With global socioeconomic development and improvement in the general health care system, life expectancy increases, resulting in an increasing incidence of end-stage renal disease in the elderly population. We compared the survival rate in elderly patients aged ≥ 65 years with Stage 5 chronic kidney disease, managed with either renal replacement therapy (RRT) or conservative treatment. We also tried to identify factors associated with survival in these two groups. This is a single-center retrospective study of patients aged ≥ 65 years with Stage 5 chronic kidney disease, who were referred to the nephrology team for renal advance care planning to assist in decision making for RRT or conservative treatment from 2005 to 2013. They were followed up till death or till December 31, 2014. Baseline characteristics (demographics, clinical data, functional status, socioeconomic factors, and laboratory parameters) and mortality data between the two groups were compared. A total of 558 patients were recruited during the study period, in which 126 (22.6%) patients opted for RRT and 432 (77.4%) for conservative treatment. Patients with less significant comorbidities, lower modified Charlson's Comorbidity Index scores, better functional and mental statuses, as well as better socioeconomic status were more likely to choose RRT. The RRT group had a longer median survival of 44.6 months compared with 10.0 months in the conservative treatment group. The survival advantage of the RRT group was lost in patients older than 85 years, or in those with high comorbidity (modified Charlson's Comorbidity Index score of ≥11) or dependent mobility. Age, comorbidity, and mobility were predictors of mortality in the RRT group. For the conservative group, age, mobility, and sex were predictors of mortality. Elderly patients with end-stage renal disease can be benefited from RRT. However, the survival advantage of RRT was lost in very-advanced-age patients older than 85 years of age, in those with high comorbidity, or in functionally dependent patients. 在全球性的社會經濟發展下;預期壽命得以延長;導致在老年人口中;末期腎病的發生率亦有所增長。我們在 ≥ 65 歲的第 5 期慢性腎病年老患者間;比較了腎置換療法 (RRT) 與保守療法所達到的存活率。同時;我們亦嘗試找出影響這兩組病人存活的因素。 這是一項單中心的回溯性研究;對象為 ≥ 65 歲的第 5 期慢性腎病患者。他們是在 2005 年至 2013 年期間;被轉介至腎科團隊接受預設照顧計劃;以協助他們選擇 RRT 或保守療法;追蹤期至 2014 年 12 月 31 日或病人去世為止。我們比較了兩組病人的基線特徵及死亡率數據。 本研究共納入 558 位病人;其中 126 (22.6%) 人選擇了 RRT;432 (77.4%) 人選擇了保守療法。RRT 組的存活中位數為 44.6 個月;較保守療法組的 10.0 個月長。然而;在 >85 歲、共病顯著 (mCCI ≥ 11)、或不能獨立行動的病人中;RRT 的存活優勢消失。在 RRT 組中;年齡、共病、及行動力是死亡的預測因子,在保守療法組中;年齡、行動力、及性別是死亡的預測因子。 年老末期腎病患者可以獲益於 RRT,然而;在 >85 歲的極高齡者、共病顯著者、或不能獨立行動的病人中;RRT 的存活優勢不復存在。
Glomerulonephritis is among the most important group of diseases causing end-stage renal disease (ESRD). The prevalence of glomerulonephritis varies depending on age, sex, geographical features, etc. In the present study, we evaluated the clinical and laboratory parameters of patients who underwent renal biopsy. In this retrospective study, demographic and clinical characteristics, specific diagnoses of glomerular diseases, and biopsy findings of all patients in whom native renal biopsy was performed in our hospital between January 2009 and December 2014 were analyzed. A total of 384 patients were divided into two groups as primary glomerular diseases (PGD) and secondary glomerular diseases (SGD). Some 37.1% of patients with PGD and 49.2% of patients with SGD were female. The mean age was 43.8 ± 14.1 years in the PGD group and 47.3 ± 16.1 years in the SGD group (p = 0.044). Nephrotic syndrome in the PGD group and unexplained renal dysfunction in the SGD group were observed more frequently at the time of admission. In the SGD group, biopsy findings (crescents, sclerosis, vascular involvement, etc.) were dominant and more pronounced (p < 0.001). In the PGD group, responsiveness to the therapy was higher than in the SGD group (p < 0.001). Mortality rates were 2.27% in the PGD group and 18.3% in the SGD group. According to the multivariate analysis, the increase of creatinine level after treatment (odds ratio 1.49) and presence of SGD (odds ratio 7.74) were independent risk factors for patient death (p < 0.001). The present study showed important data about the etiology, clinical findings, follow ups, and prognosis of PGD and SGD among adults in our center. We observed that mortality was higher in patients with SGD. 腎小球腎炎是導致末期腎病 (ESRD) 的最重要疾病,其盛行率與年齡、性別、及地域特性有關。在本研究中,我們在接受腎臟組織活檢的腎小球疾病患者間,對相關的臨床及檢驗特徵進行了調查。 在本回溯性研究中,對象為於 2009 年 1 月至 2014 年 12 月期間,在本院接受自身腎臟組織活檢的病人。我們對其人口學與臨床特徵、腎小球疾病診斷、及活檢結果進行了分析。 調查對象為 384 位原發性腎小球疾病 (PGD) 或次發性腎小球疾病 (SGD) 患者。在 PGD 及 SGD 組別中,女性比例分別佔 37.1% 及 49.2%,平均年齡分別為 43.8 ± 14.1 歲及 47.3 ± 16.1 歲 (p = 0.044)。入院時,PGD 組以腎病症候群較常見,SGD 組則以原因不明之腎臟功能障礙較常見。在 SGD 組間,活檢結果較多樣化 (新月形、硬化、血管病變等) 且較明顯 (p < 0.001)。治療反應比率以 PGD 組高於 SGD 組 (p < 0.001),死亡率分別為 PGD 組的 2.27% 及 SGD 組的 18.3%。多變項分析顯示,治療後肌酸酐的增加 (OR 1.49)、及 SGD 的存在 (OR 7.74) 是病人死亡的獨立危險因子 (p < 0.001)。 對於本中心的 PGD 與 SGD 成年患者,本研究提供了成因、臨床表現、追蹤、及預後等方面的重要數據,並觀察到 SGD 患者的死亡率較高。
Autosomal dominant polycystic kidney disease (ADPKD) is characterized by numerous epithelium-lined cysts in the kidney and is the leading genetic cause of end-stage renal disease worldwide. Endothelin-1 is a potent vasoactive peptide implicated in the regulation of basal vascular tone. Endothelin (ET)-converting enzyme 1 (ECE1) is well known for its critical role in the process of ET. We investigated ECE1 gene variants to unravel ECE1 modifier effects associated with renal disease progression in ADPKD. Three ECE1 functional polymorphisms [rs213046 (−839 A>C), rs213045 (−338 G>T), and rs1076669 (Thr338Ile)] were genotyped using a fluorescence resonance energy transfer-based KASPar method in 106 ADPKD patients and 112 healthy participants. A Chi-square test was used to determine the relationship between ADPKD and ECE1 variants, and multivariate logistic regression analysis was performed to assess the effect of ECE1 variants on chronic kidney disease (CKD) progression. Mantel-Haenszel stratified analysis was performed to assess relationships between different CKD stages, hypertension, and their interaction. All loci are polymorphic and followed a Hardy-Weinberg equilibrium. Distribution of ECE1 genotypes in controls and ADPKD groups was not statistically significant, and linkage disequilibrium was not strong between pairs of single-nucleotide polymorphisms. The rs213046 variant genotypes were overrepresented in advanced CKD stages (p = 0.031). Significant confounding effects of hypertension on CKD progression in ADPKD were observed. These results suggested that the ECE1 gene variant is a modifier of CKD advancement among ADPKD patients. 自體顯性多囊性腎病 (ADPKD) 的特點,是腎臟呈現相當多由上皮構成的囊腫,在全球是導致末期腎病 (ESRD) 的主要遺傳性原因。Endothelin-1 (ET-1) 是一種具有高度血管活性的胜肽,被認為與基礎血管張力的調節有關。眾所周知,endothelin (ET) 轉化酵素 1 (ECE1) 則在 ET 代謝上佔有重要的角色。 在本研究中,我們調查了在 ADPKD 患者間,ECE1 基因變體與 CKD 病情發展的可能關聯。我們採用以 FRET 為基礎的 KASPar 方法,對 106 位 ADPKD 患者及 112 位健康人士,作出 3 種 ECE1 功能性多態性 [rs213046 (-839 A>C)、rs213045 (-338 G>T) 及 rs1076669 (Thr338Ile)] 的基因型辨識。對於 ADPKD 與 ECE1 基因變體的關聯,我們採取卡方檢驗;ECE1 基因變體與 CKD 病情發展的關聯,以多變項邏輯迴歸進行分析;CKD 分期與高血壓的關聯及兩者的交互作用,則採用 Mantel-Haenszel 分層分析。 所有基因座 (loci) 均呈現多態性,且遵循 Hardy-Weinberg 平衡。ADPKD 患者與對照組間的 ECE1 基因型分佈並無明顯差別。單核苷酸多態性鹼基對 (SNP pairs) 之間,並未呈現出明顯的連鎖不平衡 (LD)。在晚期 CKD 患者間,rs213046 變體基因型呈現過度的表達 (p = 0.031)。 我們觀察到,在 ADPKD 患者間,高血壓是 CKD 病情發展的一個明顯的干擾因素。以上結果意味著,在 ADPKD 患者間,ECE1 基因變體可影響 CKD 的病情發展。
With the increase in epidemic proportions of diabetes worldwide, the number of patients who will require renal replacement therapy (RRT) will be a great challenge to the health infrastructures of developing countries such as Nigeria. Because those mostly affected are in the economically productive age group, a vicious circle is established whereby those who keep the economy going are the same people affected. Secondary and tertiary care of chronic kidney disease involving RRT would exact disproportionate toll on the income of patients in the developing world where patients pay out of pocket for their own care. Whilst there is an increase in the number of facilities offering RRT, there is no commensurate sustainability of care either by the patients themselves or even by the government. The level of unemployment is increasing. Kidney transplantation is out of reach in addition to the cost of post-transplant care, which includes hospitalization and immunosuppressive medications. Most of the end-stage kidney disease patients who enlisted in our dialysis program were unable to get or sustain adequate hemodialysis. The data also showed that more men were dialyzed at our facilities over the period under review and the age distribution has not changed much over the decade. From this dismal picture in the last decade emerges a series of questions as to why this is so and what must be done to increase access to RRT. Prudent fund management and cost containment, local manufacture of dialysis materials and nongovernmental sources of funding are means of driving down the cost of dialysis. In countries where drugs and equipment for health services are locally manufactured, such as India and other countries, the cost of health care is more affordable than in countries such as Nigeria where these are imported.
The peritoneal membrane of long-term peritoneal dialysis (PD) patients is characterized by morphological and microvascular changes. It is said that lactate-based peritoneal dialysate is implicated in the development of these changes. The aim of this study is to compare the effects of long-term exposure to glucose-based, lactate-buffered (Dianeal), and biocompatible bicarbonate/lactate-buffered, low glucose degradation product (Physioneal) peritoneal solutions on the peritoneal membrane. Thirty-nine incident PD patients were randomized into two groups: 19 patients with Dianeal dialysate (Group A) and 20 with biocompatible Physioneal dialysate (Group B). All patients used automated PD for a median of 31 months in Group A and 32 months in Group B. Three biopsies at one occasion only were taken from the peritoneal membrane at the end of the study. All samples were collected and fixed in accordance with a standardized protocol, and a histopathologist blinded to the clinical status and PD solutions allocated to the patients carried out the analysis. The commonest change observed was peritoneal fibrosis, seen in 35 out of 39 cases (89.7%); it was moderate to severe in 28 cases (71.8%) and mild in 11 (28.2%) cases. This was followed by loss of mesothelial cells (22 cases, 56.4%), elastosis (20 cases, 51.3%), increased blood vessels (15 cases, 38.5%), thick-walled blood vessels (10 cases, 25.6%), and finally chronic inflammation and mesothelial cell hyperplasia (7 cases, 17.9%, and 6 cases, 15.4%, respectively). Of the patients with blood vessel abnormalities, 22 (88.0%) exhibited significant fibrosis and only three (12.0%) did not. Of those without blood vessel changes, only six (42.9%) patients exhibited similar degree of fibrosis (p < 0.01). The prevalence of vascular changes, moderate to severe fibrosis, as well as mesothelial cell abnormalities increased as the duration of PD increased. The prevalence of fibrosis, mesothelial cell loss, and vascular abnormalities increased significantly with diabetes mellitus (p < 0.001). There was no difference in the effects of long-term exposure to glucose-based, lactate-buffered, and biocompatible bicarbonate/lactate-buffered, low glucose degradation product peritoneal solutions on the peritoneal membrane. Risk factors other than PD dialysate composition need to be considered when assessing peritoneal membrane adequacy. The factors that were proved to be significant in our study are duration of end-stage renal disease, diabetes mellitus, and time on PD. 在接受長期腹膜透析 (PD) 的病人間，腹膜會出現若干的形態學與微血管變化，這些變化被認為與採用乳酸鹽腹膜透析液有關。本研究旨在比較兩種透析液的長期暴露—乳酸鹽緩衝之 Dianeal®、與生物相容之 Physioneal® 對病人腹膜的影響。 共 39 位剛開始接受 PD 的病人被分為兩組：19 人接受 Dianeal 透析液 (A 組)、20 人接受生物相容之 Physioneal 透析液 (B 組)，所有病人接受的均為自動化 PD (APD)。研究結束時，我們對病人腹膜進行了活組織檢驗。 在 A 組及 B 組之間，間皮細胞消失分別發生於 52.6% 及 60.0% 的病人，間皮細胞增生則分別發生於 21.1% 及 15.0% 的病人 (p > 0.05)；嚴重間質纖維化分別發生於 42.1% 及 45.0% 的病人，中度間質纖維化則分別發生於 31.6% 及 25.0% 的病人 (p > 0.05)。在 A 組及 B 組的病人之間，彈性組織變性 (elastosis) 達到 “3+” 的比率分別為 15.8% 及 20.0%，達到 “2+” 的比率分別為 15.8% 及 15.0% (p > 0.05)；異常微血管增加則分別出現於 42.1% 及 35.0% 的病人 (p > 0.05)。在糖尿病患者之間、及接受 PD 較久的病人之間，腹膜病理性變化的比率均有所增加 (p < 0.001)。 長期採用以上兩種腹膜透析液於 PD 病人中，並未導致不同的腹膜變化。然而，以下因素則可能導致不同的腹膜變化：末期腎病、糖尿病、及 PD 的持續時間。
We herein present a case of an intrarenal pseudoaneurysm developing 2 weeks after renal transplantation. The patient presented with hemorrhagic shock. Computed tomography confirmed an intrarenal pseudoaneurysm with extravasation of contrast and a large surrounding hematoma. Angiography confirmed the pseudoaneurysm, and embolization of the segmental graft renal artery was performed. In view of the uncertain etiology and the possibility of a mycotic pseudoaneurysm, we administered empiric antimicrobial therapy. The clinical course, investigations, and management are described. Finally, a review of the literature regarding post-transplantation pseudoaneurysms is presented.
Cardiovascular disease is the leading cause of mortality among kidney transplant recipients. Carotid intima-media thickness (CIMT) of the common carotid artery is a surrogate marker for early atherosclerosis. We wanted to compare the prevalence of increased CIMT among kidney transplant recipients with matched controls and its association with clinical and laboratory parameters. A comparative cross-sectional study involving kidney transplant recipients and controls matched for age, sex, chronic kidney disease staging, and cardiovascular risks was used. CIMT measurements were done using carotid ultrasound and considered increased if >75th percentile matched for age- and sex-matched normal controls. Standard laboratory investigations, high sensitivity C-reactive protein, and asymmetric diamethylarginine were analyzed. Thirty-six kidney transplant recipients (25 men, 11 women) with a median age of 41 years [interquartile range (IQR), 38–52 years] and 36 matched controls with a median age of 44 years (IQR, 37–53 years) were enrolled. There were no demographic differences between the two groups. Kidney transplant recipients had a significantly increased CIMT, 0.8 mm (IQR, 0.6–0.9) compared to matched-controls 0.55 mm (IQR, 0.5–0.7, p = 0.001). Two thirds of kidney transplant recipients had increased CIMT, which was associated with a higher low density lipoprotein (LDL) (p = 0.022) and higher hemoglobin (p = 0.006). Smoking status (p = 0.058) and male sex (p = 0.073) had a trend towards significance to increased CIMT. Multiple linear stepwise regression demonstrated both age and hemoglobin were independent predictors of CIMT (p < 0.001). We found no relationship between high sensitivity C-reactive protein and asymmetric diamethylarginine with CIMT. CIMT among our kidney transplant recipients was significantly higher compared to controls thereby increasing their cardiovascular risk. 心血管疾病是腎臟移植接受者的主要死因,總頸動脈的內膜中膜厚度 (CIMT) 則是早期動脈粥樣硬化的替代性指標。在本研究中,我們比較了 CIMT 增厚於腎臟移植接受者與匹配對照組之間的盛行率,並調查了 CIMT 與臨床及實驗室參數之間的關聯。 這是一項橫斷式比較性研究,涉及的對象包括腎臟移植接受者、及與其匹配 (年齡、性別、慢性腎病分期及心血管風險) 的對照者。CIMT 以頸動脈超音波測量,增厚的定義為對應年齡性別匹配正常對照組之 > 75th 百分位數。其他測量項目除了標準實驗室參數外,亦包括高敏感度 C-reactive protein (hs-CRP) 及 asymmetric diamethylarginine (ADMA)。 分析對象包括 36 位年齡中位數 41 歲 (38,52) 之腎臟移植接受者 (25 男、11 女) 及 36 位年齡中位數 44 歲 (37,53) 之匹配對照者,兩組間的人口學特徵並無不同。腎臟移植接受者之 CIMT 為0.8 mm (0.6,0.9 mm),明顯高於匹配對照者之 0.55 mm (0.5,0.7 mm) (p = 0.001)。腎臟移植接受者之間,3 分之 2 呈現 CIMT 增厚的情形,較厚的 CIMT 與較高的低密度脂蛋白 (p = 0.022) 及較高的血色素 (p = 0.006) 有關。吸煙狀況 (p = 0.058) 及男性性別 (p = 0.073) 亦有傾向與 CIMT 增厚有關。多變項線性逐步迴歸分析顯示,年齡及血色素均是CIMT的獨立預測因子 (p < 0.001)。對於 CIMT 與 hs-CRP 或 ADMA 數值之間,我們並未發現明顯的關係。 在本研究的腎臟移植接受者中,CIMT 明顯高於對照組,因此具較高的心血管風險。
There is increasing recognition of the need to integrate advance care planning (ACP) into end-stage renal disease (ESRD) care with attention to medical, ethical, psychosocial, and spiritual issues but publications comparing patients who chose renal replacement therapy (RRT) and renal palliative care (RPC) is scarce. We here share our experience on ACP for ESRD patients in a center with renal replacement and palliative programs in place. From June 2006 to December 2011, ESRD patients were empowered to make an informed choice of future medical care in a structured ACP that was emphasized to be an ongoing process. Patients who opted for RRT and RPC would be followed up at the predialysis clinic and the one-stop multidisciplinary RPC clinic, respectively. This was a single-center study in a secondary care hospital. A total of 600 patients (265 RRT, 335 RPC) were enrolled and followed up over a median of 782 days. The majority of patients and relatives declined dialysis because of perceived physical burden. Only 1.6% of palliative care patients changed their decision and commenced dialysis. Baseline characteristics differed between patients who chose RRT or RPC. Survival declined according to the modified Charlson Comorbidity Index scores. Older age, mental incompetence, hyperlipidemia, high modified Charlson Comorbidity Index, low estimated glomerular filtration rate, and low albumin were important independent predictors of poor survival. Factors affecting the ACP decision were discussed in the Chinese culture context. A structured ACP could empower the patient to make an informed decision on the management of ESRD. 於未期腎病患者的照顧中加入關注身心社靈和倫理問題的預設照顧計劃(ACP)受到日益重視，但有關比較接受腎替代療法和接受腎臟紓緩治療文獻討論為數不多。作為同時提供腎透析服務以及腎臟紓緩治療的部門，本文旨在分享我們為未期腎病者討論預計照顧計劃的經驗。 自二零零六年六月至二零一零五月間，透過有組織的預設照顧計劃討論，未期腎病患者會被鼓勵就未來的治療計劃作出知情選擇。選擇腎透析和腎臟紓緩治療的病人會分別於透析預備門診和一站式跨科際腎臟紓緩治療門診去覆診。本研究於一家二級醫院進行。總共有六百病人參與此研究，當中265名接受腎透析，335名接受腎臟紓緩治療，其中位跟進日數為782日。 大部份病人和家屬之所以拒絕腎透析是由於預計的身體負累，只有百分之一點六接受腎臟紓緩治療會改變主義而接受腎透析。選擇腎透析和腎臟紓緩治療的病人在基本的身體狀況有明顯分別。生存率亦隨著修改版查爾森共病量表的分數而下降。年長、精神自主能力缺欠、高血脂、修改版查爾森共病量表分數高、腎小球濾過率低、白蛋白低均屬重要暨獨立的因素以預計較差的生存率。本文亦會探討在中國文化處境下影響預設照顧計劃討論的因素。 有組織的預設照顧計劃討論能幫助病人在未期腎病的醫療方向作出知情的選擇。
The objective of this study is to determine whether tacrolimus trough level is appropriate for therapeutic drug monitoring (TDM) of Advagraf in stable Chinese kidney transplant recipients (KTRs). In this single-center pharmacokinetic study, stable adult Chinese KTRs on Advagraf were recruited and their blood tacrolimus levels measured at 12 time points within 24 hours. Trough level was defined as predose drug level (C0). The pharmacokinetic parameters were calculated using standardized noncompartmental methods. Drug exposure, defined as 24-hour area under the curve (AUC0–24), was calculated using the linear trapezoidal method. Whole blood tacrolimus level measurement was performed by high-performance liquid chromatography/tandem mass spectrophotometry. Fourteen patients (8 males; mean age, 47.1 ± 9.2 years; mean duration of transplant, 8.3 ± 3.6 years) completed the study. The mean C0 was 4.4 ± 1.9 ng/mL, and the mean AUC0–24 was 143.8 ± 57.0 ng h/mL. The mean maximum concentration (Cmax) was 10.2 ± 3.9 ng/mL, and the median time to Cmax was 2.0 hours (interquartile range, 1.0–3.0 hours). There was a strong correlation between C0 and AUC0–24 (r = 0.90, p < 0.001). Patients receiving diltiazem had higher mean AUC0–24 (153.0 ± 55.3 ng h/mL vs. 110.1 ± 60.1 ng h/mL) despite a lower dose (mean tacrolimus dose, 0.039 ± 0.022 mg/kg/d vs. 0.054 ± 0.021 mg/kg/d), although both differences did not reach statistical significance. Apart from C0, tacrolimus level obtained from 6 hours to 12 hours (C6 to C12) also had good correlation with AUC0–24. Tacrolimus trough level is a good surrogate marker for TDM of Advagraf in stable Chinese KTRs. The role of C6 to C12 in TDM remains to be determined. 本研究旨在調查在病情穩定的華裔腎臟移植接受者 (KTRs) 間,Cmin 是否適用於藥物血中濃度監測 (TDM)。 在這一項單中心藥物動力學研究中,對象為病情穩定的華裔 KTRs,在 24 小時內 12 個時間點接受了動脈血的取樣,谷值的定義為服藥前藥物濃度 (C0)。藥物動力學參數的計算是採用標準化無房室模式,AUC0–24 的計算採用線性梯形方式。全血 tacrolimus 濃度的測量儀器,則是採用高效能液相色層分析串聯質譜儀 (HPLCMS/MS)。 本研究共納入 14 位服用 Advagraf® 的病人,平均 C0 為 4.4 ± 1.9 ng/ml,平均 AUC0–24 為 143.8 ± 57.0 ng·h/ml,平均最高濃度 Cmax 為 10.2 ± 3.9 ng/ml,達到 Cmax 的時間中位數 tmax 則為 2.0 小時 (四分位數間距 1.0–3.0 小時);C0 與 AUC0–24 存在明顯的相關性 (r = 0.90、p < 0.001)。在接受 diltiazem 的病人中,平均 AUC0–24 較高 (153.0 ± 55.3 ng·h/ml vs. 110.1 ± 60.1 ng·h/ml),即使他們服用較低的 tacrolimus 劑量 (平均劑量 0.039 ± 0.022 mg/kg/day vs. 0.054 ± 0.021 mg/kg/day);這兩種差異未達統計學意義。除了 C0 之外,6 至 12 小時 (C6 to C12) 之 tacrolimus 濃度亦與 AUC0–24 存在顯著的相關性。 對於病情穩定的華裔 KTRs,tacrolimus 谷值乃 AUC0–24 的一個良好替代指標;至於 C6 to C12 的角色則仍有待證實。
Chronic alcohol use and gallstones are the most frequent causes of acute pancreatitis (AP), a life-threatening medical emergency. Above-normal calcium levels in these patients indicate potential malignancy or hyperparathyroidism (HPT). Whereas primary HPT has been associated with AP, tertiary HPT has seldom been linked with AP. Herein we present a case of peritoneal dialysis presenting with recurrent AP and incidental pancreatic duct calcification due to tertiary HPT.
The employment status of peritoneal-dialysis patients could have been related to selection bias. This study examined the employment rate and associated factors in a population with peritoneal-dialysis-first policy. We performed a single-center cross-sectional survey on the employment status of prevalent peritoneal-dialysis patients between January and September 2013 in Hong Kong. The survey included 383 prevalent peritoneal-dialysis patients, with 128 of them in the labor force. Among the patients in the labor force, the employment rates were 65.8% and 18.9% for automated peritoneal-dialysis patients and continuous-ambulatory-peritoneal-dialysis patients, respectively, whereas 39.1% of patients in the labor force had expressed that they were able to work, but were unemployed. In adjusted analysis, the use of automated peritoneal dialysis (adjusted odds ratio of 7.93; 95% confidence interval 2.92–21.74) was independently associated with employment, whereas older age was associated with lower likelihood of employment (adjusted odds ratio of 0.53 for each 10 years old; 95% confidence interval 0.38–0.72). The employment rate in peritoneal-dialysis patients is very low when compared to that in the general population. Patients on automated peritoneal dialysis were more likely to be employed. 腹膜透析患者就業狀況的研究,有可能會受到選擇性偏倚的影響。這項調查 是在一個採納了 é腹膜透析第一û 政策的地區,進行就業率及其相關因素的研究。 在2013年1月至9月期間,我們在香港一個腹膜透析中心對現存的腹膜透析患者的就業狀況進行了一次橫斷面調查。 本次調查包括383名現存的腹膜透析患者,其中有128人被納入勞動力人口。在勞動力人口的患者中,自動腹膜透析的使用者就業率為65.8 %,連續性家居腹膜透析的使用者就業率為18.9 % 。另一方面,39.1%的勞動力人口患者,表示他們有能力工作,但並未受僱用。在調整後的分析,使用自動腹膜透析與就業率有獨立關聯,另外,較年長的患者與較低就業率有關聯。 相比一般香港人,腹膜透析患者的就業率非常低。自動腹膜透析的患用者較易就業。
A peritoneal dialysis patient with cirrhosis presented with drowsiness, vomiting, and mild hyponatremia. Despite no active correction of hyponatremia, she developed convulsion and quadriplegia. Magnetic resonance imaging of the brain showed changes of osmotic demyelination syndrome. This case illustrates that osmotic demyelination syndrome may occur in peritoneal dialysis without rapid correction of hyponatremia.
