Background and objectives: Few studies have examined risk factors for hemorrhage in hemodialysis patients. The contribution of warfarin and antiplatelet agent exposure to the incidence of first major bleeding episodes in hemodialysis patients was determined.Design, setting, participants, & measurements: Retrospective chart review was performed in eligible hemodialysis patients. Incidence rates were determined as the number of first major bleeding events divided by the total exposure time on each treatment combination. Time-dependent covariates and Cox proportional hazard models were used to determine the hazard rate of having a first major bleeding event.Results: A total of 1028 person-years of exposure were observed from 255 patients with a median follow-up time of 3.6 yr. The incidence rate of major bleeding episodes was 2.5% per person-year. The incidence of major bleeding episodes was 3.1% per person-year of warfarin exposure, 4.4% per person-year of aspirin exposure, and 6.3% per person-year of exposure to the combination of warfarin and aspirin. Compared with patients who were not prescribed warfarin or aspirin, the multivariable hazard ratio for time to first major bleeding event was 3.59 for warfarin, 5.24 for aspirin, and 6.19 for the combination of aspirin and warfarin.Conclusions: The risk for major bleeding episodes in hemodialysis patients increases significantly while on aspirin and/or warfarin, although warfarin alone did not reach statistical significance. Future studies should evaluate the efficacy of these agents in the secondary prevention of cardiovascular events in this high-risk population.

"Poor sleep" is common in CKD patients. Quality of sleep decreases in the early stages of CKD and does not appear to be associated with the subsequent degree of renal failure. Large prospective longitudinal studies of quality of sleep in CKD patients are needed to confirm the high prevalence of impaired quality of sleep in this population and examine the association between renal function and quality of sleep while controlling for potential confounding variables.

Abstractnon-elective hospitalization prior to dialysis initiation. Further study is needed to determine the extent to Background. Although there is abundant research describing predictors of patient morbidity and mortal-which aggressive pre-dialysis management of anaemia and cardiovascular disease can improve patient ity among dialysis patients, predictors of adverse clinical outcomes among pre-dialysis patients are less well outcomes. defined. The purpose of this study was to identify Keywords: chronic renal insufficiency; morbidity; baseline predictors of first non-elective hospitalization mortality; outcomes; pre-dialysis; progressive renal among a retrospective cohort of 362 pre-dialysis insufficiency patients. Methods. Univariate and multivariate Cox proportional hazard models were used to identify predictors of hospitalization prior to dialysis initiation, adjusted

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Black renal transplant recipients experience shorter graft survival than white recipients, but no published data describe the graft outcomes among black Canadian recipients. Here, we analyzed data from the Canadian national renal replacement therapy registry, which included 20,243 incident dialysis patients (3% black, 97% white), 5036 of whom received a renal transplant during the study period. Black patients were significantly less likely to receive a renal transplant (deceased and living-donor combined) when compared with white patients (hazard ratio 0.59; 95% confidence interval 0.51 to 0.69; P Ͻ 0.0001). Among patients who underwent a renal transplant, there was no significant difference in the likelihood of graft failure between black and white patients, even after adjustment for comorbidities and socioeconomic status; black patients, however, had significantly lower posttransplantation mortality compared with white patients (hazard ratio 0.49; 95% confidence interval 0.28 to 0.88; P ϭ 0.02). In conclusion, graft outcomes between black and white Canadian renal transplant patients are similar. Because this differs from the experience reported from the United States, further direct comparisons between the two populations is warranted.