Eggerthella lenta is rarely isolated from blood but may occur as an opportunistic pathogen with high morbidity and mortality. We report a case of E. lenta bacteremia after an endoscopic retrograde cholangiopancreatography in an end-stage renal disease patient.
Bacteremia* ; Cholangiopancreatography, Endoscopic Retrograde* ; Humans ; Kidney Failure, Chronic* ; Mortality

BACKGROUND AND OBJECTIVE

Several studies have examined the predictors of mortality among COVID-19-infected patients; however, to date, few published studies focused on end-stage renal disease patients. The present study,therefore, aims to determine the predictors of in-hospital mortality among end-stage renal disease patients with COVID-19 admitted to a Philippine tertiary hospital.

The researcher utilized a retrospective cohort design. A total of 449 adult end-stage renal disease patients on renal replacement therapy diagnosed with moderate-to-severe COVID-19 and were admitted at the National Kidney and Transplant Institute from June 2020 to 2021 were included. Logistic regression analysis was used to determine the factors associated with in-hospital mortality.

In-hospital mortality among end-stage renal disease patients with COVID-19 was 31.18% (95% CI: 26.92- 35.69%). Older age (OR=1.03), male sex (OR=0.56), diabetes mellitus (OR=1.80), coronary artery disease (OR=1.71), encephalopathy (OR=7.58), and intubation (OR=30.78) were associated with in-hospital mortality.

Patients with ESRD and COVID-19 showed a high in-hospital mortality rate. Older age, diabetes mellitus, coronary artery disease, encephalopathy, and intubation increased the odds of mortality. Meanwhile, males had lower odds of mortality than females.

Background and Objective: Several studies have examined the predictors of mortality among COVID-19-infected patients; however, to date, few published studies focused on end-stage renal disease patients. The present study,therefore, aims to determine the predictors of in-hospital mortality among end-stage renal disease patients with COVID-19 admitted to a Philippine tertiary hospital. Methods: The researcher utilized a retrospective cohort design. A total of 449 adult end-stage renal disease patients on renal replacement therapy diagnosed with moderate-to-severe COVID-19 and were admitted at the National Kidney and Transplant Institute from June 2020 to 2021 were included. Logistic regression analysis was used to determine the factors associated with in-hospital mortality. Results: In-hospital mortality among end-stage renal disease patients with COVID-19 was 31.18% (95% CI: 26.92- 35.69%). Older age (OR=1.03), male sex (OR=0.56), diabetes mellitus (OR=1.80), coronary artery disease (OR=1.71), encephalopathy (OR=7.58), and intubation (OR=30.78) were associated with in-hospital mortality. Conclusion Patients with ESRD and COVID-19 showed a high in-hospital mortality rate. Older age, diabetes mellitus, coronary artery disease, encephalopathy, and intubation increased the odds of mortality. Meanwhile, males had lower odds of mortality than females.
COVID-19 ; Kidney Failure, Chronic ; Hospital Mortality ; Renal Replacement Therapy

Hypertension affects the majority of patients with chronic kidney disease (CKD) and increases the risk of cardiovascular disease, end-stage renal disease and mortality. Previously, many hypertension guidelines have suggested blood pressure targets in patients with CKD. Recently, the American College of Cardiology/American Heart Association 2017 Guideline for Hypertension suggests a new definition for hypertension and therapeutic targets, which were equally applicated to patients with CKD. These changes reflect the results of the Systolic Blood Pressure Intervention Trial (SPRINT) study, but the renal outcome of intensive blood pressure control was not good. Furthermore, the majority of hypertension guidelines including those of the Korean Society of Hypertension and the European Society of Hypertension have retained the traditional definition. Herein, we intend to analyze in detail the effect of intensive blood pressure control on kidney through the post-hoc analyses of the SPRINT study.
Blood Pressure ; Cardiovascular Diseases ; Diagnosis ; Heart ; Humans ; Hypertension ; Kidney ; Kidney Failure, Chronic ; Mortality ; Renal Insufficiency, Chronic

Drugs, Chinese Herbal ; pharmacology ; Humans ; Kidney Failure, Chronic ; mortality ; physiopathology ; Renal Dialysis ; methods ; mortality ; Survival Rate

With the widespread availability of dialysis, the lives of end-stage renal disease patients have been prolonged over the past fifty years. Hemodialysis relies on the diffusion of molecules across a semipermeable membrane along the concentration gradient. In addition to diffusion, movement of waste products from the circulation into the dialysate can occur as a result of convective clearance. Use of high-flux dialyzer has increased the removal of the middle molecules such as beta2-microglobulin. Recently on-line hemodiafiltration which combined the hemodialysis and hemofiltration to increase the convective clearance of the large molecules has been available. About the hemodialysis adequacy, the result of hemodialysis (HEMO) study suggests that increasing the dose to greater than a single-pool Kt/Vurea 1.4 does not improve the survival of the patients. While the technical and scientific improvement in hemodialysis has led to a noticeable improvement in the survival of the dialysis patients, cardiovascular mortality and event rates are extraordinarily high in dialysis population. In addition to hemodialysis treatment, nephrologists taking care of dialysis patients must recognize and treat the diverse complications that can result from the loss of kidney function.
Dialysis ; Diffusion ; Hemodiafiltration ; Hemofiltration ; Humans ; Kidney ; Kidney Failure, Chronic ; Membranes ; Mortality ; Renal Dialysis* ; Waste Products

With the widespread availability of dialysis, the lives of end-stage renal disease patients have been prolonged over the past fifty years. Hemodialysis relies on the diffusion of molecules across a semipermeable membrane along the concentration gradient. In addition to diffusion, movement of waste products from the circulation into the dialysate can occur as a result of convective clearance. Use of high-flux dialyzer has increased the removal of the middle molecules such as beta2-microglobulin. Recently on-line hemodiafiltration which combined the hemodialysis and hemofiltration to increase the convective clearance of the large molecules has been available. About the hemodialysis adequacy, the result of hemodialysis (HEMO) study suggests that increasing the dose to greater than a single-pool Kt/Vurea 1.4 does not improve the survival of the patients. While the technical and scientific improvement in hemodialysis has led to a noticeable improvement in the survival of the dialysis patients, cardiovascular mortality and event rates are extraordinarily high in dialysis population. In addition to hemodialysis treatment, nephrologists taking care of dialysis patients must recognize and treat the diverse complications that can result from the loss of kidney function.
Dialysis ; Diffusion ; Hemodiafiltration ; Hemofiltration ; Humans ; Kidney ; Kidney Failure, Chronic ; Membranes ; Mortality ; Renal Dialysis* ; Waste Products

BACKGROUND: Chronic anemia inceases cardiovascular risk and its related mortality in patients with undergoing maintenance hemodialysis. To resolve the issue of anemia due to diminished synthesis of erythropoietin (EPO), regular injection of parenteral recombinant human EPO was adopted in most dialysis center. But we are not aware of previous reports of the relationship between modality or intensity of dialysis and anemia with EPO resistancy. For these reasons, we investigated the relation between the adequacy of dialysis and the response of EPO in end stage renal disease (ESRD) patients who were receiving maintenance hemodialysis at least for three months in same condition. METHODS: We studied prospectively 57 adult ESRD patients with hemoglobin below 11 g/dL. RESULTS: 13 patients showed the under dialysis, and there was no differences in clinical features with the control groups, except the ratio of gender. At the beginning of the study, the control groups who received adequate dialysis showed better nutritional state. The groups who had received under dialysis showed the increment of 37% in Kt/V from 3.02+/-0.79 to 4.21+/-0.24 (p< 0.01), Hb from 8.98+/-0.79 to 9.34+/-0.97 g/dL (p< 0.01), and Hct from 26.44+/-2.38 to 27.31+/-2.95% (p< 0.05) after increase of the dialysis doses. CONCLUSION: Based on above results, we concluded that the patients with EPO could be improved in chronic anemia by means of increased dialysis doses.
Adult ; Anemia* ; Dialysis* ; Erythropoietin ; Humans ; Kidney Failure, Chronic ; Mortality ; Prospective Studies ; Renal Dialysis*

BACKGROUND: Although patients with end-stage renal disease (ESRD) experience excess mortality compared with the general population, the standardized mortality ratio (SMR) for Korean patients on dialysis has not yet been investigated. In this study, we evaluated the SMR among all Korean ESRD patients on maintenance ialysis in 2009 and 2010, and compared it according to age categories, sex, and dialysis modality. METHODS: We used data from all patients on maintenance dialysis between January 1, 2009 and December 31, 2010 in Korea using the database of the Korean Health Insurance Review and Assessment Service, and the SMR was determined by calculating of the ratio between the number of actual deaths and expected deaths. RESULTS: A total of 45,568 patients in 2009 and 48,170 patients in 2010 were included in the analysis. The overall age- and sex-adjusted SMR was 10.3 [95% confidence interval (CI), 10.0-10.6] in 2009 and 10.9 (95% CI, 10.7-11.2) in 2010. The SMR for females was much higher than for males. The SMR gradually decreased with increasing age groups. The overall SMR for maintenance hemodialysis patients was lower than that of peritoneal dialysis patients. CONCLUSION: The SMR among Korean ESRD patients is likely to be higher than in other countries. Further evaluation is needed to attempt to improve the outcomes.
Dialysis* ; Female ; Humans ; Insurance, Health ; Kidney Failure, Chronic ; Korea ; Male ; Mortality* ; Peritoneal Dialysis ; Renal Dialysis

BACKGROUND AND OBJECTIVES: Sirolimus-eluting stents (SES), as opposed to bare metal stents (BMS), have been shown to markedly reduce restenosis. However, many clinical trials have excluded the subset of patients (pts) with end-stage renal disease (ESRD). The aim of this study was to evaluate the clinical outcomes following SES implantation in ESRD pts. SUBJECTS AND METHODS: We analyzed the clinical outcomes in 50 pts from our registry following SES implantation, and compared the outcomes between those with ESRD receiving SES (SES-ESRD) and BMS (BMS-ESRD), and with non-ESRD pts following SES implantation (SES-non ESRD). RESULTS: A comparison of the SES-ESRD (50 pts, 72 lesions) with BMS-ESRD groups (42 pts, 45 lesions); those in the SES-ESRD group included; diabetes 78%, hypertension 94% and age 62+/-10 years. Those in the SES-ESRD group were more likely to have diabetes (diabetes of BMS-ESRD, 57%; p=0.04). The reference vessel diameters (RVD) of the SES-ESRD group were smaller (2.76+/-0.50 mm vs. 3.05+/-0.46 mm, p<0.001), but the lesion length was longer (25.6+/-7.0 mm vs. 19.1+/-8.8 mm, p<0.001) than those of the BMS-ESRD group. The SES-ESRD group had a lower 1-year major adverse cardiac events (MACE) rate than the BMS-ESRD group (6.0% vs. 33.3%; p<0.001). There were no differences in mortality and incidence of myocardial infarction between the two groups. The incidence of target vessel revascularization decreased significantly in the SES-ESRD group (2.0% vs. 19.0%, p=0.01). From a multivariate regression analysis, the use of SES was the only significant independent predictor of MACE (OR=0.054, 95% confidence interval 0.01 to 0.26, p<0.001). A comparison with SES-non ESRD group in our total registry (644 pts, 758 lesions); MACE in the SES-ESRD group (6.0%) was higher than in the SES-non ESRD group (3.1%), but there was no statistical significance (p=0.23). CONCLUSION: Compared with BMS, SES caused an improvement in the clinical outcomes in pts with ESRD.
Angioplasty* ; Humans ; Hypertension ; Incidence ; Kidney Failure, Chronic* ; Mortality ; Myocardial Infarction ; Stents*