Analysis of current status of and barriers to exercise participation among patients on maintenance hemodialysis

Objective:The objective of this study was to analyze the current status of barriers to exercise participation(EP)among patients on maintenance hemodialysis(MHD).Materials and Methods:A cross-sectional study was conducted on 277 outpatients undergoing MHD in 2 tertiary first-class hospitals in Beijing from February 2023 to June 2023 who were selected using convenience sampling method.The data of patients on MHD were collected using the general information questionnaire,Physical Activity Rating Scale,Exercise Benefits/Barriers Scale(EBBS),and Exercise Self-Efficacy Scale(ESES).The relationship between EP and barriers to EP was analyzed through univariate and multivariate linear regression models.Results:Patients on MHD had a low exercise volume score of 13.71±0.68 points and a medium EBBS score of 63.36±0.40 points.Multivariate logistic analysis showed that exercise volume was significantly related to the following four aspects,including low monthly household income per capita(odds ratio[OR]=86.741,95%confidence interval[CI][1.164-6.465],P=0.042),primary underlying disease of diabetic nephropathy(OR=45.993,95%CI[1.353-1.564],P=0.033),the belief that“fatigue in lower extremities hinders exercise”(OR=4.697,95%CI[1.127-19.585],P=0.034),and the belief that“physical exercise bringing optimistic and positive life attitude”(OR=0.074,95%CI[0.007-0.830],P=0.035).Conclusions:Since patients on MHD had low physical exercise volume,the health-care provider should pay more attention on the controllable factors that affect the EP of patients on MHD.Therefore,feasible and effective intervention measures can be formulated based on ESES in clinical nursing.

Analysis of the Short-Term Curative Effect of Roxadustat in Treating Renal Anemia in Patients with Peritoneal Dialysis

Objective:To analyze the short-term curative effect of roxadustat in the treatment of renal anemia in patients with peritoneal dialysis.Methods:70 patients with peritoneal dialysis renal anemia admitted to the dialysis department of our hospital from March 2021-March 2023 were selected as research objects,divided into a research group and a reference group according to random number drawing method,with each group consisting of 35 cases.The patients in the research group were treated with roxadustat,and those in the reference group were treated with recombinant human erythropoietin.The total efficacy,anemia index,iron metabolism index,and occurrence of adverse reactions were compared between the two groups.Results:The total efficacy of the treatment received in the research group was significantly higher than that in the reference group(P<0.05).In terms of anemia indicators,there was no statistically significant difference between the hemoglobin(Hb),the red blood cell(RBC),and the hematocrit(HCT)of both groups(P>0.05)before treatment.After treatment,the anemia indicators of the patients in the research group were significantly better than those in the reference group,(P<0.05).In terms of iron metabolism,before treatment,there was no significant difference between the total iron-binding capacity(TIBC),the transferrin(TRF),the ferritin(FER),and iron(Fe)of both groups(P>0.05).After treatment,the research group’s iron metabolism indicators were significantly better than those of the reference group(P<0.05).The incidence of adverse reactions in the research group was significantly lower than that in the reference group(P<0.05).Conclusion:The short-term curative effect of roxadustat in the treatment of peritoneal dialysis patients was demonstrated through this study,making it a viable treatment option.

Residual renal function in peritoneal dialysis with failed allograft and minimum immunosuppression

Immunosuppression(IS) is often withdrawn in patients with end stage renal disease secondary to a failed renal allograft, and this can lead to an accelerated loss of residual renal function(RRF). As maintenance of RRF appears to provide a survival benefit to peritoneal dialysis(PD) patients, it is not clear whether this benefit of maintaining RRF in failed allograft patients returning to PD outweigh the risks of maintaining IS. A 49 year-old Caucasian male developed progressive allograft failure nine years after living-donor renal transplantation. Hemodialysis was initiated via tunneled dialysis catheter(TDC) and IS was gradually withdrawn. Two weeksafter IS withdrawal he developed a febrile illness, which necessitate removal of the TDC and conversion to PD. He was maintained on small dose of tacrolimus(1 mg/d) and prednisone(5 mg/d). Currently(1 year later) he is doing exceedingly well on cycler-assisted PD. Residual urine output ranges between 600-1200 m L/d. Total weekly Kt/V achieved 1.82. RRF remained well preserved in this patient with failed renal allograft with minimal immunosuppressive therapy. This strategy will need further study in well-defined cohorts of PD patients with failed allografts and residual RRF to determine efficacy and safety.

Efficacy of roxadustat in treatment of peritoneal dialysis patients with renal anaemia

BACKGROUND There are no studies on the use of roxadustat in patients on regular peritoneal dialysis in China.AIM To observe the efficacy and safety of roxadustat in treating renal anaemia in peritoneal dialysis patients.METHODS Patients with renal anaemia who were regularly followed at the Peritoneal Dialysis Center of the First Affiliated Hospital of China Medical University from November 1,2019 to June 30,2020 were selected.A before-and-after self-control design was performed to retrospectively analyse the treatment effects on anaemia in patients treated with recombinant human erythropoietin(EPO)and roxadustat.RESULTS A total of 31 patients with renal anaemia on long-term peritoneal dialysis treated with roxadustat were included.Haemoglobin(Hb)levels were maintained or increased in all patients(100%),and no patients had a decrease in Hb compared with the previous phase.Patients had a mean Hb of 86.2±14.8 g/L with Hb compliance(Hb≥110 g/L)of 16.1%during the EPO phase and a mean Hb of 112.4±18.5 g/L with Hb compliance of 67.7%during the roxadustat phase.No major adverse cardiovascular events occurred in any patient.CONCLUSION The application of roxadustat in peritoneal dialysis patients with renal anaemia can effectively improve the Hb compliance rate.

Impact of Dialysis Coverage on the Provision of Universal Health Insurance in the Republic of the Congo

Introduction: The launch of health insurance in the Republic of the Congo took place against a backdrop of extremely high costs for dialysis, which was not one of the services financed within this framework. The aim of this study is to assess the impact of including dialysis in the health insurance package in Congo. Methodology: This is a descriptive cross-sectional study with an evaluative aim, analyzing the impact of dialysis on the financing capacity of health insurance and health facilities to provide this type of care. Results: The results show that including dialysis in the universal health insurance package will require an additional financial effort of 6.20% of the current total financing capacity of the care basket. Most dialysis sessions are provided by the private health sector (87.5%), whose health facilities are unevenly distributed across the country, and concentrated in the country’s two major cities. This problem is the dual consequence of the very high cost of a dialysis session (average cost 140,234,375 FCFA or 229 US Dollars) and the number of patients under care, which will increase in the absence of effective and ongoing prevention efforts against chronic diseases in general and end-stage renal failure in particular. Conclusion: Dialysis is a high-impact public health intervention. The impact of its inclusion in the universal health insurance care package is difficult to bear financially. For dialysis to be covered by universal health insurance, additional funding and improved technical facilities are needed.

When to initiate renal replacement therapy: The trend of dialysis initiation

The timing of renal replacement therapy for patients with end-stage renal disease has been subject to considerable variation. The United States Renal Data System shows an ascending trend of early dialysis initiation until 2010, at which point it decreased slightly for the following 2 years. In the 1990 s, nephrologists believed that early initiation of dialysis could improve patient survival. Based on the Canadian-United States Peritoneal Dialysis study, the National Kidney Foundation Dialysis Outcomes Quality Initiative recommended that dialysis should be initiated early. Since 2001, several observational studies and 1 randomized controlled trial have found no beneficial effect when patients were placed on dialysis early. In contrast, they found that an increase in mortality was associated with early dialysis initiation. The most recent dialysis initiation guidelines recommend that dialysis should be initiated at an estimated glomerular filtration rate(e GFR) of greater than or equal to 6 mL /min per 1.73 m2. Nevertheless, the decision to start dialysis is mainly based on a predefined eG FR value, and no convincing evidence has demonstrated that patients would benefit from early dialysis initiation as indicated by the eG FR. Even today, the optimal dialysis initiation time remains unknown. The decision of when to start dialysis should be based on careful clinical evaluation.

The Effect of Glucose Added to the Dialysis Fluid on Blood Pressure, Vasoactive Hormones and Energy Transfer during Hemodialysis in Chronic Renal Failure

Background: Previous studies showed that blood pressure was reduced in patients with chronic renal failure during hemodialysis with glucose added to the dialysis fluid. We wanted to test the hypotheses that blood pressure is reduced in non-diabetic and diabetic dialysis patients, when glucose is added to the dialysis fluid, and that blood pressure changes are caused by changes in plasma concentrations of vasoactive hormones or to vasodilation secondary to an increase in body temperature. Methods: The effect of dialysis with glucose added to the dialysis fluid was measured in three randomized, placebo-controlled, un-blinded and cross-over studies with periods of one week duration. In non-diabetic nephropathy (Study 1, n = 19) and diabetic nephropathy (Study 2, n = 15), we measured blood pressure (BP) and pulse rate (PR), plasma concentrations of glucose (p-Glucose), renin (PRC), angiotensin II (p-AngII), endothelin (p-Endot), insulin (p-Ins), glucagon (p-Glu), and human growth hormone (p-hGH). In non-diabetic nephropathy (Study 3, n = 24), we measured the effect of dialysis with glucose added to the dialysis fluid on energy transport from form the body using body temperature control. Results: Study 1 and 2 showed that BP, PRC, p-AngII, and p-Ins were unchanged, whereas P-Endot increased and P-hGH decreased, in dialysis patients with or without glucose added to the dialysis fluid. In diabetics, a marginal increase in p-Glu was measured during dialysis with glucose, but not without glucose. Study 3 showed that SBP increased significantly using dialysis with temperature control of dialysis fluid compared with no temperature control (145 versus 138 mm Hg). In parallel with the increase in SBP, the energy flux from the patients was significantly higher with temperature control than without. Conclusion: In non-diabetics and diabetics, blood pressure was unchanged during dialysis with glucose added to the dialysis fluid in a short-term study. Vasoactive hormones in plasma were changed in the same way independently of glucose in the dialysis fluid. Systolic blood pressure increased using dialysis with temperature control of dialysis fluid, presumably due to vasoconstriction to prevent or antagonize a fall in body temperature.

Prevalence of Renal Failure in Children and the Need for Dialysis in Paediatric Nephrology in a Developing Country

Background: Renal failure is among the major visceral failures responsible for morbidity and mortality in children. Epidemiological data on renal failure in children are limited in sub-Saharan Africa, including Senegal. We conducted this study to assess the prevalence of renal failure (RF) and the need for dialysis in the paediatric nephrology unit. Patients and methods: This was a retrospective and descriptive study in the pediatric nephrology unit from 1st January 2020 to 30 June 2021, including children with acute or chronic RF. The need for dialysis was judged to be met by its effectiveness in face of an indication. The data collected were analysed on sphinx plus 2017 software. Results: The prevalence of RF was 60% (n/N = 132/220). RF was acute in 59% (n/N = 78/132) of cases. The mean age was 6.53 ± 4.77 years with a sex ratio of 1.8. The mean serum creatinine level was 27.22 mg/L (240.9 μmol/L) and BUN at 0.85 g/L. The aetiologies were dominated by prerenal AKI (Acute Kidney Injury) complicating nephrotic syndrome (NS) in 37.2% (n/N = 29/78) and dehydration due to stomach flu in 17.6% (n/N = 9/51). Acute post-infectious glomerulonephritis including group A streptococcus and plasmodium falciparum accounted for 16.7% (n = 13/78) of intrinsic AKI. The need for dialysis was unmet in 50% (n/N = 7/14) with a mortality of 14.1% (n/N = 11/78). The mean age of the patients with chronic RF was 8.68 ± 4.74 years with a sex ratio of 2.6. The mean serum creatinine level was 36.56 mg/L (323.5 μmol/L) and the BUN level was 0.99 g/L. Half of the children were classified as having CKD stage II (early stage). The aetiologies were dominated by primary focal and segmental glomerulosclerosis (FSGS), 53.7% (n/N = 29/54), renal hypoplasia, 22.2% (n/N = 12/54) and reflux nephropathy, 29.4% (n/N = 5/17). The need for dialysis was unmet in 46.1% (n/N = 6/13). The overall mortality of chronic kidney disease (CKD) with RF was 29.6% (n/N = 8/27). Conclusion: The prevalence of RF was high in the unit. Most aetiologies of AKI were accessible to prevention. Only half of the children had access to free dialysis, hence the need for a dedicated pilot dialysis centre.

Pain during Arteriovenous Fistula Cannulation in Chronic Renal Patients on Hemodialysis

This study aimed to evaluate pain intensity in chronic renal patients under hemodialysis during the arteriovenous fistula cannulation. It was a cross-sectional study conducted in a hemodialysis clinic in the second semester of 2014. 70 individuals participated in the research and were assessed by the visual analogue scale. The project was approved with opinion number 453.508-2013. During cannulation, the pain reported was moderate in 58.5% of patients, intense in 30% and mild in 11.5%. There was no association between the occurrence of pain in relation to gender, shift and time of hemodialysis. The study points out to the need for pre-cannulation analgesia to improve comfort during the procedure.

Effects of endogenous L-cystathionine on enzymatic assays of serum homocysteine in samples from renal dialysis patients

Homocysteine (Hcy) is a thiol-containing amino acid produced by the intracellular demethylation of methionine.Approximately 80% of circulating Hcy in the blood is protein bound by disulfide linkage.The remaining unbound Hcy combines by oxidation either with itself to form the dimer homocystine or with cysteine to form the mixed disulfide cysteine-Hcy.

Effects of Shenkang Injection Combined with Hemodialysis on Dialysis Rate and Nutriture in Patients with Chronic Renal Failure

OBJECTIVE: To explore the effects of Shenkang Injection combined with hemodialysis on dialysis rate and nutriture in patients with chronic renal failure (CRF).METHODS: A total of 110 CRF patients admitted in the hospital from January 2016 to January 2018 were randomly divided into 2 groups.The control group was treated with hemodialysis while the observation group was additionally treated with Shenkang Injection on the treatment basis of the control group.They were treated for 4 weeks and reexamined 1 d after the treatment.Renal function,nutriture,dialysis adequacy,oxidative stress level and inflammatory factor level in the 2 groups were determined before and after the treatment,and traditional Chinese medicine (TCM) syndrome score,dialysis rate within 1 week and incidence of adverse reactions during the treatment were counted before and after the treatment.RESULTS: After the treatment,the levels of serum creatinine (Scr) and urea nitrogen (BUN) in the observation group were lower than those in the control group,and the endogenous creatinine clearance rate (Ccr) was higher than that in the control group (P < 0.05).After the treatment,the nutriture in the observation group was better than that in the control group (P < 0.05).After the treatment,the dialysis rate and time average concentration of urea (TACurea) in the observation group were lower than those in the control group,while the overall urea clearance rate (Kt/V) and protein catabolic rate (PCR) were higher than those in the control group (P < 0.05).After the treatment,the TCM syndrome scores in the observation group was lower than that in the control group (P < 0.05) and the level of serum malondialdehyde (MDA) in the observation group was lower than that in the control,while the level of superoxide dismutase (SOD) and total antioxidant capacity (T-AOC) in the observation group were higher than those in the control group (P < 0.05).After the treatment,the levels of inflammatory factors in the observation group were lower than those in the control group (P < 0.05).No serious adverse reactions occurred in the 2 groups.CONCLUSION: Shenkang Injection combined with hemodialysis for the treatment of CRF can effectively improve clinical symptoms and nutriture,and reduce the dialysis rate.

Effect of peritoneal dialysis on inflammatory factors, nutritional index and renal function in patients with chronic renal failure

Objective:To explore the effect of peritoneal dialysis on inflammatory factors, nutritional index and renal function indexes in patients with chronic renal failure, and to provide help for clinical treatment of patients with chronic renal failure. Methods:80 cases of chronic renal failure patients in our hospital were selected as the study group, given peritoneal dialysis treatment;80 healthy people during the same period in our hospital selected as the normal group. The inflammatory factors [C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α) and IL-8], renal function indices [BUN (Urea nitrogen) and SCR (serum creatinine)] and nutritional index [PA (prealbumin), Hb (hemoglobin), ALB (albumin) and TF (Transferrin)] levels were detected in healthy population and patients with chronic renal failure patients before and after treatment of 1 and 30 d, and the relative significance was analyzed. Results:Compared with the normal group, the inflammatory factors (CRP, IL-6, TNF-αand IL-8) and renal function indices (BUN and SCR) of patients with chronic renal failure in study group increased significantly and nutritional indexes (TF, PA and ALB) decreased significantly (P<0.05). The inflammatory factors (CRP, IL-6, TNF-αand IL-8), nutritional index (TF, PA and ALB) and renal function indices (BUN and SCR) of patients with chronic renal failure by peritoneal dialysis in the treatment of 1 d in research group were significantly lower than the level before treatment, and Hb was significantly higher than that before treatment (P<0.05). After 30 d of dialysis, inflammatory factors (CRP, IL-6, TNF-αand IL-8), nutritional index (TF, PA and ALB) and renal function indices (BUN and SCR) decreased further and Hb increased further (P<0.05). Conclusions:Peritoneal dialysis can improve the inflammatory factors levels of patients with chronic renal failure, reduce the renal function index, and can affect the nutritional index of patients, and has important significance in clinical treatment of patients with chronic renal failure.

Correlation of serum vitamin C content with renal anemia,oxidative stress and microinflammatory state in patients with peritoneal dialysis

Objective: To study the correlation of serum vitamin C content with renal anemia, oxidative stress and microinflammatory state in patients with peritoneal dialysis. Methods: A total of 96 patients undergoing peritoneal dialysis in the First Affiliated Hospital of Soochow University between January 2016 and January 2017 were selected as the peritoneal dialysis group, and 50 healthy volunteers receiving physical examination in the First Affiliated Hospital of Soochow University during the same period were selected as the normal control group. The contents of VitC as well as renal anemia, oxidative stress and microinflammation-related indexes in peripheral blood of two groups of subjects were detected, and Pearson test was used to evaluate the correlation of serum VitC content with renal anemia, oxidative stress and microinflammatory state in patients with peritoneal dialysis. Results: VitC content in peripheral blood of peritoneal dialysis group was lower than that of normal control group;renal anemia-related indexes Hb, RBC and TIBC levels in peripheral blood were lower than those of normal control group;oxidative stress indexes LHP, MPO and AOPPs contents in serum were higher than those of control group while SOD and GSH-Px contents were lower than those of control group;inflammatory factors CRP, IL-6, IL-8, IL-10 and IL-13 contents in serum were higher than those of normal control group. VitC content in serum of patients with peritoneal dialysis was positively correlated with Hb, RBC, TIBC, SOD and GSH-Px levels, and negatively correlated with LHP, MPO, AOPPs, CRP, IL-6, IL-8, IL-10 and IL-13 contents. Conclusion: Serum VitC content is lower in patients with peritoneal dialysis, and the specific content is directly correlated with the severity of renal anemia, oxidative stress and microinflammatory state.

Analyzing risk factors for postoperative acute renal failure requiring dialysis after valve surgery

Objective To evaluate risk factors for postoperative acute renal failure requiring dialysis (ARF-D) after hear valve surgery. Methods Adult patients (age≤18 years) underwent valve surgery with preoperative serum creati nine 【 300 μmol / L were included between January 2005 and December 2008. Fifty patients developed ARF-D

Gastrointestinal symptoms in patients undergoing peritoneal dialysis: Multivariate analysis of correlated factors

AIM: To investigate gastrointestinal (GI) symptoms in peritoneal dialysis (PD) patients and to explore related factors contributing to GI symptoms. METHODS: One hundred and twelve patients undergoing PD participated in the study. The gastrointestinal symptom rating scale was used for measuring GI symptoms. Information on age, height, weight, body mass index, disease leading to chronic renal failure, history of corticosteroid therapy, presence of predialytic GI symptoms, daily dosage of pills, and duration, type and daily dialysate volume of PD was obtained by interviewing patients and/or reviewing the medical records. Hemoglobin, albumin and Kt/V data were obtained from follow-up database. We used multiple regression analysis with stepwise backward variable selection to test for factors predicting GSRS scores with significance level of selection entry at 0.05 and selection of stay at 0.10. RESULTS: The prevalence of eating dysfunction, reflux and indigestion in the PD patients was 44.2%, 32.7%,32.7%, respectively. A history of corticosteroid therapy (b = 8.93, P < 0.001) and all pills daily intake (b = 0.16, P = 0.007) were positively correlated to GI symptoms, while residual renal Kt/V (b =-3.47, P = 0.009) was negatively correlated to GI symptoms. Other factors were proven to be not associated with GI symptoms, with P > 0.05. CONCLUSION: Eating dysfunction, reflux and indigestion were common in PD patients. Daily dosage of pills and corticosteroid history predicted GI symptoms, while residual renal function prevented them.

Proton-pump inhibitors for prevention of upper gastrointestinal bleeding in patients undergoing dialysis

AIM:To investigate the preventive effects of low-dose proton-pump inhibitors(PPIs) for upper gastrointestinal bleeding(UGIB) in end-stage renal disease.METHODS:This was a retrospective cohort study that reviewed 544 patients with end-stage renal disease who started dialysis at our center between 2005 and 2013.We examined the incidence of UGIB in 175 patients treated with low-dose PPIs and 369 patients not treated with PPIs(control group).RESULTS:During the study period, 41 patients developed UGIB, a rate of 14.4/1000 person-years.The mean time between the start of dialysis and UGIB events was 26.3 ± 29.6 mo.Bleeding occurred in only two patients in the PPI group(2.5/1000 person-years) and in 39 patients in the control group(19.2/1000 person-years).Kaplan-Meier analysis of cumulative non-bleeding survival showed that the probability of UGIB was significantly lower in the PPI group than in the control group(log-rank test, P < 0.001).Univariate analysis showed that coronary artery disease, PPI use, anti-coagulation, and anti-platelet therapy were associated with UGIB.After adjustments for the potential factors influencing risk of UGIB, PPI use was shown to be significantly beneficial in reducing UGIB compared to the control group(HR = 13.7, 95%CI:1.8-101.6; P = 0.011).CONCLUSION:The use of low-dose PPIs in patients with end-stage renal disease is associated with a low frequency of UGIB.

Importance of the creation of a short musculofascial tunnel in peritoneal dialysis catheter placement

BACKGROUND Peritoneal dialysis(PD)catheter migration impedes the efficacy of dialysis.Therefore,several techniques involving additional sutures or incisions have been proposed to maintain catheter position in the pelvis.AIM To evaluate the efficacy of creating a short musculofascial tunnel beneath the anterior sheath of the rectus abdominis during PD catheter implantation.METHODS Patients who underwent PD catheter implantation between 2015 and 2019 were included in this retrospective study.The patients were divided into two groups based on the procedure performed:Patients who underwent catheter implantation without a musculofascial tunnel before 2017 and those who underwent the procedure with a tunnel after 2017.We recorded patient character istics and catheter complications over a two-year follow-up period.In addition,postoperative plain abdominal radiographs were reviewed to determine the catheter angle in the event of migration.RESULTS The no-tunnel and tunnel groups included 115 and 107 patients,respectively.Compared to the no-tunnel group,the tunnel group showed lesser catheter angle deviation toward the pelvis(15.51±11.30 vs 25.00±23.08,P=0.0002)immediately after the operation,and a smaller range of migration within 2 years postoperatively(13.48±10.71 vs 44.34±41.29,P<0.0001).Four events of catheter dysfunction due to migration were observed in the no-tunnel group,and none occurred in the tunnel group.There was no difference in the two-year catheter function survival rate between the two groups(88.90%vs 84.79%,P=0.3799).CONCLUSION The musculofascial tunnel helps maintain catheter position in the pelvis and reduces migration,thus preventing catheter dysfunction.

Gastrointestinal symptoms: A comparison between patients undergoing peritoneal dialysis and hemodialysis

AIM: To compare the prevalence and diversity of gastrointestinal(GI) symptoms in patients undergoing peritoneal dialysis(PD) and hemodialysis(HD).METHODS: Two hundred and ninety-four end-stage renal disease patients participated in the study, including 182 HD and 112 PD patients. Dimension scores were calculated from a modified gastrointestinal symptom rating scale(GSRS) 18-item questionnaire, including items concerning eating dysfunction, and were used for measuring GI symptoms. Information on patient age, condition contributing to end-stage renal disease and the most recent dialysis adequacy assessment(serum Kt/V urea value) was obtained from the follow-up database and by interviewing patients and/or reviewing the medical records. Differences between the HD and PD groups were evaluated using Student's t, Pearson's χ2 or Fisher's exact tests.RESULTS: The overall prevalence of GI symptoms,defined by a GSRS > 1, in end-stage renal disease patients was 70.7%(208/294), which differed between HD and PD patients(76.4% vs 61.6%, P < 0.01). HD patients had a higher prevalence of constipation, abdominal pain and diarrhea compared to PD patients(36.3% vs 17.9%, 32.4% vs 5.4%, 17.6% vs 4.5%, respectively, P < 0.05). PD patients had a higher prevalence of reflux compared to HD patients(32.1% vs 24.2%, P < 0.05). Additionally, reflux and eating dysfunction were more severe in PD patients(GSRS: 1.71 ± 1.15 vs 1.30 ± 0.67, 1.57 ± 0.84 vs 1.39 ± 0.61, respectively, P < 0.05), whereas HD patients had greater abdominal pain, diarrhea and constipation(GSRS: 1.22 ± 0.39 vs 1.04 ± 0.19, 1.19 ± 0.53 vs 1.07 ± 0.35, 1.51 ± 0.83 vs 1.23 ± 0.58, respectively, P < 0.05). Finally, 14.8%(27/182) of HD patients presented with more than three GI symptoms, compared to 7.2%(8/112) of PD patients(P < 0.01).CONCLUSION: HD and PD patients differ in prevalence, severity and diversity of GI symptoms.

Recuperation of severe tumoral calcinosis in a dialysis patient: A case report

BACKGROUND One of the common late sequela in patients with end-stage renal disease(ESRD)is the calcium phosphate disorder leading to chronic hypercalcemia and hyperphosphatemia causing the precipitation of calcium salt in soft tissues.Tumoral calcinosis is an extremely rare clinical manifestation of cyst-like soft tissue deposits in different periarticular regions in patients with ESRD and is characterized by extensive calcium salt containing space-consuming painful lesions.The treatment of ESRD patients with tumoral calcinosis manifestation involves an increase in or switching of renal replacement therapy regimes and the adjustment of oral medication with the goal of improved hypercalcemia and hyperphosphatemia.CASE SUMMARY We describe a 40-year-old woman with ESRD secondary to IgA-nephritis and severe bilateral manifestation of tumoral calcinosis associated with hypercalcemia,hyperphosphatemia and tertiary hyperparathyroidism.The patient was on continuous ambulatory peritoneal dialysis and treatment with vitamin D analogues.After switching her to a daily hemodialysis schedule and adjusting the medical treatment,the patient experienced a significant dissolution of her soft tissue calcifications within a couple of weeks.Complete remission was achieved 11 mo after the initial diagnosis.CONCLUSION Reduced patient compliance and subsequent insufficiency of dialysis regime quality contribute to the aggravation of calcium phosphate disorder in a patient with ESRD leading to the manifestation of tumoral calcinosis.However,the improvement of the treatment strategy and reinforcement of patient compliance enabled complete remission of this rare disease entity.