BACKGROUND & AIMS: BACKGROUND:Pulse wave velocity is a measurement of arterial stiffness and associated with increased cardiovascular mortality. Previous reports in peritoneal dialysis have linked increased pulse wave velocity with an expansion in extracellular water. As cardiovascular mortality is increased in peritoneal dialysis patient, we wished to determine whether changes in pulse wave velocity mirrored changes in extracellular water. METHODS:We repeated aortic pulse wave velocity and bioimpedance-derived extracellular water measurements in peritoneal dialysis patients attending for assessment of peritoneal membrane function. RESULTS:Sixty-six patients, 41 males (62.1%), mean age of 66.2 ± 13.9 years, median duration of peritoneal dialysis treatment (14.3 (3.1-31.9) months) had repeated measurement 6.4 (5.8-10.2) months apart, with no significant change in aortic pulse wave velocity (10.1 ± 3.2 to 9.9 ± 2.8 m/s). In univariate analysis, the initial aortic pulse wave velocity was associated with extracellular water (r = 0.26, p = 0.034) and serum N-terminal pro brain-type natriuretic peptide (r = 0.25, p = 0.04), and on follow-up, aortic pulse wave velocity with N-terminal pro brain-type natriuretic peptide (r = 0.31, p = 0.01). Aortic pulse wave velocity increased in 50% of patients, and these patients had greater serum C-reactive protein 3(2-10) versus 2(1-4) mg/L, and ferritin (778(444-1099) versus 585(313-811), p < 0.05), but there were no differences in either absolute or adjusted extracellular water. Both log C-reactive protein (odds ratio 4.7 (95% confidence limits 1.3-17.1), p = 0.019) and prescription of calcium channel blockers (odds ratio 4.9 (95% confidence limits 1.2-19.1), p = 0.024) were independently associated with an increase in aortic pulse wave velocity. CONCLUSION:We did not find an independent association between a change in aortic pulse wave velocity and extracellular water, suggesting that changes in aortic stiffness in peritoneal dialysis patients are more complex than simply following changes in extracellular water.

背景与目标： 背景：脉搏波速度是对动脉僵硬度的一种测量，并与心血管死亡率的增加有关。腹膜透析的先前报道已将脉搏波速度增加与细胞外水的膨胀联系起来。随着腹膜透析患者心血管疾病死亡率的增加，我们希望确定脉搏波速度的变化是否反映了细胞外水的变化。
方法：我们对参加腹膜透析功能评估的腹膜透析患者重复进行主动脉脉搏波速度和生物阻抗来源的细胞外水测量。
结果：66例患者，男性41例（62.1％），平均年龄为66.2±13.9岁，腹膜透析治疗的中位时间为14.3（3.1-31.9）个月，重复测量间隔为6.4（5.8-10.2）个月，主动脉脉搏波速度无明显变化（10.1±3.2±9.9±2.8μm/ s）。在单变量分析中，初始主动脉脉搏波速度与细胞外水（r = 0.26，p = 0.034）和血清N端脑前利尿钠肽（r = 0.25，p = 0.04）有关，并随诊N端脑部利钠肽前体的主动脉脉搏波速度（r = 0.31，p = 0.01）。 50％的患者主动脉脉搏波速度增加，这些患者的血清C反应蛋白3（2-10）比2（1-4）mg / L和铁蛋白（778（444-1099）对585（ 313-811），p <0.05），但绝对或调整后的细胞外水均无差异。 log C反应蛋白（比值4.7（95％置信度极限1.3-17.1），p = 0.019）和钙通道阻滞剂的处方（ods比4.9（95％置信度1.2-19.1），p = 0.024）是独立的与主动脉脉搏波速度增加有关。
结论：我们没有发现主动脉脉搏波速度变化与细胞外水之间存在独立的联系，这表明腹膜透析患者的主动脉僵硬度变化比单纯跟随细胞外水变化更为复杂。

BACKGROUND & AIMS: BACKGROUND:Although the soluble form of suppression of tumorigenicity 2 (sST2) and soluble low-density lipoprotein receptor relative with 11 ligand-binding repeats (sLR11) have emerged as novel cardiovascular biomarkers in patients with cardiovascular disease, their prognostic value has not been fully investigated in peritoneal dialysis (PD) patients. METHODS:We included 74 prevalent PD patients from a prospective cohort and measured serum sST2 and sLR11 concentrations by an enzyme-linked immunosorbent assay. The association of these biomarkers and all-cause mortality and major adverse cardiac and cerebrovascular events (MACCEs) was evaluated. RESULTS:During a follow-up of 38.5 months, all-cause deaths and MACCEs were observed in 13 (17.6%) patients and 23 (31.3%) patients. Multivariable Cox analyses demonstrated that greater sST2 was independently associated with higher risk of all-cause mortality (≥75.8 ng/mL; hazard ratio [HR] = 5.551; 95% confidence interval [CI] = 1.360-22.660) and MACCEs (≥72.5 ng/mL; HR = 4.609; 95% CI = 1.608-13.208). Furthermore, sST2 showed additive predictive value for mortality to the base model including traditional risk factors (net reclassification index = 0.598, P = 0.04). sLR11 was not significantly associated with all-cause mortality or MACCE. CONCLUSIONS:sST2, but not sLR11, indicated a significant prognostic value for all-cause mortality and cardiovascular events in PD patients. Further research is needed to validate emerging biomarkers in these populations.

背景与目标： 背景：尽管抑制致癌性2（sST2）的可溶性形式和相对于11种配体结合重复序列（sLR11）的可溶性低密度脂蛋白受体已成为心血管疾病患者的新型心血管生物标志物，但其预后价值尚未完全在腹膜透析（PD）患者中进行了调查。
方法：我们纳入了来自前瞻性队列的74名流行的PD患者，并通过酶联免疫吸附测定法测量了血清sST2和sLR11的浓度。评估了这些生物标记物与全因死亡率以及主要不良心脏和脑血管事件（MACCE）的关联。
结果：在38.5个月的随访中，观察到13例（17.6％）和23例（31.3％）患者的全因死亡和MACCE。多变量Cox分析表明，更大的sST2与更高的全因死亡率风险（≥75.8ng / mL；危险比[HR] = 5.551； 95％置信区间[CI] = 1.360-22.660）和MACCEs（≥72.5）独立相关ng / mL； HR + ＝ 4.609； 95％CI ＝ 1.608-13.208）。此外，sST2对包括传统危险因素在内的基本模型的死亡率显示出附加的预测价值（净重分类指数= 0.598，P = 0.04）。 sLR11与全因死亡率或MACCE无关。
结论：sST2而非sLR11提示PD患者全因死亡率和心血管事件具有重要的预后价值。需要进一步的研究来验证这些人群中新兴的生物标志物。

BACKGROUND & AIMS: OBJECTIVES:Home haemodialysis (HD) and peritoneal dialysis (PD) have seen growth in utilisation around the globe over the last few years. However, home dialysis, with its attendant technical complexity and risk of adverse events continues to pose challenges for wider adoption. We examined whether differences in patients' learning styles are associated with differing risk of adverse events in both home HD and PD patients. DESIGN:Retrospective cohort study. SETTING:Tertiary care hospital in Toronto, Ontario, Canada. PARTICIPANTS:One hundred and eighteen prevalent adult (≥18 years) home dialysis patients (40 PD and 78 home HD) were enrolled. Patients on home dialysis for less than 6 months or receiving home nursing assistance for dialysis were excluded from the study. INTERVENTIONS:Enrolled patients completed (VARK) Visual, Aural, Reading-writing and Kinesthetic questionnaires to determine learning styles. PRIMARY AND SECONDARY OUTCOME MEASURES:Home HD and PD adverse events were identified within 6 months of completing home dialysis training. Event rates were then stratified and compared according to learning styles. RESULTS:Thirty patients had a total of 53 adverse events. We used logistic regression analysis to determine unadjusted and adjusted ORs for a single adverse event. Non-visual learners were 4.35 times more likely to have an adverse event (p=0.001). After adjusting for age, gender, dialysis modality, training duration, dialysis vintage, prior renal replacement therapy, visual impairment, education and literacy, an adverse event was still four times more likely among non-visual learners compared to visual learners (p=0.008). A subgroup analysis of home HD patients showed adverse events were more likely among non-visual learners (OR 11.1; p=0.003), whereas PD patients showed a trend for more adverse events in non-visual learners (OR: 1.60; p=0.694). CONCLUSIONS:Different learning styles in home dialysis patients exist. Visual learning styles are associated with fewer adverse events in home dialysis patients within the first 6 months of completing training. Individualisation of home dialysis training by learning style is warranted.

背景与目标： 目标：过去几年，家庭血液透析（HD）和腹膜透析（PD）的使用率在全球范围内有所增长。然而，家庭透析及其伴随的技术复杂性和不良事件的风险继续为广泛采用带来挑战。我们检查了家庭HD和PD患者中患者学习方式的差异是否与不良事件发生风险的不同相关。
设计：回顾性队列研究。
地点：加拿大安大略省多伦多的三级医疗医院。
参与者：入选了118位普遍的成年人（≥18岁）家庭透析患者（40位PD和78位家庭HD）。本研究不包括接受家庭透析少于6个月或接受家庭护理透析的患者。
干预措施：已入组的患者完成（VARK）视觉，听觉，阅读写作和动觉问卷，以确定学习方式。
主要和次要指标：在完成家庭透析培训后的6个月内发现家庭HD和PD不良事件。然后将事件发生率分层，并根据学习风格进行比较。
结果：30例患者共发生53例不良反应。我们使用逻辑回归分析来确定单个不良事件的未调整和调整后的OR。非视觉学习者发生不良事件的可能性高4.35倍（p = 0.001）。在调整了年龄，性别，透析方式，培训时间，透析时间，先前的肾脏替代治疗，视觉障碍，教育和识字能力之后，非视觉学习者的不良事件发生率仍然是视觉学习者的四倍（p = 0.008） ）。对家庭高清患者的亚组分析显示，非视觉学习者中发生不良事件的可能性更高（OR 11.1； p = 0.003），而PD患者呈现非视觉学习者中发生不良事件的趋势（OR：1.60； p = 0.694）。 ）。
结论：家庭透析患者存在不同的学习方式。在完成培训的前6个月内，视觉学习方式与家庭透析患者的不良事件较少相关。必须通过学习方式来个性化家庭透析培训。

BACKGROUND & AIMS: :Biofilms are commonly associated with an increased risk of patient infection. In peritoneal dialysis (PD), catheter associated infection, especially peritonitis, remains a clinically relevant problem. Although the presence of a biofilm is recognized in relapsing, repeat, and catheter-related peritonitis, it remains poorly characterized. In this review, an update on the role of biofilms in PD infections is presented. The emerging concept that host cells and tissue associated biofilms, in addition to the biofilms on the catheters themselves, contribute to the recalcitrance of infections is discussed. Furthermore, the evidence of biofilms on PD catheters, their developmental stages, and the possible influence of the PD environment are reviewed. The focus is given to ex vivo and in vitro studies that contribute to the elucidation of the interplay between host, microbial, and dialysis factors. The key issues that are still to be answered and the challenges to clinical practice are discussed.

背景与目标： 生物膜通常会增加患者感染的风险。在腹膜透析（PD）中，导管相关的感染，尤其是腹膜炎，仍然是临床相关的问题。尽管在复发性，重复性和与导管相关的腹膜炎中都可以识别出生物膜的存在，但生物膜的特征仍然很差。在这篇综述中，介绍了生物膜在PD感染中的作用的最新进展。除了导管本身上的生物膜之外，还讨论了宿主细胞和组织相关生物膜的新兴概念，它们也有助于抵抗感染。此外，综述了PD导管上生物膜的证据，它们的发育阶段以及PD环境的可能影响。重点是体外研究和体外研究，这些研究有助于阐明宿主，微生物和透析因子之间的相互作用。讨论了仍有待解决的关键问题以及对临床实践的挑战。

BACKGROUND & AIMS: :Cardiac resynchronization therapy (CRT) is often deferred in dialysis-dependent patients with heart failure (HF) because of a perceived lack of benefit and potentially higher risks, although the outcomes associated with CRT in dialysis have not been reported. We therefore studied our center's experience with CRT in dialysis-dependent patients. We constructed a descriptive assessment of these patients (n = 15) and performed a case-control analysis matching for age, gender, bundle branch morphology, diabetes mellitus, cardiomyopathy origin, and β-blocker and angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker use. Baseline and 6-month echocardiograms were assessed for evidence of reverse remodeling. No periprocedural or long-term complications were observed among dialysis patients. Heterogenous improvement in ejection fraction (+3.1 ± 9.2%) was noted and 2 patients derived absolute improvements of 8% and 22%, respectively. Dialysis patients demonstrated the following 3-year event rates: HF hospitalization, 31%; all-cause hospitalization, 100%; mortality, 73%; and HF hospitalization or death, 82%. In the case-control analysis, controls demonstrated superior reverse remodeling (+9.2 ± 9.5% increase in ejection fraction), decreased mortality (73% vs 44%, p = 0.038), and all-cause hospitalizations (76% vs 100%, p = 0.047), with no difference in HF hospitalizations (p = 0.39), compared with dialysis patients. In conclusion, at our center, the dialysis-dependent patients with HF who underwent CRT implantation did so safely and no serious complications were observed. Certain dialysis patients demonstrated compelling improvement after device implantation. Compared with matched controls, dialysis patients were at increased risk for adverse events and worsened echocardiographic outcomes.

背景与目标： ：由于尚无与透析相关的CRT结局的报道，由于认为缺乏获益和潜在的更高风险，通常在依赖透析的心力衰竭（HF）患者中推迟进行心脏再同步治疗（CRT）。因此，我们研究了我们中心在依赖透析的患者中使用CRT的经验。我们对这些患者（n = 15）进行了描述性评估，并根据年龄，性别，束支形态，糖尿病，心肌病起源，β受体阻滞剂和血管紧张素转换酶抑制剂或血管紧张素II受体进行了病例对照分析阻止者使用。评估基线和6个月的超声心动图，以寻找逆向重构的证据。在透析患者中​​未观察到围手术期或长期并发症。观察到射血分数的异质性改善（3.1±9.2％），2例患者的绝对改善分别为8％和22％。透析患者的3年事件发生率如下：心衰住院率为31％；心衰住院率为31％。全因住院，100％；死亡率73％；而心衰住院或死亡的比例为82％。在病例对照分析中，对照表现出优异的逆向重构（射血分数增加9.2±9.5％），死亡率降低（73％对44％，p = 0.038）和全因住院（76％对100％，p = 0.047），与透析患者相比，HF住院患者没有差异（p = 0.39）。总之，在我们中心，接受CRT植入的依赖透析的HF患者安全地这样做，并且未观察到严重的并发症。某些透析患者在装置植入后表现出令人信服的改善。与对照组相比，透析患者发生不良事件的风险增加，超声心动图结果恶化。

BACKGROUND & AIMS: BACKGROUND:Despite efforts to increase arteriovenous fistula and graft use, 80% of patients in the United States start hemodialysis on a central venous catheter (CVC). METHODS:To better understand in incident hemodialysis patients how sex and race/ethnicity are associated with time on a central venous catheter and transition to an arteriovenous fistula and graft, our observational cohort study analyzed US Renal Data System data for patients with incident ESKD aged ≥66 years who started hemodialysis on a CVC in July 2010 through 2013. RESULTS:At 1 year, 32.7% of 74,194 patients transitioned to an arteriovenous fistula, 10.8% transitioned to an arteriovenous graft, 32.1% stayed on a CVC, and 24.5% died. Women spent a significantly longer time on a CVC than men. Compared with white patients, patients who were black, Hispanic, or of another racial/ethnicity minority spent significantly more days on a CVC. In competing risk regression, women were significantly less likely than men to transition to a fistula and more likely to transition to a graft. Compared with white patients, blacks were significantly less likely to transition to a fistula but more likely to transition to a graft, Hispanics were significantly more likely to transition to a fistula, and other races/ethnicities were significantly more likely to transition to either a fistula or a graft. CONCLUSIONS:Female patients spend a longer time on a CVC and are less likely to transition to permanent access. Compared with white patients, minorities also spend longer time on a CVC, but are more likely to eventually transition to permanent access. Strategies to speed transition to permanent access should target groups that currently lag in this area.

背景与目标： 背景：尽管努力增加动静脉瘘和移植物的使用，美国80％的患者开始通过中央静脉导管（CVC）进行血液透析。
方法：为了更好地了解事件性血液透析患者的性别和种族/民族与时间在中心静脉导管上以及过渡到动静脉瘘和移植物之间的关系，我们的观察性队列研究分析了美国肾脏数据系统对≥≥ESKD事件的患者的数据。 66岁的人从2010年7月至2013年开始在CVC上进行血液透析。
结果：在1年中，74194例患者中有32.7％转变为动静脉瘘，10.8％转变为动静脉移植物，32.1％留在CVC上，有24.5％死亡。女性在CVC上花费的时间比男性长得多。与白人患者相比，黑人，西班牙裔或其他少数种族/民族的患者在CVC上花费的时间明显更多。在竞争性风险消退中，女性比男性更不可能转换为瘘管，而更有可能转换为移植物。与白人患者相比，黑人转移到瘘管的可能性要小得多，但移植到瘘管的可能性要大得多，西班牙裔人转移到瘘管的可能性要大得多，其他种族/族裔的人转移到任一瘘管的可能性都更大或嫁接。
结论：女性患者在CVC上花费的时间更长，并且不太可能过渡到永久使用。与白人患者相比，少数族裔在CVC上花费的时间也更长，但最终过渡到永久性访问的可能性更大。加快向永久访问权过渡的策略应针对当前滞后于该领域的人群。

BACKGROUND & AIMS: :We prospectively evaluated the efficacy and safety of a low concentrate citrate lock versus heparin lock in permanent single lumen hemodialysis catheters. The frequency of clot formation, complete catheter occlusion, flow problems and the use of urokinase as well as catheter infection episodes were monitored during 1370 dialysis sessions in 19 patients, randomised in two study groups. There was a significantly higher number of dialysis sessions with clot formation in the citrate group but regarding the need for urokinase bolus or infusion, complete obstruction of the catheter or local infections, there were no statistically significant differences between groups. The higher incidence of clotting in the citrate locked catheters had no repercussion on dialysis efficiency, effective blood flow or on the use of thrombolytic therapy. We found that low concentrate citrate is as safe as heparin for long-term interdialytic anticoagulation of permanent single lumen hemodialysis catheters but is more efficient from a pharmaco-economic viewpoint.

背景与目标： ：我们前瞻性评估了永久性单腔血液透析导管中低浓度柠檬酸盐锁与肝素锁的疗效和安全性。在19个患者的1370次透析期间，对血凝块形成的频率，完全的导管阻塞，流量问题和尿激酶的使用以及导管感染的发作进行了监测，并随机分为两个研究组。柠檬酸盐组的透析时间明显增加，但有凝块形成，但考虑到需要尿激酶推注或输注，完全阻塞导管或局部感染，两组之间在统计学上没有显着差异。柠檬酸盐锁定导管中较高的凝结发生率对透析效率，有效血流量或溶栓治疗的使用没有影响。我们发现低浓度的柠檬酸盐对永久性单腔血液透析导管的长期透析间抗凝治疗与肝素一样安全，但从药物经济学角度来看更有效。

BACKGROUND & AIMS: BACKGROUND:The Stanford BCNU protocol (carmustine, etoposide and cyclophosphamide) is a high-dose conditioning regimen widely used prior to autologous stem cell transplantation. While acute renal failure requiring renal replacement therapy is a known but rare complication of autologous stem cell transplantation, acute nephrotoxicity following carmustine and etoposide has not yet been reported. CASE:We present the first case of carmustine-induced acute kidney injury in the setting of autologous stem cell transplantation and perform a review of the literature. Renal failure was associated with a sharp rise in serum creatinine, oliguria and trace proteinuria. Urgent haemodialysis was required; however, renal failure resolved after 7 days. CONCLUSION:Although a rare complication, its severity mandates close monitoring of renal function as early recognition and treatment may limit long-term sequelae.

背景与目标： 背景：斯坦福大学BCNU协议（卡莫司汀，依托泊苷和环磷酰胺）是一种高剂量的调理方案，在自体干细胞移植之前被广泛使用。尽管需要肾脏替代治疗的急性肾功能衰竭是自体干细胞移植的已知但罕见的并发症，但尚未报告卡莫司汀和依托泊苷后的急性肾毒性。
案例：我们介绍了自体干细胞移植中卡莫斯汀引起的急性肾脏损伤的第一例病例，并进行了文献复习。肾衰竭与血清肌酐，少尿和微量蛋白尿的急剧升高有关。需要紧急血液透析；但是，肾功能衰竭在7天后消失。
结论：尽管并发症少见，但其严重性要求密切监测肾功能，因为早期识别和治疗可能会限制长期后遗症。

BACKGROUND & AIMS: BACKGROUND:There is a deficit of information regarding the factors that influence peritoneal protein excretion (PPE) during PD therapy. In particular, the effects of the modality of PD and other conditions of the dialysis prescription remain unclear. METHOD:This prospective, observational study analysed the effects of prescription characteristics on 24-hour PPE (study variable) in a cohort of patients starting PD. Our statistical analysis included a multi-level mixed model and standardised estimations of peritoneal protein transport during serial four-hour peritoneal equilibrium tests in order to control for disparities in the characteristics of patients managed on different regimens. RESULTS:We evaluated 284 patients, 197 on CAPD and 87 on automated PD (APD), at the start of PD treatment. The two groups differed in terms of clinical characteristics and peritoneal function. Univariate, serial estimates of 24-hour PPE were marginally higher in CAPD patients, and remained essentially stable over time in both groups. Multivariate analyses identified CAPD (B=888.5mg, 95% CI: 327.5/1448.6), total dialysate volume infused per day (B=275.9 mg/Ll; 153.9/397.9) and ultrafiltration (B=0.41 mg/mL; 0.02/0.80) as independent predictors of 24-hour PPE. The model also revealed a minor trend for a lower 24-hour PPE as time on PD increases. CONCLUSIONS:The individual characteristics of peritoneal protein transport are the major determinants of 24-hour PPE. The use of CAPD as the dialysis modality is associated with higher PPE rates than the APD technique, although this difference is counterbalanced by a direct correlation between PPE and the volume of dialysate infused per day. Ultrafiltration and time on dialysis also act as minor independent predictors of PPE during PD therapy.

背景与目标： 背景：关于PD治疗期间影响腹膜蛋白排泄（PPE）的因素的信息不足。特别是，PD方式和透析处方其他条件的影响仍不清楚。
方法：这项前瞻性观察性研究分析了处方特征对一群开始PD的患者24小时PPE（研究变量）的影响。我们的统计分析包括一个多级混合模型和一系列连续四个小时的腹膜平衡测试过程中的腹膜蛋白运输的标准化估计，以控制采用不同方案治疗的患者的特征差异。
结果：在PD治疗开始时，我们评估了284例患者，其中CAPD为197例，自动PD为87例。两组的临床特征和腹膜功能不同。 CAPD患者24小时PPE的单变量，系列估计略高，两组随时间的推移基本保持稳定。多变量分析确定了CAPD（B = 888.5mg，95％CI：327.5 / 1448.6），每天注入的总透析液体积（B = 275.9 mg / Ll; 153.9 / 397.9）和超滤（B = 0.41 mg / mL; 0.02 / 0.80 ）作为24小时个人防护装备的独立预测指标。该模型还显示出随着PD持续时间的增加，PPE降低的趋势很小。
结论：腹膜蛋白运输的个体特征是24小时PPE的主要决定因素。使用CAPD作为透析方式比使用APD技术具有更高的PPE率，尽管这种差异可以通过PPE和每天注入的透析液量之间的直接相关性来抵消。超滤和透析时间也是PD治疗期间PPE的次要独立预测指标。

BACKGROUND & AIMS: AIM:This study set out to measure the quality of life (QoL) of the dialysis patient. The first aim was to investigate the QoL of Hong Kong dialysis patients, and the second to understand the relationship between the demographic data and the QoL of the subjects. RATIONALE:Patients undergoing dialysis experience problems with disease-specific symptoms. The combination of a decrease in energy, the unavoidable emergence of socioeconomic problems, and emotional reactions compounds the stress facing the patient. The life of a dialysis patient may be lacking in quality. Few studies have examined the QoL of Hong Kong dialysis patients. More information is needed to establish how patients can be helped to lead more productive lives. METHODS:The Chinese Dialysis QoL Scale was used. A convenience sampling method was used to recruit patients from the outpatient clinics of dialysis centres. The distribution score on each item and the overall score were computed, with a lower score indicating greater negative impact of dialysis. To compare whether there is a difference in the average QoL score obtained between different groups on each of the demographic variables, one-way ANOVA followed by Tukey's post hoc analysis were used. Pearson's product moment correlation was used to examine the relationships between the demographic variables and the overall QoL score. FINDINGS:Of the 180 scales distributed, 164 were returned, giving a response rate of 91%. The mean of the total score was 132.5 with SD 16.68, varying between 97 and 179. The item mean score was 3.31. Marital status, type of modalities, and age appear to have no relationship to QoL. CONCLUSION:Patients undergoing dialysis in this study experienced multiple physical, social, economic and psychological changes. The priority of healthcare services should therefore be to provide support in the areas of family and social life, information and employment.

背景与目标： 目的：该研究旨在测量透析患者的生活质量（QoL）。第一个目的是调查香港透析患者的生活质量，第二个目的是了解人口统计学数据与受试者的生活质量之间的关系。
理由：接受透析的患者会遇到疾病特定症状的问题。能量减少，不可避免的社会经济问题的出现以及情绪反应的结合加剧了患者面临的压力。透析患者的生活质量可能不高。很少有研究检查香港透析患者的生活质量。需要更多的信息来确定如何可以帮助患者过上更有生产力的生活。
方法：采用中国透析质量量表。使用便利采样方法从透析中心的门诊诊所招募患者。计算每个项目的分布得分和总得分，得分越低表明透析的负面影响越大。为了比较在每个人口统计学变量的不同组之间获得的平均QoL分数是否存在差异，使用了单向方差分析和Tukey事后分析。皮尔逊的乘积矩相关性用于检验人口统计学变量与总体QoL得分之间的关​​系。
结果：在分配的180个量表中，返回了164个，响应率为91％。总分的平均值为132.5，标准差为16.68，介于97和179之间。项目的平均分数为3.31。婚姻状况，方式类型和年龄似乎与生活质量没有关系。
结论：本研究中接受透析的患者经历了多种生理，社会，经济和心理变化。因此，医疗保健服务的优先重点应该是在家庭和社会生活，信息和就业领域提供支持。

BACKGROUND & AIMS: OBJECTIVES:The relationships among body mass index (BMI), diabetes, age, and all-cause mortality in hemodialysis patients remain unclear. We examined BMI-stratified relationships between diabetes, age, and the risk of long-term mortality in incident hemodialysis patients. METHODS:This is a cohort study. Data were obtained from the national dialysis registry in Japan 2007 that included 35,415 incident hemodialysis patients and 6,061 patients aged ≥20 years with BMI data. Patients were divided into 6 categories according to baseline BMI (low: <18.5, normal: 18.5-25, Obesity: ≥25) and the presence or absence of diabetes. The primary outcome was all-cause mortality during a 5-year follow-up. Hazard ratios were estimated using Cox's model for the relationships among diabetes, BMI categories, and all-cause mortality, and adjusted for potential confounders. Patients with a normal BMI and non-diabetic were the reference category. We also examined the effects of age on these relationships. RESULTS:A total of 6,061 patients, including 3,239 with diabetes, were enrolled. During the follow-up, 31.0% and 30.7% of all and diabetic patients, respectively, died. Cox's regression analysis showed that low BMI, but not obesity, was independently associated with an increased risk of all-cause death in patients with and without diabetes. When patients were divided into 2 groups-younger and older than 60 years-the risk of mortality in both groups was increased in low BMI with diabetes. CONCLUSIONS:Among Japanese incident hemodialysis patients, low BMI increases the risk of all-cause mortality. The markedly high mortality rate in diabetic patients with low BMI regardless of age warrants attention.

背景与目标： 目的：血液透析患者的体重指数（BMI），糖尿病，年龄和全因死亡率之间的关系尚不清楚。我们检查了糖尿病，年龄和事件性血液透析患者长期死亡风险之间的BMI分层关系。
方法：这是一项队列研究。数据是从2007年日本国家透析注册中心获得的，其中包括35,415名事件性血液透析患者和6,061名年龄≥20岁的患者的BMI数据。根据基线BMI（低：<18.5，正常：18.5-25，肥胖：≥25）以及是否存在糖尿病将患者分为6类。主要结局是5年随访期间的全因死亡率。使用Cox模型估算了糖尿病，BMI类别和全因死亡率之间的关系，并针对潜在的混杂因素进行了调整。 BMI正常且非糖尿病的患者为参考类别。我们还研究了年龄对这些关系的影响。
结果：共纳入6061例患者，其中3239例患有糖尿病。在随访期间，所有和糖尿病患者分别死亡31.0％和30.7％。 Cox回归分析显示，低BMI（而非肥胖）与患有和不患有糖尿病的患者全因死亡风险增加独立相关。当将患者分为年龄小于60岁和年龄大于60岁的两组时，在低BMI的糖尿病患者中，两组的死亡风险均增加。
结论：在日本发生血液透析的患者中，低BMI会增加全因死亡的风险。无论年龄大小，低BMI糖尿病患者的死亡率均显着较高，值得关注。

BACKGROUND & AIMS: :Although red cell distribution width (RDW) has emerged as a biomarker of clinical prognostic value across a variety of clinical settings in the last two decades, limited evidence is available for its role in end-stage renal disease. We enrolled 313 incident patients undergoing continuous ambulatory peritoneal dialysis (CAPD) in this retrospective observational study from 2006 to 2015. In the fully adjusted model of Cox regression analysis, the adjusted hazard ratios for the high RDW group versus the low RDW group were 2.58 (95% confidence interval (CI) = 1.31-5.09, p = 0.006) and 3.48 (95% CI = 1.44-8.34, p = 0.006) for all-cause and cardiovascular disease (CVD)-related mortality, respectively. Based on area under the receiver operating characteristic curve (AUC) analysis, RDW (AUC = 0.699) had a stronger predictive value for all-cause and CVD-related mortality than other biological markers including hemoglobin (AUC = 0.51), ferritin (AUC = 0.584), iron saturation (AUC = 0.535), albumin (AUC = 0.683) and white blood cell count (AUC = 0.588). Given that RDW is a readily available hematological parameter without the need for additional cost, we suggest that it can be used as a valuable index to stratify the risk of mortality beyond a diagnosis of anemia.

背景与目标： ：尽管在过去的二十年中，红细胞分布宽度（RDW）已成为各种临床环境中临床预后价值的生物标志物，但有关其在终末期肾脏疾病中的作用的证据有限。在2006年至2015年的这项回顾性观察性研究中，我们纳入了313名接受连续非卧床腹膜透析（CAPD）的事件患者。在完全调整的Cox回归分析模型中，高RDW组与低RDW组的调整后风险比为2.58（全因和与心血管疾病（CVD）相关的死亡率分别为95％置信区间（CI）= 1.35-1.09，p = 0.006）和3.48（95％CI = 1.44-8.34，p = 0.006）。根据接受者工作特征曲线（AUC）分析下的面积，RDW（AUC = 0.699）较其他生物标志物，包括血红蛋白（AUC = 0.51），铁蛋白（AUC = 0.584），铁饱和度（AUC = 0.535），白蛋白（AUC = 0.683）和白细胞计数（AUC = 0.588）。鉴于RDW是易于获得的血液学参数，不需要额外的费用，因此我们建议将其用作有价值的指标，以对诊断为贫血以外的死亡风险进行分层。

BACKGROUND & AIMS: :To evaluate the operative result and the perioperative management of dialysis patients undergoing elective cardiac surgery, we retrospectively reviewed consecutive adult patients with chronic renal failure dependent on maintenance dialysis. Between April 1994 and March 2002, 20 patients who underwent cardiopulmonary bypass (CPB) procedures were studied. Fourteen patients underwent isolated coronary artery bypass grafting, four valve replacements and two combined procedures. Our strategy for the chronic dialysis patients was as follows: dialysis the day before the operation, intraoperative hemodialysis (HD) during CPB, and no dialysis or hemofiltration (HF) on the operative day. Intraoperative HD produces the optimal fluid and electrolyte balance at the end of the operation. The mean interval between the end of surgery and the commencement of HD was 31.2+/-12.5 h. No patients required any hemocatharsis such as HF or HD on the day of operation. The overall operative mortality was 5.0%. There were six late deaths (30.0%). Overall, including the operative and non-cardiac death, actuarial survival rate was 85.0% at 1 year, 70.0% at 5 years, and 65.0% at 6 years. Intraoperative HD has an advantage in the postoperative period; it avoids the hemodynamic instability and the risk of heparin-associated bleeding associated with the use of HD.

背景与目标： ：为了评估接受择期心脏手术的透析患者的手术效果和围手术期管理，我们回顾性地回顾了依赖维持透析的连续成年慢性肾功能衰竭患者。在1994年4月至2002年3月之间，研究了20位接受了体外循环（CPB）程序的患者。 14例患者接受了孤立的冠状动脉搭桥术，4例瓣膜置换术和2例联合手术。我们针对慢性透析患者的策略如下：手术前一天进行透析，CPB期间进行术中血液透析（HD），手术当天不进行透析或血液滤过（HF）。术中HD在手术结束时可产生最佳的液体和电解质平衡。手术结束与HD开始之间的平均间隔为31.2 /-12.5 h。没有患者在手术当天需要任何血液透析，例如HF或HD。总体手术死亡率为5.0％。有六例晚期死亡（30.0％）。总体而言，包括手术和非心脏死亡，精算生存率在1年时为85.0％，在5年时为70.0％，在6年时为65.0％。术中HD在术后期间具有优势。它避免了使用HD引起的血液动力学不稳定和肝素相关性出血的风险。

BACKGROUND & AIMS: :Mesenchymal stroma cells (MSCs) have potential as an emerging cell therapy for treating many different diseases, but discovery of the practical sources of MSCs is needed for the large-scale clinical application of this therapy. This study was to identify MSCs in peritoneal dialysis (PD) effluents that were discarded after PD. The effluents were collected from patients who were on the dialysis for less than 1 month. Adherent cells from the effluents were isolated by incubation in serum-containing medium in plastic culture dishes. Cell surface markers were determined by a flow cytometric analysis, and the in vitro differentiation to chondrocytes, osteocytes or adipocytes was confirmed by staining with a specific dye. After four passages, these isolated cells displayed the typical morphology of mesenchymal cells in traditional 2-D cultures, and were grown to form spherical colonies in 3-D collagen cultures. Flow cytometric analysis revealed that the unsorted cells from all of seven patient samples showed robust expression of typical mesenchymal marker CD29, CD44, CD73, CD90 and CD166, and the absence of CD34, CD79a, CD105, CD271, SSEA-4, Stro-1 and HLA-DR. In differentiation assays, these cells were induced in vitro to chondrocytes, osteocytes or adipocytes. In conclusion, this preliminary study suggests the presence of MSCs in the "discarded" PD effluents. Further characterization of the phenotypes of these MSCs and evaluation of their therapeutic potential, particularly for the prevention of PD failure, are needed.

背景与目标： 间充质基质细胞（MSCs）作为治疗许多不同疾病的新兴细胞疗法具有潜力，但是该疗法的大规模临床应用需要发现MSCs的实际来源。这项研究是为了确定腹膜透析（PD）流出物中的MSC，这些MSC在PD后被丢弃。从透析时间少于1个月的患者中收集污水。通过在塑料培养皿中的含血清培养基中孵育，分离出流出物的粘附细胞。通过流式细胞术分析确定细胞表面标志物，并通过用特定染料染色确认体外分化为软骨细胞，骨细胞或脂肪细胞。经过四次传代后，这些分离的细胞在传统的2-D培养物中显示出间充质细胞的典型形态，并在3-D胶原培养物中生长形成球形菌落。流式细胞仪分析显示，来自所有七个患者样品的未分选细胞均表现出典型的间充质标记CD29，CD44，CD73，CD90和CD166的强表达，而不含CD34，CD79a，CD105，CD271，SSEA-4，Stro-1和HLA-DR。在分化测定中，这些细胞在体外被诱导成软骨细胞，骨细胞或脂肪细胞。总之，这项初步研究表明在“丢弃的” PD废水中存在MSC。需要进一步表征这些MSC的表型并评估其治疗潜力，尤其是对于预防PD衰竭。

BACKGROUND & AIMS: :Developing guidelines on a subject as broad as hypertension is difficult, especially when the guidance relates to hypertension in the chronic kidney disease (CKD) population. The Kidney Disease: Improving Global Outcomes Guideline Development Group has applied a rigorous methodology in reviewing all available evidence, and their recommendations are consistent with the evidence-based approach. As a result, the European Renal Best Practice endorses most of its recommendations. However, the Work Group feels that some additional advice could help clinicians in daily practice: (i) individualization of treatment should be taken into account, especially (cardiovascular) co-morbidities, age, gender and race; (ii) side-effects, such as postural dizziness should be monitored closely, particularly in elderly, diabetics and patients with arterial stiffness; (iii) the importance of salt restriction should not be neglected; (iv) although angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blocker (ARBs) remain a cornerstone in the management of hypertension, and especially cardiovascular protection, in some particular situations such as in advanced CKD and in patients without proteinuria, their role is less well defined; (v) as most CKD patients need more than one antihypertensive drug to achieve blood pressure control, the specific (renal) (dis)advantages of other classes than ACE-I or ARB should be taken into account.

背景与目标： ：很难针对广泛的高血压制定指南，尤其是当指南涉及慢性肾脏病（CKD）人群的高血压时。肾脏疾病：改善全球结果指南制定小组在审查所有可用证据时采用了严格的方法，其建议与基于证据的方法一致。因此，欧洲肾脏病最佳实践认可了其大部分建议。但是，工作组认为，一些其他建议可以在临床实践中为临床医生提供帮助：（i）应考虑到个体化治疗，尤其是（心血管）合并症，年龄，性别和种族； （ii）应严密监测姿势性头晕等副作用，尤其是在老年人，糖尿病患者和动脉僵硬患者中； （iii）不应限制盐的重要性； （iv）尽管在某些特殊情况下（例如晚期CKD和无蛋白尿的患者），血管紧张素转换酶抑制剂（ACE-Is）和血管紧张素受体阻滞剂（ARBs）仍是控制高血压，尤其是心血管保护的基础，他们的角色定义不太明确； （v）由于大多数CKD患者需要一种以上的降压药物来控制血压，因此应考虑ACE-1或ARB以外的其他类别的特定（肾脏）（不利）优势。