BACKGROUND/AIMS: Many studies have compared patients with systemic lupus erythematosus (SLE) on renal replacement therapy (RRT) with non-lupus patients. However, few data are available on the long-term outcome of patients with end-stage renal disease (ESRD) secondary to SLE who are managed by different types of RRTs. METHODS: We conducted a retrospective multicenter study on 59 patients with ESRD who underwent maintenance RRT between 1990 and 2007 for SLE. Of these patients, 28 underwent hemodialysis (HD), 14 underwent peritoneal dialysis (PD), and 17 patients received kidney transplantation (KT). We analyzed the clinical outcomes in these patients to determine the best treatment modality. RESULTS: The mean follow-up period was 5 +/- 3 years in the HD group, 5 +/- 3 years in the PD group, and 10 +/- 5 years in the KT group (p = 0.005). Disease flare-up was more common in the HD group than in the KT group (p = 0.012). Infection was more common in the PD and HD groups than in the KT group (HD vs. KT, p = 0.027; PD vs. KT, p = 0.033). Cardiovascular complications were more common in the HD group than in the other groups (p = 0.049). Orthopedic complications were more common in the PD group than in the other groups (p = 0.028). Bleeding was more common in the HD group than in the other groups (p = 0.026). Patient survival was greater in the KT group than in the HD group (p = 0.029). Technique survival was lower in the PD group than in the HD group (p = 0.019). CONCLUSIONS: Among patients with ESRD secondary to SLE, KT had better patient survival and lower complication rates than HD and lower complication rates than PD. The prognosis between the HD and PD groups was similar. We conclude that if KT is not a viable treatment option, any alternative treatment should take into account the patient's general condition and preference.
Adult ; Female ; Humans ; Kidney Failure, Chronic/etiology/mortality/*therapy ; Lupus Nephritis/*complications ; Male ; Middle Aged ; *Renal Replacement Therapy ; Retrospective Studies ; Treatment Outcome

INTRODUCTIONFournier's gangrene (FG) is a life-threatening infection of the perineal and genital areas. We examined the comorbid diseases, treatments and factors affecting mortality in FG.

METHODSThis retrospective clinical study involved 52 patients who were treated for FG. The demographics, aetiologies, comorbid diseases, laboratory and bacteriology findings, treatment methods and length of hospital stay were compared between patients who died and those who survived the infection.

RESULTSOut of the 52 patients, 12 died and 40 survived. Patients who died and those who survived were similar in terms of their mean age at first presentation (62 vs. 55 years), the mean number of debridements (3.6 vs. 2.9), the mean length of hospital stay (25 vs. 34 days) and gender (p > 0.05 for each). However, the mean leukocyte count was higher in patients who died than in surviving patients (33.6 ± 7.2 vs. 14.3 ± 4.9 cells/mml; p < 0.05). The most common aetiology in both groups was perianal abscess. Deviating colostomy was performed in 13 patients. Of the patients who died, nine had haemodialysis-dependent chronic renal failure and type II diabetes mellitus (DM), while one had type II DM and hypertension.

CONCLUSIONHaemodialysis-dependent chronic renal failure and a high leukocyte count at first presentation were found to be the factors affecting mortality in FG patients.

Adult ; Aged ; Anti-Bacterial Agents ; therapeutic use ; Comorbidity ; Debridement ; methods ; Female ; Fournier Gangrene ; complications ; mortality ; therapy ; Humans ; Kidney Failure, Chronic ; etiology ; Length of Stay ; Leukocyte Count ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Survival Rate

This study was to evaluate the status of initiating pattern of hemodialysis (HD). Five hundred-three patients in 8 University Hospitals were included. Presentation mode (planned vs. unplanned), and access type (central venous catheters [CVC] vs. permanent access) at initiation of HD were evaluated, and the influence of predialysis care on determining the mode of HD and access type was also assessed. Most patients started unplanned HD (81.9%) and the most common initial access type was CVC (86.3%). The main reason for unplanned HD and high rate of CVC use was patient-related factors such as refusal of permanent access creation and failure to attend scheduled clinic appointments. Predialysis care was performed in 57.9% of patients and only 24.1% of these patients started planned HD and 18.9% used permanent accesses initially. Only a minority of patients initiated planned HD with permanent accesses in spite of predialysis care. To overcome this, efforts to improve the quality of predialysis care are needed.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Arteriovenous Fistula ; Female ; Glomerular Filtration Rate ; Humans ; Kidney Failure, Chronic/etiology/mortality/therapy ; Male ; Middle Aged ; Multivariate Analysis ; Nephrology/*methods ; Renal Dialysis/*methods ; Retrospective Studies ; Treatment Outcome

The number of patients with end-stage renal disease (ESRD) is rising very rapidly as the number of elderly and patients with diabetes increases in Korea. ESRD Registry Committee of the Korean Society of Nephrology (KSN) collected dialysis therapy data in Korea through an online registry program on the KSN website. The status of renal replacement therapy in Korea at the end of 2009 was as follows. First, total number of patients with ESRD was 56,396 (hemodialysis [HD], 37,391; peritoneal dialysis [PD], 7,618; functioning kidney transplant [KT], 11,387). The prevalence of ESRD was 1,113.6 patients per million population (PMP). Proportion of patients undergoing renal replacement therapy was 66.3% with HD, 13.5% with PD, and 20.2% with KT. Second, a total of 8,906 (HD, 6,540; PD, 1,125; KT, 1,241; incidence rate of 175.9 PMP) patients developed ESRD in 2009. Third, the most common primary causes of ESRD were diabetic nephropathy (45.4%), hypertensive nephrosclerosis (18.3%), and chronic glomerulonephritis (11.1%). Fourth, mean urea reduction rate was 67.5% and 73.8% in male and female patients, respectively, undergoing HD. Mean Kt/V was 1.38 in male patients and 1.65 in female patients. Fifth, the overall 5-year survival rate of male patients undergoing dialysis was 65.4% and that of female patients was 67.4%.
Adult ; Aged ; Anemia/drug therapy/etiology ; Comorbidity ; Erythropoietin, Recombinant/therapeutic use ; Female ; Hematinics/therapeutic use ; Humans ; Incidence ; Kidney Failure, Chronic/mortality/*therapy ; Male ; Middle Aged ; Prevalence ; Registries ; *Renal Dialysis/adverse effects/mortality ; Republic of Korea/epidemiology ; Risk Factors ; Survival Rate ; Time Factors ; Treatment Outcome