Kidney Function

Background:: Although dementia has predicted mortality in large dialysis cohorts, little is known about the relationship between less pronounced cognitive deficits and mortality in patients with end-stage renal disease. This study assessed whether cognitive impairment without dementia was an independent predictor of 7-year survival in dialysis patients after controlling for other risk factors.Study Design:: Prospective single-cohort study.Setting & Participants:: 145 prevalent dialysis patients from 2 units in London, UK, were followed up for 64.3 ± 27.4 months and censored at the time of change to a different treatment.Predictors:: Cognitive impairment, defined as performance 1 standard deviation less than normative values on 2 or more cognitive tests within a neurocognitive battery assessing attention/concentration, memory, and psychomotor function domains. Depression, quality-of-life, and clinical measures also were obtained.Outcomes & Measurements:: All-cause mortality was the primary outcome. Cox proportional hazard models were used to assess the contribution of demographics and clinical and psychological measures and cognitive impairment to mortality.Results:: 98 (67.6%) patients were cognitively impaired at baseline. At follow-up, 56 (38.6%) patients had died, 29 of cardiac causes. Unadjusted Kaplan-Meier analysis showed higher mortality in cognitively impaired patients, in whom 7-year survival was 49% versus 83.2% in those with no cognitive impairment (P < 0.001). Mortality risk associated with cognitive impairment remained significant in adjusted analysis controlling for sociodemographic, clinical, and psychological factors (adjusted HR, 2.53; 95% CI, 1.03-6.22; P = 0.04).Limitations:: Small sample size and number of events.Conclusions:: Cognitive impairment is an independent predictor of mortality in dialysis patients. Although the implications of early recognition and treatment of cognitive impairment for clinical outcomes are unclear, these results suggest that patient management protocols should attempt to ensure prevention of cognitive decline in addition to managing coexisting medical conditions.

Everyone is potentially at risk of transmission of HIV/AIDS (Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome). As HIV/AIDS is contracted through the exchange of body fluids, sterilization, disinfection and sanitation procedures at dialysis facilities are very important. The spread of HIV/AIDS can be prevented through careful adherence to guidelines for infection control known as universal blood and body fluid precautions that include the following for health care workers:

• Wear protective gear such as gloves, scrub suits, lab coats or aprons
• Wear gowns and protective eyewear and masks when blood splashes are likely
• Put on a fresh pair of gloves for each direct patient encounter
• Wash hands when entering the patient area, when starting or completing patient care, before leaving the work area and between patients
• Dispose of needles or other sharp instruments in purchase-resistant containers located close to dialysis area
• Never recap needles

Similar safety procedures are currently in use to control the spread of infection of Hepatitis B in dialysis units. The HIV/AIDS virus is spread much less readily than Hepatitis B in dialysis unites because the blood of a person infected with HIV/AIDS has fewer infectious viral particles than does the blood of someone with Hepatitis B. In addition, all blood donations are being screened for the HIV/AIDS antibody making any blood transfusion as safe as possible.

Background:: Phosphorus binders are used to treat hyperphosphatemia in maintenance dialysis patients, in whom the use of these medications has been associated with lower mortality in some observational studies. It is not clear whether similar benefits can be seen in patients with non–dialysis-dependent chronic kidney disease (CKD).Study Design:: Historical cohort.Setting & Participants:: 1,188 men with moderate and advanced non–dialysis-dependent CKD at a single medical center.Predictor:: Administration of any phosphorus binder.Outcomes & Measurements:: We examined associations of any phosphorus-binder administration with all-cause mortality and the slopes of estimated glomerular filtration rate using time-varying Cox models and mixed-effects models. Associations also were examined in intention-to-treat analyses and in 133 patient-pairs matched according to propensity scores.Results:: 344 patients were treated with a phosphorus binder; 658 patients died (mortality rate, 141 deaths/1,000 patient-years; 95% CI, 131-153) during a median follow-up of 3.1 years. Treatment with phosphorus binders was associated with significantly lower mortality (adjusted HR, 0.61; 95% CI, 0.45-0.81; P < 0.001). Results were similar when exposure was modeled in intention-to-treat analyses and examining propensity-matched patients. Phosphorus-binder use was not associated with significant changes in kidney function loss.Limitations:: Results may not apply to all patients with non–dialysis-dependent CKD.Conclusions:: Administration of phosphorus binders is associated with lower mortality in men with moderate and advanced non–dialysis-dependent CKD. Clinical trials are needed to determine the risks and benefits of phosphorus-binder use in this patient population.