Depressive symptoms, assessed using a self-report type of questionnaire, have been associated with poor outcomes in dialysis patients. Here we determined if depressive disorders diagnosed by physicians are also associated with such outcomes. Ninety-eight consecutive patients on chronic hemodialysis underwent the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders administered by a physician. Depression was diagnosed in about a quarter of the patients. Associations adjusted for age, gender, race, time on dialysis and co-morbidity were determined using survival analysis. Using time to event (death or hospitalization) models of analysis the hazard ratios were 2.11 and 2.07 in unadjusted and adjusted models respectively. The finding of poor outcome using a formal structured physician interview suggests that a prospective study is needed to determine whether treatment of depression affects clinical outcomes.

Among CKD subjects in this study, the risk of death greatly outweighed the risk of reduced eGFR or development of ESRD following ACS and the occurrence of cath +/- PCI was not associated with significant differences in long-term renal function. The presence of CKD should not preclude potentially beneficial interventions and research should focus on reducing the high cardiovascular burden in this population.

Comparing outcomes related to dialysis modality is complicated by selection bias introduced by patients and physicians. To address the impact of selection bias, this study compared mortality by initial dialysis modality among patients who had ESRD and were placed on the transplant waiting list. This study was a historical prospective cohort of 12,568 patients in the United States who initiated dialysis between May 1, 1995, and October 31, 1998, and were placed on the transplant waiting list before dialysis initiation. Two-year mortality was compared using Kaplan-Meier curves and Cox proportional hazards models that analyzed patients primarily using an intention-to-treat approach and separately censored patients on a modality switch. At 2 yr, the unadjusted mortality rate was 6.6% among peritoneal dialysis (PD) patients compared with 6.9% among hemodialysis (HD) patients (hazard ratio [HR] 1.01; 95% confidence interval [CI] 0.82 to 1.23). After controlling for differences in baseline characteristics, comorbidities, and laboratory variables, the selection of PD versus HD remained associated with a similar 2-yr mortality risk (HR 1.03; 95% CI 0.83 to 1.28). In separate models, 2-yr mortality associated with PD versus HD was significant among patients with body mass index (BMI) >26 kg/m 2 (HR 1.37; 95% CI 1.01 to 1.83) but not among patients with BMI <26 kg/m 2 (HR 0.81; 95% CI 0.61 to 1.07). Results were similar after censoring on a modality switch. In conclusion, although choice of initial dialysis modality seems to be associated with equivalent outcomes among patients who have ESRD and are placed on the transplant waiting list, patients with BMI >26 kg/m 2 have increased 2-yr mortality associated with the selection of PD versus HD. Because the interpretation of observational data is highly affected by residual confounding and selection bias, further efforts should focus on the formation and testing of hypotheses to improve dialysis delivery.

Leptin is a mediator of metabolism and disease in a variety of organ systems, most notably as an agent of energy stores. However, its role in renal disease as an inflammatory agent as well as its potential impact on the cachexia of uremia have sparked new interest in the molecule for nephrologists. This review elucidates the complex uremic state, the historical discovery of leptin and its physiology, and the potential interactions leptin has on both the progression of kidney disease as well as the morbidity and mortality of end-stage renal disease.

Background and objectives: Estimating equations for calculating glomerular filtration rate (eGFR) occasionally identify patients with elevated eGFR, yet the prognostic significance remains to be determined. This study sought to define the association of an elevated eGFR on the risk for death and cardiovascular outcomes among subjects with atherosclerotic cardiovascular disease.Design, setting, participants, & measurements: Data from 8941 subjects who had a history of atherosclerotic vascular disease and were enrolled in the Blockade of the Glycoprotein IIb/IIIa Receptor to Avoid Vascular Occlusion trial were analyzed. Time to the composite end point of death, congestive heart failure, myocardial infarction, or stroke was modeled using Cox proportion hazards regression. Glomerular filtration rate was estimated using the Modification of Diet in Renal Disease and Cockcroft-Gault formulas.Results: Compared with subjects with eGFR of 100 to 125 ml/min per 1.73 m 2 , subjects with eGFR >125 (n ‫؍‬ 462) were younger, female, and nonwhite. In addition, subjects with an elevated eGFR were more likely to have diabetes and congestive heart failure. In adjusted analyses, every 10-ml/min per 1.73 m 2 decrease in eGFR <100 was associated with a 13% increased hazard for the composite end point. In addition, every 10-ml/min per 1.73 m 2 increase in eGFR >100 was associated with a 9% increased hazard for the composite end point.Conclusions: In individuals with a history of vascular disease, the relationship between eGFR and cardiovascular outcomes may be parabolic, with increased risk among patients with both reduced and elevated eGFR.

different maneuvers are described in Table 1. As he no longer exhibited the previously observed BP fall with pressor stimulation, we did not feel compelled to draw arterial blood gas samples. Of note, his respiratory rate was unchanged, though we did not measure his tidal volume.1. Raj SR, Luther JM, Sato K et al. Response to labile hypertension can be due to autonomic nervous system failure.