Hemodialysis is widely used for kidney failure patients, it is well known that oxidative stress is induced during hemodialysis process. To figure out what kind of proteins may adhere to the hemodialysis tube, and were those proteins oxidized during dialysis process. In this study, proteins adhere to hemodialysis membrane are eluted and examined by protein two-dimensional gel electrophoresis and MALDI-TOF technique. The two-dimensional gel electrophoresis results demonstrate 153 proteins binding to hemodialysis tube including Vsm-Rho GEF, Fibroblast growth factor 23, Prothrombin, Glomulin and Nucleobindin-1. The oxidation detection shows that some tube binding proteins are oxidized including MAP4K3 protein and Sulfiredoxin-1, and the oxidation level of hemodialysis tube binding proteins are higher then serum proteins. In conclusion, we find out 20 novel proteins which bind to hemodialysis tube and 5 novel proteins which oxidized during hemodialysis. And protein oxidation level was related to inflammation where high CRP levels were detected.

Class of 2014 Abstract / Specific Aims: The main objectives of the study are to compare the number of antihypertensive medications upon admission versus discharge, determine the fluctuation index ((SBPmax – SBPmin)/Avg)x100) between inpatient HD sessions, determine the minimum SBP during each inpatient HD session and compare pre-HD weight to post-HD weight for each inpatient HD session to determine inter-dialytic weight gain. The findings of this study are expected to have a positive impact on the management of blood pressure and fluid overload in HD patients by identifying the adverse effects associated with an increased anti-hypertensive medication burden. Methods: The Institutional Review Board approved this retrospective chart review. The electronic medical record system identified patients that received HD between January 1, 2010 and January 1, 2013. The following data was collected: the admission diagnosis and patient comorbidities; time on dialysis prior to admission and time since last HD session; the number and class of anti-hypertensive medications documented on admission, while inpatient, and upon discharge; the use of midodrine, receipt of erythropoietin stimulating agents, total time on dialysis while admitted, intra-dialytic hypotensive events, blood pressure readings pre- and post-HD, and inter-dialytic weight gain. Descriptive and demographic variables were also collected from the electronic medical record systems. The investigators will use this information to compare the number of anti-hypertensive medications upon admission versus discharge, determine the fluctuation of systolic blood pressure (SBP) between each inpatient HD session, determine the minimum SBP during each inpatient HD session and compare pre-HD weight to post-HD weight to determine inter-dialytic weight gain and total volume removed per each HD session. Descriptive statistics will be used to analyze our demographic data. Multiple linear regression analyses will be completed to evaluate independent predictors of inter-dialytic weight gain and intra-dialytic hypotension. Main Results: Pending Conclusion: Pending

Uremic pruritus remains one of the most frustrating and potentially disabling symptoms in patients with endstage renal disease. It affects up to 90% of patients on dialysis. Several hypotheses have been postulated for the possible underlying etiology, but none is conclusive. Aside from kidney transplantation, which is the only definitive treatment, therapeutic approaches have largely been empirical, and no firm evidence-based treatments are available. The main goal of therapy remains to minimize the severity of pruritus and improve the quality of life especially among those who are not transplantation candidates or are waiting for surgery.

Purpose: Cardiovascular events and complications are the major causes of death in patients with end-stage renal disease (ESRD)¹⁻³. Antihypertensive agents that block the renin-angiotensin-aldosterone system (RAAS) are considered first-line therapy in patients with ESRD as these patients have a propensity for RAAS overactivation⁴⁻⁷. Studies show that aldosterone receptor blockade reduces BP in patients with chronic kidney disease (CKD) and helps prevent negative outcomes from continued renal cellular damage⁸⁻¹⁰. Spironolactone, an aldosterone antagonist, has the potential to provoke hyperkalemia. Consequently, current guidelines do not recommend spironolactone to manage hypertension in ESRD because of this risk⁶⁻⁷. Our primary objectives were to determine the change in BP and serum potassium levels following spironolactone use. Methods: This study was a retrospective, pre-post cohort study in ESRD patients with difficult-to-control BP receiving HD. Patients prescribed spironolactone (25 mg to 50 mg) between January 2009 and January 2013 were identified using an e-prescribing record from three HD clinics in San Antonio, TX. Patients were included if they were prescribed spironolactone as 'add-on' therapy to control BP for at least 8 weeks. Results: Seventy patients were evaluated and the majority of them were overweight, diabetic, Hispanic females with a mean 65 years of age. Mean SBP and DBP decreased from baseline to week 8 [-20.74 mmHg (p < 0.0001) and -9.7 mmHg (p < 0.0426), respectively]. Mean serum potassium levels increased by an average of 0.18 mEq/L (4.5 mEq/L to 4.68 mEq/L, p = 0.09). Data analysis revealed that only 9 of 70 patients had a serum potassium level > 5.5 mEq/L at week 8. There were no adverse cardiac events reported as a result of these potassium concentrations. A two-fold decrease in SBP was seen in patients with a body mass index (BMI) > 25 kg/m² compared to patients with a BMI of ≤ 25 kg/m². At the end of the study, 23 patients (33%) achieved the goal BP for healthy adults of < 140/90 mmHg. Conclusion: These findings demonstrated that using spironolactone use in ESRD patients receiving HD can be effective and safe. / text

Background: The growth in the number of individuals with end-stage renal disease has implications in terms of both the health of individuals, especially older adults (aged 65 years and older), and the capacity of the health care system to provide adequate treatment needed by these patients. Much has been written regarding the pathophysiology of end-stage renal disease as well as how modern advances in technology have contributed to the ‘dialysis world’. However, the literature is sparse in relation to how older adults experience end-stage renal disease and the technological complexity of dialysis in their daily lives. Objective: The purpose of this study was to explore the meaning of being hemodialysis-dependent for the older adult living with end-stage renal disease. Method: A descriptive method using a qualitative interviewing approach was used. Systematic focused thematic analysis guided by the Crisis of Physical Illness conceptual model allowed for the findings to surface. Data sources included individual interviews, direct observation of participants and the hemodialysis unit, along with field notes. A purposive sample of nine participants was obtained from two different hemodialysis units, both operated by Kingston General Hospital. Data were analyzed using the Colaizzi method. Findings: Five themes were identified by the participants: The Will to Live, Recognition of a Lifetime Commitment, Learning to Live with Technology, The Yin and Yang of Dialysis, and Transcending Dialysis. Conclusions: End-stage renal disease and thrice weekly hemodialysis treatment have an impact on the daily life of older adults and their ability to cope with the changes. This study revealed that despite the restrictions of being on hemodialysis, all of the participants had the will to live and some expressed the need for further education using a variety of strategies that would meet the specific needs of this population. A more in-depth understanding of how older adults experience hemodialysis is needed to provide adequate care/resources for this special population. / Thesis (Master, Nursing) -- Queen's University, 2011-09-15 13:02:28.548

Background: End-stage renal disease (ESRD) is a chronic medical condition where 90% or more of the kidneys are nonfunctional (Doig & Huether, 2014). The current treatment for ESRD is Hemodialysis [HD] (National Institute of Diabetes and Digestive and Kidney Disease [NIDDK], 2013). Individuals who have ESRD who undergo HD suffer from tremendous symptom and treatment burden that affects various facets of life (Axelsson, Klang, Hagelin, Jacobson, & Gleissman, 2014; Axelsson et al., 2012; Tamura & Cohen, 2010). Unfortunately, the symptom and treatment burden associated with ESRD are underrecognized and undertreated (Feely et al., 2016; Gelfman & Meyer, 2012; Murtagh, Addington-Hall, & Higginson, 2007; Russon & Mooney, 2010; Tamura & Meier, 2013). Purpose: The purpose of this quality improvement project is to explore if ESRD patients in Davita Desert Dialysis are knowledgeable about palliative care and if providing education might change their behavior. The primary aim is to create awareness in patients about PC services in an effort to improve their quality of care through education. Design: A quantitative pre- and post survey approach using qualtrics software was utilized to assess the baseline and post-education knowledge of patients who met the inclusion criteria. Setting: DaVita Desert Dialysis, Sun City, AZ. Intervention: The educational intervention is the viewing of a three-minute voice over presentation about palliative care. Limitations: The sample size was small and exposes this study to marked bias and non-generalizability due to the limited number of recruited individuals. Results: One hundred percent of the individuals in the posttest had better awareness about and knowledge about PC. Conclusion: PC can improve the quality of life of patients that suffer from the undertreated and underrecognized symptom and treatment burden (Tamura & Meier, 2013). Further data and studies will be needed to establish PC in the field of nephrology as it relates to the ESRD population undergoing HD. However, the quality improvement focus of increasing PC awareness among ESRD patients undergoing HD has shown great promise as all participants had increased awareness, knowledge availability, and readiness for PC services.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第22123号 / 社医博第98号 / 新制||社医||10(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 中山 健夫, 教授 柳田 素子, 教授 長船 健二 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Background Glomerulonephritis is a major cause of end-stage kidney disease (ESRD) in Africa. There is scanty data on the clinico-pathological characteristics and outcome of the mesangioproliferative glomerulonephritides in Africa, despite the non-IgA subtype being reported as a common cause of nephrotic syndrome. This study will assess the outcome of patients with biopsy proven mesangioproliferative glomerulonephritis (MesPGN) from a single centre in Cape Town, South Africa. Methods The study is designed as 10-year retrospective analysis of patients with biopsy proven MesPGN. The MesPGN patterns were divided into non-IgA MesPGN and IgA nephropathy (IgAN), depending on the predominant type of immune deposit. Univariate cox regression analysis was used to determine factors associated with ESRD. Results Data of 109 patients with renal biopsy-proven MesPGN were included for the period between 2005-2014. The mean age at biopsy was 33.8 ±14.9 years, 53.2% were males, and 39.4% were black Africans. Clinically, 58.7% presented with nephrotic syndrome. On histology 79.8% had non-IgA MesPGN, and 20.2% had IgAN. Compared to the non-IgA group, most patients with IgAN were not treated with immunosuppression (72.7% vs. 40.2%; p=0.006). At the last visit, 10.1% reached ESRD (40.9% vs. 2.3%; p<0.0001) and 30.2% achieved complete remission (9.1% vs. 35.7%; p=0.015) for IgAN and non-IgA MesPGN respectively. The 5-year renal survival for IgAN and non-IgA MesPGN respectively, were: 63.3% vs. 97.6%, log rank p=0.001. Overall, hypertension (p=0.019), not receiving immunosuppression (p=0.046) and having IgAN (p=0.007) were independent predictors of progression to ESRD. Conclusion There is a significantly higher ESRD-free survival of patients with biopsy proven non-IgA MesPGN than IgAN. Whether this is related to the limited use of immunosuppressive therapy in IgAN patients or represents a true nature of the disease still requires further research.

No description available.

In the setting of an increasing incidence of endocarditis in the United States, we report a patient with necrotizing crescentic glomerulonephritis (GN) associated with native valve bacterial endocarditis due to Streptococcus parasanguinis. He was started on appropriate antibiotic treatment and subsequent blood cultures showed no growth. However, due to continuing decline in kidney function, immunosuppressive therapy was started. Despite immunosuppressive therapy and antibiotics, renal function did not improve and chronic hemodialysis was required. Due to rarity of condition, there are no definite treatment guidelines available. Antibiotics, steroids, immunosuppressive agents can be of help in most cases. Further research in this regard may help with early diagnosis and better treatment modalities.