Symptom prevalence and the negative emotional states in end-stage renal disease patients with or without renal replacement therapy: a cross-sectional analysis

Background: Limited comparative data are available on the symptom severity and burden of dialyzed versus nondialyzed end-stage renal disease (ESRD) patients and their association with negative emotional states. Objective: To investigate the prevalence of symptom burden and severity of ESRD patients and correlate the findings with their psychological status. Methods: This was a cross-sectional study of dialyzed (N = 87) and nondialyzed (N = 100) patients. The symptom burden and severity were determined using the Dialysis Symptom Index (DSI) and the psychological assessment using Depression Anxiety Stress Scale 21 (DASS-21). Results: Symptom severity evaluated using the DSI was comparable in both groups with fatigue as the most common symptom (n = 141, 75.4%), followed by sleep-related, sexual dysfunction, and dry skin problems. The symptom burden for worrying, dry skin and mouth, decreased appetite, numbness, and leg swelling were significant in not dialyzed group (p < 0.05).The DASS-21 scores revealed that 11% of patients were depressed, 21.8% were stressed, and 15.6% were anxious (p < 0.030). The prevalence of psychological disturbances was associated with high symptom burden regardless of their treatment options (p < 0.005). Dialyzed patients showed a positive psychological status trend on DASS-21 assessment. The not dialyzed group consisted of 34% from comprehensive conservative group, 26% of choice-restricted conservative care, and 40% with no definitive future plan. Conclusions: There was no difference in the prevalence of symptom burden and severity, irrespective of the type of treatment. Psychological disturbances were associated with higher symptom burden and severity and, therefore, should be screened thoroughly to achieve optimal ESRD management

Strengthening Renal Registries and ESRD Research in Africa

CITATION: Davids, M. R., et al. 2017. Strengthening renal registries and ESRD research in Africa. Seminars in Nephrology, 37(3):211-223, doi:10.1016/j.semnephrol.2017.02.002.The original publication is available at http://www.seminarsinnephrology.orgENGLISH ABSTRACT: In Africa the combination of non-communicable diseases, infectious diseases, exposure to environmental toxins and acute kidney injury related to trauma and childbirth are driving an epidemic of chronic kidney disease (CKD) and end-stage renal disease (ESRD). Good registry data can inform the planning of renal services and can be used to argue for better resource allocation, audit the delivery and quality of care, and monitor the impact of interventions. Few African countries have established renal registries and most have failed due to resource constraints. In this paper we briefly review the burden of CKD and ESRD in Africa then consider the research questions which could be addressed by renal registries. We describe examples of the impact of registry data and summarise the sparse primary literature on country-wide renal replacement therapy (RRT) in African countries over the past 20 years. Finally, we highlight some initiatives and opportunities for strengthening research on ESRD and RRT in Africa. These include the establishment of the African Renal Registry and the availability of new areas for research. We also discuss capacity-building, collaboration, open access publication and the strengthening of local journals, all measures which may improve the quantity, visibility and impact of African research outputs.AFRIKAANSE OPSOMMING: Geen opsomming beskikbaarhttp://www.seminarsinnephrology.org/article/S0270-9295(17)30002-5/fulltextPostprin

Prognostic factors of all-cause mortalities in continuous ambulatory peritoneal dialysis: a cohort study

Background: The role of small solute clearance on mortalities in patients with CAPD has been controversial. We therefore conducted a study with 3 years' follow up in adult patients who participated in the CAPD-first policy. Methods: There were 11,523 patients with end-stage renal disease who participated in the CAPD-first policy between 2008 and 2011. Among them, 1,177 patients were included in the retrospective cohort study. A receiver operating characteristic curve was applied to calibrate the cutoffs of tKt/V, rKt/V and tCrcl. Kaplan-Meier and Cox-regression models with time varying covariates were applied to estimate overall death rate, probability of death and prognosis, respectively. Results: The cutoffs of rKt/V and tKt/V were 0.25 and 1.75, respectively. The Cox regression suggested that the higher these clearance parameters, the lower the risks of death after adjusting for covariables. The risks of death for those above these cutoffs were 57% (HR = 0.43, 95% CI: 0.31, 0.60) and 29% (HR = 0.71, 95% CI: 0.52, 0.98) lower for rKt/V and tKt/V, respectively. Age, serum albumin, hemoglobin, systolic blood pressure, and ultra-filtration volume significantly affected the mortality outcome. Conclusions: Our study suggested that the cutoffs of 0.25 and 1.75 for rKt/V and tKt/V might be associated with mortality in CAPD patients. A minimum tKt/V of 1.75 should be targeted, but increased dialysis dosage to achieve tKt/V > 2.19 adds no further benefit. Serum albumin, hemoglobin, SBP, and UF volume are also associated with mortality. However, our study may face with selection and other unobserved confounders, so further randomized controlled trials are required to confirm these cutoffs