Prevalence and determinants of severity of uremic pruritus in hemodialysis patients: a multicentric study.

Uremic pruritus (UP) is a common and distressing symptom in patients with advanced or end-stage renal disease under hemodialysis (HD). The present multicentric study aimed to identify prevalence and determinants of severity of UP among Egyptian patients. Performed investigations included serum urea, creatinine, calcium, phosphorus, parathormone, ferritin and liver enzymes. Pruritus was evaluated using the visual analog scale. The study included 295 patients on maintenance HD. They comprised 151 patients (51.2%) with UP. Independent predictors of UP included associated hypertension (OR: 0.48, 95% CI 0.28 to 0.83, p=0.008), higher calcium levels (OR: 1.29, 95% CI 1.02 to 1.62, p=0.032), higher phosphorus levels (OR: 1.18, 95% CI 1.02 to 1.37, p=0.03) and higher high-sensitivity C-reactive protein (hsCRP) levels (OR: 1.0, 95% CI 1.0 to 1.01, p=0.049). Independent predictors of significant UP included longer HD duration (OR: 1.23, 95% CI 1.1 to 1.38, p<0.001), lack of vitamin D supplementation (OR: 3.71, 95% CI 1.03 to 13.4, p=0.045), lower albumin levels (OR: 0.32, 95% CI 0.14 to 0.74, p=0.008) and higher hsCRP levels (OR (CRP): 1.02 (1.0-1.03), p=0.011). In conclusion, UP is fairly common among Egyptian HD patients. Independent predictors of UP severity include longer HD duration, lack of vitamin D supplementation, lower albumin levels and higher hsCRP levels.

Reducing the Risk of Stroke in Patients with Impaired Renal Function: Nutritional Issues.

Patients with renal failure have extremely high cardiovascular risk; in dialysis patients the risk of stroke is increased approximately 10-fold over that in the general population. Reasons include not only a high prevalence of traditional risk factors such as diabetes, hypertension and dyslipidemia, but also the accumulation of toxic substances that are eliminated by the kidneys, so have very high levels in patients with renal failure. These include plasma total homocysteine, asymmetric dimethylarginine, thiocyanate, and toxic products of the intestinal microbiome (Gut-Derived Uremic Toxins; GDUT), which include trimethylamine N- oxide (TMAO), produced from phosphatidylcholine (largely from egg yolk) and carnitine (largely from red meat). Other GDUT are produced from amino acids, largely from meat consumption. Deficiency of vitamin B12 is very common, raises plasma tHcy, and is easily treated. However, cyanocobalamin is toxic in patients with renal failure. To reduce the risk of stroke in renal failure it is important to limit the intake of meat, avoid egg yolk, and use methylcobalamin instead of cyanocobalamin, in addition to folic acid.

Survey of depression by Beck Depression Inventory in uremic patients undergoing hemodialysis and hemodiafiltration.

High prevalence of depression has been reported in patients with end stage kidney disease and depression is associated with increased morbidity and mortality. We aimed to investigate the prevalence of depression in patients receiving standard hemodialysis (SHD) and hemodiafiltration (HDF) and compare the associated factors between these treatment modalities. The Beck Depression Inventory (BDI) was used to survey for major depressive symptoms. Demographic and biochemical data were reviewed and collected. Point prevalence of depression in HDF patients was significantly lower than SHD patients (23.9% vs. 43.1%, P < 0.05). The BDI score was also higher in SHD than HDF group (13.2 ± 11.6 vs. 8.7 ± 11.2, P < 0.05). SHD patients with major depressive symptoms had significantly lower levels of hemoglobin, albumin, creatinine, sodium and hand grip strength but had higher prevalence of diabetes and high sensitivity C-reactive protein (hs-CRP) levels. In HDF patients, phosphorus level was significantly lower in patients with major depressive symptoms. Logistic regression analysis revealed that hs-CRP, serum sodium and hand grip strength were significantly associated with major depressive symptoms in patients treated with SHD; while serum phosphorus was identified in HDF groups. We concluded that prevalence of depression was high in dialysis patients. Patients receiving HDF had a lower mean BDI score and a nearly 50% lower prevalence rate of major depressive symptoms than that of SHD. Factors associated with depression were different between two modalities.

A marked decline in the incidence of renal replacement therapy for amyloidosis associated with inflammatory rheumatic diseases - data from nationwide registries in Finland.

Risk for amyloidosis in rheumatic diseases is associated with a long-lasting inflammation. To assess possible changes in the incidence of terminal uraemia due to amyloidosis associated with rheumatic diseases on a nationwide basis, we scrutinised the files of the Finnish Registry for Kidney Diseases for patients suffering from amyloidosis associated with rheumatoid arthritis (RA), ankylosing spondylitis (AS) or juvenile idiopathic arthritis (JIA) over the period 1995-2008. The registry has an estimated 97-99% coverage of all patients accepted for renal replacement therapy (RRT) in the country. Data on the consumption of antirheumatic drugs were collected from two sources: the Social Insurance Institution's Drug Reimbursement Register, and the Sales Register of the National Agency for Medicines from the above period. Altogether 264 cases were identified. Two hundred twenty-nine of them had RA, 15 AS and 20 JIA. When the total annual number of new admissions to RRT varied between 20 and 37 at the end of 1990s, it was under half of that from 2002 onwards. Over this period, the number of users of low-dose methotrexate (MTX) has increased 3.6-fold, the drug being the most frequently used disease modifying anti-rheumatic drug in Finland. The present nationwide series is the first to show that the incidence of end-stage renal disease due to amyloidosis associated with rheumatic diseases is decreasing. An obvious reason for this is intensive anti-rheumatic drug therapy.

Influencia de la diálisis peritoneal aguda en la evolución clínica y laboratorial de pacientes urémicos, Hospital Regional Honorio Delgado, oct. 93 a set. 95

La insuficiencia renal crónica terminal es un cuadro grave, que denota una función renal muy deteriorada o ausente, que es irreversible y conlleva a la muerte si no se trata oportuna y adecuadamente. En el HRHD se está realizando diálisis peritoneal aguda como forma de tratamiento a estos pacientes, desconociéndose los resultados. Siendo el motivo de nuestro estudio precisamente determinar la influencia de la DPA en la evolución clínica y laboratorial de los pacientes urémicos crónicos. Para lograr esto se desarrolló un trabajo multivariado, retrospectivo, transversal y analítico. Encontrándose una frecuencia de 0.66 por ciento de pacientes, con predominio de mujeres(varones/mujeres=0.78) y con una edad promedio de 57,88 años DS=17.30. La etiología no pudo definirse en el 24.39 por ciento, siendo las causas más frecuentes la nefropatía diabética y la uropatía obstructiva. Las principales manifestaciones urémicas: anemia crónica, acidosis metabólica, hiperkalemia, encefalopatía urémica, hipertensión, hiperfosfatemía e insufeciencia cardíaca congestiva. Se realizaron 14 procedimientos de diálisis, con un tiempo medio de 103 hrs(DS=ñ55.3) por paciente, acumulándose 1442 hrs de experiencia. Realizándose 43.5 recambios(DS=ñ34.7), utilizándose 2000 ml por recambio; en todos los casos se utilizó catéter rígido, para DPA y el acceso fue infraumbilical. Se obtuvo una ultrafiltración promedio de 96.6 ml por recambio(DS=ñ64). Se logró una disminución significativa p=0.001 de los valores de urea, creatinina, potasio, pH, bicarbonato y CO2T; PCO2, P=0.001; así como una mejoría clínica significativa. Las principales complicaciones de diálisis peritoneal fueron dolor abdominal(64.29 por ciento), dificultad en la salida de líquido(42.86 por ciento), hipokalemia(35.71 por ciento) y alcalosis respiratoria(28.57 por ciento). Ningún paciente falleció durante el procedimiento, sólo en dos pacientes la diálisis no fue efectiva, falleciendo 1 y 7 días de terminada esta. La causa más frecuente de muerte fue el edema agudo de pulmón. En conclusión podemos decir que la diálisis peritoneal aguda influyó favorablemente en la evolución de los pacientes urémicos con una efectividad inmediata del 85.7 por ciento