Supporting and maintaining the frail patient on long-term renal replacement therapy

Cancer Mortality in People Receiving Dialysis for Kidney Failure: An Australian and New Zealand Cohort Study, 1980-2013

RATIONALE & OBJECTIVE

Cancer is a significant cause of morbidity in the population with kidney failure; however, cancer mortality in people undergoing dialysis has not been well described. We sought to compare cancer mortality in people on dialysis for kidney failure with cancer mortality in the general population.

STUDY DESIGN

A retrospective cohort study using linked health-administrative and dialysis registry data.

SETTING & PARTICIPANTS

All people receiving dialysis represented in the Australian and New Zealand Dialysis and Transplantation Registry, 1980-2013.

EXPOSURE

Dialysis; hemodialysis (HD) and peritoneal dialysis (PD).

OUTCOME

Death and underlying cause of death ascertained using health administrative data and classified using International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) codes.

ANALYTICAL APPROACH

Indirect standardization on age at death, sex, year, and country to estimate standardized mortality ratios (SMR).

RESULTS

Over 269,598 person years of observation, 34,100 deaths occurred among 59,648 people on dialysis, including 3,677 cancer deaths. The relative risk of all-site cancer death in dialysis was twice (SMR, 2.4 [95% CI, 2.33-2.49]) that of the general population and highest for oral and pharynx cancers (SMR, 24.3 [95% CI, 18.0-31.5]) and multiple myeloma (SMR, 22.5 [95% CI, 20.3-23.9]). Women on dialysis had a significantly higher risk of all-site cancer mortality (SMR, 2.7 [95% CI, 2.59-2.89]) compared with men (SMR, 2.3 [95% CI, 2.17-2.36]) (P < 0.001). People on HD (SMR, 2.2 [95% CI, 2.11-2.30]) experienced greater excess deaths from all-site cancer compared with people on PD (SMR, 1.3 [95% CI, 1.23-1.44]). Excess deaths have gradually decreased over time for all-site, multiple myeloma, and kidney cancers (P < 0.001) but have not kept up with improvements in the general population. By contrast, among people receiving dialysis, excess deaths increased for colorectal and lung cancers (P < 0.001).

LIMITATIONS

Confirmation of cancer diagnoses and population incidence data were not available; inability to exclude pre-existing cancers.

CONCLUSIONS

People on dialysis experience excess all-site and site-specific cancer mortality compared with the general population. Mortality differs by modality type, age, and sex. Understanding the role of kidney failure and other morbidities in the treatment of cancer is important for shared decision-making regarding cancer treatments and identifying potential approaches to improve outcomes.

An intradialytic aerobic exercise program ameliorates frailty and improves dialysis adequacy and quality of life among hemodialysis patients: a randomized controlled trial

Background

Hemodialysis patients with chronic kidney disease exhibit impaired exercise tolerance and functional decline. Despite the life-saving benefits of adequate dialysis, those declines translate into frailty and deteriorating quality of life (QoL). This study evaluated the effects of an intradialytic aerobic exercise program on frailty, dialysis adequacy, and QoL among hemodialysis patients.

Methods

Patients at an university hospital-affiliated hemodialysis center were randomly assigned to an exercise group (n = 18) or a control group (n = 21). The 12-week aerobic exercise program comprised 40 to 70 minutes of ergometer cycling 3 times/wk and a single education session. The control group completed only the education session. Outcomes were assessed at the time of enrollment, week 4, week 8, and week 12 using Fried’s frailty phenotype measures (gait speed, grip strength, vitality, body mass index, and physical activity), the short physical performance battery (SPPB), Kt/V urea, and the Short Form-36 questionnaire.

Results

There were significant interactions between groups and follow-up times in the frailty score (p < 0.001), gait speed (p < 0.001), SPPB (p < 0.001), and mental QoL (p = 0.03). The intention-to-treat and per-protocol analyses revealed that the exercise group exhibited significant improvements in frailty score (p < 0.001), gait speed (p < 0.001), grip strength (p < 0.001), exhaustion (p = 0.02), SPPB (p = 0.01), dialysis adequacy (p = 0.01), and physical QoL (p = 0.003).

Conclusion

An intradialytic aerobic exercise program could be a safe, feasible, and appropriate additional strategy to routine care among hemodialysis patients for improvements in frailty, dialysis adequacy, and QoL.

Exploring New Kingdoms: The Role of Extracellular Vesicles in Oxi-Inflamm-Aging Related to Cardiorenal Syndrome

The incidence of age associated chronic diseases has increased in recent years. Although several diverse causes produce these phenomena, abundant evidence shows that oxidative stress plays a central role. In recent years, numerous studies have focused on elucidating the role of oxidative stress in the development and progression of both aging and chronic diseases, opening the door to the discovery of new underlying mechanisms and signaling pathways. Among them, senolytics and senomorphics, and extracellular vesicles offer new therapeutic strategies to slow the development of aging and its associated chronic diseases by decreasing oxidative stress. In this review, we aim to discuss the role of extracellular vesicles in human cardiorenal syndrome development and their possible role as biomarkers, targets, or vehicles of drugs to treat this syndrome.

Comparative study on the efficacy of peritoneal dialysis and hemodialysis in patients with end-stage diabetic nephropathy

Objective

Diabetic nephropathy is a serious threat to human health, and its incidence is on the rise. End-stage diabetic nephropathy (ESDN) requires extra investigation due to its complexity and severity, as well as serious concurrent diseases. Our objective was to compare the efficacy of hemodialysis (HD) and peritoneal dialysis (PD) in the treatment of ESDN.

Methods

Clinical data of 84 patients with ESDN admitted to our hospital from June 2016 to June 2018 were retrospectively analyzed. The patients were divided into an HD group that received hemodialysis and a PD group that received peritoneal dialysis. Their general conditions, biochemical indicators, residual renal function and incidence of complications were recorded and compared between the two groups.

Results

(1) No significant difference in diastolic blood pressure, systolic blood pressure, body weight, or urine output was detected between the two groups at the beginning of dialysis (P>0.05). (2) Compared to the PD group, the HD group had significantly lower total cholesterol (TC) and triglyceride (TG) (P<0.05), and significantly higher total protein (TP) and albumin (ALB) after treatment (P<0.05). (3) The two groups also showed significant difference in residual renal function after treatment (P<0.05). (4) The HD group had significantly higher systolic pressure than the PD group after treatment (P<0.05). And more cases of infection were observed in the PD group than the HD group (P<0.05).

Conclusion

Both HD and PD are used for treatment of ESDN, and can achieve similar calcium and phosphorus control. Compared to HD, PD has less adverse effect on hemodynamics and better preserves residual renal function, but is more likely to cause malnutrition and disorders of lipid metabolism. Therefore, choice of dialysis method should be based on specific conditions of each patient.