1. Depression Symptoms and Low Physical Activity May Keep Dialysis Patients from Working
Efforts to Improve Mood and Activity Might Help Patients Remain Employed

Many patients with kidney failure employed during the year before beginning dialysis are no longer employed early in their first year of treatment. A recent survey by Nancy Kutner, PhD (Emory University) and her colleagues indicates that depression and reduced physical activity may play a role. Among 585 dialysis patients who had worked in the previous year, only 191 (32.6%) continued working after initiating dialysis. The study revealed that only 12.1% of patients who remained employed had possible or probable depression, compared with 32.8% of patients who were no longer employed. In addition, patients who scored higher on questions related to their level of physical activity were more likely to continue working. "More attention to improving mood disorders and increasing usual activity levels among kidney disease patients might help them to maintain employment and would undoubtedly contribute to overall improvements in patients' quality of life," said Dr. Kutner. The article, entitled "Depressed Mood, Usual Activity Level, and Continued Employment after Starting Dialysis," will appear online at http://jasn.asnjournals.org/ on September 30, 2010, doi 10.2215/CJN.03980510.

2. Modifying Blood Access Reduces Kidney Disease Patients' Risk of Hospitalization
Patients Benefit by Switching from Catheters to Arteriovenous Access

For kidney disease patients who must undergo dialysis, experts recommend an arteriovenous blood access, preferably a fistula which is created by connecting a vein and an artery to form a long-lasting site through which blood can be removed and returned. Many patients become complacent with using a catheter instead—even though catheters are associated with increased infections, complications, and deaths—because they do not require advanced surgery and attachment to the dialysis machine does not require needles. A new study shows that patients who convert from catheters to arteriovenous access have a lower risk of being hospitalized for any reason. Eduardo Lacson Jr., MD (Fresenius Medical Care, North America) and his colleagues studied the health of 70,852 dialysis patients, 19,792 of whom had catheters. Over a 4-month period, 10.3% of these converted to arteriovenous access. Compared with patients who kept their catheters, patients who converted had a similarly lower risk (by about 30%) of being hospitalized within one year as patients who were dialyzing with arteriovenous accesses during the entire study period, while patients with arteriovenous access who switched to catheters were 22% more likely to be hospitalized. The article, entitled "Change in Vascular Access and Hospitalization Risk in Long-Term Hemodialysis Patients," will appear online at http://jasn.asnjournals.org/ on September 30, 2010, doi 10.2215/CJN.08961209.