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Reliable models of renal failure in large animals are critical to the successful translation of the next generation of renal replacement therapies (RRT) into humans. While models exist for the induction of renal failure, none are optimized for the implantation of devices to the retroperitoneal vasculature. We successfully piloted an embolization-to-implantation protocol enabling the first implant of a silicon nanopore membrane hemodialyzer (SNMHD) in a swine renal failure model. Renal arterial embolization is a non-invasive approach to near-total nephrectomy that preserves retroperitoneal anatomy for device implants. Silicon nanopore membranes (SNM) are efficient blood-compatible membranes that enable novel approaches to RRT. Yucatan minipigs underwent staged bilateral renal arterial embolization to induce renal failure, managed by intermittent hemodialysis. A small-scale arteriovenous SNMHD prototype was implanted into the retroperitoneum. Dialysate catheters were tunneled externally for connection to a dialysate recirculation pump. SNMHD clearance was determined by intermittent sampling of recirculating dialysate. Creatinine and urea clearance through the SNMHD were 76–105 mL/min/m2 and 140–165 mL/min/m2, respectively, without albumin leakage. Normalized creatinine and urea clearance measured in the SNMHD may translate to a fully implantable clinical-scale device. This pilot study establishes a path toward therapeutic testing of the clinical-scale SNMHD and other implantable RRT devices. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is a worldwide public health problem related to adverse results of end-stage renal disease (ESRD), kidney failure, cardiovascular disease (CVD), and premature death. The study is aimed to investigate the knowledge, attitude, and practice toward the prevention and early detection of chronic kidney disease. Two ordinal variables and one nominal response variable with 20 predictor variables were independently fitted. Ordinal multicategories , such as proportional odds, continuation ratio, and partial proportional models for attitude and practice, whereas the baseline multicategory logit model for knowledge was fitted. The findings implied that some predictors have a significant effect on attitude, whereas other covariates have a significant effect on practice. Moreover, as there are two independent logit models for the nominal response, in the first logit model Monthly income and Diabetes2, whereas in the second logit model, Smo_R_CKD3 and Diabetes2 have a significant effect on knowledge. In conclusion, more educated ones have more knowledge and attitude toward the prevention and early detection of chronic kidney disease, also more likely to perform preventive and early detecting practices. People are inadequately informed on the prevention and early detection of CKD, especially those who are with low income, are at risk of developing CKD and its complications. [ABSTRACT FROM AUTHOR]

Purpose Chronic kidney disease is highly prevalent in the general population and can progress to end-stage renal disease (ESRD). The purpose of this pilot study was to assess dental hygiene and dental therapy students' knowledge, attitudes, and perceptions towards ESRD and evaluate the feasibility of a larger scale study. Methods A convenience sample (n=59) of dental hygiene (DH) and dual degree DH/dental therapy students were invited to participate in an electronic survey for the pilot study. The investigator designed survey consisted of a total of 37 items: demographics (4), perceived knowledge, confidence, importance and attitudes (14), knowledge of chronic kidney disease (18). The knowledge questions were adapted from the Chronic Kidney Disease Self-Management Knowledge Tool (CKD-SMKT) with permission. Descriptive statistics and the non-parametric two-sample Wilcoxon rank sum test were used to analyze the data. Results Twenty-five participants completed the survey for a 42% response rate. Fewer than half (36%) perceived having some knowledge regarding ESRD, its oral manifestations (28%) and mental health implications (12%). The importance of managing oral health for ESRD was rated by most respondents as "very important" or "extremely important" (76%). Respondent attitudes indicated high interest (68%) regarding employment in hospital settings to care for individuals with ESRD. Knowledge scores from the CKD-SMKT were low in the categories of general knowledge of ESRD and dental hygiene care modifications for individuals with ESRD. Conclusion Results of this pilot study indicate that using a validated instrument on a national sample is feasible to determine the knowledge, attitudes and perceptions of dental hygiene students regarding ESRD. Future research should include knowledge and awareness of hypertension, diabetes, and the role that management of chronic kidney disease plays in the prevention of ESRD. [ABSTRACT FROM AUTHOR]

To investigate the prevalence of depression and anxiety in patients undergoing maintenance hemodialysis (MHD) in Hohhot, a large city on the northern border of China, and to identify independent risk factors for depression and anxiety in these patients. Patients receiving MHD for >3 months were enrolled in the four largest hemodialysis centers between September 2020 and December 2020. Depression and anxiety were assessed using the Zung self-rated depression scale (SDS) and Zung self-rated anxiety scale (SAS), respectively, with demographic and other data collected for logistic regression analyses. Among 305 MHD patients included in this study, the prevalence of depression was 55.1%, including 27.5%, 21.0%, and 6.6% with mild, moderate and severe cases, respectively. The prevalence of anxiety was 25.9%, with 20.0%, 4.6%, and 1.3% having mild, moderate, and severe cases, respectively. An independent protective factor for depression was family income of ≥1415 US dollars/month relative to <157 US dollars/month (odds ratio [OR] 0.209, 95% confidence interval [CI] 0.065–0.673), and predictors of depression included ≥3 comorbidities (OR 18.527, 95% CI 1.674–205.028) and severe pruritus (OR 15.971, 95% CI 5.173–49.315). Independent predictors of anxiety included infrequent exercise (OR 3.289, 95% CI 1.411–7.664) and severe pruritus (OR 5.912, 95% CI 1.733–20.168). The correlation between depression and anxiety in these patients was significant (rs = 0.775, p < 0.001). MHD patients in Northern China had high prevalence rates of depression (55.1%) and anxiety (25.9%). Lower family income, more comorbidities, and a higher degree of pruritus were predictors of depression, while infrequent exercise and severe pruritus were predictors of anxiety. Depression correlated significantly with anxiety. Attention should be given to family income, comorbidity, exercise, and pruritus severity for improved management of depression and anxiety among MHD patients. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is a common medical problem with well‐known dermatologic manifestations, some of which highly disturb the patients' quality of life. This cross‐sectional study was designed to identify the prevalence and type of cutaneous involvement in CKD patients. The skin manifestations of 49 patients with CKD undergoing hemodialysis at Akhavan Hospital in Kashan, Iran, were recorded over 2 months. Diabetes (35%) was the most common cause of chronic renal failure in the patients, and the most common skin manifestations were xerosis (95.9%), uremic pigmentation (89.8%), scleral discoloration (87.8%), dental discoloration (85.2% among the patients with natural teeth), dry mouth (65.3%), varicosity (61.2%), pruritus (57.1%), skin atrophy (49%), lentigo (46.9%), subungual hyperkeratosis (42.9%), half and half nail dystrophy (34.7%), and purpura (26.5%). Mucocutaneous involvement has a very high prevalence in CKD patients undergoing hemodialysis, and some of the cases are medically and cosmetically disturbing; therefore, with better knowledge about the type and prevalence of these involvements, the consequences can be better predicted and managed. Further studies are recommended to be conducted on the association between these signs and CKD grade, and clinical trials are also required for establishing the treatment options available for these signs and then assessing the patients' quality of life as a primary outcome measure. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is a growing problem among aging population, and the number of individuals at risk of end stage renal disease is rising. Part of the reason lies in incomplete understanding of the pathways underlying renal aging and kidney disease, as well as insufficient delivery of evidence-based treatment to elderly patients with CKD. This review aims to address these unsolved issues by delineating updated mechanisms of renal senescence and summarizing recent findings on key clinical aspects of CKD in the elderly. Challenges and obstacles in caring for older people with CKD are discussed, with an emphasis on modification of risk factors, prevention of acute kidney injury, stabilization of progression and decision on dialysis initiation. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Kidney Disease (CKD) has become a major health issue worldwide. CKD patients require Renal Replacement Therapy (RRT) throughout their life. Haemodialysis is one of the options for RRT. Arterio-Venous Fistula (AVF) creation is required for haemodialysis. The radio cephalic fistula is the initial option for creating vascular access. Fistula can be created by anastomosing cephalic vein to radial artery either by End-To-Side (ETS) or Side-To-Side (STS) techniques. Aim: To compare the efficacy rate of radio cephalic AVF using ETS or STS anastomotic methods. Materials and Methods: This was a retrospective analytical study conducted at SDM college of medical sciences and hospital, Dharwad from March 2017 to February 2020. A total of 43 CKD patients were enlisted for the above duration from the hospital records. These patients were included in the study since they underwent radio cephalic AVF creation. AVF creation at other anatomical sites for rest of the CKD patients was excluded. Out of 43 patients, 24 of them underwent ETS technique and 19 STS technique; 15 patients from the former group and 17 from the latter were followed-up for a period of three months. Eleven patients were lost to follow up. Demographic variables were analysed with frequency, mean and standard deviation. Its association with two different operative techniques was analysed using Fisher’s-exact test. Outcome of the two operative procedures was analysed using Student’s t-test. Results: Effectively 15 patients from ETS group and 17 from STS group were compared. Three (20%) in ETS group and 5 (29.41%) in STS group had primary failure. Mean of maturation time in weeks in ETS group was 4.73±2.73 weeks and in STS group was 5.29±3.75 weeks. Three months patency rate in ETS group was 12 (80%) and in STS group was 12 (70.58%). Student’s t-test was performed comparing the above parameters and no statistical significance was noted. Conclusion: Comparison of two techniques of radio cephalic AVF creation proves that both the techniques are beneficial with no superiority of one over other. [ABSTRACT FROM AUTHOR]

Background: Patients with kidney failure have multifaced clinical needs. Continuous quality improvement (CQI) programs initiated by large healthcare provider networks bear the promise of improving guideline adherence and improving patient-centered outcome, including health-related quality of life (HRQOL). We aimed at evaluating the association between key performance indicators (KPI) adopted for our CQI and HRQOL in a large network of dialysis providers. Methods: We conducted a survey study in 39 centers belonging to the Portuguese Fresenius Medical Care (FME) network, in September 2017. For each participant, we retrospectively extracted clinical information during the 6-month period preceding survey administration. We used this information to calculate KPI as defined by the FME-CQI policy. Those KPI were selected in the FME-CQI policy as modifiable intermediate endpoints for which previous evidence suggested a causal relationship with patients' morbidity and mortality. HRQOL was assessed by the Kidney Disease Quality of Life Short Form 36 (KDQOL-36) questionnaire. Results: Among 4691 eligible patients who were invited to participate in the survey, 2263 (48.2%) answered the self-administered survey. Based on KPI standards, patients had 1.5 (± 1.2) off-target clinical parameters on average. KDQOL-36 score were generally higher than those observed in European reference population. We found a significant linear association between KPI parameters and HRQOL. This pattern was robust to adjustment for satisfaction scores. Conclusions: Our data demonstrated a graded, monotonic, dose–response relationship between the number of off-target KPIs and HRQOL. Such relationship was not mediated by patients' satisfaction and may be attributed to amelioration of disease-specific symptoms and functional capacity. [ABSTRACT FROM AUTHOR]

Introduction: Focal segmental glomerulosclerosis (FSGS) accounts for 20% of nephrotic syndromes among children as well as 75% of the steroid resistant nephrotic syndrome (SRNS). The aim of the present study was to evaluate the influence of parental consanguinity on clinical course and outcome of FSGS in children.Methods: This historical cohort was carried out on 69 children affected by steroid resistant FSGS. Patients' data were recorded at the initial and the final analyses and response to therapeutic measures. Subjects were also questioned about the history of parental consanguinity.Results: Forty-four participants (63.8%) were male with a male to female proportion of 1.76:1. Mean baseline age was 5.69 ± 2.39 (range: 1 to 10). Fifty-one patients (73.9%) reported consanguinity. A more significant resistance to cyclosporine A and cyclophosphamide was observed in participants denoting parental consanguinity than those with no kinship. The average renal survival time obtained significantly lower among those reporting consanguinity compared to the others (8.33 vs. 10.44 years, P < .05). According to univariate analysis results, parental consanguinity was a risk factor for developing chronic kidney disease (HR = 4.56, 95% CI: 1.06 to 19.47; P < .05).Conclusion: Patients with FSGS plus parental consanguinity presented less renal survival time with more resistance to cures being more predisposed to the development of CKD. [ABSTRACT FROM AUTHOR]

End Stage Renal Disease (ESRD) patients receiving hemodialysis are at a higher risk of developing dyslipidemia which is undoubtedly a predisposing factor of cardiac related disease in these patients. Objectives: To assess serum lipid profile in subjects having end stage renal disease and receiving maintenance hemodialysis and to compare it with normal healthy controls and also to assess the effects of duration of hemodialysis on the lipid profile. Study Design: Case-control study. Setting: Executed in the Nephrology Department of JPMC. Period: January 2018 to January 2019. Material and Methods: Blood samples were obtained from a total of 90 subjects. Subjects were stratified into 3 groups including cases of ESRD receiving maintenance hemodialysis and matched healthy controls. Analysis for serum triglyceride, serum VLDL, total cholesterol, LDL and HDL was done. Results: A significant rise in serum triglyceride content and total serum cholesterol of hemodialysis patients (p < 0.01) was detected as compared to healthy controls. A statistically significant decrease was found in serum HDL level (p < 0.01) in hemodialysis patients in comparison to healthy controls. The impact of the hemodialysis duration was found to deteriorate the lipid profile of patients having longer duration of hemodialysis. Conclusion: Dyslipidemia was found to be evident in hemodialysis patients. The duration of hemodialysis sessions was found to affect the lipid profile of ESRD patients, which may play a role in higher incidence of atherosclerotic related cardiac events among these patients. [ABSTRACT FROM AUTHOR]

Introduction: Cardiovascular complications are considered as the main cause of mortality in patients with End-Stage Renal Disease (ESRD). Cardiovascular Disease (CVD) includes disorders of the Left Ventricular Hypertrophy (LVH) of the heart which is the most frequent cardiac alteration in ESRD. Galectin-3 (GAL-3), a ß-galactoside-binding protein has been proposed to be a new clinical biomarker that reflects cardiac fibrosis in patients with Heart Failure (HF). Aim: To evaluate the relationship between GAL-3 and biochemical parameters in Peritoneal Dialysis (PD) patients with and without LVH. Materials and Methods: This cross-sectional study enrolled 45 patients (25 women and 20 men) with ESRD who were categorised as having CVD with (n=12) or without (n=33) LVH. Demographic, biochemical and clinical characteristics of 45 patients were analysed. The relationship of plasma GAL-3 levels was analysed with the biochemical parameters for both the groups of patients. For comparison between groups, Student unpaired t-test was used for the data of normal distribution while Mann-Whitney test was used for data of non- Gaussian distribution. Pearson's correlation test was performed to examine various correlations. Results: Significantly high number (83.3%) of female patients were observed in ESRD with LVH. The groups did not differ significantly in their demographic, and biochemical and clinical parameters. There was significant increase in Left Ventricular End-Diastolic Diameters (LVEDD), Left Ventricular (LV) mass and LV mass index in patients with LVH as compared to the patients without LVH. The levels of GAL-3 showed slight increase (91±23.98 ng/mL) levels in LVH patients as compared to the patients without LVH (83.68±32.8 ng/mL). Exponential positive correlation between serum levels of GAL-3 and creatinine in all ESRD patients (r2=0.5488, p=0.0002). GAL-3 also showed positive correlations with urea (r=0.3825, p=0.011) as well as and uric acid (r=0.347, p=0.021) for ESRD patients without LVH. However, GAL-3 showed no association with uric acid and urea (r=0.04487, p=0.896; r=0.2383, p=0.48) in ESRD patients with LVH. Conclusion: GAL-3 positively correlated to the biochemical parameters in ESRD patients. Patients with LVH only showed positive correlation between GAL-3 and creatinine. Moreover, GAL-3 could not be used as the biomarker because it did not correlate with established diagnostic parameter like LV mass and LV mass index. Hence, in this study GAL-3 is not a potential clinical biomarker for the progression of cardiovascular complications in ESRD patients. Overall, these data reflect the need for further investigation of GAL-3 to HF in patients with ESRD. [ABSTRACT FROM AUTHOR]

Chronic Kidney Disease (CKD) is emerging as a major public health priority worldwide. It is a chronic condition influenced by lifestyle and behavior. The risk factors for CKD are highly prevalent among the Indian population, and the number of Indians at risk is increasing. Preventive measures focusing on reducing the prevalence of CKD by limiting exposure to risk factors could be cost effective in a country like India. Kidney diseases disproportionally affect disadvantaged populations and reduce the number of productive years of life. Furthermore, the prospect of financial burden discourages many patients from undergoing treatment, thereby leading to preventable morbidity and death. The management of patients with CKD is focused on early detection or prevention, treatment of the underlying cause (if possible) to curb progression and attention to secondary processes that contribute to ongoing nephron loss. Blood pressure control, inhibition of the renin-angiotensin system and disease-specific interventions are the cornerstones of therapy. Health literacy and self-management are critical to improving the outcomes of chronic conditions such as chronic kidney disease. Primary Care and Family physicians act as a bridge between the nephrologist specialist and the CKD patients; which will help in improving the quality of life, reduce physical and psychologic limitations and complications associated with CRF, and help patients return to their families, jobs, and social lives [ABSTRACT FROM AUTHOR]

Cardiovascular disease is the main cause of morbidity and mortality in end-stage renal disease (ESRD) patients. Recent population based epidemiological studies demonstrated a correlation between reduced renal function and risk for all causes and cardiovascular mortality, 50% of patients dying before the commencement of renal replacement therapy. Vascular calcifications (VC) and arterial stiffness are major contributors to cardiovascular disease and are independent predictors of cardiovascular mortality in ESRD patients. Scarce information is available on the risk factors and prognosis of predialysis patients with VC. The aim of this study was to evaluate the contribution of traditional and uremia related risk factors to abdominal aortic calcification in predialysis patients. A single center, retrospective study was performed on 305 adult patients monitored at the Bucharest University Emergency Hospital for at least 6 months. Our study reports an increased incidence of VC in predialysis chronic kidney disease (CKD) patients, higher in those with advanced age, history of cardiovascular disease, osteoporosis, and declining renal function. [ABSTRACT FROM AUTHOR]

Aim: This study assessed the determinants of quality of life among chronic kidney disease patients and the socio -demographic variables contributing to the quality of life of chronic kidney disease patient attending Renal Clinics of two Tertiary Hospitals in Ondo State. Material and Methods: Descriptive cross sectional research design was utilized. Total enumeration method was used to select 140 respondents for the study. Adapted World Health Organization quality of life - BREF Version questionnaire was used to collect data, data generated were processed and analyzed using the Statistical Package for Social Sciences (SPSS) version 20; both descriptive and inferential statistics were used. Results: Finding revealed that the mean age of the respondent was 47.81±1.69 years. More (57.1%) of the respondents were males. The mean quality of life score of the respondents was found to be (38. 51±13.45). Results further showed that highest quality of life were observed in the environmental domain (mean score 16.21±5.66) followed by physical health (mean score 9.08±3.98) and the lowest in the social relation domain (mean score 5.13±3.31). Result showed that only family type is a significant determinant contributing to quality of life of patients (p = 0.038). There is no significant relationship between the socio demographic variable of respondent’ (age p= 0.12, gender p= 0.627, marital status p=0.167, educational qualification p=0.131) and their quality of life. Conclusion: Quality of life was poor among the respondents. To enhance the quality of life in patients with CKD, Good family and social relationships are of great importance and are the source of positive feelings and self-esteem as they improve the quality of life of patients. [ABSTRACT FROM AUTHOR]

The global prevalence of chronic kidney disease (CKD) is between 11 to 13%. Renal replacement therapies (RRT) – which include dialysis and renal transplantation – consume a significant portion of a country’s health resources even though only 0.1% of all CKD patients are at stage 5, also known as end-stage renal disease (ESRD). The aim of this review was to compare the magnitude of the economic burden of ESRD on national healthcare systems of selected countries with high prevalence of ESRD including Malaysia. The quantity of interest in this review were total ESRD expenditures and its proportions to the national health systems' expenditure. It was identified that total ESRD expenditure contributes between 0.91% to 7.1% of national health system expenditure in countries selected for this review. In Malaysia, the public sector - through its various agencies at the federal and state levels, accounted for almost 70% of dialysis funding; the remaining 30% came from the private sector and out-of-pocket payments. The ESRD expenditures in Malaysia constitutes 4.2% of total health expenditure by the public sector, relatively high compared to other countries. This review will summarise findings of the currently available economic evaluations of RRT in Malaysia. Based on available evidence, estimated weighted cost of treating ESRD patient in Malaysia is MYR39,346 per patient per year (USD26,648, PPP 2016). [ABSTRACT FROM AUTHOR]

Introduction: New diagnostic tools are needed to accurately detect acute myocardial infarction (AMI) in patients with end stage renal disease (ESRD) presenting with ischemic chest pain. We aimed in this study to investigate circulating miR-122, -192 and -499 expression levels in patients with AMI on top of ESRD and evaluate the potential of these miRNAs as blood-based biomarkers for AMI in patients with ESRD.Material and Methods: The study included 80 ESRD patients without AMI, 80 patients with ESRD associated with AMI and 60 healthy subjects. Assessment of microRNAs was done using SYBR Green based real-time PCR.Results: Levels of miR-122 were 28-fold and 20-fold higher in controls than in ESRD patients with or without AMI respectively (p < 0.001), while no differences were detected between the two patient groups (p = 0.9). Levels of miR-192 showed a marked increase in ESRD patients with and without AMI compared to the control group (> 500-fold, > 8000-fold respectively, p ≤ 0.001). Patients who developed AMI had lower expression than ESRD patients without AMI (p < 0.001). Non-significant miR-499 elevation was found in ESRD patients without cardiac disease compared to the control group, while highly significant elevation of miR- 499 was demonstrated in ESRD patients who developed AMI compared to other ESRD patients and the control group (> 100-fold, > 350-fold respectively, p = 0.001).Conclusions: Altered expression of miR-122 and -192 may contribute in pathogenesis of ESRD. MiR-192 and -499 may serve as potential biomarkers for AMI in ESRD. Further studies are needed to correlate these miRNAs with disease progression and outcome. [ABSTRACT FROM AUTHOR]

Context: Turmeric (Curcuma longa) is a wild plant of the ginger family native to tropical South Asia. Evidence Acquisitions: Directory of Open Access Journals (DOAJ), Google Scholar, Pubmed (NLM), LISTA (EBSCO) and Web of Science have been searched. Results: Emerging evidence indicate that turmeric/curcumin inhibits cytokines and TGF-β production. From the various factors involved in the genesis of chronic kidney disease and pathogenesis of primary and secondary glomerulonehritis, TGF-β has emerged as a key factor in the cascade of events. Leading to glomerulosclerosis, tubulointerstitial fibrosis and end-stage renal disease. Conclusions: considering the inhibitory effect of turmeric/curcumin on cytokines and TGF-β, it seems wise to assume that supplementary turmeric/curcumin might be a candidate remedy for chronic kidney disease and possibly prevention of subsequent end stage renal disease. [ABSTRACT FROM AUTHOR]

Background: Focal segmental glomerular sclerosis (FSGS) and necrotizing crescentic glomerulonephritis is a rare combination of diagnoses in the same patient. We report on a patient with FSGS who 10 years later developed anti-neutrophil cytoplasmic antibody (ANCA) associated glomerulonephritis. Case Presentation: Patient is a 60-year-old female with chronic kidney disease stage 3, osteopenia and anemia. In 2007, she was positive for ANCA proteinase-3 antibody, but kidney biopsy revealed FSGS. She was treated with high-dose oral steroids with tapered dose and went into remission. In 2017, she developed acute renal failure with increased proteinuria. Despite prior FSGS diagnosis, her new kidney biopsy revealed pauci-immune necrotizing glomerulonephritis. Patient was treated with methylprednisolone 250 mg IV for three days and high dose oral steroids with tapered dose. She was also started on rituximab 375 mg/m2 IV once weekly for 4 doses. Given the extent of kidney damage, the patient decided to start peritoneal dialysis and she is also on the kidney transplant list. Conclusions: The rare concurrence of FSGS and ANCA associated glomerulonephritis has not yet been reported. The case also emphasizes the significance of screening for ANCA or obtaining kidney biopsy when indicated not only as the gold standard for diagnosis but also as prognostic value. [ABSTRACT FROM AUTHOR]

Adult patients on hemodialysis experience a high prevalence of poor oral health and periodontitis. The chronic inflammation associated with poor periodontal health can increase the risk of cardiovascular disease and mortality among patients on hemodialysis. A systematic review of research articles published from 2012-2018 was conducted to synthesize current literature on the subject. Forty-three articles were identified. Findings were summarized into two categories: clinical measurements and lifestyle/quality of life. We suggest the development, implementation, and evaluation of oral health nursing interventions and periodontal treatments among patients on hemodialysis. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the level of end-stage renal disease (ESRD) knowledge among patients on peritoneal dialysis and haemodialysis and test associations between the level of their ESRD knowledge with sociodemographic and clinical variables. An in-centre cross-sectional study was conducted on a randomly selected 178 dialysis (57 peritoneal dialysis and 121 haemodialysis) patients receiving renal care at Rimba Dialysis Centre, Brunei, of which 50.6% (n=90) were females and 49.4% (n=88) were males. A validated, structured 10-Item ESRD knowledge questionnaire (with score scale of 0-10; and classified as <5 limited, 5-7 moderate, and 7-10 substantial knowledge) was self-administered by the respondents to assess their ESRD knowledge. Additional sociodemographic information was collected, and clinical variables were extracted from their dialysis records. The mean age of the respondents was 50.1 (SD=13.57) years. The mean knowledge score of the patients was 5.84 (SD=2.29), indicating moderate knowledge among ESRD patients on dialysis. Higher educational attainment (P<0.001), higher income (P=0.041), longer duration on dialysis (P=0.008), and dialysis initiation at a younger age (P=0.001) were significantly associated with better ESRD knowledge. On the other hand, the type of dialysis modality (P=0.117), age (P=0.106), employment status (P=0.662), marital status (P=0.187), dietary restrictions; potassium and phosphate (P=0.182), systolic blood pressure (P=0.172), diastolic blood pressure (P=0.062), intra-dialytic weight gain (P=0.592) and dialysis adequacy (P=0.977) were not associated with ESRD knowledge. Most patients, especially those with low income and education status demonstrated limited knowledge regarding ESRD and treatment, suggesting the need for educational interventions. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency and pattern of dyslipidemia in pediatric patients with end stage renal disease presenting in a tertiary care hospital. Study Design: Cross-sectional, observational study. Place and Duration of Study: The Children's hospital and the Institute of Child Health Lahore, from Sep 2016 to Nov 2017. Material and Methods: Children aged 5-15 years, of either gender and diagnosed with end stage renal disease were selected for the study. All the patients were undergoing renal replacement therapy in the form of hemodialysis and/or continuous ambulatory peritoneal dialysis. The serum levels of total cholesterol, triglycerides, high density lipoprotein, low density lipoprotein and very low density lipoprotein were measured. Results: There were 138 patients in the study with mean age 11.24 ± 2.37 years and male to female ratio 2.5:1. The mean ± SD values of total serum cholesterol, triglycerides, and low density lipoprotein were found to be 174.0 ± 54.1, 241.2 ± 142.4 and 95.2 ± 49.0 mg/dl respectively. The frequency of abnormally high levels of total serum cholesterol, triglycerides, and low density lipoprotein were found to be 21.7%, 84.8% and 19.6% respectively. The lipid profile of patients on peritoneal dialysis was markedly elevated as compared to that of patients on maintenance hemodialysis (p-value ≤0.05). Conclusion: Majority of pediatric patients with end stage renal disease had suffered from dyslipidemia especially raised serum triglycerides. Timely identification of abnormal lipid levels and appropriate management is expected to help reduce cardiovascular morbidity and mortality associated with dyslipidemia in these pediatric patients. Moreover, lipid profile of patients on peritoneal dialysis was more deranged than those on hemodialysis. [ABSTRACT FROM AUTHOR]

Background: Calciphylaxis is a potentially fatal condition previously observed in patients with poor renal function. We present a case of atypical presentation in a patient with good renal function after transplantation. Case Presentation: A-68-year old African American female with history of end-stage renal disease (ESRD) secondary to type II diabetes mellitus on hemodialysis for ten years, status post living related donor kidney transplant from her son three years prior to this presentation, parathyroidectomy, and atrial fibrillation on warfarin presented to our institution with progressively worsening, severely tender bilateral thigh lesions that were diagnosed as calciphylaxis. She was treated with sodium thiosulfate infusions for six months and continues to do well. Conclusions: Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), has traditionally been associated with ESRD patients on maintenance dialysis, however several nonuremic cases of CUA have been reported in recent years. Multiple pathophysiologic mechanisms for CUA development have been proposed expanding the scope of known risk factors and possible triggers. CUA can be a life-threatening condition that is important for clinicians to recognize and treat as soon as possible. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the level of engagement with medication among kidney transplant recipients in South Africa. A descriptive cross-sectional study design with random sampling was used. Data were collected through structured face-to-face interviews. Total engagement with medication scores among kidney transplant recipients ranged from 60% to 100%, with a mean score of 80%. Although over half of the participants (55%) scored above the mean, only 19% had high levels of engagement with medication. Engagement with medication was significantly associated with race (Chi-square value = 66.225, df=42, P=0.010) and years post-kidney transplantation (Chi-square value = 415.423, df=364, P=0.032). [ABSTRACT FROM AUTHOR]

Objective: The main goal of this study is to develop a stochastic model for the progression of Chronic Kidney Disease (CKD) into different stages based on estimated Glomerular Filtration Rate (eGFR). Material and Methods: The present study is a retrospective study of 117 patients suffering from CKD during the period March 2006 to October 2016. The prognostic factors such as gender, age, body mass index, diabetes, hypertension, hemoglobin, urea, serum creatinine, albumin and duration of the disease were recorded for each patient. We have applied the continuous time homogeneous multistate model based on Markov processes. The deterioration of disease is continuous in time and the probability of transition from one state to another state depends on the length of time and is independent of time on which transition takes place. Also, Cox proportional hazard model has been used to examine the effects of prognostic factors on the transition rates. Results: The probabilities of staying in the same state in first five years i.e. stage 1, stage2, stage 3, stage 4 and stage 5 are 0.6126, 0.5508, 0.5631, 0.0596 and 1 respectively. The probabilities of moving to the next state are also computed for first five and ten years. The prognostic factors age, hypertension, diabetes, hemoglobin, urea, serum creatinine are significant factors for the progression of CKD into different stages. Conclusions: The mean sojourn times along with p-next probabilities provide more intuitive parametric information of continuous time multistate model based on Markov processes than crude transition intensities. [ABSTRACT FROM AUTHOR]

Under normal conditions each of the two million nephrons of the kidney works in an organized approach to filter, reabsorb, and excrete various solutes and water. The kidney is a primary regulator of sodium and water as well as acid-base homeostasis. The kidney also produces hormones necessary for red blood cell synthesis and calcium homeostasis. Impairment of normal kidney function is often referred to as renal insufficiency. Based on the time course of development, renal insufficiency has historically been divided into two broad categories. Acute renal failure (ARF) refers to the rapid loss of renal function over days to weeks. Chronic kidney disease (CKD), also called chronic renal insufficiency (CRI) by some, is defined as a progressive loss of function occurring over several months to years, and is characterized by the gradual replacement of normal kidney architecture with interstitial fibrosis. Progressive kidney disease or nephropathy is generally synonymous with CKD, and the two phrases are often used interchangeably. The working group of the National Kidney Foundation's Kidney Dialysis Outcomes and Quality Initiative (K/DOQI) has recently developed a new scheme to classify CKD based on the presence of kidney damage, structural or functional, for =3 months, with or without decreased glomerular filtration rate (GFR) from normal values of approx.120 mL/min. CKD is further categorized by the level of kidney function (as defined by GFR) into stages 1 through 5.1 Although these stages are defined later in this review, it is necessary to denote at this point that Stage 5 was previously referred to as End-Stage Renal Disease (ESRD) or End-Stage Kidney Disease (ESKD). The aim of this review article is to focus on the medical therapies which induce nephrotoxicity. [ABSTRACT FROM AUTHOR]

Background It is not clear on which level of estimated glomerular filtration rate to start dialysis until now. Objective To compare between patient groups according to estimated glomerular filtration rate at dialysis initiation. Methods Eighty-seven Patients are selected randomly from a list of patients admitted for dialysis (Hemodialysis or Peritoneal dialysis) at Northern General Hospital - Sheffield Kidney Institute from 1st of January to 31st of December 2000. Patients have been categorized into two groups. First group includes 45 patients started dialysis with glomerular filtration rate less than 5 ml/min/1.73m². Second group includes 42 patients started dialysis with glomerular filtration rate from 5-10 ml/min/1.73m². Patients have been followed up for five years retrospectively until 31st December 2005. Results The study showed males are the predominant gender. White Caucasian patients are majority of patients. The mean age is 56 years. About half of patients are middle aged (45-65 years) and are overweight or obese. This study shows no difference between patients who started dialysis early (estimated glomerular filtration rate 5-10 ml/min/1.73m²) versus late (estimated glomerular filtration rate below 5 ml/min/1.73m²) in term of mortality and morbidity throughout five years of follow up. Conclusion This study showed no justification to decide on time to initiate dialysis based solely on estimated glomerular filtration rate level. [ABSTRACT FROM AUTHOR]

[Display omitted] • EDCs are released by medical devices and detected in dialysis fluids. • Patients treated by dialysis are overexposed to seven EDCs. • Strategies to reduce EDCs exposure have been suggested. • Manufacturers must reconsider the conception of medical devices. Endocrine disrupting chemicals (EDCs) were defined as "an exogenous substance or mixture that alters function(s) of the endocrine system and consequently causes adverse health effects". These compounds are mainly eliminated by the renal route. However, patients with end-stage kidney disease treated by dialysis (ESKDD) can no longer eliminate these EDCs efficiently. Furthermore, EDCs exposure could occur via leaching from medical devices used in dialysis therapy. As a result, ESKDD patients are overexposed to EDCs. The aims of this study were to summarize EDCs exposure of ESKDD patients and to evaluate the factors at the origin of this exposure. To handle these objectives, we performed a literature review. An electronic search on PubMed, Embase and Web of science databases was performed. Twenty-six studies were finally included. The EDCs reported in these studies were Bisphenol A (BPA), Bisphenol S (BPS), Bisphenol B (BPB), Nonylphenol, Di(2-ethylhexyl) phthalate (DEHP), Di-n-butyl phthalate (DBP), and Butylbenzyl phthalate (BBP). Regarding the environment of dialysis patients, BPA, BPB, BPS, DEHP, DBP and nonylphenol have been found. Environmental exposure affects EDCs blood levels in ESKDD patients who are overexposed to BPA, BPS, BPB and DEHP. For ESKDD patients, dialyzers with housing in polycarbonate and fibers in polysulfone seem to overexpose them to BPA. Regarding dialysis therapy, peritoneal dialysis seems to decrease patient exposure vs hemodialysis therapy, and hemodiafiltration therapy seems to reduce this exposure vs hemodialysis therapy. Regarding DEHP, levels tend to increase during dialysis and when DEHP plasticizer is used in PVC devices. Finally, in the European Union a regulation on medical devices was adopted on 5 April 2017 and has been applied recently. This regulation will regulate EDCs in medical devices and thereby contribute to reconsideration of their conceptions and, finally, to reduction of ESKDD patients' exposure. [ABSTRACT FROM AUTHOR]

Hospital readmissions are responsible for considerable health care costs. About 35% of patients with end stage renal disease (ESRD) who are hospitalized are readmitted within 30 days of discharge (United States Renal Data System, 2017). Studies point to the considerable percentage of readmissions that are preventable through effective discharge planning and patient follow-up after discharge (Mistiaen & Poot, 2006). Telephone follow up is a high-quality, low-cost method of providing discharge follow up. This project examined the effectiveness of an evidence-based quality improvement process in providing post-discharge telephone follow up to adult patients on hemodialysis by experienced nephrology nurses through standardized unit workflow and leveraging of the electronic medical record (EMR). Results indicated a lower percentage of admissions from the emergency department (59.9% pre- vs. 55.4% post-intervention) and a lower percentage of 30-day readmissions (28.4% pre- vs. 24.6% post-intervention). [ABSTRACT FROM AUTHOR]

Background: Chronic Kidney Disease is a global public health issue, with increasing incidence. It consists wide spectrum of renal conditions that lead to progressive decline in renal function and abnormal GFR. Liver disorders are common among chronic kidney diseases. LFT's particularly play a vital role in the diagnosis and monitoring CKD patients. Currently, eGFR considered being the most valuable parameter for diagnosing CKD. But it has some limitations, it is not done routinely in apparently healthy people, secondly, GFR has different normal values for different ethnic groups so the formulae for calculating eGFR being used in west might not be applicable in eastern population and vice versa. Objectives: This study was carried out to compare hepatic enzymes of patients with different stages of chronic kidney disease. Materials and methods: A total of 257 persons were recruited. Cases were divided into two subgroups based on the glomerular filtration rate (GFR). Subgroup 1: 85 Cases had GFR <15, subgroup 2: 99 cases with GFR > 15 and Subgroup 3: 73 normal healthy controls. The hepato-renal profile was done for all cases and controls. Results: Hepatic transferases in the patients undergoing dialysis fell into the normal range. But the same enzymes showed a marked elevation in the patients with chronic kidney disease having non-invasive treatment. Alkaline phosphatase showed mark elevation for both groups A and B as compared to normal controls. [ABSTRACT FROM AUTHOR]

Acquired cystic kidney disease (ACKD) is a condition that occurs predominantly in patients with end-stage renal disease (ESRD). In contrast to hereditary cystic kidney disease, ACKD is characterized by the presence of multiple small cysts in bilaterally small kidneys. Limited pediatric data suggest a high incidence (21.6-45.8%) of ACKD in children on dialysis, comparable to that in adults, with an increased frequency associated with a longer duration of dialysis. Recent research has shed light on the pathogenesis of ACKD, such as activation of proto-oncogenes. Although most patients with ACKD are asymptomatic, the condition can be complicated by renal cell carcinoma. Routine surveillance should therefore be considered in at-risk populations. [ABSTRACT FROM AUTHOR]

Objective: To perform an assessment of comorbidities of our hemodialysis dependent patients. Material & Methods: This was a cross-sectional descriptive study conducted in the Institute of Kidney Diseases Hayatabad, Peshawar and Khyber Teaching Hospital, Peshawar, Pakistan. The study included 177 patients and the study duration was 04 months (December 2015 to March 2016). ESRD patients on maintenance hemodialysis were asked about their comorbid conditions. This information was recorded on a questionnaire. Results: A total of 177 patients responded to a specially designed questionnaire asking questions about their comorbidity status. Out of these 177 patients 111 (62.7%) were male (M:F 1.7:1). The mean age for male patients was 43.1 years (SD ±14.8 and range from 18 to 70 years). While the mean age for females was 42.3 years (SD ±15.2 and range from 18 to 80 years). About 79% patients were on hemodialysis for duration of less than 03 years. Only 7.3% patients were undergoing hemodialysis at the recommended frequency of 03 or more sessions per week. All but 24.3% patients reported no emergency visits to hospital and all except 33.9% patients had no hospital admission in the previous 06 months. Around 34% patients had more than 5 emergency visits, while 37.8% patients had more than 5 admissions in the previous 06 months. Around 55.3% of patients were taking more than 5 types of drugs in a single day, while 76.7% were taking more than 3 drugs per day. Hypertension was the commonest comorbidity found in about 93.8% of patients. This was followed by cardiac diseases (46.9%) and diabetes (40.6%). Viral hepatitis was found in 21.4% patients, Infections in 12.4%, pulmonary diseases in 9.0%, and strokes were reported by 4.0% patients. Off the male patients, 67.5% (n=75) had two or more co-morbidities while 37.8% (n=42) had both Diabetes and hypertension. Off the female patients 89.3% (n=59) had two or more comorbidities while 45.4% (n=30) had both Diabetes and Hypertension. Conclusion: Comorbidities are common in our ESRD patients. Hypertension is the most common comorbidity followed by Diabetes Mellitus and cardiac diseases. The frequency of these comorbidities is higher in our patients when compared to the international data. This could explain the higher morbidity and mortality of our ESRD patients. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the prevalence of anxiety and depression in chronic kidney disease (CKD) patients according to CKD stages. STUDY DESIGN: A descriptive study. PLACE AND DURATION: Department of Nephrology, Rawal Institute of Health Sciences, Islamabad from 1st May 2016 to 30th Sep 2016. METHODOLOGY: 103 patients diagnosed of chronic kidney disease were evaluated for anxiety and depression using Beck Anxiety Inventory (BAI) score and Beck Depression Inventory (BDI) score. RESULTS: Out of 103 patients 74% had stage V disease, 16% had stage IV disease, 5.8% had stage III disease and 2.9% had stage II disease. No patient had stage I disease. 38% patients had moderate to severe anxiety and 38% had mild anxiety in stage V. 40% patients had moderate to severe depression and 19% had mild depression in stage V. CONCLUSION: This study shows that anxiety and depression is quite prevalent in chronic kidney disease patients especially in stage IV and V. [ABSTRACT FROM AUTHOR]

Patients receiving care for the management of end stage renal disease require transport to nephrology practice settings and treatment centers for hemodialysis and peritoneal dialysis. This type of transportation, defined as non-emergency medical transportation, has long presented a challenge for patients, families, and healthcare providers. This article explores the current and projected statistics and trends for chronic kidney disease, transportation challenges faced by patients and nephrology healthcare providers, and examples of successful transportation services and programs. Implications for practice with a focus placed on the importance of an interprofessional approach are described. [ABSTRACT FROM AUTHOR]

Dialysis remains the mainstay treatment for patients with end stage renal disease. In the UK, there has been a signifi cant decline in home dialysis despite its benefi ts and cost effectiveness. Patients with chronic kidney disease (CKD) are often known to other specialties who they may continue to consult when approaching dialysis. We wished to assess the knowledge of the non-renal multidisciplinary team (MDT) regarding home dialysis and establish whether further education was warranted. This was assessed using an online survey sent to specialties likely to deal with CKD patients. In total, 364 questionnaires were sent out with a 26.4% response rate. According to the survey responses, 81.5% of non-renal MDTs lack confi dence in discussing home dialysis options with patients and 74.55% feel that they need further education about home dialysis. Targeted education may increase home dialysis uptake by multimorbid CKD patients who have a consistent message delivered by all relevant healthcare teams about the benefi ts of home dialysis. [ABSTRACT FROM AUTHOR]

The article discusses the role of advanced practice nurses (APNs) in palliative care for patients with chronic kidney disease. Topics covered include the drop in the number of physicians who have specialized training in hospice and palliative medicine, the pillars of the collaborative model for nurse practitioners (NP) and the sustainability of an NP-based model of specialist palliative care in patients' homes.

Introduction: Peripherally inserted central venous catheters (PICCs) may adversely impact future successful arteriovenous fistulae (AVF). As part of a quality improvement project, the performance of tunneled small bore tunneled central venous catheters (TSB-CVCs), as alternatives to PICCs, was evaluated. Methods: A retrospective observational study, involving individuals ≥18 years of age who underwent TSB-CVC placement by Interventional Radiology at Mayo Clinic, Rochester, MN between 1/1/2010 and 8/30/2013. Findings: The study cohort included 92 patients with a median age of 55 (46-67) years, who underwent 108 TSB-CVC placements. Baseline renal disease was present in 71% (77/108). Most TSB-CVCs were placed in hospitalized patients (94%; 102/108); five French in diameter (61%; 66/108) and located in an internal jugular vein (84%; 91/108). Median catheter indwelling time was 20 (11-43) days (n = 84). TSB-CVC-related bloodstream infection, deep venous thrombosis (DVT), and superficial venous thrombosis (SpVT) rates per line were 0.009 (1/108), 0.018 (2/108), and 0.009 (1/108), respectively. Venous outcomes in a subgroup of 54 patients, who had documented PICC placements (n = 161) in addition to TSB-CVC (n = 58) were compared. TSB-CVC-DVT rate was lower than the PICC-DVT rate (0.017 [1/58] vs. 0.106 per line [17/161]; P = 0.04). The TSB-CVC-SpVT rate was not different from the PICC-SpVT rate (0 [0/58] vs. 0.037 [6/161] per line; P = 0.14). Discussion: TSB-CVCs demonstrated an excellent safety profile in our study. These catheters should be preferentially utilized for arm vein preservation in advanced kidney disease. Their impact on future AVF success needs further evaluation. [ABSTRACT FROM AUTHOR]

Peritoneal dialysis (PD) offers the healthiest way for starting renal replacement therapy (RRT) in End Stage Renal Disease patients, however exposes long-term PD patients to a dangerous complication named encapsulating peritoneal sclerosis (EPS). In this study, we searched for possible risk factors of EPS. Data were collected from two PD centers covering period 1995–2012 and comprised 464 patients. Control group defined as PD patients stayed on PD >42 month (n = 122), and case group was 12 confirmed EPS patients. Associations were analyzed using linear regression analysis. Prevalence and incidence of EPS were 2.59% and 8.9% with an incidence of 0.7% patient-years, respectively. The age at start of PD in EPS patients (32.75 ± 10.8 year) was significantly lower compared with control group (49.61 ± 16.18 year,p = .0001). The mean duration of PD in EPS and control group were 2494.4 ± 940.9 and 1890.2 ± 598.8 days (p = .002). Control group had 145 episodes of peritonitis during total duration of 7686 patient months (peritonitis rate of 1/53). This was 1/26 with a total 38 episodes of peritonitis during the total duration of 997 patient months (p = .01) for EPS group. In regression analysis, PD duration, age at PD start and duration of Ultrafiltration failure (UFF) were associated with EPS. Longer time being on PD, younger age, and higher UFF duration were the risk factors for EPS development. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) leads in the majority of instances to end stage renal disease (ESRD) requiring renal replacement therapy. Our interest was to find the possible associations of HLA class II alleles with ESRD according to the gender specificity in Uzbek population. [ABSTRACT FROM AUTHOR]

The past year has seen interesting publications in the fields of chronic kidney disease and end stage renal disease. This review highlights some of these important papers and places their findings in the context of clinical care. [ABSTRACT FROM AUTHOR]

Aim Despite increase global prevalence of End stage renal disease (ESRD) and subsequent need for renal replacement therapy (RRT), relatively little is known about disease progression and prognosis of earlier stages of CKD. Current study was conducted to examine rate of CKD progression, predictors of ESRD and death. Methods A total 621 patients with estimated glomerular filtration rate (eGFR) of 15-59ml/min/1.73m2 (CKD stage 3 & 4) were selected and followed up for 10 years or until ESRD or death, whichever occurred first. Subjects who did not meet inclusion criteria were excluded (n=1474). Results Annual cumulative decline in eGFR was 3.01±0.40 ml/min/1.73m2. Overall disease progression was observed in 60% patients while 18% died. Among patients with CKD stage 3, 21% progressed to stage 4, 10% to stage 5ND (non-dialysis) and 31% to RRT while mortality was observed in 16% patients. On the other hand, 8% patients with CKD stage 4 progressed to stage 5ND, 31% to RRT and mortality was observed in 24% cases. Patients with CVD, higher systolic blood pressure, elevated phosphate levels, heavy proteinuria, microscopic hematuria and use of diuretics were more likely to develop ESRD. Advancing age, low eGFR, low systolic blood pressure, low hemoglobin and baseline diabetes were found to be significant predictors of mortality while being female reduced risk of mortality. Conclusion Our data suggest that, in this CKD cohort, patients were more likely to develop ESRD than death. Prime importance should be given to mild forms of CKD to retard and even reverse CKD progression. [ABSTRACT FROM AUTHOR]

Aim Studies investigating the association between blood phosphorus and renal outcomes yielded inconsistent results, and studies from Asian population are extremely limited. We initiated the present cohort study, aiming to prospectively examine the association between blood phosphorus and adverse renal outcomes in a prospective chronic kidney disease (CKD) cohort of Chinese patients majorly with glomerulonephritis. Methods A total of 1430 patients were involved in the study. Linear regression analyses were used to assess the relationship between phosphorus and the slope of estimated glomerular filtration rate (eGFR). Cox regression analyses were used to assess the association between phosphorus and composite outcomes, which were defined as the presence of at least one of: eGFR halving, end stage renal disease, or death. Results During follow-up for an average of 41.4 months, 196 patients developed composite outcomes. The time-average plasma phosphorus was independently associated with the slope of eGFR (β = -0.18, 95% CI: -4.42 to -2.19, P < 0.001). Each 1 mg/dL increases of baseline and time-average phosphorus were respectively associated with a 1.33 (95% confidence interval (CI): 1.09-1.63; P = 0.005) and 2.79 (95%CI: 2.21-3.52; P < 0.001) fold higher risk of composite outcomes. Compared with participants in the bottom quartile of time-average phosphorus, those in the top quartile were at increased risk of composite outcomes, with a hazard ratio of 6.52 (95% CI: 3.05-13.90; P < 0.001). Conclusion Plasma phosphorus level is an independent risk factor of adverse renal outcomes in Chinese CKD patients majorly with glomerulonephritis. Compared with baseline value, time-average phosphorus has a stronger relationship with renal prognosis. [ABSTRACT FROM AUTHOR]

Background End stage renal disease (ESRD) contributes to a higher mortality rate in peptic ulcer bleeding (PUB) patients. A crucial question is whether early Helicobacter pylori ( H. pylori ) eradication therapy is necessary for H. pylori -infected chronic kidney disease (CKD) patients. To explore whether H. pylori eradication therapy has a lower risk of PUB at the pre-ESRD stage than at the ESRD stage. Methods and patients Patients meeting 2 criteria were defined as newly diagnosed ESRD cases: (1) patients diagnosed with ESRD and receiving regular dialysis between 2000 and 2009; and (2) patients with no history of dialysis between 1997 and 1999. We divided the study participants into pre-ESRD and ESRD groups on the basis of the time between H. pylori eradication and dialysis. The date of the first PUB diagnosis was defined as the primary endpoint. Stratified Cox proportional hazard regression analysis was used to estimate the effect of H. pylori eradication at the pre-ESRD and ESRD stage on the occurrence of PUB. Results We included 476 patients in the pre-ESRD cohort and 476 patients in the matched ESRD cohort. After adjustment for age, sex, the presence of comorbidities, and medication use, the hazard ratio of PUB was 0.66 times less in the pre-ESRD cohort than in the ESRD cohort. Factors such as Charlson's score more than 3, and nonsteroidal anti-inflammatory drugs were associated with an increased risk of PUB. Conclusion Our result supports that early H. pylori eradication has a lower risk of PUB in H. pylori -infected CKD patients. [ABSTRACT FROM AUTHOR]

Glomerular filtration rate and/or creatinine are not accurate methods for renal failure prediction. This study tested homocysteine (Hcy) as a predictive and prognostic marker for end stage renal disease (ESRD). In total, 176 subjects were recruited and divided into:healthy normal group(108 subjects);mild-to-moderate impaired renal function group(21 patients);severe impaired renal function group(7 patients); andchronic renal failure group(40 patients) who were on regular hemodialysis. Blood samples were collected, and serum was separated for analysis of total Hcy, creatinine, high sensitive C-reactive protein (CRP), serum albumin, and calcium. Data showed that Hcy level was significantly increased from normal-to-mild impairment then significantly decreases from mild impairment until the patient reaches severe impairment while showing significant elevation in the last stage of chronic renal disease. Creatinine level was increased in all stages of kidney impairment in comparison with control. CRP level was showing significant elevation in the last stage. A significant decrease in both albumin and calcium was occurred in all stages of renal impairment. We conclude Hcy in combination with CRP, creatinine, albumin, and calcium can be used as a prognostic marker for ESRD and an early diagnostic marker for the risk of renal failure. [ABSTRACT FROM AUTHOR]

Though renal transplant is preferred mode of renal replacement therapy (RRT), peritoneal dialysis (PD) is an important modality of treatment for children with end stage renal disease (ESRD) but it is underutilized in Pakistan despite several advantages over haemodialysis (HD). The burden of paediatric chronic kidney disease (CKD) and ESRD is under reported, since majority of children (24-63%) present with acute on chronic kidney disease often complicated by multiple co-morbid conditions which may result in death before consideration of long term RRT. In Pakistan, the available care of ESRD/CKD is exclusively hospital based rather than home based dialysis. Manual PD is used as first line option of treatment for acute kidney injury (AKI) or acute on CKD at few centers and long term maintenance PD is not offered at all as first line option of treatment for children with ESRD. Generally, long term PD is less expensive than HD or at least as expensive as HD. This holds true even for most of the developed countries using automated cycler machines but scenario in developing countries like Pakistan is quite different. HD is the only option offered to older children for short period and very few of them become successful to get a renal transplant. Home dialysis or Continuous Ambulatory PD (CAPD) may be the only option to treat young infants to make them free of complications of uraemia and provide adequate nutrition for growth till either HD or transplant become possible. This may be possible once paediatric and adult nephrologists as well as pediatricians recommend and advocate this option for survival of children with ESRD. Furthermore, we need to strengthen the existing RTT facilities and develop more paediatric peritoneal dialysis centers; local production of dialysis fluid and disposables or government should allow free import of PD equipments and solutions. This will not be possible without efforts of all of us including professionals, dialysis nurses or technicians, media persons, pharma industry and community workers as well as parents. [ABSTRACT FROM AUTHOR]

Home dialysis offers many advantages over in-center dialysis, but peritoneal dialysis and home hemodialysis are infrequently used. To better understand why, a survey of dialysis healthcare professionals (N = 273) in the United States was conducted to assess their knowledge, perceptions, and beliefs about home dialysis modalities. Most survey respondents demonstrated a lack of knowledge about home dialysis and perceived many barriers to home therapy, which may affect patient modality choice; however, 90% of respondents stated they would choose home dialysis for themselves if they required dialysis. Additional staff education may help reduce misperceptions, address knowledge gaps, and subsequently, increase use of home modalities. [ABSTRACT FROM AUTHOR]

Chronic kidney disease is usually related with anemia and the level of anemia correlates with the severity of renal failure. A chronic kidney disease is complicated by anemia and anemia may contribute to adverse clinical outcomes. No large-scale population data are available for patients with chronic kidney disease regarding prevalence of anemia, subpopulations at risk, and relationships between anemia and renal dysfunctionObjectives:The objective of this study is to determine the frequency of different patterns of anemia in relation to glomerular filtration rate in patients suffering from chronic kidney disease stage II and above patients.Material &Methods:Study Design: Cross sectional study. Setting:Medical and Nephrology wards of Liaquat University Hospital Hyderabad / Jamshoro. Period:20th January 2013 to 19thDecember 2013.Results:During the study period, total 339 patients of chronic kidney disease with stage II and above patients were enrolled. The mean age ± Standard Deviation and range) of patients was 50.65 ± 11.86 (16 to 80 years, n = 339). 211(62.2%) were male and 128(37.8%) were female. (Male to Female Ratio 1:6). Mean Hemoglobin ± SD was 7.16 ± 3.89 (3.0 to 17.0 g/dL). The frequency of anemia was present in 285(84.1%) patients with mean Hb± SD 6.02 ± 2.1 (g/dL). The mean weight ± SD was 56.50 ± 9.84 (40 to 81 kg). The mean serum creatinine ± SD was 5.63 ± 2.48 (0.9 to 12.0 mg/dL) and we observed that most frequent pattern of anemia was normocytic-normochromic anemia in 216(77.0%) patients, hypochromic-microcytic in 61(18.0%) and macroyctic in 17(5.0%) patients. We alsofound that as anemia increased progressively with declining GFR with mean hemoglobin concentration of 11.78 ±2.8 g/dL in CKD stage 2, 10.14 ± 3.6 g/dL in CKD stage 3, 6.8 ± 3.6 g/dL in CKD stage 4, 7.44 ± 4.0 g/dL in CKD stage 5.Conclusion: Frequency of anemia increases with the progression of stage of chronic kidney disease (decreased GFR) and anemia was most common in stage 5 patients of chronic kidney disease.Most frequent pattern of anemia is normocytic normochromic anemia. [ABSTRACT FROM AUTHOR]

The role of oxidative stress in patients with end stage renal disease (ESRD), which occurs at significantly higher levels than in the general population, is often underestimated in clinical practice. Emerging evidence highlights the strong correlation of oxidative stress with chronic inflammation and cardiovascular disease, which are highly prevalent in most patients on maintenance haemodialysis (HD) and are a major risk factor for mortality in this population. In this study, total plasma thiols and plasma S-thiolated proteins were measured in patients with ESRD, before and after a regular HD session, and compared to age-matched healthy subjects. We found a significant decrease in the level of total plasma thiols and, conversely, a significant increase in the level of S-thiolated proteins in these patients. In most patients, post-HD plasma level of total thiols did not differ from the one in healthy subjects, whereas plasma level of S-thiolated proteins was lower in HD patients than in age-matched healthy controls. This suggests that a single HD session restores plasma thiol redox status and re-establishes the antioxidant capacity of plasma thiols. Additionally, we determined protein thiolation index (PTI), i.e., the molar ratio between the sum of all low molecular mass thiols bound to S-thiolated plasma proteins and protein free cysteinyl residues. Patients with ESRD had a significantly higher PTI compared to age-matched healthy subjects and HD was associated with a decrease in PTI to normal, or lower than normal, levels. Although this study is limited in size, our results suggest that PTI is a useful indicator of thiol-specific oxidative stress in patients with ESRD on maintenance HD. This study also emphasizes that PTI determination is a cheap and simple tool suitable for large-scale clinical studies that could be used for routine screening of thiol-specific oxidative stress. [ABSTRACT FROM AUTHOR]

Background: Patients with Chronic Kidney Disease (CKD) are at high risk for developing cardiovascular disease (CVD). Carotid intima media thickness (CIMT) has been found to correlate with coronary artery atherosclerosis. Methodology: This was a prospective study of carotid intima media thickness in patients of CKD, done in the Department of Medicine, G.R. Medical College & J.A. Group of Hospitals, Gwalior (M.P.), India. A total of 70 patients of CKD and 35 age and sex matched controls were enrolled. Bilateral assessment of intima media thickness was done in common carotid artery and higher value of CIMT of any one carotid artery was recorded. Results: Out of total 70 patients of CKD, 42 were males. Clinical findings in CKD patients were anemia (92.5%), edema (71.4%), decreased urine output (41.42%), obesity (12.5%). Proteinuria (>300mg/24 hrs) was seen in 91.4% patients. CIMT in CKD patients was between 0.9-1.0mm whereas in controls was between 0.5-0.6mm. 62.5% of total patients (CIMT 0.91±0.24 to 1.15±0.24) were having mean BP between 90 to 130 mmHg, 12.7% of total patients (CIMT 1.00±0.26) were having mean BP>130 mmHg. CKD patients with dyslipidemia were having mean CIMT 1.08±0.19 in comparison to controls with dyslipidemia having mean CIMT 0.67±0.22. Conclusion: CIMT was increased in CKD patients with increased age, progression of stage of CKD and proteinuria. Mean CIMT was increased in all stages of CKD and there was no significant difference in CIMT in different stages of CKD. Patients having high mean blood pressure was having higher mean CIMT in comparison to patients having lower mean blood pressure, patient with dyslipidemia had high mean CIMT as compared to mean CIMT of controls having dyslipidemia. [ABSTRACT FROM AUTHOR]

Cardiovascular is the major cause of death in chronic kidney disease and end-stage renal disease. The cardiovascular mortality rate of patients with renal impairment is evaluated to be higher than general population. Coronary artery disease seems to be an important type of cardiovascular complication among patients with chronic kidney disease and end-stage renal disease before the renal replacement therapy. Due to the strong association between chronic kidney disease and the incidence of coronary artery disease, accurate screening, diagnosis, and management of cardiovascular complications would be essential in patients at different stages of renal dysfunction. Despite the need for the comprehensive knowledge about different aspects of coronary artery disease in patients with renal failure, there is not sufficient evidence regarding the pathophysiology, ideal diagnosis, and treatment strategies for coronary heart disease in population with chronic kidney disease. In this study, we briefly reviewed the existing literatures about the possible screening, diagnosis, and the treatment approaches of risk of coronary heart disease in patients with kidney dysfunction. [ABSTRACT FROM AUTHOR]

Introduction: The global prevalence of chronic kidney disease (CKD) is estimated to be 8-16%. Studies have shown that the increased mortality in patients with CKD is due to anemia that leads to cardiovascular disease (CVD), also known as "Cardio renal anemia syndrome". The present study was undertaken to look into the laboratory profiles of end stage renal disease (ESRD) patients. Aim: To study the laboratory profiles of End stage renal disease (ESRD) patients coming for hemodialysis. Materials and Methods: The study was a retrospective, crosssectional study done by collecting data from the medical case records of all patients during a period of one year from January 1st 2014 to December 31st 2014. Records of a total of 140 patients who underwent hemodialysis during this period were taken. The laboratory profiles that was recorded included haemoglobin, serum sodium, potassium, chloride, fasting glucose, calcium and phosphorus. Results: The mean age of the subjects was 53.5±14.5 yrs. All the patients had moderate anaemia. There was a significant difference in the mean systolic and diastolic blood pressure, serum creatinine and serum urea values between males and females. The mean serum calcium levels were low. Conclusion: The present study is the first such study in this rural area and shows evidence of a relatively young population with ESRD having moderate anaemia and hypertension. There is evidence of hypocalcaemia and serum phosphorus is on the higher end of the normal range. These findings are usually associated with a higher risk of mortality. With the explosion of diabetes and hypertension in India, chronic kidney disease should be diagnosed and managed as early as possible if not prevented. [ABSTRACT FROM AUTHOR]