60 results on '"End stage renal disease"'
Search Results
2. Renal Embolization-Induced Uremic Swine Model for Assessment of Next-Generation Implantable Hemodialyzers
- Author
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Moyer, Jarrett, Wilson, Mark W, Sorrentino, Thomas A, Santandreu, Ana, Chen, Caressa, Hu, Dean, Kerdok, Amy, Porock, Edward, Wright, Nathan, Ly, Jimmy, Blaha, Charles, Frassetto, Lynda A, Fissell, William H, Vartanian, Shant M, and Roy, Shuvo
- Subjects
Pharmacology and Pharmaceutical Sciences ,Biomedical and Clinical Sciences ,Assistive Technology ,Kidney Disease ,Bioengineering ,Prevention ,Humans ,Swine ,Animals ,Kidneys ,Artificial ,Creatinine ,Pilot Projects ,Silicon ,Swine ,Miniature ,Renal Insufficiency ,Dialysis Solutions ,Urea ,end stage renal disease ,acute kidney injury ,chronic kidney disease ,dialysis ,hemodialysis ,artificial organs ,Biochemistry and Cell Biology ,Pharmacology and pharmaceutical sciences - Abstract
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.
- Published
- 2023
3. Long-term ozone exposure and mortality in patients with chronic kidney disease: a large cohort study
- Author
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Ejin Kim, Hyuk Huh, Yongwon Mo, Jae Yoon Park, Jiyun Jung, Hajeong Lee, Sejoong Kim, Dong Ki Kim, Yon Su Kim, Chun Soo Lim, Jung Pyo Lee, Yong Chul Kim, and Ho Kim
- Subjects
Chronic kidney disease ,End stage renal disease ,Mortality ,Ozone ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Abstract Background Epidemiologic studies on the effects of long-term exposure to ozone (O3) have shown inconclusive results. It is unclear whether to O3 has an effect on chronic kidney disease (CKD). We investigated the effects of O3 on mortality and renal outcome in CKD. Methods We included 61,073 participants and applied Cox proportional hazards models to examine the effects of ozone on the risk of end-stage renal disease (ESRD) and mortality in a two-pollutants model adjusted for socioeconomic status. We calculated the concentration of ozone exposure one year before enrollment and used inverse distance weighting (IDW) for interpolation, where the exposure was evenly distributed. Results In the single pollutant model, O3 was significantly associated with an increased risk of ESRD and all-cause mortality. Based on the O3 concentration from IDW interpolation, this moving O3 average was significantly associated with an increased risk of ESRD and all-cause mortality. In a two-pollutants model, even after we adjusted for other measured pollutants, nitrogen dioxide did not attenuate the result for O3. The hazard ratio (HR) value for the district-level assessment is 1.025 with a 95% confidence interval (CI) of 1.014–1.035, while for the point-level assessment, the HR value is 1.04 with a 95% CI of 1.035–1.045. The impact of ozone on ESRD, hazard ratio (HR) values are, 1.049(95%CI: 1.044–1.054) at the district unit and 1.04 (95%CI: 1.031–1.05) at the individual address of the exposure assessment. The ozone hazard ratio for all-cause mortality was 1.012 (95% confidence interval: 1.008–1.017) for administrative districts and 1.04 (95% confidence interval: 1.031–1.05) for individual addresses. Conclusions This study suggests that long-term ambient O3 increases the risk of ESRD and mortality in CKD. The strategy to decrease O3 emissions will substantially benefit health and the environment.
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- 2024
- Full Text
- View/download PDF
4. Long-term ozone exposure and mortality in patients with chronic kidney disease: a large cohort study.
- Author
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Kim, Ejin, Huh, Hyuk, Mo, Yongwon, Park, Jae Yoon, Jung, Jiyun, Lee, Hajeong, Kim, Sejoong, Kim, Dong Ki, Kim, Yon Su, Lim, Chun Soo, Lee, Jung Pyo, Kim, Yong Chul, and Kim, Ho
- Subjects
CHRONIC kidney failure ,CHRONICALLY ill ,OZONE ,PROPORTIONAL hazards models ,COHORT analysis - Abstract
Background: Epidemiologic studies on the effects of long-term exposure to ozone (O
3 ) have shown inconclusive results. It is unclear whether to O3 has an effect on chronic kidney disease (CKD). We investigated the effects of O3 on mortality and renal outcome in CKD. Methods: We included 61,073 participants and applied Cox proportional hazards models to examine the effects of ozone on the risk of end-stage renal disease (ESRD) and mortality in a two-pollutants model adjusted for socioeconomic status. We calculated the concentration of ozone exposure one year before enrollment and used inverse distance weighting (IDW) for interpolation, where the exposure was evenly distributed. Results: In the single pollutant model, O3 was significantly associated with an increased risk of ESRD and all-cause mortality. Based on the O3 concentration from IDW interpolation, this moving O3 average was significantly associated with an increased risk of ESRD and all-cause mortality. In a two-pollutants model, even after we adjusted for other measured pollutants, nitrogen dioxide did not attenuate the result for O3 . The hazard ratio (HR) value for the district-level assessment is 1.025 with a 95% confidence interval (CI) of 1.014–1.035, while for the point-level assessment, the HR value is 1.04 with a 95% CI of 1.035–1.045. The impact of ozone on ESRD, hazard ratio (HR) values are, 1.049(95%CI: 1.044–1.054) at the district unit and 1.04 (95%CI: 1.031–1.05) at the individual address of the exposure assessment. The ozone hazard ratio for all-cause mortality was 1.012 (95% confidence interval: 1.008–1.017) for administrative districts and 1.04 (95% confidence interval: 1.031–1.05) for individual addresses. Conclusions: This study suggests that long-term ambient O3 increases the risk of ESRD and mortality in CKD. The strategy to decrease O3 emissions will substantially benefit health and the environment. [ABSTRACT FROM AUTHOR]- Published
- 2024
- Full Text
- View/download PDF
5. Risk of Chronic Kidney Disease Progression
- Published
- 2023
6. Efficacy of Diuretics in Kidney Disease
- Author
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Tammy Lisa Sirich, Assistant Professor of Medicine
- Published
- 2022
7. Palm Tocotrienols in Chronic Hemodialysis (USA) (PATCH)
- Author
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DaVita Dialysis, Great Lakes Dialysis, LLC, National University of Malaysia, Universiti Putra Malaysia, Ministry of Health, Malaysia, National Kidney Foundation, PEMANDU, Henry Ford Hospital, Kidney Foundation Hospital and Research Institute, Bangladesh, Fortis Hospital, India, and Pramod Khosla, Professor
- Published
- 2022
8. Retrospective analysis of SGLT2 inhibitors in heart failure with preserved ejection fraction
- Author
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John S. Clemmer, Taylor J. Ward, and Seth T. Lirette
- Subjects
Heart failure with preserved ejection fraction ,Heart failure ,SGLT2 inhibitors ,Antihypertensive therapy ,Chronic kidney disease ,End stage renal disease ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Aims Heart failure (HF) is one of the leading causes of cardiovascular morbidity and mortality. HF with preserved ejection fraction (HFpEF), or diastolic failure, accounts for half of all HF cases and differs from HF with reduced ejection fraction (HFrEF). Patients with HFpEF are typically older, female, and commonly seen with chronic kidney disease (CKD), one of the leading independent risk factors for mortality in these patients. Unfortunately, drugs that had shown significant improvements in mortality in HFrEF have not shown similar benefits in HFpEF. Recently, sodium glucose transporter 2 inhibitors (SGLT2i) have been shown to reduce cardiovascular morbidity and mortality in HFrEF patients and slow down CKD progression. This study aimed to elucidate the impact of this drug class on mortality and risk of end stage renal disease in patients with HFpEF, which is currently unclear. Methods and results We retrospectively analysed the Research Data Warehouse containing electronic health records from de‐identified patients (n = 1 266 290) from the University of Mississippi Medical Center from 2013 to 2022. HFpEF patients had an average follow‐up of 4 ± 2 years. Factors associated with increased all‐cause mortality during HFpEF included age, male sex, and CKD. Interestingly, the only treatments associated with significant improvements in survival were angiotensin converting enzyme inhibitors/angiotensin receptor blockers and SGLT2i, regardless of CKD or diabetes status. Additionally, SGLT2i use was also associated with significant decrease in the risk of end stage renal disease. Conclusions Our results support the use of SGLT2i in an HFpEF population with relatively high rates of hypertension, CKD, and black race and suggests that improvements in mortality may be through preserving kidney function.
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- 2023
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9. Bellavere's scoring in chronic kidney disease: A study protocol [version 1; peer review: awaiting peer review]
- Author
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Saket Toshniwal, Sunil Kumar, and Sourya Acharya
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Study Protocol ,Articles ,Cardiac autonomic neuropathy ,chronic kidney disease ,bellavere’s score ,heart rate variability ,valsalva ratio ,blood pressure ,hemodialysis ,end stage renal disease - Abstract
Background: Chronic kidney disease (CKD) refers to abnormalities in kidney structure and/or function for more than three months; cardiac autonomic neuropathy (CAN) is an indicator of cardiovascular death due to various abnormalities such as cardiac arrhythmias. Heart rate variability (HRV) is an important component of CAN and has been shown to be related to CAN. This study aims to evaluate cardiac autonomic neuropathy at different stages of CKD with the Bellavere score and to correlate CAN with lipids, plasma, electrolytes and blood pressure in patients with CKD at different stages. Methods: Consent of 95 patients who met the diagnosis of chronic kidney disease according to Modification of Diet in Renal Disease (MDRD) criteria were included in the study. All subjects will have blood tests for lipids, anaemia, and electrolytes. All participants' blood pressure will be monitored. All subjects will also be scored based on the Bellevere scoring system, the Valsava ratio, and the 30:15 ratio. Data will be analyzed using SPSS version 21 and appropriate statistical tests will be used depending on the study objectives and the data collected. Expected results: Based on the literature review and previous studies, the results of this study should demonstrate the relationship between CAN and CKD at this stage. The study also expects to find higher Bellavere scores in patients with different stages of CKD.
- Published
- 2023
- Full Text
- View/download PDF
10. Frequency of Subclinical Hypothyroidsim Among Patients with end Stage Renal Disease on Hemodialysis Presenting to A Tertiary Care Hospital
- Author
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Wajid Abdullah, Salman Tahir Shafi, Irfan Ahmad, and Sana Ashraf
- Subjects
Chronic kidney disease ,End stage renal disease ,Subclinical hypothyroidism ,Medicine ,Medicine (General) ,R5-920 - Abstract
Objective: Aim of this study was to determine the frequency of subclinical hypothyroidism among patients with end stage renal disease presenting to tertiary care hospital. Study Design: Cross sectional study. Place and Duration of Study: Department of Nephrology, Sharif Medical City Hospital, Lahore. Pakistan, from Mar 2020 to Dec 2020. Methodology: A total of 200 cases studied. Informed consent was obtained from them. Data was noted in the proforma. Using aseptic techniques blood sample was taken for testing serum TSH and free T4 levels through radioimmunoassay. Results were collected by the researcher next day and were labeled and noted as subclinical hypothyroidism according to its clinical definition. Privacy of the data was maintained. Results: In 200 study cases age interval was 15-80 years with mean age of 46.22±19.67 years. The minimum Serum TSH level was 4.1 and maximum was 4.6 with mean serum TSH level was 4.31±0.16. The minimum Serum T4 levels was 0.5 and maximum was 2.1 with mean Serum T4 levels was 1.28±0.68. Duration of chronic kidney disease was 3-60 months with mean duration of 17.58±14.14 months. It was observed that there were 56.5% male patients while females were 43.5%. Subclinical Hypothyroidism was present in 9.5% patients with ESRD reporting to tertiary care hospital while it was absent in 90.5% patients. Conclusion: The frequency of subclinical hypothyroidism was found as 9.5% among patients with end stage renal disease presenting to tertiary care hospital.
- Published
- 2023
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11. Retrospective analysis of SGLT2 inhibitors in heart failure with preserved ejection fraction.
- Author
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Clemmer, John S., Ward, Taylor J., and Lirette, Seth T.
- Subjects
HEART failure ,VENTRICULAR ejection fraction ,CHRONIC kidney failure ,SODIUM-glucose cotransporter 2 inhibitors ,ACE inhibitors ,ANGIOTENSIN-receptor blockers ,ALDOSTERONE antagonists ,ELECTRONIC health records - Abstract
Aims: Heart failure (HF) is one of the leading causes of cardiovascular morbidity and mortality. HF with preserved ejection fraction (HFpEF), or diastolic failure, accounts for half of all HF cases and differs from HF with reduced ejection fraction (HFrEF). Patients with HFpEF are typically older, female, and commonly seen with chronic kidney disease (CKD), one of the leading independent risk factors for mortality in these patients. Unfortunately, drugs that had shown significant improvements in mortality in HFrEF have not shown similar benefits in HFpEF. Recently, sodium glucose transporter 2 inhibitors (SGLT2i) have been shown to reduce cardiovascular morbidity and mortality in HFrEF patients and slow down CKD progression. This study aimed to elucidate the impact of this drug class on mortality and risk of end stage renal disease in patients with HFpEF, which is currently unclear. Methods and results: We retrospectively analysed the Research Data Warehouse containing electronic health records from de‐identified patients (n = 1 266 290) from the University of Mississippi Medical Center from 2013 to 2022. HFpEF patients had an average follow‐up of 4 ± 2 years. Factors associated with increased all‐cause mortality during HFpEF included age, male sex, and CKD. Interestingly, the only treatments associated with significant improvements in survival were angiotensin converting enzyme inhibitors/angiotensin receptor blockers and SGLT2i, regardless of CKD or diabetes status. Additionally, SGLT2i use was also associated with significant decrease in the risk of end stage renal disease. Conclusions: Our results support the use of SGLT2i in an HFpEF population with relatively high rates of hypertension, CKD, and black race and suggests that improvements in mortality may be through preserving kidney function. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
12. Open-Label Extension Study for the Long-Term Efficacy and Safety of Roxadustat in Participants With Dialysis and Non-Dialysis Chronic Kidney Disease
- Author
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AstraZeneca and Astellas Pharma Inc
- Published
- 2021
13. Health equity in dialysis care: Time for action
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Senthilkumar Ramasamy, Vinay Rathore, Abhiruchi Galhotra, and Sanjana Agrawal
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chronic kidney disease ,dialysis ,end stage renal disease ,equity ,Public aspects of medicine ,RA1-1270 - Abstract
The development of chronic kidney disease and its progression to End Stage Renal Disease requiring renal replacement therapy remains a significant source of reduced quality of life and premature mortality. The global dialysis population and treatment gap is growing, especially in low- and middle- income countries. In India, 70% of those starting dialysis, die or discontinue treatment in the initial period due to the high cost of treatment and lack of access to dialysis therapy. Achieving health equity requires ensuring access to the resources that needs to be healthy, and addressing social determinants of health involves needs factors that influence the health outcomes. Universal Health Coverage requires an alternate model to address the substantial Out-Of-Pocket-Expenditure borne by these patients for traveling and medications.
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- 2023
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14. Prevalence of depression and anxiety and their predictors among patients undergoing maintenance hemodialysis in Northern China: a cross-sectional study
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Yan Meng, Hao-tian Wu, Jia-le Niu, Yuan Zhang, Hua Qin, Liang-liang Huang, Xiao-jun Zhang, Lei Yu, Hong-yan Yu, Tao Yan, and Jian-rong Zhao
- Subjects
Chronic kidney disease ,chronic renal failure ,end stage renal disease ,maintenance hemodialysis ,depression ,anxiety ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Objective 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.Methods 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.Results 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
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- 2022
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15. Endocrine disruptors in dialysis therapies: A literature review
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Guillaume Cambien, Antoine Dupuis, Jérémy Guihenneuc, Marc Bauwens, Mohamed Belmouaz, and Sarah Ayraud-Thevenot
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Endocrine disruptors ,Dialysis ,Chronic kidney disease ,Exposure ,Plasticizers ,End stage renal disease ,Environmental sciences ,GE1-350 - Abstract
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.
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- 2023
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16. Prevalence of depression and anxiety and their predictors among patients undergoing maintenance hemodialysis in Northern China: a cross-sectional study.
- Author
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Meng, Yan, Wu, Hao-tian, Niu, Jia-le, Zhang, Yuan, Qin, Hua, Huang, Liang-liang, Zhang, Xiao-jun, Yu, Lei, Yu, Hong-yan, Yan, Tao, and Zhao, Jian-rong
- Subjects
- *
ANXIETY , *POOR families , *INCOME , *MENTAL depression , *LOGISTIC regression analysis - Abstract
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]
- Published
- 2022
- Full Text
- View/download PDF
17. Renal Embolization-Induced Uremic Swine Model for Assessment of Next-Generation Implantable Hemodialyzers
- Author
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Jarrett Moyer, Mark W. Wilson, Thomas A. Sorrentino, Ana Santandreu, Caressa Chen, Dean Hu, Amy Kerdok, Edward Porock, Nathan Wright, Jimmy Ly, Charles Blaha, Lynda A. Frassetto, William H. Fissell, Shant M. Vartanian, and Shuvo Roy
- Subjects
end stage renal disease ,acute kidney injury ,chronic kidney disease ,dialysis ,hemodialysis ,artificial organs ,Medicine - Abstract
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.
- Published
- 2023
- Full Text
- View/download PDF
18. Health Literacy and its Related Factors in Dialysis Patients: A Cross-sectional Study in Iran.
- Author
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Yazdinejad, Tahereh, Karamoozian, Ali, Mousavi, Maryam Alsadat, Banseshi, Mohammad Reza, Borhaninejad, Vahid Reza, and Iranpour, Abedin
- Subjects
HEALTH self-care ,HEALTH literacy ,HEMODIALYSIS patients ,CROSS-sectional method ,MEDICAL care costs ,CHRONIC kidney failure - Abstract
Background: Inadequate health literacy (HL) in dialysis patients increases the risk of poor self-care and decreases severe self-care and severe negative health outcomes in these patients. This study aimed to investigate HL and its related factors in dialysis patients in Kerman, Iran, in 2021. Methods: This cross-sectional study was performed on 280 dialysis patients who referred to Kerman (Iran) dialysis centres. The participants were selected through multi-stage sampling method. The study was conducted using the Iranian Health Literacy Questionnaire (IHLQ). The higher score shows a better HL. Results: The mean age of the subjects was 57.75±13.87 years. The mean score of HL was 9.12±4.54 out of 20 points. During multivariate regression, there was a significant relationship between HL and age (β=-0.08, P=0.02) and level of education (elementary/ literacy (β=4.607, P<0.001), middle school (β=6.38, P<0.001), high school (β=8.573, P<0.001) and academic education (β=9.410, P<0.001), and there was a significant relationship between HL and eye disease (β=-0.903, P=0.001). Conclusion: Most participants did not have adequate HL, while HL as the most important determinant of self-care can improve patients’ quality of life and reduce their health care costs. Therefore, in order to increase self-care, planning and necessary interventions, the HL of these patients seems to be necessary. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
19. Micronutrients and Renal Outcomes: A Prospective Cohort Study.
- Author
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Chen, Chun-Yu, Chiu, Chun-Hui, Wu, I-Wen, Hsu, Heng-Jung, Chen, Yih-Ting, Hsu, Cheng-Kai, Pan, Heng-Chih, Lee, Chin-Chan, and Sun, Chiao-Yin
- Abstract
Background: Micronutrients are essential in maintaining normal human physiology. Data regarding the association between micronutrients and renal outcomes in chronic kidney disease (CKD) are lacking. Methods: This prospective observational cohort study enrolled 261 patients with CKD stages 1–5 and 30 subjects with normal renal function. Baseline serum zinc (Zn), selenium (Se), chromium, manganese, and copper, and laboratory tests were performed at enrolment. The primary endpoint was the presence of end-stage renal disease (ESRD) requiring long-term renal replacement therapy. Results: The median follow-up periods of renal and non-renal survivals were 67.78 and 29.03 months, respectively. Multiple linear regression showed that Zn and Se (β ± SE: 24.298 ± 8.616, p = 0.005; 60.316 ± 21.875, p = 0.006, respectively) levels were positively correlated with renal function. Time to ESRD was significantly longer for those with Zn levels ≥1287.24 ng/g and Se levels ≥189.28 ng/g (both p < 0.001). Cox regression analysis identified a higher Zn level as an independently negative predictor of ESRD after adjusting for renal function (hazard ratio, 0.450, p = 0.019). Conclusion: Serum Se and Zn concentrations are positively associated with renal function and better renal outcomes. A higher Zn concentration could independently predict better renal survival. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
20. Prevalence and risk factors of chronic kidney disease among commercial motorcyclists in Ado-Ekiti, Ekiti State, Nigeria
- Author
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Funmilayo A. Ibitoba, Oluwaseyi A. Akpor, and Oghenerobor B. Akpor
- Subjects
Prevalence ,Risk factors ,Chronic kidney disease ,End stage renal disease ,Renal replacement therapy ,Science - Abstract
Chronic kidney disease (CKD) is a silent killer that has become a global public health issue in the past decades and affects more than 10% of the population worldwide. The study aimed to investigate the prevalence and risk factors of CKD among commercial motorcyclists in Ado-Ekiti. The study adopted a descriptive cross-sectional survey design. A multistage sampling technique was employed to select 310 respondents. Socio-demographic data, knowledge, and risk factors for CKD were determined using a standardized questionnaire while CKD prevalence and incidence of end stage renal disease were investigated with biophysical measurements and laboratory investigations. Descriptive analyses were used to answer the research questions while inferential statistics were used to test hypotheses at a significant level of p
- Published
- 2022
- Full Text
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21. A cross-sectional study to evaluate etiopathogenesis, clinical features, complications, and treatment of patients of chronic kidney disease.
- Author
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Patel, Dushyant Shantilal, Patel, Nirav Rasiklal, Patel, Jagdishkumar Virabhai, and Chavda, Avani Bipinchandra
- Subjects
CHRONIC kidney failure ,CHRONICALLY ill ,KIDNEYS ,ITCHING ,DIABETIC nephropathies - Published
- 2022
- Full Text
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22. A Pilot Observational Study Assessing Long-Term Changes in Clinical Parameters, Functional Capacity and Fall Risk of Patients With Chronic Renal Disease Scheduled for Hemodialysis
- Author
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Damiano D. Zemp, Olivier Giannini, Pierluigi Quadri, Mauro Tettamanti, Lorenzo Berwert, Soraya Lavorato, Silvio Pianca, Curzio Solcà, and Eling D. de Bruin
- Subjects
chronic kidney disease ,end stage renal disease ,hemodialysis (HD) ,physical activity ,motor capacity ,cognitive capacity ,Medicine (General) ,R5-920 - Abstract
BackgroundPatients with end-stage renal disease are known to be particularly frail, and the cause is still widely seen as being directly related to specific factors in renal replacement therapy. However, a closer examination of the transitional phase from predialysis to long-term hemodialysis leads to controversial explanations, considering that the frailty process is already well-described in the early stages of renal insufficiency. This study aims to describe longitudinally and multifactorially changes in the period extending from the decision to start the replacement therapy through to the end of 2 years of hemodialysis. We hypothesized that frailty is pre-existent in the predialysis phase and does not worsen with the beginning of the replacement therapy. Between 2015 and 2018 we recruited 25 patients (72.3 ± 5.7 years old) in a predialysis program, with the expectation that replacement therapy would begin within the coming few months.MethodsThe patients underwent a baseline visit before starting hemodialysis, with 4 follow-up visits in the first 2 years of treatment. Health status, physical performance, cognitive functioning, hematology parameters, and adverse events were monitored during the study period.ResultsAt baseline, our sample had a high variability with patients ranging from extremely frail to very fit. In the 14 participants that did not drop out of the study, out of 32 clinical and functional measures, a statistically significant worsening was only observed in the Short Physical Performance Battery (SPPB) score (p < 0.01, F = 8.50) and the number of comorbidities (p = 0.01, F = 3.94). A careful analysis, however, reveals a quite stable situation in the first year of replacement therapy, for both frail and fit participants and a deterioration in the second year that in frail participants could lead to death.ConclusionOur results should stimulate a reassessment about the role of a predialysis program in reducing complications during the transitional phase, but also about frailty prevention programs once hemodialysis has begun, for both frail and fit patients, to maintain satisfactory health status.
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- 2022
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23. Micronutrients and Renal Outcomes: A Prospective Cohort Study
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Chun-Yu Chen, Chun-Hui Chiu, I-Wen Wu, Heng-Jung Hsu, Yih-Ting Chen, Cheng-Kai Hsu, Heng-Chih Pan, Chin-Chan Lee, and Chiao-Yin Sun
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micronutrient ,chronic kidney disease ,zinc ,selenium ,end stage renal disease ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Background: Micronutrients are essential in maintaining normal human physiology. Data regarding the association between micronutrients and renal outcomes in chronic kidney disease (CKD) are lacking. Methods: This prospective observational cohort study enrolled 261 patients with CKD stages 1–5 and 30 subjects with normal renal function. Baseline serum zinc (Zn), selenium (Se), chromium, manganese, and copper, and laboratory tests were performed at enrolment. The primary endpoint was the presence of end-stage renal disease (ESRD) requiring long-term renal replacement therapy. Results: The median follow-up periods of renal and non-renal survivals were 67.78 and 29.03 months, respectively. Multiple linear regression showed that Zn and Se (β ± SE: 24.298 ± 8.616, p = 0.005; 60.316 ± 21.875, p = 0.006, respectively) levels were positively correlated with renal function. Time to ESRD was significantly longer for those with Zn levels ≥1287.24 ng/g and Se levels ≥189.28 ng/g (both p < 0.001). Cox regression analysis identified a higher Zn level as an independently negative predictor of ESRD after adjusting for renal function (hazard ratio, 0.450, p = 0.019). Conclusion: Serum Se and Zn concentrations are positively associated with renal function and better renal outcomes. A higher Zn concentration could independently predict better renal survival.
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- 2022
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24. Persistent Resistant Hypertension Has Worse Renal Outcomes in Chronic Kidney Disease than that Resolved in Two Years: Results from the KNOW-CKD Study
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Su-Hyun Song, Young-Jin Kim, Hong-Sang Choi, Chang-Seong Kim, Eun-Hui Bae, Curie Ahn, Kook-Hwan Oh, Sue-Kyung Park, Kyu-Beck Lee, Suah Sung, Seung-Hyeok Han, Seong-Kwon Ma, and Soo-Wan Kim
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apparent treatment-resistant hypertension ,chronic kidney disease ,renal insufficiency ,prognosis ,end stage renal disease ,Medicine - Abstract
Apparent treatment-resistant hypertension (ATRH) is closely related to chronic kidney disease (CKD); however, the long-term outcomes and the effects of improvement in ATRH in patients with CKD are not well understood. We evaluated the relationship between the persistence of ATRH and the progression of CKD. This cohort study enrolled 1921 patients with CKD. ATRH was defined as blood pressure above 140/90 mmHg and intake of three different types of antihypertensive agents, including diuretics, or intake of four or more different types of antihypertensive agents, regardless of blood pressure. We defined ATRH subgroups according to the ATRH status at the index year and two years later. The prevalence of ATRH at baseline was 14.0%. The presence of ATRH at both time points was an independent risk factor for end-point renal outcome (HR, 1.41; 95% CI, 1.04–1.92; p = 0.027). On the other hand, the presence of ATRH at any one of the time points was not statistically significant. In conclusion, persistent ATRH is more important for the prognosis of renal disease than the initial ATRH status. Continuous follow-up and appropriate treatment are important to improve the renal outcomes.
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- 2021
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25. Endocrine disruptors in dialysis therapies: A literature review.
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Cambien, Guillaume, Dupuis, Antoine, Guihenneuc, Jérémy, Bauwens, Marc, Belmouaz, Mohamed, and Ayraud-Thevenot, Sarah
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LITERATURE reviews , *ENDOCRINE disruptors , *BISPHENOL A , *BISPHENOLS , *DIALYSIS (Chemistry) , *CHRONIC kidney failure , *HEMODIALYSIS , *POLYCARBONATES - Abstract
[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]
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- 2023
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26. A Systematic Literature Review of the Epidemiology, Health-Related Quality of Life Impact, and Economic Burden of Immunoglobulin A Nephropathy
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Christopher Ngai, Christina S Kwon, Patrick Daniele, and Anna Forsythe
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medicine.medical_specialty ,Pediatrics ,Computer applications to medicine. Medical informatics ,R858-859.7 ,urologic and male genital diseases ,Nephropathy ,End stage renal disease ,Quality of life ,renal biopsy ,Epidemiology ,medicine ,immunoglobulin a nephropathy ,Depression (differential diagnoses) ,end-stage renal disease ,business.industry ,Incidence (epidemiology) ,Health Policy ,Public Health, Environmental and Occupational Health ,medicine.disease ,Nephrologic/Hepatologic Conditions ,Systematic review ,glomerular nephropathy ,epidemiology ,business ,chronic kidney disease ,Kidney disease - Abstract
Introduction: This systematic literature review analyzed published evidence on IgA nephropathy (IgAN), focusing on US epidemiology, health-related quality of life (HRQoL), and economic burden of illness. Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Embase®, MEDLINE®, Cochrane, and Econlit (January 2010 to June 2020) were searched, along with relevant congresses (2017-2020). Results: Of 123 epidemiologic studies selected for data extraction, 24 reported IgAN diagnosis rates ranging from 6.3% to 29.7% among adult and pediatric patients undergoing renal biopsy, with all reported US rates Conclusion: While economic evidence in IgAN remains sparse, management of ESRD is a major cost driver. IgAN is a rare disease where disease progression causes increasing patient burden, underscoring the need for therapies that prevent kidney function decline and HRQoL deterioration while reducing mortality.
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- 2021
27. Hyperuricemia is a risk factor for the progression to end-stage renal disease in minimal change disease
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Su Hyun Song, Tae Ryom Oh, Hong Sang Choi, Chang Seong Kim, Dong Ryeol Ryu, Sung Gyun Kim, Sun-Hee Park, Seong Kwon Ma, Soo Wan Kim, Eun Hui Bae, and on behalf of The Korean GlomeruloNEphritis sTudy Group (KoGNET)
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medicine.medical_specialty ,medicine.medical_treatment ,Specialties of internal medicine ,Hyperuricemia ,urologic and male genital diseases ,Gastroenterology ,End stage renal disease ,chemistry.chemical_compound ,End-stage renal disease ,Internal medicine ,Chronic kidney disease ,medicine ,Minimal change disease ,Risk factor ,Dialysis ,Kidney transplantation ,business.industry ,Hazard ratio ,nutritional and metabolic diseases ,General Medicine ,medicine.disease ,RC31-1245 ,eye diseases ,chemistry ,RC581-951 ,Uric acid ,Original Article ,business - Abstract
BACKGROUND Minimal change disease (MCD) is one of the most common causes of nephrotic syndrome worldwide. Hyperuricemia increases the end-stage renal disease (ESRD) risk in glomerulonephritis. In this study, we aimed to determine the effect of high serum uric acid levels on the progression to ESRD in MCD. METHODS A total of 800 patients diagnosed with MCD by kidney biopsy were retrospectively analyzed. We determined the relationship of hyperuricemia with the progression to ESRD in MCD using the Cox proportional hazard model and Kaplan-Meier survival analysis. The primary outcome was defined as the initiation of dialysis or kidney transplantation. RESULTS A total of 42 patients (5.3%) progressed to ESRD during the follow-up period. In the restricted cubic spline curve, serum uric acid levels exhibited a positive correlation with ESRD progression in patients with MCD. In the fully adjusted model, the risk of MCD progression increased by 29% for every 1 mg/dL increase in the baseline serum uric acid level (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.09-1.54; p = 0.004). Falling into the high uric acid group (serum uric acid level > 7 mg/dL in men and > 6 mg/dL in women) was also a risk factor for progression of MCD to ESRD (HR, 3.40; 95% CI, 1.59-7.31; p < 0.001). CONCLUSION Our study shows that hyperuricemia is an independent risk factor for the progression to ESRD in patients with MCD.
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- 2021
28. [Atrial fibrillation, oral anticoagulation and nephroprotection: caution or bravery?]
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Di Lullo, Luca, Magnocavallo, Michele, Vetta, Giampaolo, Lavalle, Carlo, Barbera, Vincenzo, Ronco, Claudio, Paoletti, Ernesto, Ravera, Maura, Fusaro, Maria, Russo, Domenico, De Pascalis, Antonio, and Bellasi, Antonio
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Oral ,Male ,atrial fibrillation ,chronic kidney disease ,direct oral anticoagulants ,end stage renal disease ,left atrial appendage occlusion ,warfarin ,Administration, Oral ,Anticoagulants ,Female ,Humans ,Atrial Fibrillation ,Courage ,Kidney Failure, Chronic ,Renal Insufficiency, Chronic ,Stroke ,Kidney Failure ,Administration ,Renal Insufficiency ,Chronic - Abstract
Atrial fibrillation (AF) and chronic kidney disease (CKD) are strictly related and share several risk factors (i.e. hypertension, diabetes mellitus, congestive heart failure). As consequence, AF is very common among CKD patients, especially in those with end stage renal disease (ESRD). Moreover, patients with AF and advanced kidney disease have a higher mortality rate than patients with preserved renal function due to an increased incidence of stroke and an unpredicted elevated hemorrhagic risk. The adequate long-term oral anticoagulation in this subgroup of patients represents a major challenging issue faced by physicians in clinical practice. Direct oral anticoagulants (DOACs) are currently contraindicated in patients with ESRD while vitamin K antagonists (VKAs) are characterized by a narrow therapeutic window, increased tissue calcification and an unfavorable risk/benefit ratio with low stroke prevention effect and augmented risk of major bleeding. The purpose of this review is to shed light on the applications of DOAC therapy in CKD patients, especially in ESRD patients.
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- 2022
29. A Pilot Observational Study Assessing Long-Term Changes in Clinical Parameters, Functional Capacity and Fall Risk of Patients With Chronic Renal Disease Scheduled for Hemodialysis
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Zemp, Damiano D., Giannini, Olivier, Quadri, Pierluigi, Tettamanti, Mauro, Berwert, Lorenzo, Lavorato, Soraya, Pianca, Silvio, Solca, Curzio, and de Bruin, Eling
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chronic kidney disease ,end stage renal disease ,hemodialysis (HD) ,physical activity ,motor capacity ,cognitive capacity ,falls ,frailty ,General Medicine - Abstract
Background: Patients with end-stage renal disease are known to be particularly frail, and the cause is still widely seen as being directly related to specific factors in renal replacement therapy. However, a closer examination of the transitional phase from predialysis to long-term hemodialysis leads to controversial explanations, considering that the frailty process is already well-described in the early stages of renal insufficiency. This study aims to describe longitudinally and multifactorially changes in the period extending from the decision to start the replacement therapy through to the end of 2 years of hemodialysis. We hypothesized that frailty is pre-existent in the predialysis phase and does not worsen with the beginning of the replacement therapy. Between 2015 and 2018 we recruited 25 patients (72.3 ± 5.7 years old) in a predialysis program, with the expectation that replacement therapy would begin within the coming few months. Methods: The patients underwent a baseline visit before starting hemodialysis, with 4 follow-up visits in the first 2 years of treatment. Health status, physical performance, cognitive functioning, hematology parameters, and adverse events were monitored during the study period. Results: At baseline, our sample had a high variability with patients ranging from extremely frail to very fit. In the 14 participants that did not drop out of the study, out of 32 clinical and functional measures, a statistically significant worsening was only observed in the Short Physical Performance Battery (SPPB) score (p < 0.01, F = 8.50) and the number of comorbidities (p = 0.01, F = 3.94). A careful analysis, however, reveals a quite stable situation in the first year of replacement therapy, for both frail and fit participants and a deterioration in the second year that in frail participants could lead to death. Conclusion: Our results should stimulate a reassessment about the role of a predialysis program in reducing complications during the transitional phase, but also about frailty prevention programs once hemodialysis has begun, for both frail and fit patients, to maintain satisfactory health status., Frontiers in Medicine, 9, ISSN:2296-858X
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- 2022
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30. The characteristics of anemia patients in End Stage Renal Disease (ESRD) based on age and gender
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Sambodo, Shella Violita and Nunuk Mardiana
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Anemia ,Chronic Kidney Disease ,End Stage Renal Disease ,Hemodialysis - Abstract
Anemia is one of the complications of Chronic Kidney Disease and is often associated with a decrease in the patient's quality of life, an increase in patient morbidity and mortality, and an accelerated rate of progression of CKD. In terminal stage CKD patients, it is commonly referred to as End Stage Renal Disease. To describe the characteristics of anemia patients in ESRD based on age and gender at Hemodialysis Installation in Dr. Soetomo General Hospital Surabaya. This study was a descriptive observational study with the cross sectional method using secondary data from patient medical records at Hemodialysis Installation Dr. Soetomo General Hospital Surabaya. Data from 80 research subjects, the average age is 48.08 ± 10.598, an average of gender in male is 9.46 ± 1.592 and in females is 9.04 ± 1.329. From 80 patients, there were 17 people aged ³ 18 - 40 (21.3%), aged 41 - 60 people with a total of 53 people (66.3%), > 60 years as many as 10 people (12.5%). Regarding gender in males there are 39 people (48.8%), and in females are 41 people (51.2%). Most anemia patients were aged 41 - 60 years as many as 53 people (66.3%). There are more females subjects than males , namely 41 people (51.2%) in females and 39 people (48.8%) in males.
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- 2022
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31. Pain management in patients with chronic kidney disease
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Delalić, Điđi, Prkačin, Ingrid, and Pavlović, Vedrana
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Chronic Kidney Disease ,Pain Management ,chronic kidney disease ,end stage renal disease ,opioid analgesics ,pain management ,quality of life - Abstract
Pain is a complex uncomfortable sensation caused by a multitude of etiologic factors. It is divided into many different types, differing by the mechanism of origin and the presence of other subjective sensations related to pain. The phenomenon of pain is a subjective one, with various painful stimuli being described and felt differently among individual patients. Therefore, it is often hard to quantify and accurately measure. However, one thing is for certain, regardless of its etiology, type or place of origin, and it is that pain is a disabling condition affecting an individual’s functional, social and biological status and should therefore be treated promptly and appropriately. Patients with chronic kidney disease (CKD), especially those with end stage renal disease, are often undertreated for pain, resulting in lower adherence to therapy and a higher incidence of anxiety and depression, ultimately leading to an overall lower quality of life. There are many factors included in the undertreatment of pain in this patient population, the main ones being inappropriate pain assessment and fear of prescribing pain medication due to renal function impairment affecting the pharmacokinetics of most commonly used analgesics. This review aims to educate all physicians working with CKD patients and provide an overview of the most commonly used pharmacological pain management strategies and their feasibility in treating this sensitive patient population, therefore hopefully making the current statistics of undertreated pain in CKD less grim than they currently are.
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- 2022
32. ZBRINJAVANJE BOLI PACIJENATA S KRONIČNOM BUBREŽNOM BOLESTI
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DELALIĆ, ĐIĐI and PRKAČIN, INGRID
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chronic kidney disease ,end stage renal disease ,opioid analgesics ,pain management ,quality of life ,bubrežna bolest završnog stadija ,kvaliteta života ,kronična bubrežna bolest ,opioidni analgetici ,zbrinjavanje boli - Abstract
Pain is a complex uncomfortable sensation caused by a multitude of etiologic factors. It is divided into many different types, differing by the mechanism of origin and the presence of other subjective sensations related to pain. The phenomenon of pain is a subjective one, with various painful stimuli being described and felt differently among individual patients. Therefore, it is often hard to quantify and accurately measure. However, one thing is for certain, regardless of its etiology, type or place of origin, and it is that pain is a disabling condition affecting an individual’s functional, social and biological status and should therefore be treated promptly and appropriately. Patients with chronic kidney disease (CKD), especially those with end stage renal disease, are often undertreated for pain, resulting in lower adherence to therapy and a higher incidence of anxiety and depression, ultimately leading to an overall lower quality of life. There are many factors included in the undertreatment of pain in this patient population, the main ones being inappropriate pain assessment and fear of prescribing pain medication due to renal function impairment affecting the pharmacokinetics of most commonly used analgesics. This review aims to educate all physicians working with CKD patients and provide an overview of the most commonly used pharmacological pain management strategies and their feasibility in treating this sensitive patient population, therefore hopefully making the current statistics of undertreated pain in CKD less grim than they currently are., Bol je složen, neugodan, osjećajni fenomen uzrokovan brojnim etiološkim čimbenicima. Razlikujemo nekoliko različitih vrsta boli ovisno o mehanizmu nastanka i prisutnosti drugih subjektivnih fenomena. Doživljaj boli je subjektivan te se percepcija i intenzitet različitih bolnih podražaja individualno značajno razlikuju. Stoga je često teško kvantifi cirati i precizno mjeriti bol. Bez obzira na etiologiju, vrstu ili mjesto nastanka bol je onemogućavajuće stanje koje utječe na funkcionalni, društveni i biološki status te se stoga treba liječiti primjereno i pravodobno. Pacijenti s kroničnom bubrežnom bolešću (KBB), poglavito oni s bubrežnom bolešću krajnjeg stadija, često pate od neadekvatno liječene boli, što dovodi do nižeg pridržavanja terapije i veće učestalosti tjeskobe i depresije, što za posljedicu ima sveukupno značajno nižu kvalitetu života. Mnogi su čimbenici uključeni u nedovoljno liječenje boli, a najvažniji su neadekvatna procjena boli i strah od propisivanja analgetika zbog toga što poremećaj bubrežne funkcije utječe na farmakokinetičke osobine brojnih analgetika. Ovim preglednim člankom želimo naglasiti važnost kontrole boli kod pacijenata s KBB-om s obzirom na trenutno poražavajuću kontrolu boli te predstaviti najčešće korištene farmakološke modalitete liječenja boli i njihovu prikladnost u liječenju ove osjetljive populacije pacijenata, sve u svjetlu postizanja što više kvalitete života pacijenata s KBB-om prema odrednicama Svjetskog dana bubrega 2022. godine.
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- 2022
33. A comparative study on the effect of calcitriol and cinacalcet on hyperparathyroidism in hemodialysis patients; a double-blinded randomized clinical trial
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Faranak Sadat Filsouf and Saeed Mardani
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calcitriol ,medicine.medical_specialty ,Cinacalcet ,Calcitriol ,medicine.medical_treatment ,Urology ,RM1-950 ,cinacalcet ,vitamin D deficiency ,End stage renal disease ,law.invention ,Randomized controlled trial ,law ,medicine ,Pharmacology (medical) ,Hyperparathyroidism ,end-stage renal disease ,hemodialysis ,business.industry ,medicine.disease ,Diseases of the genitourinary system. Urology ,Nephrology ,Hemodialysis ,Therapeutics. Pharmacology ,RC870-923 ,business ,chronic kidney disease ,medicine.drug ,Kidney disease - Abstract
Introduction:Chronic kidney disease (CKD) has lots of complication like calcium and phosphate metabolism disorders, hyperparathyroidism, vitamin D deficiency and metabolic acidosis. Objectives: The aim of this study was to determine and compare the effect of calcitriol and cinacalcet on hyperparathyroidism in hemodialysis patients due to end-stage renal disease (ESRD). Patients and Methods: This study was a double-blinded randomized clinical trial, which was conducted on 60 hemodialysis patients in 2017-2018. The patients were randomly assigned to two groups of 30 patients, which one group was treated with cinacalcet and the other group was treated with calcitriol. During this study, phosphorus, calcium and iPTH were measured. Results: The results showed that in the group treated with cinacalcet, the amount of calcium [t(22)=0.294, P>0.05] and the amount of phosphorus [t(22)=1.87, P>0.05] did not change significantly while iPTH values before and after the study had statistically significant difference [t(22)=4.37, PP>0.05). Calcium changes in the cinacalcet group compared to the calcitriol group [t (47) =-1.14, P>0.05] and also, the amount of phosphorus changes [t (47) =-1.022, P>0.05] was not statistically significant. The iPTH changes were not statistically significant between the two groups however iPTH in the calcitriol group was higher than the cinacalcet group [t (47) =-1.13, P>0.05]. Conclusion: In contrast to calcitriol, cinacalcet significantly reduced iPTH and did not significantly change calcium and phosphorus levels. Trial Registration: The trial was registered by Iranian Registry of Clinical Trials (IRCT) (identifier: IRCT20190702044076N1; https://en.irct.ir/trial/40547, Ethical code# IR.SKUMS.REC.1397.026).
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- 2022
34. Sex Differences in Fecal Microbiota Correlation With Physiological and Biochemical Indices Associated With End-Stage Renal Disease Caused by Immunoglobulin a Nephropathy or Diabetes
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Lei Zhang, Lu Xu, Yunyi Xiong, Jiao Wan, Xingqiang Lai, Zheng Chen, Rongxin Chen, Hai-Lin Xu, Li Li, Guanghui Li, Junjie Ma, Peng Zhang, Tao Zhang, Luhao Liu, Jiali Fang, and Weiting Zhang
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Microbiology (medical) ,Physiology ,Urine ,Gut flora ,urologic and male genital diseases ,Microbiology ,Nephropathy ,End stage renal disease ,chemistry.chemical_compound ,Diabetes mellitus ,medicine ,Original Research ,Creatinine ,end-stage renal disease ,gut microbiota ,biology ,business.industry ,Type 2 Diabetes Mellitus ,type-2 diabetes mellitus ,IgA nephropathy ,medicine.disease ,biology.organism_classification ,QR1-502 ,Postprandial ,chemistry ,clinical immune indicators ,business ,chronic kidney disease - Abstract
This study investigated the sex-specific differences in the correlation between intestinal microbiota and end-stage renal disease. Here, we compared the differences in the gut microbiota of male and female healthy controls (HC) and patients with end-stage renal disease (ESRD) caused by immunoglobulin A (IgA) nephropathy (ESRD-IgAN) or type-2 diabetes mellitus (ESRD-T2DM) using high-throughput sequencing of the 16S rRNA gene. We also analyzed the correlation between gut microbiota and clinical immune indicators. We assigned 8, 10, 5, 7, 11, and 20 volunteers to female HC, ESRD-IgAN, and ESRD-T2DM, and male HC, ESRD-IgAN, and ESRD-T2DM, respectively. The results showed sex-specific differences in both physiological and biochemical indices and intestinal microbiota composition, as well as the correlation between them. The correlations between physiological and biochemical indices in men were significantly lower than those in women, especially for indices related to immunity, blood glucose, and cardiac color sonography. Urine output, lymphocyte ratio, serum albumin, blood calcium, dialysis status, serum urea nitrogen, urine protein, and diabetes significantly correlated with male fecal microbiota composition, whereas only creatinine and 2-h post-prandial blood glucose significantly correlated with female fecal microbiota composition. The top 50 dominant operational taxonomic units showed a stronger correlation with physiological and biochemical indices in samples obtained from females than from males. These differences highlight sex-specific differences in the effectiveness of ESRD prevention and treatments via regulating intestinal microbiota.
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- 2021
35. Bilateral femoral neck fracture following a convulsion in the presence of chronic kidney disease. A case report
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Aiman Mudawi, Elhadi Babikir, Maamoun Abou Samhadaneh, Shamsi Abdul Hameed, Mohamed Hafez Elsheikh Elamin, and Isam Sami Moghamis
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medicine.medical_specialty ,Femur fracture ,business.industry ,Osteoporosis ,Case Report ,medicine.disease ,Femoral Neck Fractures ,Seizure ,End stage renal disease ,Surgery ,Convulsions ,medicine.anatomical_structure ,Bilateral femoral neck fracture ,Chronic kidney disease ,Convulsion ,medicine ,Renal osteodystrophy ,medicine.symptom ,business ,Femoral neck ,Kidney disease - Abstract
Introduction and importance Bilateral femoral neck fractures in young adults are a rare entity. It is usually associated with pre-existing metabolic diseases, such as osteoporosis, renal osteodystrophy, or hypocalcemic seizures. Hence, it is essential in such cases to look for other associated injuries following a traumatic event. Missing associated injuries may lead to significant morbidities and poor functional outcomes. Case presentation A 37 years old male, who had chronic renal failure secondary to hypertension, and presented to the emergency room following a seizure episode, in which he developed a generalized tonic-clonic convulsion secondary to electrolyte imbalances with metabolic acidosis. As a result, he developed bilateral neck of femur fracture. Intervention and outcome The medical team optimized electrolytes imbalance and then the patient underwent surgical stabilization of both femur neck fracture, 1 year following the surgical fixation the patient had full range of motion of both hips with radiological evidence of complete healing of the fracture. Conclusion In cases of fractures secondary to metabolic conditions, bilateral femoral neck fractures should be suspected and investigated; especially in young patients who develop a generalized tonic-clonic seizure. The etiology is multifactorial, and the treating surgeon should be aware of predisposing factors which may affect bone quality, thereby raising the risk of fractures even with low-energy atraumatic events. Hip preservation should always be the primary target when treating these patients., Highlights • Non-traumatic Bilateral femoral neck fractures in young adults following a generalized tonic-clonic is a rare entity. • Pre-disposing metabolic disease such as hypocalcemia seizure are usually associated with this injury pattern • Other associated fractures involving upper and lower extremities may co-exist. • Ideal control of seizure disorder in pre-existing metabolic bone disorder may reduce risk of such injuries. • Hip preservation should always be the primary target when treating these young patients.
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- 2021
36. Co-relation Between Calcium-Phosphorus Product and Hypertension in End-Stage Renal Disease Patients
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Kiran Nasir, Ruqaya Qureshi, Faiza Anser, Murtaza F Dhrolia, and Aasim Ahmad
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medicine.medical_specialty ,Mean arterial pressure ,hemodialysis ,hypertension ,business.industry ,medicine.medical_treatment ,General Engineering ,Diastole ,blood pressure ,Parathyroid hormone ,Pulse pressure ,End stage renal disease ,Blood pressure ,Nephrology ,Internal medicine ,Linear regression ,Internal Medicine ,Cardiology ,Medicine ,calcium-phosphorus product ,Hemodialysis ,business ,chronic kidney disease - Abstract
Objective In our study, we evaluated the relation between calcium-phosphorus (Ca-P) product and various measurements of pre and post-dialysis blood pressure (BP) in hemodialysis (HD) patients. Methods This is a prospective, observational, cross-sectional study in which patients undergoing maintenance HD for > six months were enrolled through non-probability consecutive sampling during a six-month period from October 2020 to March 2021. Linear regression analysis was done to study the effect of the Ca-P product for each parameter of BP and regression coefficients were acquired. Results There was a total of 111 patients in our study, of which 59 (53.2%) were male. The mean age was 50.1± 14.4. The most common comorbid was hypertension (98.2%). The mean HD vintage of patients was 5.7 ± 5.8 years. On linear regression analysis, the Ca-P product was strongly correlated with pre-HD diastolic BP (DBP) (0.7) and post-HD mean arterial pressure (MAP) (0.7) while a moderate correlation was present with pre (0.59) and post (0.64) HD systolic BP (SBP), post-HD diastolic BP (0.68), and pre-HD MAP (0.68). On the other hand, the Ca-P product was not correlated with pre and post-HD pulse pressure (0.06 and 0.1, respectively). When the independent effect of serum calcium (Ca), phosphorus (P), and parathyroid hormone on BP was studied, P had a significant correlation with pre and post-HD SBP, DBP, and MAP. Conclusion Our study demonstrates a significant association of the Ca-P product and an independent high P level with pre and post-dialysis SBP, DBP, and MAP while no association was found with pulse pressure.
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- 2021
37. Association of chronic kidney disease and end-stage renal disease with procedural complications and in-hospital outcomes from left atrial appendage occlusion device implantation in patients with atrial fibrillation: Insights from the national inpatient sample of 36,065 procedures
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Marin Nishimura, Mohammed Osman, Deepak Kumar Pasupula, Zain Ul Abideen Asad, Salman Zahid, Muhammad Zia Khan, Sudarshan Balla, Douglas Darden, Muhammad Bilal Munir, Sai Vanam, Jonathan C. Hsu, Abhishek Bhagat, Ryan Reeves, and Frederick T. Han
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medicine.medical_specialty ,Kidney Disease ,medicine.medical_treatment ,Renal and urogenital ,Disease ,Outcomes ,urologic and male genital diseases ,Left atrial appendage occlusion ,End stage renal disease ,Clinical ,Clinical Research ,Internal medicine ,Chronic kidney disease ,Atrial Fibrillation ,medicine ,Watchman ,End-stage renal failure ,business.industry ,Acute kidney injury ,Atrial fibrillation ,Odds ratio ,medicine.disease ,Confidence interval ,Good Health and Well Being ,Patient Safety ,business ,Kidney disease - Abstract
Background Left atrial appendage occlusion (LAAO) has emerged as an alternative strategy to oral anticoagulation for mitigating ischemic stroke risk in selected patients with atrial fibrillation (AF), but safety data in patients with significant kidney disease are limited. Objective To determine the association of chronic kidney disease (CKD) and end-stage renal disease (ESRD) with procedural complications and in-hospital outcomes after LAAO in AF patients. Methods Data were extracted from National Inpatient Sample for calendar years 2015–2018. Watchman implantations were identified on the basis of International Classification of Diseases, 9th and 10th Revision, Clinical Modification codes of 37.90 and 02L73DK. The outcomes assessed in our study included complications, inpatient mortality, and resource utilization with LAAO. Results A total of 36,065 Watchman recipients were included in the final analysis. CKD (9.8%, n = 3545) and ESRD (3%, n = 1155) were associated with a higher prevalence of major complications and mortality in crude analysis compared to no CKD. After multivariate adjustment for potential confounders, CKD was associated with length of stay (LOS) >1 day (adjusted odds ratio [aOR] 1.355; 95% confidence interval [CI] 1.234–1.488), median cost >$24,663 (aOR 1.267; 95% CI 1.176–1.365), and acute kidney injury (aOR 4.134; 95% CI 3.536–4.833), while ESRD was associated with in-patient mortality (aOR 7.156; 95% CI 3.294–15.544). Conclusion The prevalence of CKD and ESRD was approximately 13% in AF patients undergoing Watchman LAAO implantations. CKD was independently associated with prolonged LOS, higher hospitalization costs, and acute kidney injury, while ESRD was independently associated with in-patient mortality., Graphical abstract
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- 2021
38. Assessment of the Nutritional Status of the Hemodialysis Patients by Anthropometric Measurements
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Kiran Nasir, Aasim Ahmad, Ruqaya Qureshi, Murtaza F Dhrolia, and Sajid Sultan
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medicine.medical_specialty ,hemodialysis ,business.industry ,medicine.medical_treatment ,General Engineering ,Nutritional status ,Anthropometry ,medicine.disease ,Circumference ,Obesity ,End stage renal disease ,Malnutrition ,Nephrology ,Internal medicine ,medicine ,Hemodialysis ,business ,Body mass index ,anthropometric measurements ,end stage renal disease ,chronic kidney disease ,Nutrition - Abstract
Objective This study assessed the nutritional status of end-stage renal disease (ESRD) patients on maintenance hemodialysis (MHD) by utilizing bedside anthropometric measurements. Methods This prospective cross-sectional study was done from November 2020 till April 2021 on ESRD patients three times a week MHD at our centre. Anthropometric measurements including body mass index (BMI), triceps skinfold thickness (TSFT), mid-arm circumference (MAC), calf circumference (CC) and handgrip strength (HGS) were measured mid-arm muscle circumference (MAMC) was calculated, and nutritional status was determined. Results Out of 195 patients recruited in our study, 127 (65.1%) were male. The mean age was 51.2 ± 14.8 years with a minimum of 20 and a maximum of 90 years, while the mean duration of HD was 4.6 ± 4.1 years. The majority of our patients had TSFT of 60 % to 90% 93 (47.7%), indicating mild to moderate depletion of fat stores and MAMC of >90 % 128 (65.6%), indicating good protein stores. Among all anthropometric measures, BMI was strongly associated with age (
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- 2021
39. The correlation between fibroblast growth factor-23 and ESRD patients with hearing impairment
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Min Guo, Jiaqing Li, Jingwen Nie, Jiahui Yang, Qing Chang, Qing Li, and Yaping Cai
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Fibroblast growth factor 23 ,medicine.medical_specialty ,Hearing loss ,Parathyroid hormone ,Disease ,urologic and male genital diseases ,General Biochemistry, Genetics and Molecular Biology ,End stage renal disease ,Hearing impairment ,End-stage renal disease ,Quality of life ,Internal medicine ,Chronic kidney disease ,otorhinolaryngologic diseases ,Medicine ,medicine.diagnostic_test ,business.industry ,General Neuroscience ,General Medicine ,Hematology ,medicine.disease ,female genital diseases and pregnancy complications ,Otorhinolaryngology ,Nephrology ,Fibroblast growth factor-23 ,Audiometry ,medicine.symptom ,General Agricultural and Biological Sciences ,business ,Kidney disease - Abstract
Background End-stage renal disease (ESRD) patients often experience hearing impairment, resulting in a high rate of disability and a decline in their quality of life. Fibroblast growth factor-23 (FGF23) is a diagnostic biomarker for chronic kidney disease (CKD) and a pathogenic contributor to CKD progression. However, the correlation between FGF23 level and CKD patients with hearing impairment remains elusive. This study aimed to investigate the relationship between the FGF23 and ESRD accompanied with hearing impairment. Methods A total of 144 ESRD patients, who were admitted to the First Affiliated Hospital of Kunming Medical University from November to December 2020, were enrolled in this study. Firstly, 144 ESRD patients underwent pure-tone audiometry (PTA). Secondly, it was attempted to randomly select 20 ESRD patients with normal hearing, and 20 ESRD patients with hearing impairment (match ratio, 1:1). Age- and gender-matched healthy people (n = 20) were also recruited as controls group. The expression levels of FGF23 was detected by enzyme-linked immunosorbent assay (ELISA). Results The results of pure-tone audiometry showed that the prevalence of hearing impairment in ESRD patients was 80.5%. Male ESRD patients were more likely to develop hearing impairment compared to female patients. The incidence rate of hearing impairment at a high frequency was significantly higher than that at a low frequency (P Conclusion ESRD patients had a higher risk of hearing loss, especially high-frequency hearing impairment. As FGF23 level increased, the risk of hearing loss was also elevated. The hearing impairment in ESRD patients was associated with the degree of kidney injury, and serum FGF23 level.
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- 2021
40. Does the Combined Effect of Resistance Training with EPO and Iron Sulfate Improve Iron Metabolism in Older Individuals with End-Stage Renal Disease?
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Rosângela Vieira de Andrade, Andrea Lucena Reis, Fernanda Silveira Tavares, Lucas Santos de Gusmão Alves, Rodrigo Vanerson Passos Neves, Lysleine Alves Deus, Jonato Prestes, Víctor M Alfaro-Magallanes, Isabela Akaishi Padula, Artur Temizio Oppelt Raab, Thiago Santos Rosa, Beatriz Carneiro Habbema Maia, Victor Lopes Silva, Carlos Ernesto Santos Ferreira, Luiz Sinésio Silva Neto, Sting Ray Gouveia Moura, Hugo de Luca Corrêa, Fernando Sousa Honorato, and Rafaela Araújo Machado
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medicine.medical_specialty ,Anemia ,Iron ,Population ,nephrology ,urologic and male genital diseases ,Gastroenterology ,Article ,End stage renal disease ,chemistry.chemical_compound ,Hemoglobins ,Hepcidins ,Hepcidin ,Internal medicine ,hemic and lymphatic diseases ,medicine ,Humans ,TX341-641 ,iron metabolism ,Ferrous Compounds ,education ,Aged ,Inflammation ,education.field_of_study ,Nutrition and Dietetics ,biology ,business.industry ,Nutrition. Foods and food supply ,Resistance Training ,Middle Aged ,medicine.disease ,anemia ,female genital diseases and pregnancy complications ,Ferritin ,Iron sulfate ,chemistry ,Erythropoietin ,Ferritins ,biology.protein ,Kidney Failure, Chronic ,Hemoglobin ,hepcidin ,erythropoietin ,business ,exercise training ,chronic kidney disease ,Food Science ,medicine.drug - Abstract
We sought to investigate the effects of resistance training (RT) combined with erythropoietin (EPO) and iron sulfate on the hemoglobin, hepcidin, ferritin, iron status, and inflammatory profile in older individuals with end-stage renal disease (ESRD). ESRD patients (n: 157, age: 66.8 ± 3.6, body mass: 73 ± 15, body mass index: 27 ± 3), were assigned to control (CTL, n: 76) and exercise groups (RT, n: 81). The CTL group was divided according to the iron treatment received: without iron treatment (CTL—none, n = 19), treated only with iron sulfate or EPO (CTL—EPO or IRON, n = 19), and treated with both iron sulfate and EPO (CTL—EPO + IRON, n = 76). The RT group followed the same pattern: (RT—none, n = 20), (RT—EPO or IRON, n = 18), and (RT—EPO + IRON, n = 86). RT consisted of 24 weeks/3 days per week at moderate intensity of full-body resistance exercises prior to the hemodialysis section. The RT group, regardless of the iron treatment, improved iron metabolism in older individuals with ESRD. These results provide some clues on the effects of RT and its combination with EPO and iron sulfate in this population, highlighting RT as an important coadjutant in ESRD-iron deficiency.
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- 2021
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41. Outcome of PUV Patients Following Ablation in a Tertiary Teaching Hospital in Addis Ababa, Ethiopia
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Tihitena Negussie Mammo, Belachew Dejene, Fisseha Temesgen, Woubedel Kiflu, Hiwote Girma Assefa, Hanna Getachew, and Amezene Tadesse
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Posterior urethral valve ,medicine.medical_specialty ,end-stage renal disease ,business.industry ,Research and Reports in Urology ,Urology ,primary ablation ,Renal function ,Retrospective cohort study ,medicine.disease ,urologic and male genital diseases ,nadir serum creatinine ,End stage renal disease ,vesicostomy ,Internal medicine ,Pediatric surgery ,Medicine ,proteinuria ,business ,Urinary tract obstruction ,Postoperative Hypertension ,posterior urethral valve ,chronic kidney disease ,Kidney disease ,Original Research - Abstract
Hiwote G Assefa,1 Hanna Getachew,2 Amezene Tadesse,2 Woubedel Kiflu,2 Fisseha Temesgen,2 Belachew Dejene,2 Tihitena Negussie Mammo2 1Department of Surgery, St Paulâs Hospital, Millennium Medical College, Addis Ababa, Ethiopia; 2Department of Surgery, Addis Ababa University School of Medicine, Addis Ababa, EthiopiaCorrespondence: Hiwote G Assefa; Tihitena Negussie Mammo Email hiwotesc@gmail.com; tihutin@yahoo.comBackground: Posterior urethral valve (PUV) is the most common cause of congenital lower urinary tract obstruction in boys. It is considered that early diagnosis and intervention have good outcomes in terms of renal function, though the varying extent of embryological insult requires these boys to remain in extended follow-up and care.Objective: To assess the renal outcome of patients following PUV ablation.Methods: This was a descriptive retrospective study. Data were collected from the operation logbooks of patients from 2015 to 2019 that had been admitted to the Tikur Anbessa Specialized Hospital pediatric surgery unit with a working diagnosis of PUV and had ablation done primarily or following diversion. Data were collected from January to April 2020 and analyzed using SPSS 25. P value⤠0.05 was considered significant.Results: Seventy patients were analyzed and followed for 3 years for the development of postoperative chronic kidney disease (CKD) after PUV ablation. Postoperative CKD was found in 52.9% of patients and end-stage renal disease in 2.9%. Risk factors associated with postoperative CKD were the presence of preoperative and postoperative proteinuria, postoperative hypertension, and elevated nadir serum creatinine. Results also showed that a delay between the development of vesicostomy and ablation had a significant correlation with renal outcome. Elevated nadir serum creatinine, postoperative proteinuria, and delay between the development of vesicostomy and ablation were found to be independent risk factors of development of CKD.Conclusion: There was a high rate of CKD development in patients who had had ablation for PUV, which was comparable to other studies. Three variables were found to be independent risk factors for the progression of CKD, unlike other findings seen in low- and middle-income countries.Keywords: posterior urethral valve, primary ablation, vesicostomy, nadir serum creatinine, proteinuria, chronic kidney disease, end-stage renal disease
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- 2021
42. Changes in hemostatic factors after kidney transplantation
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Jun, Kang Woong, Cho, Jinbeom, Kim, Mi Hyeong, Hwang, Jeong Kye, Park, Sun Cheol, Moon, In Sung, and Kim, Ji Il
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hemostatic factors ,Adult ,Graft Rejection ,Male ,Observational Study ,kidney transplantation ,Middle Aged ,Hemostatics ,Cohort Studies ,Postoperative Complications ,Republic of Korea ,Electronic Health Records ,Humans ,Kidney Failure, Chronic ,Female ,end stage renal disease ,chronic kidney disease ,Research Article ,Retrospective Studies - Abstract
Chronic kidney disease affects hemostasis in complex ways, producing both thrombotic and hemorrhagic diatheses. These changes may impact patient morbidity and mortality pre-transplantation, as well as allograft survival after kidney transplantation (KT). This study was conducted to analyze changes in hemostatic factors in the early post-KT period. We retrospectively analyzed 676 recipients of kidney allografts from December 2009 to December 2014. Patients receiving plasmapheresis pre- or post-KT, experiencing early allograft failure, or receiving anticoagulants or antiplatelet agents pre- or post-KT were excluded. Of the 367 included patients, acute (≤1 month) rejection occurred in 4.1% and delayed graft function occurred in 3.3%. Postoperative bleeding complications occurred in 7.9% of patients and thrombotic complications in 3.3%. Pre-transplantation, recipients had below normal hemoglobin, above normal d-dimer and homocysteine levels, and elevated rates of antiphospholipid antibodies. Hemoglobin increased to almost normal by postoperative day (POD) 28 (P
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- 2021
43. Lipid Profile in Pre-dialysis and Post-dialysis End Stage Renal Disease Patients: A Cross-Sectional Comparative Study in Lucknow, India
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Saini, Manpreet, Vamne, Amrita, Kumar, Vijay, and Chandel, M S
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lipid profile ,hemodialysis ,Urology ,dyslipidemia ,Internal Medicine ,lipids (amino acids, peptides, and proteins) ,Public Health ,end stage renal disease ,chronic kidney disease - Abstract
Background: Chronic kidney disease (CKD) patients are at elevated risk of cardiovascular diseases (CVD) due to altered lipid profiles. Dyslipidemia is maximal in end stage renal disease (ESRD) patients and there is insufficient data on the impact of hemodialysis on lipid profile. The present study was aimed to evaluate the effect of hemodialysis on lipid profile of CKD patients. Materials and Methods: This cross-sectional study was conducted on 50 CKD patients on hemodialysis from three randomly selected hospitals of Lucknow, Uttar Pradesh, India, between March - May 2021. Serum lipid profile was analysed before and after hemodialysis session by using an auto analyzer. The mean values of different lipid parameters before and after hemodialysis were calculated and the difference between them was analyzed by using paired t-test. A p-value of
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- 2021
44. Sepsis-Associated Acute Kidney Disease and Long-term Kidney Outcomes
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Alexander H. Flannery, Xilong Li, Robert D. Toto, Javier A. Neyra, Natalie L. Delozier, Orson W. Moe, and Jerry Yee
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medicine.medical_specialty ,end-stage renal disease ,business.industry ,Septic shock ,Acute kidney injury ,Renal function ,Retrospective cohort study ,medicine.disease ,Intensive care unit ,End stage renal disease ,law.invention ,Sepsis ,sepsis ,acute kidney injury ,Nephrology ,law ,Internal medicine ,Acute kidney disease ,Internal Medicine ,medicine ,business ,long-term outcomes ,chronic kidney disease ,Kidney disease ,Original Research - Abstract
Rationale & Objective Sepsis-associated acute kidney injury often leads to acute kidney disease (AKD), predisposing patients to long-term complications such as chronic kidney disease (CKD), kidney failure with replacement therapy (KFRT), or mortality. Risk stratification of patients with AKD represents an opportunity to assist with prognostication of long-term kidney complications. Study Design Single-center retrospective cohort. Setting & Participants 6,290 critically ill patients admitted to the intensive care unit with severe sepsis or septic shock. Patients were separated into cohorts based on incident acute kidney injury or not, and survivors identified who were alive and free of KFRT up to 90 days. Predictors AKD stage (0A, 0C, or ≥1) using the last serum creatinine concentration available by discharge or up to 90 days postdischarge. Outcome Time to development of incident CKD, progression of CKD, KFRT, or death. Analytical Approach Multivariable Cox proportional hazards models. Results Patients surviving kidney injury associated with sepsis often fail to return to baseline kidney function by discharge: 577/1,231 (46.9%) with stage 0C or 1 or greater AKD. AKD stage was significantly associated with the composite primary outcome. Stages 0C AKD and 1 or greater AKD were significantly and progressively associated with the primary outcome when compared with stage 0A AKD (adjusted HR [aHR], 1.74; 95% CI, 1.32-2.29, and aHR, 3.25; 95% CI, 2.52-4.20, respectively). Additionally, stage 1 or greater AKD conferred higher risk above stage 0C AKD (aHR, 1.87; 95% CI, 1.44-2.43). CKD incidence or progression and KFRT, more so than mortality, occurred with greater frequency in higher stages of AKD. Limitations Retrospective design, single center, exclusion of patients with KFRT within 90 days of discharge, potential ascertainment bias, and inability to subclassify above AKD stage 1. Conclusions Risk stratification using recommended AKD stages at hospital discharge or shortly thereafter associates with the development of long-term kidney outcomes following sepsis-associated acute kidney injury., Graphical abstract
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- 2021
45. The Risk of Nephropathy, Retinopathy, and Leg Amputation in Patients With Diabetes and Hypertension: A Nationwide, Population-Based Retrospective Cohort Study
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Fu-Shun Yen, James Cheng-Chung Wei, Ying-Hsiu Shih, Chih-Cheng Hsu, and Chii-Min Hwu
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Adult ,Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Taiwan ,Risk Assessment ,Diseases of the endocrine glands. Clinical endocrinology ,Amputation, Surgical ,End stage renal disease ,Nephropathy ,Young Adult ,Endocrinology ,Diabetes mellitus ,Internal medicine ,medicine ,Humans ,Diabetic Nephropathies ,leg amputation ,Aged ,Retrospective Studies ,Original Research ,Aged, 80 and over ,Diabetic Retinopathy ,end-stage renal disease ,business.industry ,Retrospective cohort study ,Middle Aged ,RC648-665 ,medicine.disease ,diabetes and hypertension ,Cohort ,Hypertension ,Kidney Failure, Chronic ,sight-threatening retinopathy ,Female ,business ,chronic kidney disease ,Retinopathy ,Kidney disease ,Cohort study - Abstract
PurposeTo compare the risks of chronic kidney disease (CKD), end-stage renal disease (ESRD), sight-threatening retinopathy, and leg amputation between patients with diabetes or hypertension.MethodsFrom January 1, 2000, to December 31, 2015, we identified 28943 matched pairs of patients with diabetes with and without subsequent hypertension, 89102 pairs of patients with hypertension with and without subsequent diabetes, and 145294 pairs of patients with coexisting diabetes and hypertension with a previous history of diabetes or hypertension from Taiwan’s National Health Insurance Research Database. Cox proportional-hazard models were used for calculating the risks of CKD, sight-threatening retinopathy, and leg amputation.ResultsThe mean follow-up time of this study in different cohorts was between 3.59 and 4.28 years. In diabetes patients with vs. without subsequent hypertension, hypertension patients with vs. without subsequent diabetes, and comorbid diabetes and hypertension patients with previous diabetes vs. with previous hypertension, the adjusted HRs (95% CIs) for CKD were 2.77 (2.61-2.94), 1.73 (1.68-1.77), and 1.04 (1.02-1.07); for ESRD were 42.38 (22.62-79.4), 2.76 (2.43-3.13), and 0.72 (0.66-0.79); for sight-threatening retinopathy were 2.07 (1.85-2.3), 3.41 (3.14-3.71), and for leg amputation were 1.51 (1.43-1.58); and 4.74 (3.02-7.43), 6.27(4.72-8.31), and 1.19(1.03-1.38).ConclusionsThis study demonstrated that both diabetes and hypertension are risk factors for the development of CKD, retinopathy, and amputation. Tracing subsequent diabetes for patients with hypertension, and hypertension for patients with diabetes are important in clinical settings.
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- 2021
46. Gender-Related Differences in Chronic Kidney Disease-Associated Vascular Calcification Risk and Potential Risk Mediators: A Scoping Review
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Szu Ying Lee, Patrick Yihong Wu, Chia-Ter Chao, Jenq-Wen Huang, and Ke-Vin Chang
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Fibroblast growth factor 23 ,Leadership and Management ,030232 urology & nephrology ,Physiology ,Health Informatics ,Context (language use) ,vitamin D ,Review ,sclerostin ,030204 cardiovascular system & hematology ,Klotho ,End stage renal disease ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Health Information Management ,Diabetes mellitus ,valvular calcification ,Matrix gla protein ,medicine ,Vitamin D and neurology ,gender ,sex ,end-stage renal disease ,biology ,business.industry ,Health Policy ,aortic calcification ,medicine.disease ,fetuin-A ,mineral bone disorder ,chemistry ,osteoprotegerin ,vascular calcification ,biology.protein ,Sclerostin ,Medicine ,dialysis ,fibroblast growth factor-23 ,business ,chronic kidney disease ,Kidney disease - Abstract
Vascular calcification (VC) involves the deposition of calcium apatite in vascular intima or media. Individuals of advanced age, having diabetes mellitus or chronic kidney disease (CKD) are particularly at risk. The pathogenesis of CKD-associated VC evolves considerably. The core driver is the phenotypic change involving vascular wall constituent cells toward manifestations similar to that undergone by osteoblasts. Gender-related differences are observed regarding the expressions of osteogenesis-regulating effectors, and presumably the prevalence/risk of CKD-associated VC exhibits gender-related differences as well. Despite the wealth of data focusing on gender-related differences in the risk of atherosclerosis, few report whether gender modifies the risk of VC, especially CKD-associated cases. We systematically identified studies of CKD-associated VC or its regulators/modifiers reporting data about gender distributions, and extracted results from 167 articles. A significantly higher risk of CKD-associated VC was observed in males among the majority of original investigations. However, substantial heterogeneity exists, since multiple large-scale studies yielded neutral findings. Differences in gender-related VC risk may result from variations in VC assessment methods, the anatomical segments of interest, study sample size, and even the ethnic origins of participants. From a biological perspective, plausible mediators of gender-related VC differences include body composition discrepancies, alterations involving lipid profiles, inflammatory severity, diversities in matrix Gla protein (MGP), soluble Klotho, vitamin D, sclerostin, parathyroid hormone (PTH), fibroblast growth factor-23 (FGF-23), and osteoprotegerin levels. Based on our findings, it may be inappropriate to monotonously assume that male patients with CKD are at risk of VC compared to females, and we should consider more background in context before result interpretation.
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- 2021
47. Kidney Supportive Care in Peritoneal Dialysis: Developing a Person-Centered Kidney Disease Care Plan
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Emily Lu and Emily Chai
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Advance care planning ,medicine.medical_specialty ,end-stage renal disease ,Palliative care ,business.industry ,medicine.medical_treatment ,medicine.disease ,Diseases of the genitourinary system. Urology ,kidney failure ,End stage renal disease ,Peritoneal dialysis ,Quality of life (healthcare) ,Nephrology ,end-stage kidney disease ,Internal Medicine ,medicine ,dialysis ,RC870-923 ,Intensive care medicine ,business ,chronic kidney disease ,Kidney transplantation ,Dialysis ,Kidney disease - Abstract
Individuals receiving peritoneal dialysis (PD)—similar to those receiving hemodialysis (HD)—may experience high mortality coupled with high symptom burden and reduced health-related quality of life (HRQoL). In this context, discussion of the risks, benefits, and tradeoffs of PD and/or other kidney treatment modalities should be explored based on individual goals and preferences. Through these principles, kidney supportive care provides a person-centered approach to kidney disease care throughout the spectrum of kidney failure and earlier stages of chronic kidney disease (CKD). Kidney supportive care is offered in conjunction with life-prolonging therapies including dialysis and kidney transplantation, and is increasingly recognized as an integral part of advancing the care of PD patients. Using "My Kidney Care Roadmap" for shared decision-making (SDM), kidney supportive care guides patients undergoing PD and their clinicians to 1) elicit patient goals, values, and priorities; 2) convey medical prognosis and suitable treatment options; and 3) ask "which of these kidney treatment options will best help me achieve my goals and priorities?" to inform both current and future decisions, including choice of dialysis modalities, time-limited trials, and/or non-dialysis management. Recognizing that patient priorities and choices may evolve, this framework ultimately allows patients to continually reassess their PD care to better achieve goal-directed dialysis.
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- 2022
48. The M235T polymorphism in the angiotensinogen gene is not a major risk factor for diabetic nephropathy; a meta-analysis
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Smaranika Pattnaik, Bhuneshwar Sahu, Bhaskar V.K.S. Lakkakula, Thavanati Parvathi Kumara Reddy, Henu Kumar Verma, and Shashikant Swarnakar
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Oncology ,medicine.medical_specialty ,end-stage renal disease ,business.industry ,diabetic nephropathy ,Specialties of internal medicine ,Infectious and parasitic diseases ,RC109-216 ,Odds ratio ,End stage renal disease ,meta-analysis ,RC581-951 ,Polymorphism (computer science) ,Internal medicine ,Meta-analysis ,Genetic model ,Genotype ,medicine ,Gene polymorphism ,Risk factor ,business ,chronic kidney disease - Abstract
Introduction: Diabetic nephropathy (DN) is the leading cause of chronic kidney disease in diabetes patients. The angiotensin AGT M235T gene polymorphism, which is linked to the renin-angiotensin-aldosterone system (RAAS), has been extensively studied in DN patients, but the results are still conflicting. The current study’s goal is to conduct a meta-analysis to assess the relationship between AGT M235T gene polymorphism and DN susceptibility. Methods: Fourteen case-control studies related to AGT M235T polymorphism and DN were searched using PubMed, Web of Science and Google Scholar databases. Genotype data from the T2DM and T2DN groups were collected from all papers. The pooled odds ratio (OR) and 95 percent confidence interval (95% CI) were calculated employing a random-effects model to assess the relationship. Results: There were no statistically significant link between AGT M235T and DN risk in dominant (P=0.801, OR: 0.95; 95% CI: 0.66-1.38), allelic (P=0.933, OR: 1.01; 95% CI: 0.75-1.37) and recessive (P=0.374, OR: 1.21; 95% CI: 0.80-1.83) genetic models. Further, the stratified analysis based on ethnicity did not reveal significant link between AGT M235T and DN risk in Asian (Dom OR: 1.07; 95% CI: 0.63-1.82) and the Caucasian populations (Dom OR: 0.77; 95% CI: 0.49-1.21). In all three models, there was a high degree of heterogeneity between studies. Publication bias was not seen. Conclusion: Our findings suggest that the AGT gene M235T polymorphism does not contribute to DN risk. However, validation of this association will require multi-center and large population-based studies.
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- 2021
49. The experience of being a mother with end stage renal disease: A qualitative study of women receiving treatment at an ambulatory dialysis unit
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Juan Francisco Velarde-García, Carmen Jiménez-Antona, Pilar Carrasco-Garrido, Paloma Moro-López-Menchero, Domingo Palacios-Ceña, Miriam Álvarez-Villarreal, and Cristina García-Bravo
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Coping (psychology) ,Activities of daily living ,Epidemiology ,Maternal Health ,medicine.medical_treatment ,Disease ,Ambulatory Care Facilities ,Families ,Pregnancy ,Adaptation, Psychological ,Chronic Kidney Disease ,Medicine and Health Sciences ,Renal Transplantation ,Children ,Qualitative Research ,Multidisciplinary ,Obstetrics and Gynecology ,Middle Aged ,Qualitative Studies ,Nephrology ,Research Design ,Medicine ,Female ,Anatomy ,Research Article ,Adult ,medicine.medical_specialty ,Science ,Exploratory research ,Mothers ,Surgical and Invasive Medical Procedures ,Research and Analysis Methods ,Urinary System Procedures ,End stage renal disease ,Renal Dialysis ,Medical Dialysis ,Renal Diseases ,medicine ,Humans ,Women ,Dialysis ,Aged ,Transplantation ,business.industry ,Biology and Life Sciences ,Kidneys ,Renal System ,Organ Transplantation ,medicine.disease ,Age Groups ,Medical Risk Factors ,Family medicine ,People and Places ,Kidney Failure, Chronic ,Women's Health ,Population Groupings ,business ,Qualitative research ,Kidney disease - Abstract
BackgroundEnd-stage kidney disease (ESKD) has considerable effects on the quality of life, impairing daily activities and leading to lifestyle changes. The purpose of this study was therefore to explore the experience of motherhood and taking care of children in women with ESKD.MethodsA qualitative exploratory study was conducted based on an interpretive framework. Participants were recruited using non-probabilistic purposeful sampling. In total, 14 women with ESKD were included, who were treated at the dialysis unit of a Spanish hospital. In-depth interviews (unstructured and semi-structured interviews) and researchers’ field notes were used to collect the data. A systematic text condensation analysis was performed. The techniques performed and application procedures used to control trustworthiness were credibility, transferability, dependability, and confirmability.ResultsThree themes emerged from the data. “Coping with being a mother” described how women are faced with the decision to become mothers and assess the risks of pregnancy. The second theme, called “Children and the experience of illness”, highlighted the women’s struggle to prevent the disease from affecting their children emotionally or disrupting their lives. The third theme, “Fear of genetic transmission”, was based on the women’s fear of passing the disease on to their children.ConclusionsDeciding to become a mother and taking care of children represents a challenge for women with ESKD, coupled with the losses in their lives caused by the disease. These findings are only relevant to women on dialysis.
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- 2021
50. Coagulation Abnormalities in Renal Pathology of Chronic Kidney Disease: The Interplay between Blood Cells and Soluble Factors
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Anastasios G. Kriebardis, Konstantina A Tsante, Dimitrios Petras, Athanasia Kapota, Maria S. Venetikou, Sotirios P. Fortis, Hara T. Georgatzakou, Efrosyni G. Nomikou, Effie Papageorgiou, Andreas G. Tsantes, Marianna H. Antonelou, and Efthimia G. Pavlou
- Subjects
medicine.medical_specialty ,Endothelium ,Phosphatidylserines ,coagulation factors ,Kidney ,Microbiology ,Biochemistry ,Article ,End stage renal disease ,platelet dysfunction ,Internal medicine ,Homeostasis ,Humans ,Medicine ,Gene Regulatory Networks ,Platelet ,Platelet activation ,Renal Insufficiency, Chronic ,Thrombus ,Blood Coagulation ,Molecular Biology ,Whole blood ,Blood Cells ,hemodialysis ,business.industry ,Fibrinolysis ,Middle Aged ,Platelet Activation ,medicine.disease ,ADAMTS-13 inhibitor ,QR1-502 ,Uremia ,Oxidative Stress ,medicine.anatomical_structure ,Endocrinology ,Solubility ,Case-Control Studies ,Hemostasis ,Kidney Failure, Chronic ,Reactive Oxygen Species ,business ,chronic kidney disease ,Signal Transduction ,thrombotic risk ,red blood cells - Abstract
Coagulation abnormalities in renal pathology are associated with a high thrombotic and hemorrhagic risk. This study aims to investigate the hemostatic abnormalities that are related to the interaction between soluble coagulation factors and blood cells, and the effects of hemodialysis (HD) on it, in end stage renal disease (ESRD) patients. Thirty-two ESRD patients under HD treatment and fifteen healthy controls were included in the study. Whole blood samples from the healthy and ESRD subjects were collected before and after the HD session. Evaluation of coagulation included primary and secondary hemostasis screening tests, proteins of coagulation, fibrinolytic and inhibitory system, and ADAMTS-13 activity. Phosphatidylserine (PS) exposure and intracellular reactive oxygen species (iROS) levels were also examined in red blood cells and platelets, in addition to the platelet activation marker CD62P. Platelet function analysis showed pathological values in ESRD patients despite the increased levels of activation markers (PS, CD62P, iROS). Activities of most coagulation, fibrinolytic, and inhibitory system proteins were within the normal range, but HD triggered an increase in half of them. Additionally, the increased baseline levels of ADAMTS-13 inhibitor were further augmented by the dialysis session. Finally, pathological levels of PS and iROS were measured in red blood cells in close correlation with variations in several coagulation factors and platelet characteristics. This study provides evidence for a complex coagulation phenotype in ESRD. Signs of increased bleeding risk coexisted with prothrombotic features of soluble factors and blood cells in a general hyperfibrinolytic state. Hemodialysis seems to augment the prothrombotic potential, while the persisted platelet dysfunction might counteract the increased predisposition to thrombotic events post-dialysis. The interaction of red blood cells with platelets, the thrombus, the endothelium, the soluble components of the coagulation pathways, and the contribution of extracellular vesicles on hemostasis as well as the identification of the unknown origin ADAMTS-13 inhibitor deserve further investigation in uremia.
- Published
- 2021
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