Cancer in Patients on Chronic Dialysis in Korea

The study of cancer in patients treated with dialysis in Korea has not been reported. The aim of this study was to investigate the incidence and mortality of cancer among patients on dialysis in Korea. The study subjects were 106 cancer patients (2.3%) out of 4,562 end-stage renal disease (ESRD) patients maintained on hemodialysis (HD) or peritoneal dialysis (PD) at Yonsei University Health System from 1996 to 2005. We excluded patients in whom the diagnosis of cancer preceded dialysis or those who received renal allograft or started dialysis after renal allograft. Seventy-three (69%) of our subjects were male and 33 (31%) were female. The mean age at the time of cancer diagnosis was 57.9±11.7 yr. The mean time from the start of dialysis to the diagnosis of cancer was 75.2±63.9 months. The most common cancer site was gastrointestinal tract (GIT) (51%) followed by urinary tract (20%), lung (8%), and thyroid (7%). Sixty nine percent of the total mortality was due to cancer. The mean time from diagnosis to death was 2.9±2.5 yr. In ESRD patients with cancer, there were no significant differences in mortality rates by dialysis modality. In ESRD patients, the most common cancer was GIT cancer followed by urinary tract cancer. Therefore, careful surveillance of these cancers in ESRD patients is highly recommended

Spontaneous Re-Canalization of Thrombosed Polytetrafluoroethylene (PTFE) Grafts

Fibrinolysis is an important hemostatic process initiated either by tissue plasminogen activator (tPA) or pro-urokinase (pro-UK) released from endothelial cells. These agents act preferentially on plasminogen by converting it to the active molecule plasmin. This initiates the clot lysis process, which may take several days for completion. Most patients with end-stage renal disease (ESRD) have PTFE grafts for chronic hemodialysis. When these grafts are thrombosed, they are either surgically revised or percutaneously thrombolysed. When these measures fail another access is created without removing the clotted graft. However, it is possible that de-clotting of these thrombosed PTFE grafts can occur spontaneously. Once the graft develops an endothelial lining, these cells can contribute to the fibrinolytic process by secreting tPA or pro-UK. Because this endothelial lining may be less developed than that of a normal vessel, the fibrinolytic process may occur at a slower rate or not at all. Frequent cannulation during hemodialysis can denude existing endothelium, further contributing to the inadequacy of the graft to initiate thrombolysis. In practice, once the PTFE is clotted, the graft is ignored if it is not considered for declotting. In such circumstances the re-canalization process could be overlooked, resulting in the unnecessary placement of additional accesses. Presented here are three patients with clotted grafts in which re-canalization occurred without intervention.</jats:p