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tancy of 3 4 years, but survival for as long as 25 years is seen depending on the disease entity Studies are conflicting regarding the survival advantage associated with either peritoneal dialysis or hemodialysis
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Up to 50% of all patients with ESRD are suitable for transplantation Age is becoming less of a barrier Two-thirds of kidney transplants come from deceased donors, with the remainder from living related or unrelated donors Immunosuppressive drugs include corticosteroids, azathioprine, mycophenolate mofetil, tacrolimus, cyclosporine, and rapamycin A patient with a deceased-donor renal transplant typically requires stronger immunosuppression than patients with living related kidney donor transplants However, this depends to a great extent on the degree of HLA-type matching The 1- and 5-year kidney graft survival rates are approximately 94% and 76%, respectively, for living related and living unrelated donor transplants and 88% and 65%, respectively, for deceased donor transplants The average wait for a cadaveric transplant is 2 4 years; this is becoming progressively longer as more people are going onto waiting lists while the deceased donor pool is not expanding Aside from medication use, the life of a transplanted patient can return to nearly normal
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Mortality is higher for patients undergoing dialysis than for age-matched controls Yearly mortality is 212 deaths per 100 patient-years The expected remaining lifetime for the age group 55 64 is 22 years, whereas that of the ESRD population is 5 years The most common cause of death is cardiac dysfunction (45%) Other causes include infection (14%), cerebrovascular disease (6%), and malignancy (4%) Diabetes, age, a low serum albumin, lower socioeconomic status, and inadequate dialysis are all significant predictors of mortality For those who require dialysis to sustain life but elect not to undergo dialysis, death ensues within days to weeks In general, uremia develops and patients lose consciousness prior to death Arrhythmias can occur as a result of electrolyte imbalance Volume overload and dyspnea can be managed by volume restriction and opioids as described in 5 Meticulous efforts at palliative care are essential
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Barry JM Current status of renal transplantation Patient evaluations and outcomes Urol Clin North Am 2001 Nov;28(4): 677 86 [PMID: 11791486] Block GA et al Cinacalcet for secondary hyperparathyroidism in patients receiving hemodialysis N Engl J Med 2004 Apr 8; 350(15):1516 25 [PMID: 15071126] Collins AJ et al Cardiovascular disease in end-stage renal disease patients Am J Kidney Dis 2001 Oct;38(4 Suppl 1):S26 9 [PMID: 11576917] Go AS et al Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization N Engl J Med 2004 Sep 23;351(13):1296 305 [PMID: 15385656] JAMA patient page Kidney failure JAMA 2001 Dec 12;286 (22):2898 [PMID: 11767735]
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method is extremely operator and patient dependent Measurements of blood flow must be made at the aorta and along each third of the renal artery in order to assess the disease This test is a poor choice for patients who are obese, unable to lie supine, or have interfering bowel gas patterns Captopril renography capitalizes on the difference in renal perfusion with and without ACE inhibitors A kidney distal to a significant stenosis requires high angiotensin II levels to maintain adequate perfusion With an ACE inhibitor, perfusion is markedly diminished The affected kidney enhances less, whereas the unaffected one enhances more in the setting of a captopril challenge Sensitivity ranges from 75% to 100% and specificity from 60% to 90% This procedure is not as accurate in moderate to severe kidney disease MRA is an excellent but expensive way to screen for renal artery stenosis Sensitivity is 99 100% Specificity ranges from 71% to 96% Turbulent blood flow can cause false-positive results Renal angiography is the gold standard for diagnosis CO2 subtraction angiography can be used in place of dye when the risk of dye nephropathy exists eg, in diabetic patients with renal insufficiency Lesions are most commonly found in the proximal third or ostial region of the renal artery The risk of atheroembolic phenomena after angiography is not trivial in this population, ranging from 5% to 10% Fibromuscular dysplasia has a characteristic beads-on-a-string appearance on angiography
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Levey AS et al; National Kidney Foundation National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification Ann Intern Med 2003 Jul 15;139(2):137 47 [PMID: 12859163] Ruggenenti P et al Progression, remission, regression of chronic renal diseases Lancet 2001 May 19;357(9268):1601 8
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