Background Patients with end-stage renal disease (ESRD) are at a higher risk for chronic hepatitis, liver cirrhosis (LC) and mortality than the general population. Optimal modalities of renal replacement therapy for ESRD patients with concomitant end-stage liver disease remain controversial. We investigated the long-term outcome for chronic liver disease among dialysis patients in an endemic area. Methods Using Taiwan’s National Health Insurance claim data (NHRI-NHIRD-99182), We performed a longitudinal cohort study to investigate the impact of comorbidities on mortality in dialysis patients. We followed up 11293 incident hemodialysis (HD) and 761 peritoneal dialysis (PD) patients from the start of dialysis until the date of death or the end of database period (December 31, 2008). A Cox proportional hazards model was used to identify the risk factors for all-cause mortality. Results Patients receiving PD tended to be younger and less likely to have comorbidities than those receiving HD. At the beginning of dialysis, a high prevalence rate (6.16 %) of LC was found. Other than well-known risk factors, LC (hazard ratio [HR] 1.473, 95 % CI: 1.329-1.634) and dementia (HR 1.376, 95 % CI: 1.083-1.750) were also independent predictors of mortality. Hypertension and mortality were inversely associated. Dialysis modality and three individual comorbidities (diabetes mellitus, chronic lung disease, and dementia) interacted significantly on mortality risk. Conclusions LC is an important predictor of mortality; however, the effect on mortality was not different between HD and PD patients.

Background: Both hypokalemia (hypoK) and hyperkalemia (hyperK) are life-threatening to hemodialysis (HD) patients. This study was conducted to compare their clinical characteristics and long-term survival. Methods: Patients were divided into three groups according to the last mid-week predialysis serum potassium concentrations: hypoK (<3.5 mEq/l), normoK (between 3.5 and 5.5 mEq/l), and hyperK (>5.5 mEq/l). The maximal duration of the follow-up period was 54 months. Results: Compared with the hyperK group,patients in the hypoK group were older (p <0.05), had a higher incidence of comorbidity factors, less body weight gain prior to HD (p < 0.05), lower body mass index (BMI, p < 0.05), and higher BUN to creatinine ratio and hs-CRP (p < 0.05). The serum albumin and prealbumin concentrations were also lowest in the hypoK group, compared with the normoK and hyperK groups, respectively (all p < 0.001). A similar finding was also obtained for the normalized protein catabolism rate (nPCR, p < 0.001) among the three groups. Positive linear correlations between serum albumin and potassium concentration were only found in the hypoK and normoK groups (p < 0.001). Multiple logistic regression analysis showed that hypoalbuminemia, low BUN, and phosphate concentrations were significantly correlated with hypoK. HypoK patients also had a lower cumulative survival rate than hyperK patients. Conclusion: HypoK HD patients, with lower serum levels of albumin, prealbumin, nPCR, and BMI, but higher level of hs-CRP, showed a malnutritional and inflammatory status, and caused increased mortality rate.

No abstract

The role of specific pathological findings in the upper gastrointestinal tract in chronic renal failure remains uncertain. Most of the studies were conducted in the West, and the number of subjects was small. We have tried to look at that problem in Taiwan. Endoscopy to evaluate the source of upper gastrointestinal hemorrhage was performed in 698 patients over a 37-month period; that represents 4.4% of all patients undergoing upper gastrointestinal endoscopy for miscellaneous reasons in that time span. Fifty-eight patients (8.3%) who had been hemodialyzed for chronic renal failure were selected, as were 640 control patients who did not have renal failure. Patients with renal transplant were not included. Endoscopic diagnoses, contributing factors of bleeding, and the course and outcome of the hospitalization were analyzed. chi 2 Test with or without Yates' correction and Student's t test were used as appropriate. Erosive gastritis was the most frequent source of bleeding in patients with chronic renal failure. Erosive gastritis (p < 0.005), erosive esophagitis (p < 0.001), and esophageal ulcer (p < 0.005) were significantly more common causes of bleeding in the renal failure population than in the group without renal failure. The two groups did not differ significantly (p > 0.05) in smoking, heavy alcohol intake, or use of ulcerogenic medications. The age was older (64.1 +/- 11.4 vs. 55.7 +/- 16.2 years) and the mortality rate higher (13% vs. 2%) in patients with renal failure than in those without. The differential diagnoses of upper gastrointestinal bleeding sites differ in patients with and without chronic renal failure; they are diverse. However, erosive gastritis, rather than gastric ulcer or duodenal ulcer, is the most common cause in the patients with renal failure. The mortality rate is significantly higher in these patients than in the general population.

Background. Patients on maintenance haemodialysis are at high risk of aluminium overload. While deferoxamine (DFO) has potential adverse effects, lower DFO dosages may afford good efficacy with fewer side effects. We evaluated the therapeutic response of low-dose (2.5 mg/kg/ week) DFO among haemodialysis patients with aluminium overload. Methods. We recruited the participants via basal predialysis serum aluminium (Al) levels of ≥20 μg/L with clinical suspicion of aluminium toxicity or hyperparathyroidism indicating parathyroidectomy and positive DFO tests. Patients were randomly divided into standard-dose (5 mg/kg/ week) and low-dose (2.5 mg/kg/week) groups. We compared the differences of mineral biochemical and haematological parameters before and after DFO treatment. Successful treatment was defined as a serum aluminium increase of <50 μg/L by DFO test. Adverse events during DFO therapy between the groups were also compared. Results. In total, 42 haemodialysis patients completed treatment (standard-dose group, n = 21; low-dose group, n = 21). The demographic characteristics of the groups did not differ. Serum corrected calcium and ferritin decreased in both groups, while serum total alkaline phosphatase increased in both groups. Serum phosphorus increased in low-dose group (P = 0.029), while plasma intact parathyroid hormone increased in standard-dose group (P = 0.004). The successful treatment response rates did not differ between the two groups (standard-dose: 12/21, 57% vs low-dose: 13/21, 62%; P = 0.75). Conclusions. Low-dose DFO may offer similar therapeutic effects as standard-dose DFO therapy.