Relatives in silent kidney disease screening (RISKS) study: A Chinese cohort study.

AIM: Family members of patients with end-stage renal disease (ESRD) have higher risk for chronic kidney disease (CKD). Limited study has examined the risk of developing CKD in relatives of patients in earlier stages of CKD. METHODS: From January 2008 to June 2009, the Hong Kong Society of Nephrology studied first-degree relatives of stage 1-5 CKD patients from 11 local hospitals. A total of 844 relatives of 466 index CKD patients (stages 1-2: 29.6%; stage 3: 16.7%; stage 4: 10.9%; stage 5: 42.7%) were reviewed for various risk factors of CKD. We also defined a composite marker of kidney damage by the presence of one or more following features: (i) positive urine protein, (ii) spot urine protein-to-creatinine ratio ≥0.15 mg/mg, (iii) hypertension and (iv) estimated glomerular filtration rate (eGFR) ≤60 mL/min per 1.73 m2 and determine its association with participant and index patient factors. RESULTS: Among these 844 relatives, 23.1%, 25.9% and 4.4% of them had proteinuria (urine protein ≥1+), haematuria (urine red blood cell ≥1+) and glycosuria (urine glucose ≥1+), respectively. Proteinuria (P = 0.10) or glycosuria (P = 0.43), however, was not associated with stages of CKD of index patients. Smoking participants had a significantly lower eGFR (102.7 vs. 107.1 mL/min per 1.73 m2 ) and a higher prevalence of proteinuria (33.6% vs. 21.4%). Multivariate analysis showed that older age, male gender, obesity, being parents of index patients and being the relatives of a female index patient were independently associated with a positive composite marker. CONCLUSION: First-degree relatives of all stages of CKD are at risk of developing CKD and deserve screening. Parents, the elderly, obese and male relatives were more likely to develop markers of kidney damage.

Cross sectional survey on the concerns and anxiety of patients waiting for organ transplants.

AIM: We aimed to gain an understanding of patient concerns while on a transplantation waiting list in areas with long transplant waiting time. METHODS: The study population comprised patients with organ failure on the transplant waiting list in Hong Kong. They were invited to complete a questionnaire survey. Demographic data and waiting time were collected. Respondents rated their chance of getting transplanted, their subjective concerns and feelings, level of happiness and support received. RESULTS: A total of 442 patients on the waiting list for kidney, liver, lung and heart-lung transplants completed the questionnaire survey. The majority of patients (93.0%) were waiting for kidney transplantation. More than half of the respondents (63.3%) had been waiting for more than 3 years. Patients with longer transplant waiting times had lower self-estimated chance of receiving a transplant (P = 0.004). Self-estimated chance of getting transplanted was positively associated with the happiness score (P < 0.0001). Issues of most concerns to the patients waiting for organ transplants were: inconvenience of therapy (48.2%), disease progression (47.9%), burden to family (59.5%) and financial difficulties (52.3%). More female patients on the waiting list (50.0% vs 25.7% in male) reported concerns about suffering associated with the illnesses. 21.7% of patients considered the level of support received inadequate. CONCLUSIONS: Our patients had long waiting time for transplantation, which is associated with a lower perceived chance of getting a transplant. Attention to more psychosocial support to these patients waiting for organ transplant is important. Promoting and improving organ donation would be the ultimate way to help these patients.

Coagulase negative staphylococcal peritonitis in peritoneal dialysis patients: review of 232 consecutive cases.

BACKGROUND AND OBJECTIVES: Coagulase-negative Staphylococcus species is the most common cause of peritoneal dialysis-related peritonitis; however, the optimal treatment strategy of coagulase-negative Staphylococcus species peritonitis remains controversial. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: All of the coagulase-negative Staphylococcus species peritonitis in a dialysis unit from 1995 to 2006 were reviewed. During this period, there were 2037 episodes of peritonitis recorded; 232 episodes (11.4%) in 155 patients were caused by coagulase-negative Staphylococcus species. RESULTS: The overall primary response rate was 95.3%; the complete cure rate was 71.1%. Patients with a history of recent hospitalization or recent antibiotic therapy had a higher risk for developing methicillin-resistant strains. Episodes that were treated initially with cefazolin or vancomycin had similar primary response rate and complete cure rate. There were 33 (14.2%) episodes of relapse and 29 (12.5%) episodes of repeat peritonitis; 12 (60.6%) of the repeat episodes developed within 3 mo after completion of antibiotics. Relapse or repeat episodes had a significantly lower complete cure rate than the other episodes. For relapse or repeat episodes, treatment with effective antibiotics for 3 wk was associated with a significantly higher complete cure rate than the conventional 2-wk treatment. CONCLUSIONS: Coagulase-negative Staphylococcus species peritonitis remains a common complication of peritoneal dialysis. Methicillin resistance is common, but the treatment outcome remains favorable when cefazolin is used as the first-line antibiotic. A 3-wk course of antibiotic can probably achieve a higher cure rate in relapse or repeat episodes.