Background: End-stage kidney disease (ESKD) patients are significantly at risk of higher mortality than the general population. While cardiovascular disease and infection are the major causes of death in ESKD patients on hemodialysis (HD), the impact of vascular access type on long-term mortality in the Thai population remains unclear. Objective: To find an association between types of vascular access and long-term mortality in HD Thai patients. Methods: A multicenter, retrospective cohort of HD patients with a 55-month follow-up (November 2015 to December 2020) was conducted. Patients’ baseline characteristics, and HD profiles were reviewed. A logistic regression model and survival analysis were used to test the association and survival probability of each type of vascular access and mortality. Results: Of 196 HD patients over 55 months, the proportions of initial vascular access included 46.94% of arteriovenous fistula (AVF), 27.55% of arteriovenous graft (AVG), and 25.51% of tunneled dialysis catheter (TDC). The overall mean all-cause mortality in this cohort was 29.1%. Compared with AVF, TDC was associated with increased mortality (adjusted OR, 3.18; 95% CI, 1.37 - 7.37; P < .05) while the association between AVG and mortality was borderline significant (adjusted OR, 2.29; 95% CI, 0.96 - 5.46; P > .05). Conclusions: TDC as initial vascular access for incident HD Thai patients was associated with increased all-cause mortality at 55 months compared with functioning AVF.
Objective: To determine the association between AGE accumulation detected by skin-autofluorescence (SAF) and hospitalization among ESKD patients.Materials and Methods: 196 ESKD patients from two hemodialysis (HD) units in Bangkok were enrolled in this retrospective study from November 2015 to March 2016. Before HD treatment, AGEs were measured with the SAF device on the area with intact skin on the volar surface of the non-fistula arm. The study concluded in December 2020, and the number of and causes of hospitalization were reviewed. A logistic regression model was used to determine the association between SAF level and patient hospitalization.Results: Of the 196 patients enrolled in the study, SAF was measured in 165 patients with a mean (SD) age of 69.2 (13.0) years. Most of the participants were non-smokers who had hypertension and diabetes and were on high-flux dialyzers. The average weekly spKt/V was 2.1, and the mean (SD) SAF was 3.05 (0.81) AU. The group with high SAF consisted of older patients and had a higher proportion of diabetics and smokers, but this was not statistically significant when compared to the low SAF group. In the multivariable analysis model, SAF greater or equal to 3.05 AU (OR = 2.28; 95% CI, 1.05–4.94; P < 0.05) and increased age (OR = 1.05; 95% CI, 1.01–1.09; P < 0.05) were associated with an increased risk of hospitalization.Conclusion: Higher values of age and SAF were independently associated with increased risk of hospitalization among ESKD patients.
Background: Lanthanum carbonate is a phosphate binder in the form of a chewable tablet, which is commonly prescribed in chronic kidney disease patients. We reported an unusual radio-opaque foreign body which was accidentally found in a chest X-ray of an elderly female patient and later identified as an intact lanthanum carbonate tablet.Case Presentation: A 60-year-old woman with end stage renal disease, receiving lanthanum carbonate was found having a coin-shaped, homogeneous radiopaque foreign body in the position of esophagus of her chest X-ray. Due to awareness of mimicking other conditions (e.g. button battery or coin ingestion), urgent endoscopy was performed. An intact lanthanum carbonate tablet was found in the upper stomach and was removed successfully.Conclusion: Physicians should be aware of unchewed lanthanum carbonate tablets when a metallic-like object is detected on chest radiograph of a lanthanum carbonate user. Also, prescription of chewing medication should be cautioned particularly in an elderly female patient.
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