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Biomedical subjects

F K Port

Publications and source records attributed to F K Port.

At least 127 records · Page 7Linked to original sources
PubMed1991

Geographic variation in the incidence of treated end-stage renal disease.

To facilitate identification of geographic clusters of areas with high or low incidence of treated end-stage renal disease, the 1983 to 1988 incidence by county was studied among whites and nonwhites less than 60 yr of age in the United States. End-stage renal disease incidence counts for 1983 to 1988 were obtained from the United States Renal Data System data base and linked to the 1985 county population obtained from U.S. Census data. Maps were smoothed by the method adopted by the National Cancer Institute that smooths only according to variability of the local rates, ignoring geographic information on clustering of events. In addition to identifying specific counties with exceptionally high or low incidence, geographic patterns were observed with many similarities across whites and nonwhites: notably high rates of disease in areas of the Southwest, the Southeast and in counties with Native American reservations and low rates in the West and Northwest. On the basis of these findings, several hypotheses are presented to explain the observed variation in treated end-stage renal disease incidence rates.

Adult↗
PubMed1991

Comparison of mortality risk by choice of CAPD versus hemodialysis among elderly patients.

To evaluate patient survival among geriatric patients by dialytic treatment of choice we assigned all patients aged 65 years and older treated in Michigan to either CAPD at home or center hemodialysis (HD) according to the treatment used on day 120 of ESRD therapy. Michigan Kidney Registry files on all 308 CAPD and 1244 HD patients who started ESRD therapy during 1980-1987 were used for this study. The Cox proportional hazards model revealed a significantly increased relative death rate (RR) for patients with diabetes (RR = 1.91, p less than 0.001) and hypertension (RR 1.4, p less than 0.01) as cause of ESRD when adjusting for age, sex, race, treatment and year of incidence. White patients had a 51% higher relative death rate overall when compared to black patients (p less than 0.001) and specifically among hypertensive (RR = 1.65, p less than 0.001) and diabetic patients (RR = 1.59, p less than 0.001). Those differences were still significant when taking higher rates of withdrawal from dialysis among white patients into account. The relative death rates for CAPD patients was essentially the same as for HD patients overall, however, diabetic CAPD patients appeared to have a higher than diabetic HD patients (RR = 1.58, p = 0.1). This statistically not significant difference may be related to selection of patients with cardiovascular risk into CAPD. There was no trend in mortality over time. By modality on day 120, CAPD has similar outcomes as HD in geriatric non diabetic patients.

Age Factors↗
PubMed1990

A comparison of survival among dialytic therapies of choice: in-center hemodialysis versus continuous ambulatory peritoneal dialysis at home.

Analyses were performed on a series of 2,754 dialysis patients between the ages of 20 and 60 years whose end-stage renal disease (ESRD) therapy started in Michigan from 1980 through 1987 with the selection of either center hemodialysis (CH) or continuous ambulatory peritoneal dialysis (CAPD). The dialytic treatment at 6 months after first ESRD therapy was selected as the dialytic "treatment of choice" for each patient. Analyses of subsequent survival showed lower death rates for black patients than for white patients with hypertension (P less than 0.01) and diabetes (P less than 0.01). Death rates increased with patient age more dramatically among glomerulonephritis patients than among the other diagnostic groups (P less than 0.05). Females had significantly lower death rates than did males among diabetic patients (P less than 0.01). While no significant difference was found in average death rates between CH and CAPD (NS), there was a significant difference (P less than 0.05) in the trend in death rates. Death rates among CH patients increased significantly (P less than 0.001) during the study period, whereas death rates among CAPD patients have improved slightly (NS).

Adult↗
PubMed1990

Five-year survival for end-stage renal disease patients in the United States, Europe, and Japan, 1982 to 1987.

We compared the 5-year survival for new end-stage renal disease (ESRD) patients accepted for renal replacement therapy (RRT) between 1982 and 1987 in the United States (n = 150,862), Europe (European Dialysis and Transplant Association [EDTA]) (n = 124,796), and Japan (n = 66,244). Given these large samples that approach a census in each of the three regions, all results are statistically significant. Our analysis showed that the US patients were older and more likely to be diabetic than the patients in either EDTA or Japan. After correction for patient differences in age composition and the percent diabetic, Japan had the highest survival, followed by EDTA, and then the US. Overall, the US 5-year survival was 40%. When comparison is done by age, only the youngest patients in the US (less than 15 years) have longer survival than their counterparts in Europe and Japan. For ages greater than 14 years, the survival differences between the US and EDTA and between the US and Japan grow larger with higher patient age. The comparisons of mortality by diagnosis showed that the differences between the US and EDTA and between the US and Japan were least for diabetes. For non-diabetic patients, the age adjusted relative risk (RR) of mortality for the US compared with EDTA was 1.22, ie, 22% higher in the US; for the US compared with Japan, the RR was 1.40. In contrast, the RR for diabetic patients in the US compared with EDTA was 1.07, and 1.23 for the US compared with Japan.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Recovery from end-stage renal disease.

To evaluate the rate and associated factors for recovery of renal function in patients labeled by their nephrologists as having end-stage renal disease (ESRD), the data base of the Michigan Kidney Registry was used. All patients reported as starting treatment for ESRD between 1976 and 1985 (N = 7,404) were evaluated, excluding patients with acute tubular necrosis (ATN) or transplantation cases. While patients with ESRD due to diabetes and cystic diseases had lower recovery rates than average, patients with glomerulonephritis associated with a systemic illness, vasculopathies, and crescents had threefold to fourfold higher recovery rates. White race, older age, and later year of ESRD were associated with significantly higher recovery rates. Recovery rates did not differ substantially for patients receiving peritoneal dialysis or hemodialysis. Recovery occurred within 6 months of ESRD in approximately 48% of those recovering, 74% within 1 year, and lasted at least 1 year in 75% of the cases. The authors conclude that caution should be applied when the diagnosis of ESRD is made; the possibility of recovery should be sought and assessed, especially when early renal transplantation is considered.

Actuarial Analysis↗
PubMed1990

Mortality and causes of death in patients with end-stage renal failure.

Using data from the Michigan Kidney Registry, the survival of patients with end-stage renal disease (ESRD) was evaluated by multivariate analysis. Black patients had a significantly better outcome overall. A significantly worse outcome was found for older patients and diabetics, among both races and for black females. Causes of death were analyzed for dialysis patients and specific comments address discontinuation of dialysis leading to death.

Adult↗
PubMed1990

A prospective controlled trial of cold-storage versus machine-perfusion preservation in cadaveric renal transplantation.

A prospective controlled study was carried out in 60 consecutive cadaver renal donors comparing cold storage to pulsatile machine-perfusion preservation. Each donor served as its own control, by allocating one of the kidneys to each of the two preservation methods. There were 51 evaluable pairs of kidneys. Recipient age, panel-reactive antibody level, history of prior renal transplant, and immunosuppressive regimen were similar in the two preservation groups. Almost all recipients were treated with cyclosporine, and over 50% received antilymphoblast globulin. Total cold ischemic time was 1262 +/- 387 min in the machine-perfused group and 1309 +/- 426 min in the cold-storage group (P = NS). Prolonged ischemia (greater than 24 hr) occurred in 31% of machine-perfused and 22% of cold-stored kidneys (P = NS). Post-operative serum creatinine levels at 1, 7, and 30 days posttransplant were similar in both groups. Dialysis requirements were also similar, with 21 recipients of machine-perfused kidneys (41%) requiring at least one dialysis treatment compared to 16 patients (31%) in the cold-stored group (P = NS); the mean number of dialysis treatments required was 3.14 +/- 1.46 and 3.06 +/- 1.29, respectively (P = NS). Long ischemic time (greater than 24 hr) was associated with a higher rate of dialysis requirement in both groups, but in neither case did this achieve statistical significance. The distribution of graft losses within the first 30 days was similar in both groups, and the incidence of preservation-related graft failure was not significantly different. These results demonstrate that, in the cyclosporine era, machine perfusion offers no significant advantages over cold storage for cadaver renal preservation. Because machine perfusion is considerably more expensive and cold storage is simpler and facilitates the logistics of organ sharing, we recommend simple hypothermic storage of renal allografts as the preservation method of choice.

Analysis of Variance↗
PubMed1990

Solvent nephrotoxicity in humans and experimental animals.

Evidence from human case reports, epidemiologic studies and animal experiments have suggested that exposure to organic solvents is associated with a wide spectrum of renal disorders, including tubular necrosis, interstitial disease, glomerulonephritis and neoplasia. This review summarizes what is known about solvent-induced renal damage in humans and experimental animals, with emphasis on hypothesized mechanisms by which this broad range of disorders may occur.

Animals↗
PubMed1990

Occupational and other exposures associated with male end-stage renal disease: a case/control study.

We conducted a case-control study of 325 men ages 30-69 who were diagnosed with end-stage renal disease (ESRD) between 1976 and 1984, and resided in four urban areas of Michigan in 1984. Cases were selected from the Michigan Kidney Registry and excluded men with diabetic, congenital, and obstructive nephropathies. Controls were selected by random-digit dialing and were pair-matched to cases for age, race, and area of residence. Telephone interviews were conducted with 69 percent of eligible cases and 79 percent of eligible controls. Risk of ESRD was significantly related to phenacetin or acetaminophen consumption (odds ratio(OR) = 2.66), moonshine consumption (OR = 2.43), a family history of renal disease (OR = 9.30); and regular occupational exposures to solvents (OR = 1.51) or silica (OR = 1.67). Particular occupational exposures with elevated risk were solvents used as cleaning agents and degreasers (OR = 2.50) silica exposure in foundries or brick factories (OR = 1.92), and silica exposure during sandblasting (OR = 3.83). Little or no trend of increased risk with duration of exposure was found for these occupational exposures, with the exception of silica in sandblasting. Limitations of these data include representativeness of cases, possible overreporting by cases, and misclassification of exposures inherent in self-reports.

Adult↗
PubMed1990

Outcome of end-stage renal disease in patients with rare causes of renal failure. III. Systemic/vascular disorders.

This multicentre national study has provided demographic and outcome data on over 1700 patients with rare systemic/vascular diseases as a cause of ESRD. Except for those with Henoch-Schönlein purpura, polyarteritis nodosa and Wegener's granulomatosis, women predominated. On the other hand, black patients seem less susceptible to these illnesses than white patients except for SLE. Recovery of renal function sufficient for dialysis to be discontinued was more likely in each of these diseases except for SLE than for any of the other 'rare' diseases described by us, the usual causes of renal failure as reported by the EDTA Registry or our control patients. Overall survival was quite good except in those patients with progressive systemic sclerosis whose outlook was poor.

Adult↗
PubMed1990

Recent trends in cadaveric renal transplantation.

1. Cadaveric transplantation increased steadily from 1981 through 1986 and then leveled off. The gap between patients awaiting transplant and cadaveric transplants performed increased rapidly after 1986. 2. There has been a trend in the age distribution of cadaveric transplant recipients toward transplantation of older patients. The number of cadaveric transplants to patients 50 and over continued to increase after 1986, while the number to patients under 50 declined. The proportion of transplants to patients 60 and over has shown a particularly dramatic increase. 3. The rate of transplantation is highest in the pediatric age group and declines with age. The rate of transplantation increased in all age groups until 1986 and then declined in all age groups except the 50 and over group. The magnitude of the decline is greatest in the younger age groups. 4. Among all dialysis patients, males have a higher rate of transplantation than females, and Whites have a higher rate than Blacks. These differences in rates increase with increasing recipient age. There are moderate trends toward decreased differences by sex and increased differences by race. 5. Repeat transplants make up about 15% of all cadaveric transplants in 1988, with higher proportions of repeat transplants in the younger age groups. The transplantation rates for repeat transplants has been declining relative to that for first transplants when the relevant pool of dialysis patients is used. For the 50 and over age group, the repeat transplant rate was 3.6 times as high as the first transplant rate in 1988. 6. Compared to the general population, cadaver transplant donors are younger, less often female, and less often Black. There has been a trend toward older donors and toward a smaller difference by sex. 7. There has been a trend toward fewer nephrectomies and splenectomies prior to transplantation. 8. There are no clear time trends in sharing of organs among transplant centers and only a slight increase in the proportion of transplants with 0 HLA-antigen mismatches.

Age Factors↗
PubMed1989

Disparities in incidence of diabetic end-stage renal disease according to race and type of diabetes.

The incidence of end-stage renal disease in patients with diabetes mellitus is reportedly higher among blacks than among whites. This finding may be explained by the greater prevalence of diabetes among blacks. The relation of the type of diabetes to the risk of diabetic end-stage renal disease is largely unstudied. We addressed these issues in a study of all the black and white diabetic patients with end-stage renal disease (470 blacks and 861 whites) reported to the Michigan Kidney Registry who began treatment during 1974 through 1983. We also reviewed the medical records of a subpopulation of such patients (284 blacks and 310 whites) who were less than 65 years of age at the start of treatment for end-stage renal disease to determine what type of diabetes they had. In this study, we made use of national data on the prevalence of diabetes. We found that the incidence of diabetic end-stage renal disease was 2.6-fold higher (P less than or equal to 0.0001) among blacks after we adjusted for the higher prevalence of diabetes among blacks, with the excess risk occurring predominantly among blacks with non-insulin-dependent diabetes mellitus (NIDDM). Most black patients with diabetic end-stage renal disease had NIDDM (77 percent), whereas most white patients with diabetic end-stage renal disease had insulin-dependent diabetes mellitus (IDDM) (58 percent) (P less than or equal to 0.0005 for the difference between the races). For both races combined, the risk of diabetic end-stage renal disease during the 10-year period we studied was markedly greater for patients with IDDM (5.8 percent) than for those with NIDDM (0.5 percent). Our results indicate an increased risk of diabetic end-stage renal disease among blacks as compared with whites, particularly blacks with NIDDM. Although the risk of diabetic end-stage renal disease is higher in patients with IDDM, the majority of patients with diabetic end-stage renal disease in the population we studied had NIDDM.

Adolescent↗
PubMed1989

Independence in activities of daily living for end-stage renal disease patients: biomedical and demographic correlates.

Factors associated with physical well-being were examined in a population-based sample of adult end-stage renal disease (ESRD) patients in Michigan (n = 459). The dependent variables were two measures of physical functioning: (1) a ten-item measure of activities of daily living (ADL), and (2) the 45-item physical dysfunction dimension of the Sickness Impact Profile (SIP). Independent variables included four modalities of treatment (in-center hemodialysis, continuous ambulatory peritoneal dialysis [CAPD], related transplant, and cadaver transplant); primary cause of ESRD (eg, diabetes, glomerulonephritis); comorbidity (other illnesses besides primary cause of ESRD); and demographic characteristics (sex, race, age, marital status, education). ADL and SIP unadjusted mean scores differed significantly by category for each of the eight study factors (analysis of variance [ANOVA], P less than 0.0001), with the exception of sex for SIP means. The highest levels of dependency in ADL were reported by patients who were older, female, black, widowed, less educated, treated with in-center hemodialysis, had diabetes as the primary cause of ESRD, and/or reported more comorbidity. The partial effect of each factor on the dependent measures with adjustment for the seven other factors was assessed using analysis of covariance (ANCOVA). In the ADL analysis, sex, race, age, primary cause of kidney failure, and comorbidity were significant factors (probability values ranging from 0.05 for race to 0.0001 for sex, primary cause of ESRD, and comorbidity). The SIP physical dysfunction measure gave slightly different results. Race, age, primary cause of ESRD, comorbid status, and modality of treatment were significantly related to physical dysfunction (P less than 0.05 to P less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1989

Neoplasms in dialysis patients: a population-based study.

Cancer incidence was assessed in 4,161 end-stage renal disease (ESRD) patients on dialysis to determine whether there was any excess risk of cancer in this population. Records from the Michigan Kidney Registry (MKR) for 1973 to 1984 were linked to those of the Michigan Cancer Foundation's Metropolitan Detroit Cancer Surveillance System (MDCSS) to identify cases in the dialysis cohort. The expected number of cancers in the ESRD population was calculated using the race-, sex-, age- and calendar year-specific incidence rates of the tricounty metropolitan Detroit region of 4 million residents. The standardized incidence ratio (observed:expected) was significantly increased for all in situ tumors combined, as well as for invasive tumors of the kidney, the corpus uteri, and the prostate. The four-fold to five-fold excess (P less than 0.005) observed for renal and endometrial cancers, in addition to the significantly elevated (P less than 0.05) risk of prostate cancer indicates that patients maintained on dialysis should be evaluated for these tumors when they experience even minor symptoms. Population-based cancer and renal disease registries provide excellent opportunities for investigating etiologic hypotheses and future studies should incorporate potential risk factors when analyzing these data.

Adult↗
PubMed1989

Discontinuation of dialysis therapy as a cause of death.

Discontinuation of life-sustaining dialysis therapy led to death in 282 of 5,208 patients who started therapy for end-stage renal disease (ESRD) in Michigan during 1980-1985 with a follow-up through 1986. Based on life table estimates at 60 months after initiation of therapy, 9.4% of patients overall died due to termination of dialysis, 11% of females versus 8% of males (p = 0.02), 0.1-3.4% for ages less than or equal to 49 years versus 56% for greater than 80 years, 12% for white versus 4% for black patients (p less than 0.001) and 16% for diabetic ESRD patients (higher than any other group, p less than 0.05). The Cox regression model confirms these significant findings for race, diabetes and age, and reveals a significant 60% increase in overall withdrawals for the years 1980-1985 (1.10/year, p less than 0.02). A separate analysis of discontinuation of dialysis as the percentage of all 2,564 dialysis deaths in prevalence cases for 1980-1984 revealed an overall ratio of 8.9% with a significant difference for ages less than or equal to 64 versus greater than or equal to 65 (p less than 0.001), race (p less than 0.001) but not for prior transplant failure or continuous ambulatory peritoneal dialysis therapy. Whereas the results for age and diabetes were expected, the significant increase of dialysis withdrawal over time and the racial difference are unexplained by information available at the Michigan Kidney Registry and indicate the need for exploration by further studies.

Actuarial Analysis↗
PubMed1989

The role of pretransplant time and therapy on kidney graft survival.

1. The delay time between onset of ESRD and first cadaver kidney transplant varies considerably across patient subgroups. It is shortest for Whites and Asian Americans and longest for Blacks. Patients with blood type O and those highly sensitized have longer delays. 2. The effect of delay time on graft survival, while real and statistically significant, is quantitatively small. 3. Based on an analysis of a large national United States sample, CAPD therapy, compared to other forms of dialysis, does not have an adverse effect on 2-year graft survival.

Databases, Bibliographic↗