The presence of naturally occurring inhibitors of interleukin-1 (IL-1) and tumor necrosis factor (TNF) in a variety of diseases has been demonstrated. The IL-1 receptor antagonist (IL-1Ra) binds to IL-1 receptors and blocks the activity of IL-1, and a soluble form of the p55 TNF receptor (TNFsRp55) binds and neutralizes TNF. In the present study, plasma levels of IL-1 beta, IL-1Ra, TNF alpha and TNFsRp55 were measured in 29 undialyzed patients with chronic renal failure (CRF), 13 patients on continuous ambulatory peritoneal dialysis (CAPD), 42 patients on chronic hemodialysis (HD) and in 15 healthy controls. Of the 29 patients with CRF, 13 had end-stage renal disease (ESRD, estimated GFR < 10 ml/min). Among health controls, plasma levels of IL-1 beta, IL-1Ra and TNF alpha were at or below the limit of detection of the assay. In undialyzed patients with ESRD, or in patients on CAPD or HD, plasma levels of IL-1 beta were 428 +/- 134 pg/ml, 378 +/- 83 and 352 +/- 43 pg/ml, respectively. Although plasma levels of IL-1 beta in each group of patients were higher than those in healthy controls (< 160 pg/ml), these differences were not statistically significant. In contrast, plasma levels of IL-1Ra in undialyzed patients with ESRD (629 +/- 125 pg/ml, P = 0.03), CAPD (902 +/- 164 pg/ml, P < 0.0001) and HD patients (642 +/- 73 pg/ml, P = 0.004) were significantly higher than those in healthy controls (103 +/- 15).(ABSTRACT TRUNCATED AT 250 WORDS)

Objective: There are few detailed data on cognition in patients undergoing dialysis. We evaluated the frequency of and risk factors for poor cognitive performance using detailed neurocognitive testing.Methods: In this cross-sectional cohort study, 314 hemodialysis patients from 6 Boston-area hemodialysis units underwent detailed cognitive assessment. The neuropsychological battery assessed a broad range of functions, with established age-, sex-, and education-matched normative scores. Principal component analysis was used to derive composite scores for memory and executive function domains. Risk factors for each domain were evaluated using linear regression adjusting for age, sex, race, and education status. Analyses were repeated in those with Mini-Mental State Examination (MMSE) score $24.Results: Compared with population norms, patients on dialysis had significantly poorer executive function but not memory performance, a finding that persisted in the subgroup with MMSE score $24. In adjusted analyses, vascular risk factors and vascular disease were associated with lower executive function (p , 0.01).Conclusions: There is a high frequency of poor cognitive performance in hemodialysis patients, primar- Cognitive impairment in dialysis is an increasingly important public health problem given the aging end-stage renal disease (ESRD) population and the increasing prevalence of diabetes and vascular disease. In older studies in hemodialysis patients, cognitive impairment, defined by poor performance on the Mini-Mental State Examination (MMSE), was present in 40% to 60%. 1-3 Despite the fact that the MMSE remains the most frequently used screening tool for cognitive impairment, it focuses on memory and largely neglects other cognitive domains such as executive function; accordingly, the MMSE may not be sufficient to detect more subtle degrees of cognitive impairment.The major causes of dementia in the general population are Alzheimer disease, which initially manifests with memory loss with later involvement of other cognitive domains, and vascular dementia, which primarily manifests with impairment in executive function. [4][5][6][7] Although it is likely that patients undergoing dialysis have similar causes for cognitive impairment as the general population, there are few studies that have attempted to distinguish the prevalence of and risk factors for each type of cognitive impairment in this population.The goals of this study were therefore to evaluate the frequency of and risk factors for poor cognitive performance in hemodialysis patients using detailed measures of multiple cognitive domains, From the Division of Nephrology (M.J.S., K

Parenteral antimicrobial use was extensive, and as much as one-third was categorized as inappropriate. The findings of this study provide novel information toward minimizing inappropriate antimicrobial use.