Hemodialysis International 2014; 18:846–850
REFERENCES 1 Elramah M, Boujelbane L, Yevzlin AS, Wakeen M, Astor BC, Chan MR. Dialysis access venous stenosis: Treatment with balloon angioplasty 30-second vs. 1-minute inflation times. Hemodial Int. 2014; doi: 10.1111/hdi.12183; in press. 2 Neuen BL, Gunnarsson R, Webster AC, Baer RA, Golledge J, Mantha ML. Predictors of patency after balloon angioplasty in hemodialysis fistulas: A systematic review. J Vasc Interv Radiol. 2014; 25:917–924. 3 Neuen BL, Gunnarsson R, Baer RA, et al. Factors associated with patency following angioplasty of hemodialysis fistulae. J Vasc Interv Radiol. 2014; doi: 10.1016/ j.jvir.2014.05.020; in press. 4 Rajan DK, Bunston S, Misra S, Pinto R, Lok CE. Dysfunctional autogenous hemodialysis fistulas: Outcomes after angioplasty—Are there clinical predictors of patency? Radiology. 2004; 232:508–515.
5 Turmel-Rodrigues L, Pengloan J, Baudin S, et al. Treatment of stenosis and thrombosis in haemodialysis fistulas and grafts by interventional radiology. Nephrol Dial Transplant. 2000; 15:2029–2036. 6 Katsanos K, Karnabatidis D, Kitrou P, Spiliopoulos S, Christeas N, Siablis D. Paclitaxel-coated balloon angioplasty vs. plain balloon dilation for the treatment of failing dialysis access: 6-month interim results from a prospective randomized controlled trial. J Endovasc Ther. 2012; 19:263–272. 7 Saleh HM, Gabr AK, Tawfik MM, Abouellail H. Prospective, randomized study of cutting balloon angioplasty versus conventional balloon angioplasty for the treatment of hemodialysis access stenoses. J Vasc Surg. 2014; doi: 10.1016/j.jvs.2014.04.002; in press. 8 Haskal ZJ, Trerotola S, Dolmatch B, et al. Stent graft versus balloon angioplasty for failing dialysis-access grafts. N Engl J Med. 2010; 362:494–503.
Intracerebral hemorrhage was the highest cause of mortality among stroke subtypes in Japanese dialysis patients
To the Editor: We were greatly interested to read the article entitled “Association of blood pressure with all-cause mortality and stroke in Japanese hemodialysis patients: The Japan dialysis outcomes and practice pattern study” by Inaba et al.1 Using data from the Japan Dialysis Outcomes and Practice Patterns Study (J-DOPPS), the authors revealed that both systolic and diastolic blood pressures were positively and monotonically associated with stroke-related death, suggesting that, as shown in the general population, hypertension is a definite risk factor for strokeCorrespondence to: M. Wakasugi, MD, MPH, PhD, Center for Inter-organ Communication Research, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi 1-757, Chuo-ku, Niigata 951-8510, Japan. Email: [email protected] Conflict of interest: None declared.
related death in hemodialysis patients. However, the DOPPS questionnaire did not distinguish between ischemic and hemorrhagic stroke. We would like to suggest that many of the stroke-related deaths are likely due to intracerebral hemorrhage. Because of the efforts of the DOPPS to obtain a representative, random sample of facilities and patients within each country, the results would likely represent those from our nationwide survey. Using data from the Japanese Society for Dialysis Therapy registry and a national Vital Statistics survey, we reported that the stroke mortality rate in Japanese dialysis patients is approximately three times higher than that in the general population.2 Using the same data, we found and reported that intracerebral hemorrhage had the highest mortality rate in Japanese dialysis patients among three stroke subtypes (i.e., intracerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage).3 This is inconsistent with results from the general Japanese population in which cerebral infarction had the highest mortality
© 2014 International Society for Hemodialysis DOI:10.1111/hdi.12212
848
Hemodialysis International 2014; 18:846–850
rate.3 In previous decades, mortality from cerebral hemorrhage was higher than that from cerebral infarction in the general Japanese population. However, a continuous decline was observed from the 1960s to the 2000s as a result of the nationwide approach to hypertension prevention and control.4,5 Taken together, strict control of blood pressure among hemodialysis patients may show great potential as a way to reduce stroke-related deaths. This would be particularly true for those with cerebral hemorrhage, as was found in the general population. We believe that the study by Inaba et al.1 will contribute significantly to the prevention of stroke-related deaths, mainly those due to intracerebral hemorrhage, as it highlights the importance of blood pressure control in hemodialysis patients. Minako WAKASUGI,1 Junichiro J. KAZAMA,2 Ichiei NARITA2 1 Center for Inter-organ Communication Research, 2 Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
Manuscript received July 2014.
REFERENCES 1 Inaba M, Karaboyas A, Akiba T, et al. Association of blood pressure with all-cause mortality and stroke in Japanese hemodialysis patients: The Japan dialysis outcomes and practice pattern study. Hemodial Int. 2014; 18:607–615. 2 Wakasugi M, Kazama JJ, Yamamoto S, Kawamura K, Narita I. Cause-specific excess mortality among dialysis patients: Comparison with the general population in Japan. Ther Apher Dial. 2013; 17:298–304. 3 Wakasugi M, Matsuo K, Kazama JJ, Narita I. Higher mortality due to intracerebral hemorrhage in dialysis patients: A comparison with the general population in Japan. Ther Apher Dial. 4 Ueshima H. Explanation for the Japanese paradox: Prevention of increase in coronary heart disease and reduction in stroke. J Atheroscler Thromb. 2007; 14:278–286. 5 Ohira T, Iso H. Cardiovascular disease epidemiology in Asia: An overview. Circ J. 2013; 77:1646–1652.
Highest serum creatinine ever reported in a child
To the Editor:
EXTREME ELEVATION OF SERUM CREATININE Serum creatinine is still the most commonly used test to assess the renal function despite its drawbacks.1 Serum
Correspondence to: K. K. Upadhyay, MD, Division of Pediatric Nephrology, Department of Pediatrics, Shands Children’s Hospital, University of Florida, Gainesville, FL 32610, USA. E-mail: [email protected] Conflict of interest: The authors declare that they have no conflict of interest. Funding source: No grant or funding was obtained for the purpose of this letter.
creatinine is a reflection of muscle mass, and hence, men tend to have higher values as compared to women.2 Extreme elevation in the serum creatinine has been described in patients with end-stage renal disease (ESRD). Abuhasna reported a serum creatinine level of 61.3 mg/dL in a 20-year-old male ESRD patient.3 Here, we describe a 14-year-old adolescent girl with extremely elevated serum creatinine, which we believe is the highest ever reported in a female pediatric patient.
CASE REPORT A 14-year-old African American girl presented with 1-week history of vomiting and sore throat. She was seen at a local hospital and was prescribed amoxicillin with a presumptive diagnosis of streptococcal pharyngitis. Past medical history was significant for mild developmental
© 2014 International Society for Hemodialysis DOI:10.1111/hdi.12213
849
REFERENCES 1 Elramah M, Boujelbane L, Yevzlin AS, Wakeen M, Astor BC, Chan MR. Dialysis access venous stenosis: Treatment with balloon angioplasty 30-second vs. 1-minute inflation times. Hemodial Int. 2014; doi: 10.1111/hdi.12183; in press. 2 Neuen BL, Gunnarsson R, Webster AC, Baer RA, Golledge J, Mantha ML. Predictors of patency after balloon angioplasty in hemodialysis fistulas: A systematic review. J Vasc Interv Radiol. 2014; 25:917–924. 3 Neuen BL, Gunnarsson R, Baer RA, et al. Factors associated with patency following angioplasty of hemodialysis fistulae. J Vasc Interv Radiol. 2014; doi: 10.1016/ j.jvir.2014.05.020; in press. 4 Rajan DK, Bunston S, Misra S, Pinto R, Lok CE. Dysfunctional autogenous hemodialysis fistulas: Outcomes after angioplasty—Are there clinical predictors of patency? Radiology. 2004; 232:508–515.
5 Turmel-Rodrigues L, Pengloan J, Baudin S, et al. Treatment of stenosis and thrombosis in haemodialysis fistulas and grafts by interventional radiology. Nephrol Dial Transplant. 2000; 15:2029–2036. 6 Katsanos K, Karnabatidis D, Kitrou P, Spiliopoulos S, Christeas N, Siablis D. Paclitaxel-coated balloon angioplasty vs. plain balloon dilation for the treatment of failing dialysis access: 6-month interim results from a prospective randomized controlled trial. J Endovasc Ther. 2012; 19:263–272. 7 Saleh HM, Gabr AK, Tawfik MM, Abouellail H. Prospective, randomized study of cutting balloon angioplasty versus conventional balloon angioplasty for the treatment of hemodialysis access stenoses. J Vasc Surg. 2014; doi: 10.1016/j.jvs.2014.04.002; in press. 8 Haskal ZJ, Trerotola S, Dolmatch B, et al. Stent graft versus balloon angioplasty for failing dialysis-access grafts. N Engl J Med. 2010; 362:494–503.
Intracerebral hemorrhage was the highest cause of mortality among stroke subtypes in Japanese dialysis patients
To the Editor: We were greatly interested to read the article entitled “Association of blood pressure with all-cause mortality and stroke in Japanese hemodialysis patients: The Japan dialysis outcomes and practice pattern study” by Inaba et al.1 Using data from the Japan Dialysis Outcomes and Practice Patterns Study (J-DOPPS), the authors revealed that both systolic and diastolic blood pressures were positively and monotonically associated with stroke-related death, suggesting that, as shown in the general population, hypertension is a definite risk factor for strokeCorrespondence to: M. Wakasugi, MD, MPH, PhD, Center for Inter-organ Communication Research, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi 1-757, Chuo-ku, Niigata 951-8510, Japan. Email: [email protected] Conflict of interest: None declared.
related death in hemodialysis patients. However, the DOPPS questionnaire did not distinguish between ischemic and hemorrhagic stroke. We would like to suggest that many of the stroke-related deaths are likely due to intracerebral hemorrhage. Because of the efforts of the DOPPS to obtain a representative, random sample of facilities and patients within each country, the results would likely represent those from our nationwide survey. Using data from the Japanese Society for Dialysis Therapy registry and a national Vital Statistics survey, we reported that the stroke mortality rate in Japanese dialysis patients is approximately three times higher than that in the general population.2 Using the same data, we found and reported that intracerebral hemorrhage had the highest mortality rate in Japanese dialysis patients among three stroke subtypes (i.e., intracerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage).3 This is inconsistent with results from the general Japanese population in which cerebral infarction had the highest mortality
© 2014 International Society for Hemodialysis DOI:10.1111/hdi.12212
848
Hemodialysis International 2014; 18:846–850
rate.3 In previous decades, mortality from cerebral hemorrhage was higher than that from cerebral infarction in the general Japanese population. However, a continuous decline was observed from the 1960s to the 2000s as a result of the nationwide approach to hypertension prevention and control.4,5 Taken together, strict control of blood pressure among hemodialysis patients may show great potential as a way to reduce stroke-related deaths. This would be particularly true for those with cerebral hemorrhage, as was found in the general population. We believe that the study by Inaba et al.1 will contribute significantly to the prevention of stroke-related deaths, mainly those due to intracerebral hemorrhage, as it highlights the importance of blood pressure control in hemodialysis patients. Minako WAKASUGI,1 Junichiro J. KAZAMA,2 Ichiei NARITA2 1 Center for Inter-organ Communication Research, 2 Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
Manuscript received July 2014.
REFERENCES 1 Inaba M, Karaboyas A, Akiba T, et al. Association of blood pressure with all-cause mortality and stroke in Japanese hemodialysis patients: The Japan dialysis outcomes and practice pattern study. Hemodial Int. 2014; 18:607–615. 2 Wakasugi M, Kazama JJ, Yamamoto S, Kawamura K, Narita I. Cause-specific excess mortality among dialysis patients: Comparison with the general population in Japan. Ther Apher Dial. 2013; 17:298–304. 3 Wakasugi M, Matsuo K, Kazama JJ, Narita I. Higher mortality due to intracerebral hemorrhage in dialysis patients: A comparison with the general population in Japan. Ther Apher Dial. 4 Ueshima H. Explanation for the Japanese paradox: Prevention of increase in coronary heart disease and reduction in stroke. J Atheroscler Thromb. 2007; 14:278–286. 5 Ohira T, Iso H. Cardiovascular disease epidemiology in Asia: An overview. Circ J. 2013; 77:1646–1652.
Highest serum creatinine ever reported in a child
To the Editor:
EXTREME ELEVATION OF SERUM CREATININE Serum creatinine is still the most commonly used test to assess the renal function despite its drawbacks.1 Serum
Correspondence to: K. K. Upadhyay, MD, Division of Pediatric Nephrology, Department of Pediatrics, Shands Children’s Hospital, University of Florida, Gainesville, FL 32610, USA. E-mail: [email protected] Conflict of interest: The authors declare that they have no conflict of interest. Funding source: No grant or funding was obtained for the purpose of this letter.
creatinine is a reflection of muscle mass, and hence, men tend to have higher values as compared to women.2 Extreme elevation in the serum creatinine has been described in patients with end-stage renal disease (ESRD). Abuhasna reported a serum creatinine level of 61.3 mg/dL in a 20-year-old male ESRD patient.3 Here, we describe a 14-year-old adolescent girl with extremely elevated serum creatinine, which we believe is the highest ever reported in a female pediatric patient.
CASE REPORT A 14-year-old African American girl presented with 1-week history of vomiting and sore throat. She was seen at a local hospital and was prescribed amoxicillin with a presumptive diagnosis of streptococcal pharyngitis. Past medical history was significant for mild developmental
© 2014 International Society for Hemodialysis DOI:10.1111/hdi.12213
849
