ESRD treated with dialysis is associated with increased left ventricular hypertrophy, which, in turn, is related to high mortality. Mineralocorticoid receptor antagonists improve survival in patients with chronic heart failure; however, the effects in patients undergoing dialysis remain uncertain. We conducted a multicenter, open-label, prospective, randomized trial with 158 patients receiving angiotensin-converting enzyme inhibitor or angiotensin type 1 receptor antagonist and undergoing peritoneal dialysis with and without (control group) spironolactone for 2 years. As a primary endpoint, rate of change in left ventricular mass index assessed by echocardiography improved significantly at 6 (P=0.03), 18 (P=0.004), and 24 (P=0.01) months in patients taking spironolactone compared with the control group. Rate of change in left ventricular ejection fraction improved significantly at 24 weeks with spironolactone compared with nontreatment (P=0.02). The benefits of spironolactone were clear in patients with reduced residual renal function. As secondary endpoints, renal Kt/V and dialysate-to-plasma creatinine ratio did not differ significantly between groups during the observation period. No serious adverse effects, such as hyperkalemia, occurred. In this trial, spironolactone prevented cardiac hypertrophy and decreases in left ventricular ejection fraction in patients undergoing peritoneal dialysis, without significant adverse effects. Further studies, including those to determine relative effectiveness in women and men and to evaluate additional secondary endpoints, should confirm these data in a larger cohort.

GNRI at initiation of HD therapy could predict CVD mortality with incremental value of the predictability compared to serum albumin and body mass index in ESRD patients.

Background and objectives: Cardiac failure is directly affected by left ventricular (LV) dysfunction, and particularly LV systolic dysfunction is strongly associated with survival in ESRD patients. The aim of this study was to determine the prognostic value of reduced LV ejection fraction (LVEF) measured at the time of initiation of hemodialysis (HD) in incident HD patients.Design, setting, participants, & measurements: 1254 consecutive ESRD patients who electively started HD therapy were screened by echocardiography within 1 month after its inception. They were divided into five groups according to LVEF levels with a decrease of 0.1 each and were followed up for up to 7 years. Survival was examined with the Kaplan-Meier method and compared using the log-rank test.Results: Among the 1254 patients, LVEF levels >0. Conclusions: Reduced LVEF on starting HD therapy could stratify risk of cardiovascular and all-cause mortality in ESRD patients. Screening by echocardiography at start of HD therapy might be recommended to predict prognosis in patients with ESRD.

We examined clinical status over 3 years in the Tokai area. The results suggest that the incidence of peritonitis needs to be decreased to prevent early withdrawal of PD patients. Education systems to decrease the incidence of peritonitis and techniques to decrease culture-negative results might be important for improving the prognosis of peritonitis.

atients with end-stage renal disease (ESRD) on hemodialysis (HD) are at high risk of death from ischemic heart disease. 1-3 Furthermore, percutaneous coronary intervention (PCI) in such patients is sometimes difficult because they have more complex lesions, including massive calcification of coronary lesions and/or multivessel disease than non-HD patients. 4 Published reports have indicated that using new devices such as stents or debulking devices is associated with better outcomes after PCI in HD patients. 5,6 However, the restenosis rate in the follow-up period is higher in HD patients than in non-HD patients, although the initial success rate of PCI is similarly high in both groups. 7-10 Therefore, higher rates of restenosis remain a clinical limitation of cardiac interventions in HD patients.Recently it was reported that sirolimus-eluting stents (SES) significantly reduce the risk of restenosis after PCI in many cases, [11][12][13][14][15] and the remarkable safety and efficacy of SES has been documented not only by angiography but by intravascular ultrasound (IVUS) as well. 16,17 Moreover, even in patients with high-risk factors for coronary restenosis, including diabetes, small diameter vessels, chronic total occlusion and so on, clinical improvement has been observed. [18][19][20][21] Accordingly, in the present study we aimed to determine the efficacy of SES in patients on maintenance HD. Methods Study PopulationFrom August 2004, SES have been available in our institution, so between August 2004 and July 2005 we attempted to implant SES for all patients who needed PCI if they had no contraindications, such as acute coronary syndrome, intolerance of both of aspirin and ticlopidine, planned surgery and so on. In total, 225 consecutive Japanese patients with 322 lesions treated with SES (Cypher™) for native coronary lesions during that period were designated as the SES group and 256 patients with 307 lesions treated with bare metal stents (BMS) in the preceding 1 year were the BMS group. Of these, 166 patients with 216 lesions (88 patients with 121 lesions in the SES group and 78 patients with 95 lesions in the BMS group) received maintenance HD 3 times a week. In advance, we excluded patients who were diagnosed with acute myocardial infarction (MI), underwent bypass grafting, had a contraindication for the use of aspirin and/or ticlopidine, or were >85 years of age.Lesions were suitable for PCI if they were de novo