OBJECTIVETo determine whether dialysis treatment is an independent risk factor for foot ulceration in patients with diabetes and renal impairment.RESEARCH DESIGN AND METHODSWe performed a cross-sectional study of consecutive patients with diabetes and stage 4 or 5 chronic kidney disease (CKD) attending clinics in Manchester (U.K.). Patients were classified as either receiving dialysis therapy (dialysis) or not (no dialysis). Foot assessment included diabetic peripheral neuropathy (DPN), peripheral arterial disease (PAD), prior foot ulceration and amputation, and foot self-care. Risk factors for prevalent foot ulceration were assessed by logistic regression.RESULTSWe studied 326 patients with diabetes and CKD (mean age 64 years; 61% male; 78% type 2 diabetes; 11% prevalent foot ulceration). Compared with no dialysis patients, dialysis patients had a higher prevalence of DPN (79 vs. 65%), PAD (64 vs. 43%), prior amputations (15 vs. 6.4%), prior foot ulceration (32 vs. 20%), and prevalent foot ulceration (21 vs. 5%, all P < 0.05). In univariate analyses, foot ulceration was related to wearing bespoke footwear (odds ratio 5.6 [95% CI 2.5–13]) dialysis treatment (5.1 [2.3–11]), prior foot ulceration (4.8 [2.3–9.8], PAD (2.8 [1.3–6.0], and years of diabetes (1.0 [1.0–1.1], all P < 0.01). In multivariate logistic regression, only dialysis treatment (4.2 [1.7–10], P = 0.002) and prior foot ulceration (3.1 [1.3–7.1], P = 0.008) were associated with prevalent foot ulceration.CONCLUSIONSDialysis treatment was independently associated with foot ulceration. Guidelines should highlight dialysis as an important risk factor for foot ulceration requiring intensive foot care.

OBJECTIVETo evaluate the prevalence of lower-limb complications in a multiracial cohort of patients with diabetes receiving dialysis.RESEARCH DESIGN AND METHODSThis work was a cross-sectional study of lower-limb complications in dialysis-treated patients with diabetes in the U.K. and U.S.RESULTSWe studied 466 patients (139 U.K.; 327 U.S.). The prevalence of lower-limb complications was high (foot ulcers 12%, neuropathy 79%, peripheral arterial disease 57%, history of foot ulceration 34%, and prior amputation 18%), with no significant ethnic variation, except that foot ulcers were more common in whites than in patients of African descent (P = 0.013). Ninety-five percent of patients were at high risk of lower-limb complications. Prior amputation was related to foot ulcer history, peripheral arterial disease, and hemodialysis modality in multivariable analysis. Prevalent ulceration showed independent associations with foot ulcer history and peripheral arterial disease, but not with ethnicity.CONCLUSIONSAll patients with diabetes receiving dialysis are at high risk of lower-limb complications independent of ethnic background.

No abstract

Peritoneal membrane failure may develop during longterm peritoneal dialysis (PD). It is characterized by the occurrence of ultrafiltration failure [1] and by morphologic alterations in the peritoneal tissues. These alternations consist of an increased thickness of the collagenous submesothelial compact zone of the parietal peritoneum, sometimes accompanied by loss of surface mesothelium [2,3]. Vascular abnormalities also have been described, including an increase in the number of vessels [3,4]; subendothelial hyalinosis, especially of the venules and small veins, but also of arterioles [3,5], and extensive diabetiform lamellation of the capillary and mesothelial basement membranes [6][7][8]. Advanced glycosylation end products (AGEs) are found in peritoneal tissues, especially around the vascular wall [9,10]. Multiple peritonitis episodes might accelerate the development of these functional and anatomic alterations, but are clearly not the only source [11]. The induction of diabetiform peritoneal alterations in a peritonitis-free, long-term peritoneal exposure model in the rat [12], and the relationship with the cumulative peritoneal glucose exposure in humans [13,14], point to an important contribution by the current bioincompatible glucose-based dialysis solutions, and the need for new solutions that by their more favorable effects on the peritoneum and the patient as a whole can improve both PD technique and patient survival. BIOCOMPATIBILITY ASPECTS OF PERITONEAL DIALYSIS SOLUTIONSBiocompatibility of a PD solution can be defined as the ability of the solution to cause as little change as possible to the structure and function of the peritoneal membrane, thus allowing PD to be successful as a long-term renal replacement modality. Components of the solution can affect cellular elements of the peritoneal membrane, resulting in alterations of cytokine, chemokine, and growth factor production. They also can cause upregulation of proinflammatory and profibrotic processes, impairment

Terpenes Terpenes U 0200 Betulinic Acid and Its Derivatives as anti-Angiogenic Agents. -Compound (Ib) is reported to possess both antitumor and anti-angiogenic activity. -(MUKHERJEE, R.; JAGGI*, M.; RAJENDRAN, P.; SIDDIQUI, M. J. A.; SRIVASTAVA, S. K.; VARDHAN, A.; BURMAN, A. C.; Bioorg. Med.

No abstract

Background In-center hemodialysis (HD) has been the standard treatment for older dialysis patients, but reports suggest an associated decline in physical and cognitive function. Cross-sectional data suggest that assisted peritoneal dialysis (aPD), an alternative treatment, is associated with quality of life (QoL) outcomes that are comparable to in-center HD. We compared longitudinal changes in QoL between modalities. Methods We enrolled 106 aPD patients, matched with 100 HD patients from 20 renal centers in England and Northern Ireland. Patients were assessed quarterly for 2 years using the Hospital Anxiety and Depression Scale (HADS), SF-12 physical and mental scores, symptom score, Illness Intrusiveness Rating Scale (IIRS), Barthel's score, and the Renal Treatment Satisfaction Questionnaire (RTSQ). Mixed model analysis was used to assess the impact of dialysis modality on these outcomes during follow-up. P values were adjusted for multiple significance testing. Results Multivariate analysis showed no difference in any of the outcome measures between aPD and HD. Longitudinal trends in outcomes were also not significantly different. Higher age at baseline was associated with lower IIRS and RTSQ scores during follow-up. One-hundred and twenty-five (60.6%) patients dropped out of the study: 59 (28.6%) died, 61 (29.6%) withdrew during follow-up, and 5 (2.5%) were transplanted. Conclusions Quality of life outcomes in frail older aPD patients were equivalent to those receiving in-center HD. Assisted PD is thus a valid alternative to HD for older people with end-stage kidney disease (ESKD) wishing to dialyze at home.

No abstract