.

Prophylaxis against gram-positive organisms causing exit-site infection and peritonitis in continuous ambulatory peritoneal dialysis patients by applying mupirocin ointment at the catheter exit site.

OBJECTIVE: We evaluated the effectiveness of local application of mupirocin ointment at the catheter exit site in preventing exit-site infection and peritonitis attributable to gram-positive organisms in continuous ambulatory peritoneal dialysis patients. METHODS: This prospective randomized controlled trial included 154 patients. They were randomly allocated to a mupirocin-treated group (group M) and a control group (group C). Group M included 73 patients (47.4%) who were instructed to apply mupirocin ointment to the catheter exit site once daily after the routine daily exit-site dressing. Group C included 81 patients (52.6%) who continued their usual daily exit-site care without applying mupirocin. The two groups were followed to see whether there would be any difference in the frequency of exit-site infection and peritonitis or in the infecting organisms. RESULTS: Interim data were collected at 5 months after the start of the study. Those data showed a significantly lower incidence of exit-site infection and peritonitis attributable to gram-positive organisms in group M as compared with group C. The incidence of gram-positive exit-site infection in group C was 1 episode per 36.8 patient-months; in group M, the incidence was 1 episode per infinity patient-months (0 incidence in 5 months, p < 0.05). The incidence of gram-positive peritonitis in group C was 1 episode per 40.5 patient-months; in group M, the incidence was 1 episode per 365 patient-months (p < 0.05). Mupirocin treatment had no significant effect on the incidence of exit-site infection and peritonitis attributable to other organisms. Before mupirocin treatment, we saw a trend toward higher infection rates in diabetic patients and nasal carriers of Staphylococcus aureus as compared with non diabetic patients and nasal non carriers, although the differences were not statistically significant. Mupirocin brought the infection rate attributable to gram-positive organisms to an equally low level in diabetic and non-diabetic patients, and in nasal carriers and nasal non carriers of S. aureus. No adverse effect of local application of mupirocin was reported. CONCLUSION: Local application of mupirocin ointment at the catheter exit site is a safe and effective method of preventing exit-site infection and peritonitis involving gram-positive organisms.

Setting up a continuous ambulatory peritoneal dialysis training program.

Continuous ambulatory peritoneal dialysis (CAPD) training programs have become fundamental patient education programs in renal centers providing peritoneal dialysis (PD) services. Several key topics must be addressed in setting up a CAPD training program: Health care and organizational issues, Multidisciplinary team approach, Evidence-based practice, Pre-training patient assessment, Patient training Program evaluation. The PD nurses should identify key learning objectives for patient training. The essential elements of CAPD training are the training content and schedule, training assessment, and teaching methods. Program set-up also includes establishing a back-up system and follow-up protocols, which are essential for continuity of care in renal patients. Outcomes such as rates of peritonitis and exitsite infection, unplanned readmission, and patient satisfaction are all important indicators when the results of CAPD training programs are reviewed. The development and successful implementation of a cost-effective CAPD training program has a significant impact on patient outcomes in the renal specialty.