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Query: UMLS:C0917801 (insomnia)
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Nineteen patients treated by continuous ambulatory peritoneal dialysis (CAPD) were studied according to clinical outcome parameters: insomnia, asthenia, pruritus, arterial hypertension, anorexia, nausea and/or vomiting, anemia, and rate of hospitalization. Using clinical scores, three groups were defined: poor clinical outcome (P), intermediate (I), and good (G). The quantity of treatment by PD was evaluated monthly with urea kinetic tests (weekly Kt/V, weekly urea clearance/1.73 m2 of body surface area (BSA), index of dialysis by Teehan), and with the weekly creatinine clearance/1.73 m2 of BSA. The metabolic index was analyzed: normalized protein catabolic rate (NPCR), serum albumin (Alb) and prealbumin, and reabsorption of glucose. There was good correlation between clinical scores and quantity of dialysis. The Alb was lower in group P. Group G was differentiated from group I and from group P by quantification tests and NPCR, with lower levels as follows: weekly Kt/V = 2.06, urea clearance 70 L/week/1.73 m2, index of dialysis = 0.87, and creatinine clearance = 60 L/week/1.73 m2. We conclude that the qualitative clinical approach is not sufficient to predict deleterious signs, and the quantitative approach is predictive of the good clinical outcome and good nutritional status. We think that levels proposed to now are insufficient, and we suggest the following: weekly urea clearance > 70 L, weekly Kt/V > 2, weekly creatinine clearance > 60 L, and index of dialysis > 0.85.
Perit Dial Int 1993
PMID:Quantification of adequacy of peritoneal dialysis. 839 69

Sleep apnea is a surprisingly common disorder in end-stage renal disease (ESRD) and chronic renal failure. The symptoms of sleep apnea frequently go unreported or may be misdiagnosed as uremia, depression, chronic illness, or insomnia. A review of the literature was performed to define the prevalence, morbidity, and treatment of sleep apnea syndrome in the ESRD patient. Sleep apnea occurs in at least 60% of ESRD patients. The known complications of sleep apnea include arrhythmias, pulmonary hypertension, and systemic hypertension. In addition, sleep apnea has been implicated in coronary artery disease and strokes. The contribution of sleep apnea to the high mortality from cardiac disease and stroke in peritoneal dialysis and hemodialysis patients is unknown. The causes of the increased prevalence of sleep apnea in ESRD patients are unknown and likely differ from the general population, but the treatment is similar. The literature suggests that modality of renal replacement therapy does not matter; however, large nocturnal volume peritoneal dialysis may worsen sleep apnea. Renal transplantation may be curative. In conclusion, sleep apnea may be an under-diagnosed disease in patients on dialysis. There are significant reasons to suspect that sleep apnea may worsen the morbidity and mortality of ESRD, and there are potential successful therapies.
Adv Perit Dial 1997
PMID:Sleep apnea in renal failure. 936 Jun 57

We observed six cases of patients in a dialysis programme who were apparently intoxicated by ingestion of star fruit. After ingestion of 2-3 fruits or 150-200 ml of the fruit juice, the six patients, who had previously been stable in a regular dialysis programme, developed a variety of symptoms ranging from insomnia and hiccups to agitation, mental confusion and (in one case) death. In preliminary investigations to characterize the hypothetical neurotoxin in the fruit, an extract, when injected intraperitoneally or intracerebroventricularly in rats, provoked persistent convulsions of the tonic-clonic type. It appears that star fruit (Averrhoa carambola) contains an excitatory neurotoxin. Patients with renal failure on conservative or dialysis treatment should be dissuaded from ingestion of the fruit.
Nephrol Dial Transplant 1998 Mar
PMID:Intoxication by star fruit (Averrhoa carambola) in six dialysis patients? (Preliminary report) 955 Jun 29

The aim of our study was a comparison of comorbid scores, peritonitis rates, dialysis adequacy, and nutritional parameters in continuous ambulatory peritoneal dialysis (CAPD) patients. Patients were separated into two groups: those who, in the course of CAPD, were ingood clinical condition and underwent renal transplantation (group I, n = 11), and those who had to discontinue CAPD treatment (group II, n = 16) owing to death caused by comorbid disease or owing to transfer to hemodialysis for technique failure related mainly to recurrent peritonitis. Clinical scores were lower in group II, showing significantly more insomnia, weakness, and anorexia. The PET D/P creatinine, mean adequacy parameter, and urine output were similar in groups I and II. Daily protein intake (DPI) and daily energy intake (DEI) showed higher values in group I than in group II when expressed in g/kg and kcal/kg total body mass (TBM) respectively (DPI 1.09 +/- 0.15 g/kg TBM vs 0.92 +/- 0.31 g/kg TBM, p = 0.036; DEI 36.3 +/- 4.3 kcal/kg TBM vs 31.0 +/- 9.0 kcal/kg TBM, p = 0.048), but the intakes were not significantly different when calculated per kilogram ideal body mass (IBM). Lean body mass as a percent of total mass was 77.7% +/- 7.8% versus 73.9% +/- 6.8% (p = 0.048) in groups I and II respectively. Group I showed lower serum cholesterol than group II (179 +/- 33 mg/dL vs 231 +/- 41 mg/dL, p = 0.001) despite higher dietary intake of cholesterol (367 +/- 137 mg/day vs 251 +/- 97 mg/day, p = 0.016), correlating with DPI (r = +0.673, p = 0.023). Our results indicate that under conditions of similar CAPD adequacy, patients with a satisfactory course of CAPD therapy have higher dietary intake and are better nourished than those with a poor outcome. The changes in nutrition seem to be related to comorbid diseases and complications of CAPD therapy. Increased cholesterol level, associated with a diminished DPI, is prognostic of a poor outcome for CAPD patients.
Adv Perit Dial 1999
PMID:Differences in assessment of patients with satisfactory or complicated continuous ambulatory peritoneal dialysis courses. 1068 84

Sleep-related complaints affect 50-80% of patients on dialysis. Sleep disorders impair quality of life significantly. Increasing evidence suggests that sleep disruption has a profound impact both on an individual and on a societal level. The etiology of sleep disorders is often multifactorial: biologic, social, and psychological factors play a role. This is especially true for insomnia, which is the most common sleep disorder in different populations, including patients on dialysis. Biochemical and metabolic changes, lifestyle factors, depression, anxiety, and other underlying sleep disorders can all have an effect on the development and persistence of sleep disruption, leading to chronic insomnia. Insomnia is defined as difficulty initiating or maintaining sleep, or having nonrestorative sleep. It is also associated with daytime consequences, such as sleepiness and fatigue, and impaired daytime functioning. In most cases, the diagnosis of insomnia is based on the patient's history, but in some patients objective assessment of sleep pattern may be necessary. Optimally the treatment of insomnia involves the combination of both pharmacologic and nonpharmacologic approaches. In some cases acute insomnia resolves spontaneously, but if left untreated, it may lead to chronic sleep problems. The treatment of chronic insomnia is often challenging. There are only a few studies specifically addressing the management of this sleep disorder in patients with chronic renal disease. Considering the polypharmacy and altered metabolism in this patient population, treatment trials are clearly needed. This article reviews the diagnosis of sleep disorders with a focus on insomnia in patients on dialysis.
Semin Dial
PMID:Diagnosis and management of insomnia in dialysis patients. 1642 79

Dietary deficiency causes abnormalities in circulating lymphocyte counts. For the present paper, we evaluated correlations between total and subpopulation lymphocyte counts (TLC, SLCs) and parameters of nutrition in peritoneal dialysis (PD) patients. Studies were carried out in 55 patients treated with PD for 22.2 +/- 11.4 months. Parameters of nutritional status included total body mass, lean body mass (LBM), body mass index (BMI), and laboratory indices [total protein, albumin, iron, ferritin, and total iron binding capacity (TIBC)]. The SLCs were evaluated using flow cytometry. Positive correlations were seen between TLC and dietary intake of niacin; TLC and CD8 and CD16+56 counts and energy delivered from protein; CD4 count and beta-carotene and monounsaturated fatty acids 17:1 intake; and CD19 count and potassium, copper, vitamin A, and beta-carotene intake. Anorexia negatively influenced CD19 count. Serum albumin showed correlations with CD4 and CD19 counts, and LBM with CD19 count. A higher CD19 count was connected with a higher red blood cell count, hemoglobin, and hematocrit. Correlations were observed between TIBC and TLC and CD3 and CD8 counts, and between serum Fe and TLC and CD3 and CD4 counts. Patients with a higher CD19 count showed a better clinical-laboratory score, especially less weakness. Patients with a higher CD4 count had less expressed insomnia. Quantities of ingested vitamins and minerals influence lymphocyte counts in the peripheral blood of PD patients. Evaluation of TLC and SLCs is helpful in monitoring the effectiveness of nutrition in these patients.
Adv Perit Dial 2005
PMID:Total lymphocyte count and subpopulation lymphocyte counts in relation to dietary intake and nutritional status of peritoneal dialysis patients. 1668 82

A high prevalence of depressive disorder, between 33% and 50%, has been reported in dialysis patients, although it is difficult to distinguish the physical symptoms like general fatigue, insomnia, and loss of appetite which are common among dialysis patients, from the psychiatric symptoms seen in depressive patients. Furthermore, co-occurrence of depression has been shown to be one of the risk factors of poor prognosis in dialysis patients, partly because depressed patients are less likely to adhere to their medication regimen and modify their lifestyle appropriately. The efficacy of psychiatric interventions, including pharmacotherapy and psychotherapy, has been examined for dialysis patients with co-occurrence of depression. Randomized controlled trials of psychiatric interventions for depression in dialysis patients are needed to investigate the impact of such interventions on depression, quality of life, and mortality.
Ther Apher Dial 2006 Aug
PMID:Diagnosis and treatment of depression in dialysis patients. 1691 Nov 85

End-stage renal disease (ESRD) patients receiving hemodialysis experience a heavy burden of disease-related symptoms, which lead to reduced quality of life. This review focuses on aspects of ESRD-related pharmacokinetics and on efficacy of drugs for treatment of somatic symptoms. Fatigue, pruritus, insomnia, and cramps are the most common symptoms in ESRD, and studies suggest that they are often undertreated. However, few evidence-based guidelines exist to guide therapy in patients received dialysis. In the context of this review, we examine the role of l-Carnitine in the treatment of fatigue and cramps; human growth hormone analog Norditropin and anabolic steroid Nandrolone for the treatment of fatigue; Gabapentin and other agents for the management of pruritis; Vitamin and creatine supplementation in the management of dialysis-associated cramps, and somnambulates in the treatment of dialysis-related insomnia. Treatment decisions should be made in consultation with patients with a full accounting of the potential risks and benefits of these therapies.
Semin Dial
PMID:Pharmacologic Treatment of Common Symptoms in Dialysis Patients: A Narrative Review. 2591 2