Background Among patients with end-stage renal disease who are treated with hemodialysis, solute clearance during dialysis and nutritional adequacy are determinants of mortality. We determined the effects of reductions in blood urea nitrogen concentrations during dialysis and changes in serum albumin concentrations, as an indicator of nutritional status, on mortality in a large group of patients treated with hemodialysis. Methods We analyzed retrospectively the demographic characteristics, mortality rate, duration of hemodialysis, serum albumin concentration, and urea reduction ratio (defined as the percent reduction in blood urea nitrogen concentration during a single dialysis treatment) in 13,473 patients treated from October 1, 1990, through March 31, 1991. The risk of death was determined as a function of the urea reduction ratio and serum albumin concentration. Results As compared with patients with urea reduction ratios of 65 to 69 percent, patients with values below 60 percent had a higher risk of ...

https://www.nejm.org/doi/pdf/10.1056/NEJM199309303291404

The Urea Reduction Ratio and Serum Albumin Concentration as Predictors of Mortality in Patients Undergoing Hemodialysis

Purinoceptors: Are there families of P2X and P2Y purinoceptors?

Mortality rates among hemodialysis patients vary greatly across regions. Representative databases containing extensive profiles of patient characteristics and outcomes are lacking. The Dialysis Outcomes and Practice Patterns Study (DOPPS) is a prospective, observational study of representative samples of hemodialysis patients in France, Germany, Italy, Japan, Spain, the United Kingdom, and the United States (US) that captures extensive data relating to patient characteristics, prescriptions, laboratory values, practice patterns, and outcomes. This report describes the case-mix features and mortality among 16,720 patients followed up to 5 yr. The crude 1-yr mortality rates were 6.6% in Japan, 15.6% in Europe, and 21.7% in the US. After adjusting for age, gender, race, and 25 comorbid conditions, the relative risk (RR) of mortality was 2.84 (P < 0.0001) for Europe compared with Japan (reference group) and was 3.78 (P < 0.0001) for the US compared with Japan. The adjusted RR of mortality for the US versus Europe was 1.33 (P < 0.0001). For most comorbid diseases, prevalence was highest in the US, where the mean age (60.5 +/- 15.5 yr) was also highest. Older age and comorbidities were associated with increased risk of death (except for hypertension, which carried a multivariate RR of mortality of 0.74 [P < 0.0001]). Variability in demographic and comorbid conditions (as identified by dialysis facilities) explains only part of the differences in mortality between dialysis centers, both for comparisons made across continents and within the US. Adjustments for the observed variability will allow study of association between practice patterns and outcomes.

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Association of Comorbid Conditions and Mortality in Hemodialysis Patients in Europe, Japan, and the United States: The Dialysis Outcomes and Practice Patterns Study (DOPPS)

https://www.kidney-international.org/article/S0085-2538(15)57620-5/pdf

Survival as an index of adequacy of dialysis

The dose of hemodialysis and patient mortality

Five-Year Survival for End-Stage Renal Disease Patients in the United States, Europe, and Japan, 1982 to 1987

https://www.ajkd.org/article/S0272-6386(12)70358-X/pdf

Mortality in Chronic Dialysis Patients in Japan

A new dialysis system using direct haemoperfusion with collodion-micro-encapsulated, albumin-coated, bead-shaped petroleum activated carbon and artificial kidney in series has been devised. This new system has been applied to the purpose of treatment of patients in chronic renal failure, fulminant hepatic failure and intoxication.

Clinical Experience of Bead-Shaped Charcoal Haemoperfusion in Chronic Renal Failure and Fulminant Hepatic Failure

A case of adrenal carcinoma with the tumor thrombus extending into the right atrium and right ventricle is reported. A 46-year-old man was admitted because of abdominal distention and back pain. Angiogram, venacavography, dynamic CT, cardio-echogram and determinations of blood concentration of hormones disclosed a huge non-functional right adrenal tumor and its thrombus having extended into the right atrium and ventricle via the right adrenal vein. Right adrenalectomy and nephrectomy were followed by simultaneous removal of the tumor thrombus. The resected tumor was 14 X 11 X 7 cm in size and 880 g. The thrombus was 90 g. Pathohistological diagnosis of sarcomatoid adrenocortical carcinoma was made. The patient was discharged three weeks after operation and had been remained asymptomatic for 5 months. He died of the recurrence of the tumor on the 206th postoperative day. In the review of English and Japanese literature, 61 cases of malignant tumors extending into the right atrium were analyzed, among which only one case was an adrenal tumor. From this survey, it seems that aggressive resection would provide better survival, and a surgical excision with a use of cardiopulmonary bypass is worth trying for such conditions.

[Surgical resection of adrenal carcinoma extending into the vena cava, right atrium and ventricle: case report and review of the literature].

For the treatment of familial hypercholesterolemia, Liposorber LA-40 was clinically applied. The Liposorber is a commercially developed affinity adsorbent for plasma perfusion which selectivity adsorbs low density lipoproteins and very low density lipoproteins and is specially designed for plasmapheretic treatment of hypercholesterolemia. The Liposorber column, containing activated cellulose beads having an affinity for lipoprotein containing apolipoprotein-B, has an excellent adsorption capacity, excellent selectivity, minimum albumin loss. This new apheresis system was applied to 2 clinical cases. After seven months of trial perfusion every 2 weeks, patient condition was good, with a level of total cholesterol under 300 mg/dl. No replacement fluids were given during or after treatment. In this paper, clinical results of these patients were shown and the mechanism of adsorption of this specific adsorbent was discussed.

Michio Odaka

Papers

Five-Year Survival for End-Stage Renal Disease Patients in the United States, Europe, and Japan, 1982 to 1987

Mortality in Chronic Dialysis Patients in Japan

Clinical Experience of Bead-Shaped Charcoal Haemoperfusion in Chronic Renal Failure and Fulminant Hepatic Failure

[Surgical resection of adrenal carcinoma extending into the vena cava, right atrium and ventricle: case report and review of the literature].

Adsorption of lipoprotein containing apolipoprotein-B through plasma separation for treatment of familial hypercholesterolemia.