Hemoglobin predicts long-term survival in dialysis patients: A 15-year single-center longitudinal study and a correlation trend between prealbumin and hemoglobin.Background. Dialysis patients have much higher mortality rates than the general population. Anemia is a common complication of uremia and a major contributor to morbidity and mortality in dialysis patients. The benefits of anemia correction using recombinant human erythropoietin (rHuEPO) are well established. Optimum hemoglobin level for dialysis patients remain controversial. We have investigated the association of enrollment hemoglobin with long-term survival in hemodialysis (HD) and peritoneal dialysis (PD) patients.Methods. We enrolled 529 HD and 326 PD patients from 1987 and followed them to April 2003. Demographics, enrollment, and clinical and laboratory data were recorded. The Kaplan-Meier method was used to compute observed survival, and the multivariate Cox regression analysis was used to identify the independent predictors of mortality risk.Results. Mean ages of HD and PD patients were 60 Ϯ 16 (SD) and 54 Ϯ 16 (SD) years, respectively. Forty-seven percent of HD patients and 41% of PD patients were diabetic. Mean enrollment hemoglobin levels of HD and PD patients were 9.44 Ϯ 1.9 and 9.61 Ϯ 1.77 g/dL respectively. Cumulative 15 year observed survivals of HD (P ϭ 0.05) and PD (P ϭ 0.032) patients with hemoglobin levels greater or equal to 12 g/dL were higher than those with hemoglobin levels less than 12 g/dL. Hemoglobin Ͻ12 g/dL was a better predictor of mortality in nondiabetics than diabetics, particularly in HD patients. Both in HD and PD diabetic patients, hemoglobin was not a significant predictor of mortality. By Cox regression analysis, after adjusting for age, race, gender, and months on dialysis at enrollment, the relative risk of mortality of patients with hemoglobin Ͻ12 g/dL was 2.13-fold (P ϭ 0.008) higher for HD and 1.85-fold (P ϭ 0.06) higher for PD compared to those with hemoglobin Ն12 g/dL (P ϭ 0.035). A logistic regression analysis revealed a strong inverse relationship between the hemoglobin level and the odds risk of death in HD (OR ϭ 0.83, P ϭ 0.008) and in PD (OR ϭ 0.85, P ϭ 0.02) patients.Conclusion. Enrollment hemoglobin is a predictor of longterm survival in HD and PD patients. Patients with hemoglobin levels that are higher than current treatment recommendations

Malnutrition and inflammation in peritoneal dialysis patients.Background. Malnutrition, cardiovascular disease, and heightened inflammation are highly prevalent in dialysis patients, and major contributors to morbidity and mortality. We have investigated the inter-relationship between malnutrition and inflammation, and their impact on morbidity and mortality in peritoneal dialysis (PD) patients.Method. We enrolled 63 PD patients beginning in November 2000, and measured C-reactive protein (CRP) and various nutritional markers, including prealbumin.Results. CRP level was elevated in 29% of the PD patients. Diabetics had higher CRP than non-diabetics (24 vs. 9.3 mg/L, P ϭ 0.016). Patients who were hospitalized during the study had higher enrollment CRP (16 vs. 12.5 mg/L, P ϭ 0.05) and lower enrollment albumin (3.5 vs. 3.9 g/dL, P ϭ 0.002), blood urea nitrogen (BUN) (40 vs. 49 mg/dL, P ϭ 0.034), and protein catabolic rate (nPCR) (0.88 vs. 1.0 g/kg/day, P ϭ 0.02) than those who were not hospitalized. Enrollment level of CRP was inversely correlated with nutritional markers prealbumin (r ϭ Ϫ0.5, P Ͻ 0.0001) and creatinine (r ϭϪ0.35, P Ͻ 0.01). After adjusting for age, race, gender, diabetes, and CRP level, prealbumin continued to correlate with other nutritional markers. There was a trend toward association of elevated CRP with all-cause mortality in PD patients.Conclusion. It is useful to incorporate prealbumin and CRP in the regular assessment of PD patients, whose survival may be improved by better management of malnutrition and inflammation.

The safety and efficacy of an accelerated iron sucrose dosing regimen in patients with chronic kidney disease.Background. Provision of adequate iron to support erythropoiesis in patients with chronic kidney disease (CKD) is time consuming and may present adherence problems for patients in the outpatient setting. We studied an accelerated regimen of high-dose intravenous iron sucrose therapy in a cohort of iron-deficient, anemic CKD patients.Methods. Intravenous iron sucrose 500 mg was infused over three hours on two consecutive days in 107 CKD patients (glomerular filtration rate, 32.3 Ϯ 19.6 mL/min/1.73m 2 , baseline hemoglobin 10.2 Ϯ 1.7 g/dL). Iron indices (transferrin saturation, ferritin) were measured at baseline and at two and seven days after completion of the iron regimen. Blood pressures were monitored immediately prior to, and hourly throughout the iron sucrose infusions.Results. Transferrin saturation and serum ferritin increased from 18.5 Ϯ 8.5% and 177 Ϯ 123.8 ng/mL at baseline to 40.2 Ϯ 22.3% and 811 Ϯ 294.1 ng/mL in 102 evaluated patients (P Ͻ 0.015). In 55 patients with additional measurements at 7 days post-dosing, the transferrin saturation and ferritin had fallen to 26.3 Ϯ 10.6% and 691 Ϯ 261.8 ng/mL (P Ͻ 0.015 compared to two days' post-dose). Blood pressure rose slightly, but not significantly, throughout the infusions, and altering the infusion rate was not necessary. Two patients had seven adverse events that were considered related to iron sucrose.Conclusion. An accelerated regimen of high-dose intravenous iron sucrose therapy in CKD patients is safe and effective in restoring iron stores, and may potentially save time and improve patient adherence.The provision of adequate iron to support erythropoiesis in iron-deficient patients with chronic kidney disease is often a time-consuming process that strains the resources of clinicians and challenges patient compliance to the dosing regimen. In the United States iron sucrose is approved for the replenishment of iron stores in patients undergoing hemodialysis and erythropoietic therapy.

No abstract

No abstract

It is necessary to provide adequate amounts of bioavailable iron to correct any deficit and maintain body iron stores in anemic patients with chronic kidney disease (CKD). Although dosing regimens for intravenous iron sucrose exist, simplification of these regimens may produce financial savings and reduce the time commitment of both patients and clinicians. We have explored high-dose (500 mg or greater) intravenous iron sucrose regimens in patients with CKD and summarize our findings here. Three studies used 500 mg intravenous iron sucrose doses on 2 or more successive days, and one study examined the feasibility of a single total dose infusion of 1000 mg. We conclude that patients do not tolerate 1000 mg doses as a single infusion. On the other hand, a dosing regimen of 500 mg iron sucrose given intravenously over 3 h on successive days is safe and effective in replenishing and maintaining body iron stores. Finally, in anemic CKD patients not receiving erythropoietic hormone therapy, we found an increase in hemoglobin concentrations, and no deleterious effect on glomerular filtration rate 6 months after they were treated with iron sucrose.

No abstract

The differential diagnosis for patients with acute renal failure of their native kidneys, as a result of primary intrarenal disease, includes acute tubular necrosis, glomerulonephritis, and interstitial nephritis. The role of MAG3 renography has not been studied in this setting. The authors describe four patients with acute renal failure in whom MAG3 renal imaging reliably identified acute tubular necrosis, as confirmed by follow-up kidney biopsies. In contrast to the poor parenchymal uptake observed in glomerulonephritis and interstitial nephritis, MAG3 shows a distinctive pattern in patients with acute tubular necrosis. For patients with acute renal failure, a renal scan can facilitate decision-making regarding the initiation of therapy.