Abstract
The complex care that must be provided for patients with renal disease might interfere with provision of basic preventive measures in this population. Preventive health care, including infection screening and prophylaxis, vaccinations, management of blood glucose and lipid levels, and cancer screening, is important, as it might decrease acute morbidity and mortality. This Review highlights useful preventive and health maintenance strategies for patients with chronic kidney disease and those with end-stage renal disease.
Key Points
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People with chronic kidney disease (CKD) or end-stage renal disease (ESRD) should be vaccinated against influenza, pneumococcal disease and hepatitis B; those at risk of hepatitis A infection should also be immunized against that virus
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Patients with CKD or ESRD should be screened annually for tuberculosis
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Monitoring of fasting lipid levels and maintenance of LDL cholesterol levels below 2.6 mmol/l (100 mg/dl) should be standard practice for patients with CKD; target LDL is less than 1.8 mmol/l (70 mg/dl) for patients with CKD and diabetes mellitus
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The target glycated hemoglobin level for patients with CKD or ESRD is 7.0% or less
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Screening of people with CKD or ESRD for malignancy should encompass renal cell carcinoma, as well as cancer of the prostate, colon and/or rectum, breasts and cervix
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References
Kausz AT et al. (2005) General medical care among patients with chronic kidney disease: opportunities for improving outcomes. J Am Soc Nephrol 16: 3092–3101
Collins AJ et al. (2003) Chronic kidney disease and cardiovascular disease in the Medicare population. Kidney Int 64 (Suppl 87): S24–S31
Winkelmayer WC et al. (2002) Preventive health care measures before and after start of renal replacement therapy. J Gen Intern Med 17: 588–595
Naqvi SB and Collins AJ (2006) Infectious complications in chronic kidney disease. Adv Chronic Kidney Dis 13: 199–204
Haag-Weber M and Hörl WH (1996) Dysfunction of polymorphonuclear leukocytes in uremia. Semin Nephrol 16: 192–201
Montgomerie JZ et al. (1968) Renal failure and infection. Medicine (Baltimore) 47: 1–32
Kausz A and Pahari D (2004) The value of vaccination in chronic kidney disease. Semin Dial 17: 9–11
Descamps-Latscha B et al. (1994) Immune system dysregulation in uremia. Semin Nephrol 14: 253–260
Katneni R and Hedayati SS (2007) Central venous catheter-related bacteremia in chronic hemodialysis patients: epidemiology and evidence-based management. Nat Clin Pract Nephrol 3: 256–266
Sarnak MJ and Jaber BL (2000) Mortality caused by sepsis in patients with end-stage renal disease compared with the general population. Kidney Int 58: 1758–1764
Bibb JL et al. (2002) Pyocystis in patients on chronic dialysis: a potentially misdiagnosed syndrome. Int Urol Nephrol 34: 415–418
Remer EE and Peacock W (2000) Pyocystis: two case reports of patients in renal failure. J Emerg Med 19: 131–133
Lees JA et al. (1985) Pyocystis, pyonephrosis and perinephric abscess in end stage renal disease. J Urol 134: 716–719
Chen CH et al. (2007) Different bacteriology and prognosis of thoracic empyemas between patients with chronic and end-stage renal disease. Chest 132: 532–539
Descamps-Latscha B and Chatenoud L (1996) T cells and B cells in chronic renal failure. Semin Nephrol 16: 183–191
Kelly CJ (1994) T cell function in chronic renal failure and dialysis. Blood Purif 12: 36–41
Beaman M et al. (1989) T-cell-independent and T-cell-dependent antibody responses in patients with chronic renal failure. Nephrol Dial Transplant 4: 216–221
Aslam N et al. (2006) Comparison of infectious complications between incident hemodialysis and peritoneal dialysis patients. Clin J Am Soc Nephrol 1: 1226–1233
Piraino B (2000) Staphylococcus aureus infections in dialysis patients: focus on prevention. ASAIO J 46 (Suppl): S13–S17
Bernardini J et al. (2005) Randomized, double-blind trial of antibiotic exit site cream for prevention of exit site infection in peritoneal dialysis patients. J Am Soc Nephrol 16: 539–545
Johnson DW et al. (2002) A randomized controlled trial of topical exit site mupirocin application in patients with tunnelled, cuffed haemodialysis catheters. Nephrol Dial Transplant 17: 1802–1807
Annigeri R et al. (2001) Emergence of mupirocin-resistant Staphylococcus aureus in chronic peritoneal dialysis patients using mupirocin prophylaxis to prevent exit-site infection. Perit Dial Int 21: 554–559
Cavdar C et al. (2004) Emergence of resistance in staphylococci after long-term mupirocin application in patients on continuous ambulatory peritoneal dialysis. Adv Perit Dial 20: 67–70
Sedlacek M et al. (2007) Aspirin treatment is associated with a significantly decreased risk of Staphylococcus aureus bacteremia in hemodialysis patients with tunneled catheters. Am J Kidney. Dis 49: 401–408
Klassen JT and Krasko BM (2002) The dental health status of dialysis patients. J Can Dent Assoc 68: 34–38
Kshirsagar AV et al. (2005) Periodontal disease is associated with renal insufficiency in the Atherosclerosis Risk In Communities (ARIC) study. Am J Kidney Dis 45: 650–657
Wilson W et al. (2007) Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 116: 1736–1754
Umana E et al. (2003) Valvular and perivalvular abnormalities in end-stage renal disease. Am J Med Sci 325: 237–242
Tong DC and Walker RJ (2004) Antibiotic prophylaxis in dialysis patients undergoing invasive dental treatment. Nephrology (Carlton) 9: 167–170
Werner CW and Saad TF (1999) Prophylactic antibiotic therapy prior to dental treatment for patients with end-stage renal disease. Spec Care Dentist 19: 106–111
Kumar S et al. (1982) Bacteremia associated with lower gastrointestinal endoscopy, fact or fiction? I. Colonoscopy. Dis Colon Rectum 25: 131–134
Kumar S et al. (1983) Bacteremia associated with lower gastrointestinal endoscopy: fact or fiction? II. Proctosigmoidoscopy. Dis Colon Rectum 26: 22–24
Hussein MM et al. (2003) Tuberculosis and chronic renal disease. Semin Dial 16: 38–44
Shankar MS et al. (2005) The prevalence of tuberculin sensitivity and anergy in chronic renal failure in an endemic area: tuberculin test and the risk of post-transplant tuberculosis. Nephrol Dial Transplant 20: 2720–2724
Venkata RK et al. (2007) Tuberculosis in chronic kidney disease. Clin Nephrol 67: 217–220
Zyga S and Tourouki G (2006) Tuberculosis in haemodialysis: a problem making a comeback. EDTNA ERCA J 32: 176–178
Passalent L et al. (2007) Detecting latent tuberculosis infection in hemodialysis patients: a head-to-head comparison of the T-SPOT.TB test, tuberculin skin test, and an expert physician panel. Clin J Am Soc Nephrol 2: 68–73
Korzets A and Gafter U (1999) Tuberculosis prophylaxis for the chronically dialysed patient—yes or no. Nephrol Dial Transplant 14: 2857–2859
Dogan E et al. (2005) Tuberculin skin test results and the booster phenomenon in two-step tuberculin skin testing in hemodialysis patients? Ren Fail 27: 425–428
Wauters A et al. (2004) The value of tuberculin skin testing in haemodialysis patients. Nephrol Dial Transplant 19: 433–438
Klote MM et al. (2004) Mycobacterium tuberculosis infection incidence in hospitalized renal transplant patients in the United States, 1998–2000. Am J Transplant 4: 1523–1528
[No authors listed] (2000) Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 161: S221–S247
American Thoracic Society; Centers for Disease Control and Prevention; Infectious Diseases Society of America (2005) American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: controlling tuberculosis in the United States. Am J Respir Crit Care Med 172: 1169–1227
DaRoza G et al. (2003) Stage of chronic kidney disease predicts seroconversion after hepatitis B immunization: earlier is better. Am J Kidney Dis 42: 1184–1192
Gilbertson DT et al. (2003) Influenza vaccine delivery and effectiveness in end-stage renal disease. Kidney Int 63: 738–743
[No authors listed] (1997) Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 46: 1–24
Fuchshuber A et al. (1996) Pneumococcal vaccine in children and young adults with chronic renal disease. Nephrol Dial Transplant 11: 468–473
Johnson DW and Fleming SJ (1992) The use of vaccines in renal failure. Clin Pharmacokinet 22: 434–446
Linnemann CC Jr et al. (1986) Revaccination of renal transplant and hemodialysis recipients with pneumococcal vaccine. Arch Intern Med 146: 1554–1556
Kasiske BL et al. (2001) The evaluation of renal transplantation candidates: clinical practice guidelines. Am J Transplant 1 (Suppl 2): S3–S95
Olsen SK and Brown RS Jr (2006) Hepatitis B treatment: lessons for the nephrologist. Kidney Int 70: 1897–1904
Tokars JI et al. (2002) National surveillance of dialysis-associated diseases in the United States, 2000. Semin Dial 15: 162–171
Marusawa H et al. (2000) Latent hepatitis B virus infection in healthy individuals with antibodies to hepatitis B core antigen. Hepatology 31: 488–495
Brechot C et al. (2001) Persistent hepatitis B virus infection in subjects without hepatitis B surface antigen: clinically significant or purely “occult”. Hepatology 34: 194–203
Siagris D et al. (2006) Occult hepatitis B virus infection in hemodialysis patients with chronic HCV infection. J Nephrol 19: 327–333
Lacson E et al. (2005) Antibody response to Engerix-B and Recombivax-HB hepatitis B vaccination in end-stage renal disease. Hemodial Int 9: 367–375
Chow K et al. (2006) Antibody response to hepatitis B vaccine in end-stage renal disease patients. Nephron Clin Pract 103: c89–c93
Chau KF et al. (2004) Efficacy and side effects of intradermal hepatitis B vaccination in CAPD patients: a comparison with the intramuscular vaccination. Am J Kidney Dis 43: 910–917
Charest AF et al. (2000) A randomized comparison of intradermal and intramuscular vaccination against hepatitis B virus in incident chronic hemodialysis patients. Am J Kidney Dis 36: 976–982
Fabrizi F et al. (2006) Meta-analysis: intradermal vs. intramuscular vaccination against hepatitis B virus in patients with chronic kidney disease. Aliment Pharmacol Ther 24: 497–506
Tong NK et al. (2005) Immunogenicity and safety of an adjuvanted hepatitis B vaccine in pre-hemodialysis and hemodialysis patients. Kidney Int 68: 2298–2303
Agarwal SK et al. (1999) Comparison of two schedules of hepatitis B vaccination in patients with mild, moderate and severe renal failure. J Assoc Physicians India 47: 183–185
Fleischmann EH et al. (2002) Active immunization against hepatitis A in dialysis patients. Nephrol Dial Transplant 17: 1825–1828
Jacobs RJ et al. (2002) The cost-effectiveness of vaccinating chronic hepatitis C patients against hepatitis A. Am J Gastroenterol 97: 427–434
Oldfield EC 3rd (2002) Evaluation of chronic diarrhea in patients with human immunodeficiency virus infection. Rev Gastroenterol Disord 2: 176–188
Tsui JI et al. (2007) Association of hepatitis C seropositivity with increased risk for developing end-stage renal disease. Arch Intern Med 167: 1271–1276
Bergman S et al. (2005) Hepatitis C infection is acquired pre-ESRD. Am J Kidney Dis 45: 684–689
Fissell RB et al. (2004) Patterns of hepatitis C prevalence and seroconversion in hemodialysis units from three continents: the DOPPS. Kidney Int 65: 2335–2342
Fabrizi F et al. (2007) The impact of hepatitis C virus infection on survival in dialysis patients: meta-analysis of observational studies. J Viral Hepat 14: 697–703
Maisonneuve P et al. (1999) Cancer in patients on dialysis for end-stage renal disease: an international collaborative study. Lancet 354: 93–99
Yeh CN et al. (2005) Hepatic resection for hepatocellular carcinoma in end-stage renal disease patients: two decades of experience at Chang Gung Memorial Hospital. World J Gastroenterol 11: 2067–2071
Amarapurkar DN et al. (2007) Monotherapy with peginterferon alpha-2b {12 kDa} for chronic hepatitis C infection in patients undergoing haemodialysis. Trop Gastroenterol 28: 16–18
Rocha CM et al. (2007) Interferon-alpha therapy within the first year after acute hepatitis C infection in hemodialysis patients: efficacy and tolerance. Eur J Gastroenterol Hepatol 19: 119–123
Covic A et al. (2006) Analysis of safety and efficacy of pegylated-interferon alpha-2a in hepatitis C virus positive hemodialysis patients: results from a large, multicenter audit. J Nephrol 19: 794–801
Mousa DH et al. (2004) Alpha-interferon with ribavirin in the treatment of hemodialysis patients with hepatitis C. Transplant Proc 36: 1831–1834
Rendina M et al. (2007) The treatment of chronic hepatitis C with peginterferon alfa-2a (40 kDa) plus ribavirin in haemodialysed patients awaiting renal transplant. J Hepatol 46: 768–774
Fabrizi F et al. (2002) Hepatitis C infection and the patient with end-stage renal disease. Hepatology 36: 3–10
Bruchfeld A et al. (2006) Pegylated interferon and ribavirin treatment for hepatitis C in haemodialysis patients. J Viral Hepat 13: 316–321
Dalrymple LS et al. (2007) Hepatitis C virus infection and the prevalence of renal insufficiency. Clin J Am Soc Nephrol 2: 715–721
Morales JM et al. (2002) Hepatitis C virus infection and kidney transplantation. Semin Nephrol 22: 365–374
Kamar N et al. (2006) Treatment of hepatitis C virus infection (HCV) after renal transplantation: implications for HCV-positive dialysis patients awaiting a kidney transplant. Transplantation 82: 853–856
Baid-Agrawal S et al. (2007) Hepatitis C virus infection in haemodialysis and kidney transplant patients. Rev Med Virol [10.1002/rmv.565]
Parikh NI et al. (2006) Cardiovascular disease risk factors in chronic kidney disease: overall burden and rates of treatment and control. Arch Intern Med 166: 1884–1891
Krane V and Wanner C (2006) At which stage of chronic kidney disease should dyslipidemia be treated. Nat Clin Pract Nephrol 2: 176–177
Cases A and Coll E (2005) Dyslipidemia and the progression of renal disease in chronic renal failure patients. Kidney Int 68 (Suppl 99): S87–S93
Hunsicker LG et al. (1997) Predictors of the progression of renal disease in the Modification of Diet in Renal Disease Study. Kidney Int 51: 1908–1919
Samuelsson O et al. (1997) Lipoprotein abnormalities are associated with increased rate of progression of human chronic renal insufficiency. Nephrol Dial Transplant 12: 1908–1915
Wanner C et al. (2005) Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med 353: 238–248
Seliger SL et al. (2002) HMG-CoA reductase inhibitors are associated with reduced mortality in ESRD patients. Kidney Int 61: 297–304
Mason NA et al. (2005) HMG-coenzyme a reductase inhibitor use is associated with mortality reduction in hemodialysis patients. Am J Kidney Dis 45: 119–126
Meas T et al. (2006) Elevation of CKP induced by ezetimibe in monotherapy: report on two cases. Diabetes Metab 32: 364–366
Barshes NR et al. (2003) Sirolimus–atorvastatin drug interaction in the pancreatic islet transplant recipient. Transplantation 76: 1649–1650
Oomichi T et al. (2006) Impact of glycemic control on survival of diabetic patients on chronic regular hemodialysis: a 7-year observational study. Diabetes Care 29: 1496–1500
Snyder RW and Berns JS (2004) Use of insulin and oral hypoglycemic medications in patients with diabetes mellitus and advanced kidney disease. Semin Dial 17: 365–370
[No authors listed] (2007) KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease. Am J Kidney Dis 49 (Suppl 2): S12–S154
Port FK et al. (1989) Neoplasms in dialysis patients: a population-based study. Am J Kidney Dis 14: 119–123
Cengiz K (2002) Increased incidence of neoplasia in chronic renal failure (20-year experience). Int Urol Nephrol 33: 121–126
Vamvakas S et al. (1998) Cancer in end-stage renal disease: potential factors involved. Am J Nephrol 18: 89–95
Stewart JH et al. (2003) Cancers of the kidney and urinary tract in patients on dialysis for end-stage renal disease: analysis of data from the United States, Europe, and Australia and New Zealand. J Am Soc Nephrol 14: 197–207
Holley JL (2007) Screening, diagnosis, and treatment of cancer in long-term dialysis patients. Clin J Am Soc Nephrol 2: 604–610
Owen WF Jr (2003) Patterns of care for patients with chronic kidney disease in the United States: dying for improvement. J Am Soc Nephrol 14 (Suppl 2): S76–S80
Denton MD et al. (2002) Prevalence of renal cell carcinoma in patients with ESRD pre-transplantation: a pathologic analysis. Kidney Int 61: 2201–2209
Peces R (2003) Malignancy and chronic renal failure. Saudi J Kidney Dis Transpl 14: 5–14
Smith JW et al. (1987) Acquired renal cystic disease: two cases of associated adenocarcinoma and a renal ultrasound survey of a peritoneal dialysis population. Am J Kidney Dis 10: 41–46
Bretan PN Jr et al. (1986) Chronic renal failure: a significant risk factor in the development of acquired renal cysts and renal cell carcinoma. Case reports and review of the literature. Cancer 57: 1871–1879
Sarasin FP et al. (1995) Screening for acquired cystic kidney disease: a decision analytic perspective. Kidney Int 48: 207–219
Peces R et al. (2004) Renal cell carcinoma co-existent with other renal disease: clinico-pathological features in pre-dialysis patients and those receiving dialysis or renal transplantation. Nephrol Dial Transplant 19: 2789–2796
Smith RA et al. (2006) American Cancer Society guidelines for the early detection of cancer, 2006. CA Cancer J Clin 56: 11–25
Walter LC et al. (2006) PSA screening among elderly men with limited life expectancies. JAMA 296: 2336–2342
[No authors listed] (2000) Prostate-specific antigen (PSA) best practice policy: American Urological Association (AUA). Oncology (Williston Park) 14: 267–272
National Comprehensive Cancer Network (2007) NCCN Clinical Practice Guidelines in Oncology. [http://www.nccn.org]
Giri VN et al. (2007) Prostate cancer risk assessment program: a 10-year update of cancer detection. J Urol 178: 1920–1924
Djavan B et al. (1999) Impact of chronic dialysis on serum PSA, free PSA, and free/total PSA ratio: is prostate cancer detection compromised in patients receiving long-term dialysis. Urology 53: 1169–1174
Morton JJ et al. (1995) Influence of end-stage renal disease and renal transplantation on serum prostate-specific antigen. Br J Urol 75: 498–501
Wada Y et al. (2006) Mass screening for prostate cancer in patients with end-stage renal disease: a comparative study. BJU Int 98: 794–797
Gheissari A et al. (1990) Gastrointestinal hemorrhage in end stage renal disease patients. Int Surg 75: 93–95
Akmal M et al. (1994) The prevalence and significance of occult blood loss in patients with predialysis advanced chronic renal failure (CRF), or receiving dialytic therapy. Clin Nephrol 42: 198–202
Bini EJ et al. (2006) Predictive value of a positive fecal occult blood test increases as the severity of CKD worsens. Am J Kidney Dis 48: 580–586
Chertow GM et al. (1996) Cost-effectiveness of cancer screening in end-stage renal disease. Arch Intern Med 156: 1345–1350
Castellanos M et al. (2006) Increased breast calcifications in women with ESRD on dialysis: implications for breast cancer screening. Am J Kidney Dis 48: 301–306
Kajbaf S et al. (2002) Cancer screening and life expectancy of Canadian patients with kidney failure. Nephrol Dial Transplant 17: 1786–1789
Walter LC et al. (2006) Targeting screening mammography according to life expectancy among women undergoing dialysis. Arch Intern Med 166: 1203–1208
LeBrun CJ et al. (2000) Life expectancy benefits of cancer screening in the end-stage renal disease population. Am J Kidney Dis 35: 237–243
Beck LH (2000) Screening and preventive health practices for the end-stage renal disease patient. Adv Ren Replace Ther 7: 195–201
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Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.
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Choudhury, D., Luna-Salazar, C. Preventive health care in chronic kidney disease and end-stage renal disease. Nat Rev Nephrol 4, 194–206 (2008). https://doi.org/10.1038/ncpneph0762
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DOI: https://doi.org/10.1038/ncpneph0762
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