Vitamin-K1 (Phylloquinone) prevents sodium-fluoride (NaF)-induced skeletal fluorosis.

WOS: 000202893600097

Patient Survival With Extended Home Hemodialysis Compared to In-center Conventional Hemodialysis

Introduction: More frequent and/or longer hemodialysis (HD) has been associated with improvements in numerous clinical outcomes in patients on dialysis. Home HD (HHD), which allows more frequent and/or longer dialysis with lower cost and flexibility in treatment planning, is not widely used worldwide. Although, retrospective studies have indicated better survival with HHD, this issue remains controversial. In this multicenter study, we compared thrice-weekly extended HHD with in-center conventional HD (ICHD) in a large patient population with a long-term follow-up. Methods: We matched 349 patients starting HHD between 2010 and 2014 with 1047 concurrent patients on ICHD by using propensity scores. Patients were followed-up with from their respective baseline until September 30, 2018. The primary outcome was overall survival. Secondary outcomes were technique survival; hospitalization; and changes in clinical, laboratory, and medication parameters. Results: The mean duration of dialysis session was 418 ± 54 minutes in HHD and 242 ± 10 minutes in patients on ICHD. All-cause mortality rate was 3.76 and 6.27 per 100 patient-years in the HHD and the ICHD groups, respectively. In the intention-to-treat analysis, HHD was associated with a 40% lower risk for all-cause mortality than ICHD (hazard ratio [HR] = 0.60; 95% confidence interval [CI] 0.45 to 0.80; P 0.001). In HHD, the 5-year technical survival was 86.5%. HHD treatment provided better phosphate and blood pressure (BP) control, improvements in nutrition and inflammation, and reduction in hospitalization days and medication requirement. Conclusion: These results indicate that extended HHD is associated with higher survival and better outcomes compared to ICHD. © 202

Congenital adrenal hyperplasia: A rare cause of renal failure and a successful renal transplantation

PubMed ID: 22790459Congenital adrenal hyperplasia belongs to a group of autosomal recessive disorders affecting steroid biosynthesis; a rare disease with a prevalence of 1 case per 16,000 population. A 30-year-old phenotypically male patient had been diagnosed with 11-ß hydroxylase deficiency at the age of 16; presenting with ambiguous genitalia, growth retardation, presence of menstrual cycles, severe hypertension, hypokalemia and renal dysfunction. He developed end-stage renal disease due to hypertension and was treated with hemodialysis for 3 years. After careful evaluation, he was approved to undergo renal transplantation. The patient has now finished 6th month after transplantation and is currently under follow-up at our out-patient clinic, having no problems related to the transplant. While early treatment to prevent hypertension is mandatory in patients with congenital adrenal hyperplasia, once renal failure occurs, renal transplantation may the best choice of treatment. In this study, we describe the first report of a successful renal transplantation in an adrenal hyperplasia. © 2012 Dustri-Verlag Dr. K. Feistle

The impact of low serum sodium level on mortality depends on glycemic control

PubMed ID: 22049913Background Low serum sodium levels have been associated with mortality both in patients with and without chronic kidney disease. In this study, we investigated this association in relation to glycemic control in hemodialysis (HD) patients. Materials and methods Between March and September 2005, 697 prevalent HD patients were enrolled in this prospective observational study and followed up for all-cause and cardiovascular mortality. The associations of serum sodium concentration with both overall and cardiovascular survival rates were studied. Results At baseline, mean predialysis serum sodium concentration was 138·4±2·3mEq/L (range: 130-145mEq/L). Mild hyponatremia (<135mEq/L) was present in only 41 subjects (5·9%), and no patient had serum sodium level <130mEq/L. During 20·2±6·2months of follow-up, 119 patients (15·9%) died, 68 from CV causes. In adjusted Cox regression analysis, lowest sodium quartile was associated with 2·13-fold increased risk of overall mortality (95% confidence interval (CI) 1·14-3·98, P=0·01, model chi-square 114·6, P<0·001). As a continuous variable, each 1mEq/L increase in predialysis sodium concentration was associated with a hazard ratio (HR) of 0·87 for overall mortality (95% CI 0·81-0·95, P=0·002) and 0·86 for cardiovascular mortality (95% CI 0·78-0·96, P=0·007). The predictivity of low serum sodium was prominent in diabetic subjects but not in nondiabetics. However, relationship between serum sodium and patient survival in diabetics was lost after adjustment for the HbA1c level: HR 0·91 (95% CI 0·78-1·05, P=0·20). Conclusions Low serum sodium concentration is associated with mortality only in those with diabetes. Furthermore, the impact of serum sodium on survival in these patients seems to be derived from poor glucose control. © 2011 The Authors. European Journal of Clinical Investigation © 2011 Stichting European Society for Clinical Investigation Journal Foundation