King-Kwan Lam

Better Sleep Quality and Less Daytime Symptoms in Patients on Evening Hemodialysis: A Questionnaire‐based Study

The aims of this study were to investigate the prevalence of sleep disorders in patients with end-stage renal disease (ESRD), and to assess the effect of dialysis schedule on sleep quality and the presence of daytime symptoms. We prospectively selected 150 long-term hemodialysis (HD) patients in three groups (morning, afternoon, and evening dialysis) and gave them a sleep questionnaire, the Epworth sleepiness scale and the Pittsburgh sleep quality index. Snoring was the most common complaint (56%), followed by insomnia (38%) and restless legs syndrome (22.7%). The evening dialysis group experienced more sleep time in bed (P = 0.02), required less hypnotic medication (P = 0.049), had fewer daytime symptoms (P < 0.01), and experienced less daytime sleepiness (P = 0.034). Our study confirms the high prevalence of sleep disorders in ESRD patients, and indicates a beneficial effect of evening HD on sleep quality and reduction of daytime symptoms.

Albuminuria, proteinuria, and urinary albumin to protein ratio in chronic kidney disease.

Both albuminuria and proteinuria are important disease markers of chronic kidney disease (CKD). Their relationship and the ratio between urinary albumin and protein in patients with CKD have not been investigated. Whether clinical features can affect these measurements is not clear.

Relationship between Kt/V urea-based dialysis adequacy and nutritional status and their effect on the components of the quality of life in incident peritoneal dialysis patients

BackgroundIt is well known that the quality of life of patients with chronic kidney disease can be improved by dialysis. While previous studies have used retrospective designs and adhered to a standard target prescribed by clinical guidelines, our study prospectively investigates the association between the adequacy of peritoneal dialysis (PD) and measures of nutritional status on quality-of-life domains in a cohort of incident PD patients.MethodsIt was a prospective 6-month observational study. Eighty incident PD participants who were treated in a hospital-based PD center were enrolled. The period of enrollment was January 2009–June 2010; follow-up continued until December 2010. PD adequacy indices, including Kt/V urea, weekly Ccr (WCcr), measures of nutritional status (albumin, BMI), and nPCR were measured at 1 month and 6 months after PD initiation. SF-36 health survey questionnaires were used to measure the quality of life. The outcomes were used to measure the changes in the domains of the SF-36 after 6 months of PD therapy.ResultsSeventy-seven incident patients who underwent PD for 6 months were included in the study. The mean age was 47.3 years, and the male-to-female ratio was 38:39. A peritoneal Kt/V urea value of 1.2, which was also the baseline cutoff value, was found to have the highest influence on SF-36 domains. Patients with baseline peritoneal Kt/V urea value of <1.2 showed improvement in the physical functioning and role limitation of physical functioning components after 6 months of PD. In contrast, patients with baseline peritoneal Kt/V urea values of ≥1.2 showed remarkable improvement in the general health, physical functioning, role limitation caused by physical problems, and bodily pain components. However, the trend of improvement decreased in patients with baseline nPCR of <1.2. Baseline renal WCcr did not influence the improvement in the SF-36 domains.LimitationsA small cohort and a short observation period.ConclusionsThe baseline level of peritoneal Kt/V urea affected the components of the quality of life after PD initiation. In contrast, a lower baseline nPCR level was associated with deterioration in the quality of life after PD therapy.

Ultrasound localization of the femoral vein facilitates successful cannulation for hemodialysis

BACKGROUND Real-time ultrasound-guided techniques allow for improved cannulation of the internal jugular vein and femoral vein for hemodialysis; however, these techniques require extra sterilization procedures, specialized probes, or needle guides. A simpler ultrasound vessel localization method was performed to investigate whether this alternative approach would aid in the cannulation of the femoral vein for patients in whom temporary angioaccess was required for hemodialysis. METHODS Patients requiring temporary femoral vein catheters for hemodialysis were divided into 2 groups on alternating days of the week during a 6-month period. One group underwent ultrasound localization of the femoral vein before cannulation and the second group received conventional landmark localization. Data regarding the strength of the femoral arterial pulse, number of attempts, failures, and complications were recorded. RESULTS Ultrasound localization resulted in significantly improved first-attempt success rates, reduced attempts, and reduced failure and complication rates overall (p < 0.001, p < 0.001, p = 0.002 and p = 0.004 respectively) as well as in the group of patients with a clearly discernible arterial pulse (p < 0.001, p = 0.001, p = 0.004 and p = 0.011 respectively). The same trend was observed among patients with faintly palpable or non-palpable femoral arterial pulses, although the differences were not statistically significant. CONCLUSION Cannulation of the femoral vein for hemodialysis should be performed with the aid of ultrasound. If real-time ultrasound-guided cannulation is not available, the vessel localization method is a good alternative, given its known limitations and the fact that it is simpler. It remains to be determined whether 1 - dimensional localization or localization including vessel depth information can improve outcomes in patients with faintly palpable or non-palpable femoral arterial pulses.

Sex Differences in Kidney Size and Clinical Features of Patients With Uremia

BACKGROUND Ultrasonographic evaluation of the kidney size is a useful method for assessment of the progression and, in some cases, the type of nephropathy. Ultrasonography (USG) also plays an important role in the evaluation of both acute and chronic renal failure. OBJECTIVE To investigate the ultrasonographic appearance of the kidneys in patients with uremia, underlying renal diseases and clinical characteristics, including biological sex, were studied. METHODS This was a retrospective study of data from consecutive adult patients with uremia starting a dialysis program between January 2005 and December 2006 at the nephrology department of a university hospital in Taiwan. Kidney size was determined by USG; demographic and clinical data were obtained prior to initiation of dialysis. RESULTS Of the patients (167 men, 151 women) included in the analysis, diabetes mellitus (DM) was the leading cause of uremia (127/318; 39.9%). The distribution of DM was similar between male and female patients. In addition to levels of blood urea nitrogen and hemoglobin, body mass index was similar between male and female patients (mean [SD], 22.9 [3.1] vs 22.1 [3.4] kg/m(2), respectively). Female patients had significantly lower serum creatinine levels (P < 0.05) and higher estimated glomerular filtration rates (P < 0.01) than did male patients when they initiated chronic dialysis therapy. Among those with DM, male patients were younger and had larger kidney size on initiation of dialysis therapy than did female patients (age, 59.9 [9.4] vs 64.6 [11.9] years; right renal length, 10.3 [1.4] vs 9.5 [1.5] cm; left renal length, 10.4 [1.5] vs 9.5 [1.4] cm; all, P < 0.05). These sex differences in age and kidney size at the start of dialysis were not observed in patients who did not have DM. Patients with DM had significantly larger kidney size than those without DM (P < 0.05). CONCLUSIONS The kidney size of these uremic patients varied considerably, depending on sex and the underlying disease. Male patients with DM at the terminal stage of renal failure had larger kidney size and were younger at the start of dialysis therapy than female patients with DM. In uremic patients without DM, no such discrepancy was observed, and both male and female patients started dialysis therapy at a comparable age and kidney size.