Chronic HD Patients (chronic + hd_patient)

Distribution by Scientific Domains

Selected Abstracts

Renal diagnosis of chronic hemodialysis patients with urinary tract transitional cell carcinoma in Taiwan

CANCER, Issue 8 2007
Chung-Hsin Chang MD
Abstract BACKGROUND. Transitional cell carcinoma (TCC) is the most common malignancy in dialysis patients of Taiwan. The reason for such a high incidence of TCC is undetermined. The correlation between the underlying renal disease and the development of TCC was investigated. METHODS. The authors retrospectively reviewed the clinical data and outcome of 1537 chronic hemodialysis (HD) patients from 1993 to 2002. The incidence of TCC was computed. The Cox regression method was used to analyze the role of potential risk factors. RESULTS. After a mean dialysis duration of 46.5 months, 26 (1.69%) patients with TCC were diagnosed. The standardized incidence ratio (SIR) of TCC was 48.2 as compared with the general population and the SIR of TCC seemed higher in women (65.1) and in the age group 50 to 54 years (173.6). Of them, most cases showed no definite etiology. All these cases showed bilateral contracted kidneys. Nonnephrotic proteinuria was found in all cases and trace glucosuria was found in 17 (65%). Painless gross hematuria was the cardinal symptom and distant metastasis was rare. Also, TCC in upper urinary tracts were common and found in 14 (54%) of patients. Age at the time of dialysis, female sex, compound analgesic use, and Chinese herb use had statistical significance as risk factors (P < .05). CONCLUSIONS. Chronic HD patients have a high risk of TCC in Taiwan, especially in female and middle-aged patients. The study indicated that chronic tubulointerstitial nephritis (CTIN) is the most likely underlying renal disease in HD patients with TCC, a high percentage of the CTIN related to the usage of Chinese herbs or compound analgesics may contribute to the development of TCC, whereas diabetes or chronic glomerulonephritis play only a minor role. Cancer 2007. 2007 American Cancer Society. [source]

Higher arteriovenous fistulae blood flows are associated with a lower level of dialysis-induced cardiac injury

Abstract Native arteriovenous fistulae (AVF) remain the vascular access of choice for hemodialysis (HD). Despite being associated with superior long-term outcomes (cf. catheter use), little is known about the systemic hemodynamic consequences of AVFs. Repetitive myocardial injury (myocardial stunning) is an under-recognized common consequence of HD. The aim of this study was to examine the impact of AVF flow (Qa) on dialysis-induced cardiac injury. We studied 50 chronic HD patients. All patients underwent echocardiography (and subsequent quantitative offline analysis) at baseline, during and post dialysis, to assess left ventricular function and the development of regional wall motion abnormalities. Qa was measured using ionic dialysance. Patients were divided into Qa tertiles (<500, mean 291101 mL/min, 500,1000, mean 739130 mL/min and >1000, mean 1265221 mL/min). There were no significant differences between the groups in terms of age, sex, diabetes, or resting ejection fraction. Patients with Qa>1000 mL/min had a lower prevalence of left ventricular hypertrophy (55% vs. 76%, P=0.01). Dialysis-induced myocardial stunning (seen in 65% of the patients studied) was significantly and sequentially reduced in those patients with higher Qas. This was seen in a lower number of segments and ventricular regions developing regional wall motion abnormalities, as well as a significantly reduced mean and cumulative percentage reduction in fractional shortening of those ventricular segments affected (,18737%, ,16126%, and ,10125%, respectively, P=0.04). Relatively higher AVF flows appear to be associated with a lower level of observed HD-induced cardiac injury. [source]

Anticardiolipin antibody and Taiwanese chronic haemodialysis patients with recurrent vascular access thrombosis

F-R Chuang
Summary Vascular access failure is a major cause of morbidity in chronic haemodialysis (HD) patients. However, some factors (such as homocysteine levels) are known regarding the risk factors predisposing certain HD patients to vascular access thrombosis (VAT). Immunoglobulin-G anticardiolipin antibody (IgG-ACA) is strongly associated with venous and arterial thrombosis in patients with normal renal function. Previous investigations have reported the characteristics of patients with raised IgG-ACA titre and recurrent VAT of HD in Western countries, but few equivalent studies exist for Taiwan. This retrospective study attempts to determine whether raised IgG-ACA titres are associated with an increased risk of recurrent VAT in chronic HD patients. This study enrolled 483 patients undergoing HD. IgG-ACA titre and hepatitis B&C marker were measured for all patients. A history of recurrent (VAT more than one) and/or VAT was elicited by using information from the patient questionnaires and was verified by means of careful inpatient and outpatient chart review. Raised IgG-ACA titres were present in 21.7% (105/483) of patients. In both groups (raised IgG-ACA and normal IgG-ACA), the type of shunt differed significantly (p = 0.029). In predicting for more or one episodes of VAT by using multiple logistic regression with all significant factors, synthetic graft was also a significant factor (p < 0.0001). The 105 raised IgG-ACA titres and 378 normal IgG-ACA titres were associated between chronic HD patients and recurrent VAT (p = 0.034). In predicting for more or one episode of VAT by using multiple logistic regression with all significant factors, raised IgG-ACA titre was a non-significant factor (p = 0.336). The presence of hepatitis C had a higher percentage in group with raised IgG-ACA titres of HD patients (p = 0.042). In predicting for more or one episode of VAT by using multiple logistic regression with all significant factors, the presence of hepatitis C was also a significant factor (p = 0.022). In conclusion, the prevalence of raised IgG-ACA titres was 21.7% among HD patients. There was a weak association between raised IgG-ACA titre and recurrent VAT and this finding may be the consequence of pathogenetic role of raised IgG-ACA titres in the development of VAT status for chronic HD patients. The presence of hepatitis C was a cofactor. [source]

Coronary Artery Bypass Surgery Versus Percutaneous Coronary Artery Intervention in Patients on Chronic Hemodialysis: Does a Drug-Eluting Stent Have an Impact on Clinical Outcome?

Susumu Manabe M.D.
For chronic hemodialysis (HD) patients, however, the impact of DES on clinical outcome is yet to be determined. Forty-six consecutive chronic HD patients who underwent myocardial revascularization in our institute were retrospectively reviewed. Twenty-eight patients underwent coronary artery bypass surgery (CABG) and 18 patients underwent percutaneous coronary artery intervention (PCI). Patient characteristics were similar between the two groups. In the CABG group, bilateral internal thoracic artery (ITA) bypass grafting was performed in 27 patients and off-pump CABG was performed in 20 patients. In the PCI group, a DES was used in 12 patients. The number of coronary vessels treated per patient was higher in the CABG group (CABG: 4.25 1.32 vs. PCI: 1.44 0.78; p < 0.001). Two-year survival rates were similar between the two groups (CABG: 94.1% vs. PCI: 73.9%; p = 0.41), but major adverse cardiac event-free survival (CABG: 85.9% vs. PCI: 37.1%; p = 0.001) and angina-free survival (CABG: 84.9% vs. PCI: 28.9%; p < 0.001) rates were significantly higher in the CABG group. The one-year patency rate for the CABG grafts was 93.3% (left ITA: 100%, right ITA: 84.6%, sapenous vein: 90.9%, gastro-epiploic artery: 100%), and six-month restenosis rate for PCI was 57.1% (balloon angio-plasty: 75%, bare metal stent 40%, DES: 58.3%). Even in the era of DES, clinical results favored CABG. The difference in clinical results is due to the sustainability of successful revascularization. [source]