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Skin manifestations are commonly seen in end stage renal disease (ESRD). Skin involvement in this population can be extensive and dramatically worsen quality of life. Close observation of the skin and nails of ESRD patients by clinicians allows for timely diagnosis and treatment, which ultimately improves quality of life and reduces mortality. In this article we focus on the cutaneous changes most commonly seen in ESRD patients. PubMed/Medline database search was done for published literature on skin manifestations in ESRD patients. All the available literature was reviewed and relevant articles were used to discuss about clinical features, pathogenesis, histology and treatment of each skin disorder in ESRD patients. Most commonly encountered skin manifestations in patients with ESRD are pruritus, xerosis, pigmentation changes, nail changes, perforating disorders, calcifying disorders, bullous dermatoses and nephrogenic systemic fibrosis. Skin manifestations in ESRD can be difficult to treat and multiple comorbidities in this patient population can exacerbate these disorders. Many of the treatment options are experimental with evidence largely derived from the case reports and small clinical trials. More large‐scale trials are needed to firmly establish evidence based treatment guidelines. Prompt evaluation and management of these disorders improve morbidity and quality of life in ESRD patients. [ABSTRACT FROM AUTHOR]

Objective: Using mesenchymal stem cells (MSCs) is regarded as a new therapeutic approach for improving fibrotic diseases. The aim of this study to evaluate the feasibility and safety of systemic infusion of autologous adipose tissue-derived MSCs (AD-MSCs) in peritoneal dialysis (PD) patients with expected peritoneal fibrosis. Materials and Methods: This study was a prospective, open-label, non-randomized, placebo-free, phase I clinical trial. Case group consisted of nine eligible renal failure patients with more than two years of history of being on PD. Autologous AD-MSCs were obtained through lipoaspiration and expanded under good manufacturing practice conditions. Patients received 1.2 ± 0.1×106 cell/kg of AD-MSCs via cubital vein and then were followed for six months at time points of baseline, and then 3 weeks, 6 weeks, 12 weeks, 16 weeks and 24 weeks after infusion. Clinical, biochemical and peritoneal equilibration test (PET) were performed to assess the safety and probable change in peritoneal solute transport parameters. Results: No serious adverse events and no catheter-related complications were found in the participants. 14 minor reported adverse events were self-limited or subsided after supportive treatment. One patient developed an episode of peritonitis and another patient experienced exit site infection, which did not appear to be related to the procedure. A significant decrease in the rate of solute transport across peritoneal membrane was detected by PET (D/P cr=0.77 vs. 0.73, P=0.02). Conclusion: This study, for the first time, showed the feasibility and safety of AD-MSCs in PD patients and the potentials for positive changes in solute transport. Further studies with larger samples, longer follow-up, and randomized blind control groups to elucidate the most effective route, frequency and dose of MSCs administration, are necessary (Registration Number: IRCT2015052415841N2). [ABSTRACT FROM AUTHOR]

Introduction: Diabetic Nephropathy (DN) is a micro-vascular complication of Type 2 Diabetes Mellitus (T2DM). It is known that renal tubular damage plays an important role in DN. Liver-Type Fatty Acid Binding Protein (LFABP) is found in liver and proximal tubular cells of kidney and its levels are associated with the structural and functional changes of tubular cells of kidney. Aim: The present study was carried out to estimate the levels of urinary LFABP and its potential role as a clinical biomarker for early diagnosis of nephropathy in T2DM patients with nephropathy. Materials and Methods: A hospital based cross-sectional study was conducted on 84 subjects divided into 3 groups. Group 1: (n=28) healthy controls, Group 2: (n=28) T2DM patients without nephropathy and Group 3: (n=28) T2DM patients with nephropathy. Serum and urine creatinine were carried out by alkaline picrate Jaffe's kinetic method. Urine albumin was estimated by turbidometric method by using nephelometer. Urinary LFABP levels were measured by commercial available ELISA kit. Results: In the present study, a statistically significant difference was found in urinary Albumin Creatinine Ratio (ACR) between the study groups I and III, II and III (p=<0.001). Also, a statistically significant difference was found between the levels of urinary LFABP in groups I and II, I and III (p=0.004 and p=<0.001 respectively). Significantly increased level of urinary LFABP was found in group III as compared to group II. There was a positive correlation observed between urinary LFABP levels with urinary ACR, which indicated that LFABP can predict kidney damage even before micro-albuminuria can be detected. Also a negative correlation was observed between urinary LFABP and estimated Glomerular Filtration Rate (eGFR). Conclusion: The study suggests that the estimation of urinary LFABP could be used as a potential adjunct biomarker along with urinary ACR for early detection of DN and monitoring of progression of DN in clinical practice. This will enable the Institution for preventive strategies that could delay the onset of symptoms of full-blown DM and End Stage Renal Disease (ESRD). [ABSTRACT FROM AUTHOR]

Background: Chronic renal failure, particularly end-stage renal disease, is a serious health problem associated with a high mortality rate. Uremic syndrome leads to increased oxidative stress, inflammation, and dyslipidemia. Aims: To examine superoxide dismutase isoenzyme gene expression in peripheral blood mononuclear cells of patients on hemodialysis and to determine the associations between superoxide dismutase isoenzyme gene expression, oxidative stress, and non-enzymatic antioxidative protection. Study Design: Case control study. Methods: This study included 33 patients on hemodialysis (age, 55.33±15.31 years old) and 33 apparently healthy controls (age, 45.37±8.92 years old). Superoxide dismutase isoenzyme messenger ribonucleic acid levels were determined by real-time polymerase chain reaction. General biochemical parameters, high sensitivity C-reactive protein, total antioxidant status, thiobarbituric acid-reactive substances, and the superoxide anion radical were also determined. Results: Normalized Cu/Zn superoxide dismutase and Mn superoxide dismutase messenger ribonucleic acid levels were significantly higher in patients than controls (p<0.001 and p=0.011). A significant negative correlation was detected between normalized Cu/Zn superoxide dismutase messenger ribonucleic acid levels and total protein, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and total antioxidant status. Normalized Mn superoxide dismutase messenger ribonucleic acid levels were negatively correlated with total protein and total antioxidant status. A multiple regression analysis revealed independent associations between total antioxidant status and normalized Cu/Zn superoxide dismutase (p=0.038) and between total antioxidant status and normalized Mn superoxide dismutase messenger ribonucleic acid levels (p=0.038 and p=0.018, respectively). Conclusion: The superoxide dismutase isoenzyme gene is expressed at a higher rate in patients with end-stage renal failure, probably due to increased oxidative stress and attenuated antioxidative defense. The plasma total antioxidant status is an independent predictor of normalized superoxide dismutase isoenzyme messenger ribonucleic acid levels. [ABSTRACT FROM AUTHOR]

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

Abstract Background and aims In dialysis patients, vascular morbidities are highly prevalent and linked to leukocyte extravasation, especially of polarized monocytes. Experimental data demonstrate that phenotypic changes in monocytes require Y-box binding protein-1 (YB-1) upregulation. Methods We determined YB-1 expression in circulating and vessel-invading monocytes from healthy controls and dialysis patients to correlate results with intima plaque formation and systemic inflammation. Results Compared to healthy subjects, dialysis patients have fewer classical and more intermediate and non-classical monocytes. Post-translationally modified YB-1 (lysine 301/304 acetylation) is detected at high levels in the nucleus of adherent and invading CD14+CD68+ monocytes from umbilical cord and atherosclerosis-prone vessels. The content of non-acetylated YB-1 is significantly decreased (p < 0.001), whereas acetylated YB-1 is correspondingly increased (p < 0.001) throughout all monocyte subpopulations, such that the overall content remains unchanged. Conclusions In dialysis patients the YB-1 acetylation status is higher with prevailing diabetes and intima plaque formation. Pro-inflammatory mediators TNFα, IL-6, uPAR, CCL2, M-CSF, progranulin, ANP, and midkine, as well as anti-inflammatory IL-10 are significantly increased in dialysis patients, emphasizing a systemic inflammatory milieu. Strong positive correlations of monocytic YB-1 content are seen with ANP, IP-10, IL-6, and IL-10 serum levels. This is the first study demonstrating an association of cold shock protein YB-1 expression with inflammation in hemodialysis patients. Highlights • In hemodialysis (HD) patients the level of acetylated YB-1 is increased (p < 0.001) in all monocytic subpopulations. • In HD patients with vascular damage (intima plaques, increased intima media thickness) alterations of monocytic YB-1 content are apparent. • Serum cytokine levels show a close correlation between monocytic YB-1 content and systemic inflammatory status. • The correlation of monocytic YB-1 content with disease and systemic inflammation suggests a causal link. [ABSTRACT FROM AUTHOR]

End stage renal disease (ESRD) affects African Americans more than any other ethnic group. Adherence is a challenge. Patients with ESRD must adhere to medication, diet, fluid restrictions, and dialysis treatment schedules if they do not receive a kidney transplant. The purpose of this exploratory, descriptive study was to assess adherence in 120 African Americans with ESRD undergoing hemodialysis (HD). Participants completed a demographic questionnaire and the ESRD Adherence Questionnaire (ESRD-AQ). Biomarkers were collected from medical records. Few participants (24%) adhered to dietary restrictions; however, fluid restriction was reported as the most difficult to manage, which was consistent with the interdialytic weight gain biomarker. Older participants were more adherent. Participants were adherent with HD attendance and medication. Participants reported frequent communication with the healthcare team, but a more formal process needs to be implemented with follow up to ensure understanding and reinforce adherence. [ABSTRACT FROM AUTHOR]

Overhydration and sarcopenia, related to an individual's nutritional status, have been associated with increased cardiovascular mortality and poor prognosis in patients on hemodialysis. The purpose of this study was to investigate the prediction of overhydration and sarcopenia on mortality in patients on hemodialysis using a body composition monitor. We conducted a systematic review and meta-analysis using a random-effects model. We searched the Cochrane Central Register, OVID MEDLINE, EMBASE and PubMed databases for all studies published prior to December 9, 2016 and reviewed the reference lists of relevant reviews, registered trials and relevant conference proceedings. The overhydration group (fluid excess, >15% vs. the normohydration group) and the low lean tissue index group ( <10%) were compared with a reference group. Six trials, consisting of 29,469 patients, were included in the pooled analysis. The pooled hazard ratio for overall survival of the overhydration group, compared with the reference normohydration group was 1.798 (95% confidence interval [CI]: 1.53-2.804, p = .001). The hazard ratio for mortality in the low lean tissue index group was 1.533 (95% CI, 1.411-1.644; p = .001) in the random-effects model. The results from the most recent study showed the greatest heterogeneity in the sensitivity analysis. Low lean tissue index and overhydration, measured using a body composition monitor, were associated with a high mortality rate in patients on hemodialysis. [ABSTRACT FROM AUTHOR]

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

Aim: Chronic kidney disease is a critical condition with considerable public health implications. It affects a significant proportion of the general population and when progressive, has an increasing influence on morbidity and mortality. The main purpose of this study was to explore the distribution and trends of renal replacement therapy and vascular access practice patterns among Saskatchewan end stage renal disease patients. Material and Method: This is a registry-based retrospective observational study. Prevalence of patient's on renal replacement therapy in the Canadian Organ Replacement Register who has information for renal replacement therapy from 2006 to 2016 in the province of Saskatchewan. The composite of demographics, mortality, type of renal replacement therapy, type of vascular access and important blood markers ranges were recorded among both haemodialysis and peritoneal dialysis patients. Results: From 2006 through 2016, a total of 2103 patients with mean age of 69.52±13.2 initiated renal replacement therapy in Saskatchewan. Among those patients, over half of the patients were female (62%). Majority of the patients were Caucasians and Aboriginals. Nearly two third of them were overweight and obese. Less than half developed end stage renal diseases secondary to diabetes and 14.9% had a primary diagnosis of glomerulonephritis. At the end of 2015, prevalence of end-stage kidney disease patients was 1330 in the Saskatchewan. During 2006 to 2016, 72.3% received haemodialysis, 22.8% received peritoneal dialysis, and, catheter was the most frequently used dialysis access method (64.6%). Conclusion: An increasing number of patients with advanced renal disease are being initiated on long-term dialysis every year. Haemodialysis and peritoneal dialysis are the two main types of dialysis provided under renal care programs. Alarmingly, in Saskatchewan, catheter was the most frequently used dialysis access method. [ABSTRACT FROM AUTHOR]

Purpose:The aim of this study was to assess long-term efficacyy of tunnelled permanenThemodialysis catheters in end stage renal insufficiency patients and to detect complications which result in catheter dysfunction. Materials and Methods: We inserted 68 permanent catheters to 40 end stage renal insufficiency patients (28 female, 1 0 m ale; m ean a ge 5 8,2 years, r ange 2 0-80 years) under the guidance of ultrasonography and fluoroscopy in the study period of two years. We evaluated catheter related complications retrospectively and calculated survival of hemodialysis catheters. Results: We determined 58 long term complications (5.2 times in 1000 catheter days) which were; 28 cases of catheter thrombosis in 10 patients (2.5/1000 days), 14 cases of catheter related sepsis in 14 patients (1.25/1000 days), 3 cases of spontaneous extrusion of catheter in 3 patients (0.27/1000 days), 7 cases of bleeding at catheter insertion site in 6 patients (0.63/1000 days), 3 cases of inadequate blood flow in 3 patients (0.27/1000 days). The mean survival of catheters were 186 days, 133 days and 164 days in primary, secondary and in total respectively. Conclusion: The native arteriovenous (AV) fistulas are the best procedure of vascular access in chronic hemodialysis. Tunnelled permanenThemodialysis catheters prove to be a good alternative for patients who can not use AV fistulas. [ABSTRACT FROM AUTHOR]

Introduction: Systemic inflammation and oxidative stress play a central role in the pathogenesis of cardiovascular disease and numerous other complications of CKD. Recent studies demonstrated that consumption of a diet enriched with amylose (HAM‐RS2), attenuates oxidative stress and inflammation, and improves intestinal microbiome in CKD rats. The present study was designed to explore the effect of dietary amylose supplementation in hemodialysis patients. Methods: Forty‐six stable hemodialysis patients were randomized to receive biscuits containing 20 g/day during the first four weeks and 25 g/day in the next four weeks of either HAM‐RS2 or wheat‐flour. Fasting predialysis blood samples obtained before, during and at the end of trial were processed for biomarkers of oxidative stress and inflammation. Findings: There was no significant difference in baseline clinical or biochemical parameters between the two groups. Serum levels of TNF‐α, IL‐6, and malondialdehyde declined significantly (P < 0.05) in the HAM‐RS2‐treated group but remained unchanged in the placebo‐treated group. No significant difference was observed in serum Interleukin‐1β (IL‐1β) and hs‐CRP concentrations and total antioxidant activity between two groups. Serum urea and creatinine concentrations significantly declined and severity of constipation improved in HAM‐RS2‐treated patients (P < 0.05). HAM‐RS2 consumption was well tolerated and did not cause discernible side effects. Discussion: Administration of HAM‐RS2 for eight weeks significantly reduced levels of inflammatory and oxidative markers in hemodialysis patients confirming the results observed in CKD animals. Long term trials are needed to explore the impact of HAM‐RS2 supplementation on clinical outcomes in end stage renal disease population. [ABSTRACT FROM AUTHOR]

Background: The highly polymorphic gene encoding human renalase (RNLS) is a 311,000 bp gene located on chromosome 10. Aim: This study aimed at studying the possible association of the two RNLS gene polymorphisms rs2576178 and rs10887800 with chronic kidney disease in general or specifically with hypertensive nephropathy in Egyptian end stage renal disease (ESRD) patients on maintenance hemodialysis. Subjects and method: This case control study was conducted on two hundred and eighty one individuals, divided equally into two groups; an end stage renal disease patients on maintenance hemodialysis with/ without hypertension and healthy matching individuals as a control group. Full clinical examination, Biochemical analysis and Molecular genetic testing were performed to detect single nucleotide polymorphism using restriction fraction length polymorphism (RFLP) for RNLS rs2576178 and rs1088780. Results: The results of this study demonstrated that the risk of developing ESRD was increased among carriers of AA genotype for the rs10887800 (3.05 times) p = 0.001, OR = 3.05, CI95% (1.558-5.971) and GG genotype for the rs2576178 p = 0.047, OR = 1.949, CI95% (1.028-3.694). Conclusion: Our study revealed that the risk of developing end stage renal diseases was increased among carriers of AA genotype for the rs10887800 polymorphism and GG genotype for the rs2576178 polymorphism. [ABSTRACT FROM AUTHOR]

Objective: To explore the effects of peritoneal dialysis (PD) and hemodialysis (HD) on calcium-phosphorus metabolism and micro inflammatory state in patients with end-stage renal disease (ESRD). Results: 94 patients with ESRD who were treated in our hospital fromJanuary 2016 to February 2017 were selected as the subjects, the patients were divided into PDgroup (47 cases) and HD group (47 cases) by random number table, the PD group were treated with ambulatory continuous PD treatment, the HD group were treated with HD, after 6 months treatment, the levels of serumcalcium, phosphorus metabolism and micro inflammation were compared between the two groups, the incidence of complications in the two groups was also counted. After 6 months treatment, the serum calcium levels of the two groups increased significantly, serum phosphorus levels decreased significantly (P<0.05), but there was no significant difference between the HD group and the PD group (P>0.05). After 6 months treatment, the levels of serum c-reactive protein (CRP) in two groups were significantly increased, and the HD group was higher than the PD group, the differences were statistically significant (P<0.05). After 6 months treatment, the level of procalcitonin (PCT) was lower than that at before treatment, the difference was statistically significant (P<0.05), but there was no significant difference between the HD group and the PD group (P>0.05). The incidence of infection and hypoproteinemia in PD group were higher than that in HD group, and the incidence of hypertension, arrhythmia andcongestive heart failure in HDgroup were higher than that inPDgroup, the differenceswere statisticallysignificant (P<0.05). Conclusion: The PD and HD treatment both can improve the metabolismof calcium and phosphorus in patients with ESRD, but both of them will aggravate the micro inflammatory reaction, and HD has more influence on the micro inflammatory state of the patients. [ABSTRACT FROM AUTHOR]

Background/Aims: Fabry disease (FD) is a lysosomal storage disorder characterized by pervasive renal involvement. However, this disease is underdiagnosed in patient with chronic kidney disease (CKD), including those with end stage renal disease (ESRD), so their investigation represents an unexploited opportunity for early diagnosis of the disease and for its identification in relatives of affected patients. Methods: We investigated Fabry disease in a clinical and biological database including ESRD patients of unknown cause in a geographical area with 2 million residents. The study was based on state of art GLA gene sequencing and was extended to relatives of affected ESRD patients. Results: Among ESRD patients qualified for enrollment into this study, a previously undiagnosed young man harboring the mutation p.I91T was identified. The study of the proband's family led to the identification of 8 additional cases. In another ESRD male patient, we identified the functional polymorphism p.D313Y. Furthermore, in 55 ESRD patients (24.2%) we found intronic polymorphisms of uncertain functional relevance in the non-coding regions of the GLA gene. Conclusion: A comprehensive survey of ESRD patients in a geographical area of 2 million residents identified one undiagnosed case of Fabry disease and led to the identification of 8 additional cases among his relatives. Screening protocols starting from the dialysis population and upstream extended to families of affected individuals may be an effective strategy to maximize the early identification of subjects with Fabry disease. [ABSTRACT FROM AUTHOR]

BACKGROUND: Arterial stiffening is a major contributing factor in the development of cardiovascular disease in patients with end-stage renal disease (ESRD). However, there is no gold standard for evaluating arterial stiffness. This study aimed to evaluate the newly developed speckle-tracking carotid strain imaging method in assessing arterial stiffness in patients with ESRD. METHODS: In total, 85 patients with normal renal function (controls) and 36 with ESRD were enrolled in this single-center study. Carotid B-mode ultrasonography was performed for all patients. Arterial stiffness indices and strain parameters of the common carotid arteries were analyzed. Values were compared between the groups, and multivariate linear regression analysis was performed to assess the impact of ESRD on carotid strain. RESULTS: There were no differences in the intima-media thickness, ß stiffness index, and arterial compliance, but arterial distensibility was lower, and the elastic modulus and pulse wave velocity ß (PWV) were higher among patients with ESRD (all p < 0.05), whether assessed in the longitudinal or transverse plane. Both longitudinal and transverse strain rates were reduced in patients with ESRD (all p < 0.05). In multivariate analyses, ESRD independently reduced both transverse radial strain and strain rate (all p < 0.05), and the transverse circumferential strain and strain rate (p < 0.05). However, all conventional aortic stiffness indices and longitudinal strain parameters were not associated with ESRD. CONCLUSIONS: Speckle-tracking carotid strain ultrasonography was successfully performed in both normal subjects and patients with ESRD. Multidirectional carotid strain analyses may provide more value than conventional aortic stiffness indices for risk stratification in patients with ESRD. [ABSTRACT FROM AUTHOR]

Introduction: This study is to examine the clinical outcome results of drug eluting balloon (DEB) angioplasty to complex femoropopliteal lesions in patients with end stage renal disease (ESRD). Methods: A retrospective chart review identified 30 patients who were treated for symptomatic peripheral artery disease with DEB angioplasty in ESRD patients between September 2012 and February 2016. Restenosis or reocclusion at femoropopliteal site after 12 months' follow-up was the primary end point whereas amputations (minor or major) after12 months' follow-up was the secondary end point. Results: Thirty ESRD patients underwent endovascular therapy with DEB. The mean lesion length was 135.6±46.0mm. Primary patency was 73.1% and the secondary end point was 10.7 % at 1-year. Mean follow-up of patients were 16.0 ± 5.0 months and all cause mortality rate was 7.1% (n=2). A significant increase in the ankle-brachial index (ABI, 0.45±0.04 preoperative to 0.88±0.05 postoperative) after intervention demonstrated a hemodynamic success where as the decrease in mean Rutherford Becker Class (RBC) demonstrated a clinical success. Conclusion: DEB angioplasty is efficient and safe even in long and calcified obstructive lesions including the distal superficial femoral and popliteal artery in patients with ESRD. [ABSTRACT FROM AUTHOR]

ABSTRACT: Aims: The data regarding the treatment of chronic hepatitis C (CHC) in renal transplant recipients is lacking from the Asia‐Pacific region. The aim of the present study was to assess the safety and efficacy of directly acting antivirals (DAAs) in the treatment of CHC infection in renal transplant recipients. Methods: A total of 47 CHC infected renal transplant recipients were enrolled in this real life observational cohort analysis between March 2015 and September 2016. Presence of hepatic fibrosis/cirrhosis was assessed on transient elastography (Fibroscan). Fourteen patients were treated with Sofosbuvir and Ribavirin for 24 weeks. Twenty‐two patients received Sofosbuvir and Ledipasvir and 12 patients received Sofosbuvir and Daclatasvir with (n = 3) or without (n = 31) Ribavirin for 12 or 24 weeks depending on genotype and underlying cirrhosis. Data were analyzed for safety and treatment efficacy [sustained virological response at 12 weeks (SVR12)]. Results: The median baseline HCV RNA concentration in the whole group was 7.38 × 106 IU/mL (1.23 × 104–6.36 × 107). The SVR12 rates were 100% in all groups except in the Sofosbuvir and Ribavirin group (86%). Transient Elastography revealed minimal or no fibrosis (F0‐F1) in 31 (65.96%) patients, moderate fibrosis (F2) in 11 (23.4%) patients and cirrhosis in five (10.64%) patients. The only serious adverse effect was anaemia observed in eight (57%) patients in the Sofosbuvir and Ribavirin group. Conclusion: DAAs including Sofosbuvir, Daclatasvir and Ledipasvir with or without ribavirin are safe and effective for the treatment of chronic hepatitis C in renal transplant recipients. [ABSTRACT FROM AUTHOR]

Abstract: Aim: This study was designed to investigate the impact of paediatric end‐stage renal disease (ESRD) on parents, based on the PedsQL Family Impact Module (FIM), and the relationship to the quality of life (QOL) of paediatric ESRD patients measured by PedsQL 3.0 ESRD module. Methods: We performed a cross‐sectional study using Korean translations of the PedsQL FIM and the PedsQL 3.0 ESRD module. In all, 79 patients were enrolled, including 47 children receiving dialysis and 32 children who underwent renal transplant. Results: FIM scores, analyzed for every category according to treatment modality, were significantly lower in haemodialysis (HD) than in peritoneal dialysis (PD) or renal transplant patients. Mother's age, duration since diagnosis of ESRD and the existence of comorbidity were variables to have significant effects on FIM scores. The correlation between total FIM and QOL scores of paediatric patients were significant, in both parent‐proxy and child‐self report. Conclusions: The PedsQL FIM appears to be a useful tool for the assessment of family impact on children with ESRD. Further prospective studies focused on the QOL of parents and caregivers should be performed with the goal of improving clinical outcomes for paediatric ESRD patients. [ABSTRACT FROM AUTHOR]

Background: Renal cancer is the commonest renal tumor and is usually treated by radical nephrectomy. Development of laparoscopic surgery was associated with reduction of post-surgical complications and the invent of mini-laparoscopic devices proposed to be associated with marked reduction of postoperative complications. Objective: to compare between mini and conventional laparoscopic nephrectomy as regards perioperative complications. Patient and Methods: Eligible patients underwent transperitoneal conventional or minilaparoscopy (ML) or conventional laparoscopy depending on surgeon preference. Preoperatively, patients were evaluated by history and clinical examination, with routine Lab and radiological investigations. Both operative and postoperative data were collected and documented. Results: both groups were comparable as patient demographics, associated medical diseases, preoperative data or the type of nephrectomy. However, operative time was significantly shorter, while blood loss was significantly larger in conventional group. In addition, postoperative pain was significantly higher and duration of hospital stay was significantly longer in conventional group. Finally, total cosmoses score was statistically decreased in conventional group. Conclusion: Compared with mini-laparoscopy, conventional laparoscopy showed better intraoperative parameters as shorter operative time, blood loss and less need for conversion to open surgery. However, the overall complications were comparable for both groups. [ABSTRACT FROM AUTHOR]

Background: Native arteriovenous (AV) fistulas, which are the most commonly used access line, enable sufficient and repeated hemodialysis (HD) applications and improves the rate of survival and quality of life in patients with end-stage renal disease (ESRD) when performed timely in an appropriate anatomic location using a fine technique. Objectives: We aimed to assess factors responsible for fistula secondary failure in patients on hemodialysis. Patients and Methods: Thirty patients with end stage renal disease (ESRD) on regular HD were included. All patients underwent history taking, clinical examination and ultrasound examination was carried out for all patients to assess AVF and factors associated with its patency and failure. Results: There was no statistically significant differences between group I and group II as regards to age, BMI, HD duration and AVF age (p-value >0.05). There was statistically high significant difference between patients with well functioning AVF (group I) and patients with malfunctioning (secondary failed) AVF (group II) as regarding SVP and mean arterial blood pressure (P-value < 0.01) and there was statistically significant difference between group I and group II as regarding DVP (p-value < 0.05). There was statistically high significant difference between group I and group II as regarding venous diameter and FV (P-value < 0.01), while there was no statistically significant difference between group I and group II as regarding arterial diameter (P-value > 0.05). There was statistically high significant difference between group I and group II as regarding hemoglobin & dialysis adequacy (Kt/V) (P-value < 0.01). Conclusion: The native AVF is the vascular access of choice for patients who require hemodialysis: it lasts longer and is associated with fewer complications than other types of vascular access; for hemodialysis patients, these benefits translate into better quality of life and longer survival. The result of this study showed a significant positive correlation between access blood flow (Qa) and Kt/V. This confirm the importance of well-functioning non stenotic AVF in delivering adequate dialysis. [ABSTRACT FROM AUTHOR]

Patients with end-stage renal disease experience significant mortality and morbidity, including cognitive decline. Advance care planning has been emphasized as a responsibility and priority of physicians caring for patients with chronic kidney disease in order to align with patient values before decision-making capacity is lost and to avoid suffering. This emphasis has proven ineffective, as illustrated in the case of a patient treated in our hospital. Is this ineffectiveness a consequence of failure in the courtroom or the clinic? Through our own experience we affirm what has been written before: that legal precedent favors intensive treatment in virtually all cases without ‘clear and convincing evidence’ of a patient’s previously declared wishes to the contrary. Equally clear is that more than 20 years of support in the clinical literature suggesting advance care planning early in the course of disease can address challenges in the legal system for those lacking capacity. However, many physicians fail to recognize the need for advance care planning in a timely manner and lack the necessary training to provide it. The need for more training and new tools to recognize opportunities for advance care planning in daily practice remains unmet. [ABSTRACT FROM AUTHOR]

Caregiver burden has negative consequences on the perceived health and quality of life of caregivers. There is limited research on the positive aspects of caregiving. A descriptive convenience sample of 89 caregivers of patients on hemodialysis responded to an online survey distributed on the National Kidney Foundation's email list. Participants completed the Self- Assessed Health Measure (SAH), Positive Aspects of Caregiving (PAC), and the Caregiving Stress Appraisal (CAS) survey instruments. Caregivers with higher self-assessed levels of health, who view their caregiver role positively, experienced lesser degrees of burden (Pearson r=-0.537, p=0.000; and r=-0.335, p=<0.001, respectfully). Healthcare providers must take into consideration the health, wellness, and needs of unpaid caregivers. [ABSTRACT FROM AUTHOR]

Abstract: Pain management in end stage renal disease (ESRD) patients is a complex and challenging task to accomplish, and effective pain and symptom control improves quality of life. Pain is prevalent in more than 50% of hemodialysis patients and up to 75% of these patients are treated ineffectively due to its poor recognition by providers. A good history for PQRST factors and intensity assessment using visual analog scale are the initial steps in the management of pain followed by involvement of palliative care, patient and family counseling, discussion of treatment options, and correction of reversible causes. First line should be conservative management such as exercise, massage, heat/cold therapy, acupuncture, meditation, distraction, music therapy, and cognitive behavioral therapy. Analgesics are introduced according to WHO guidelines (by the mouth, by the clock, by the ladder, for the individual, and attention to detail) using three‐step analgesic ladder model. Neuropathic pain can be controlled by gabapentin and pregabalin. Substitution/addition of opioid analgesics are indicated if pain control is not optimal. Commonly used opioids in ESRD patients are tramadol, oxycodone, hydromorphone, fentanyl, methadone, and buprenorphine. Methadone, fentanyl, and buprenorphine are the ideal analgesics in ESRD. However, complex pain syndrome requires multidrug analgesic regimen comprising opioids, non‐opioids, and adjuvant medication, which should be individualized to the patient to achieve adequate pain control. [ABSTRACT FROM AUTHOR]

Introduction. HCV is considered the most encountered viral infection that affect patients after hemodialysis sessions. Even though liver biopsy is considered the golden standard for hepatic diagnosis, additional methods have been used for assessing liver fibrosis. Transient elastography (TE) has evolved as a reference method in some European countries and allows the physician to carry out a fibrosis evaluation in a noninvasive, low-cost and rapid method. Our objective was to assess the efficacy of TE in staging patients with HCV liver disease associated with ESRD, thus choosing the correct moment to perform the procedure. Materials and Methods. We included 34 patients known with ESRD within the regional Nephrology Clinic of Olt County Hospital and also having positive hepatitis C viral liver marker. TE was performed before and hemodialysis and data was analyzed. Results. The patients where we have encountered significant changes were especially within the F0 and F1 stage with a decrease of fibrosis after hemodialysis. Thus, 7 patients which had no fibrosis (F0) went from 4,14±0,98kPa to 3,54±0,84 (p<0,05) and 12 patients from the F1 stage went from 6,22±0,39kPa to 5,47±0,58kPa. The other stages had no significant changes with F2 changing after hemodialysis from 8.03±0,62kPa to 7,76±0,6kPa. Conclusions. TE represents a valuable tool for stiffness assessment and should be taken into considerations as a major option for ESRD patients with liver disease. However, more patients should be enrolled to strengthen this theory and thus providing more reliable results. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective study of patients who were hospitalized for infectious spondylodiscitis over a 13-year period.Objective: To elucidate the epidemiology and prognostic factors of infectious spondylodiscitis in hemodialysis (HD) patients and to identify the impact of HD on infectious spondylodiscitis.Summary Of Background Data: Only a few case studies of infectious spondylodiscitis in HD patients can be found in the literature. Reports of prognostic factors are limited and patients' outcomes have not been well described.Methods: The cases of 1402 patients who were hospitalized for infectious spondylodiscitis over a 13-year period were retrospectively reviewed. Of these, 102 patients on maintenance HD were enrolled in this study. Cox proportional hazard model was used to evaluate the risk factors of mortality and recurrence.Results: The 102 enrolled patients had an average age 63.3 ± 11.2 years old and male-to-female ratio of 1:1.04. Back pain was present in 75.5% of patients and the most commonly infected site was the lumbosacral spine. Infection associated with vascular access was identified in 31.4% of patients. The prevalence of dialysis via central venous catheters was higher than prevalent HD patients. Methicillin-resistant Staphylococcus aureus was the most common pathogen, followed coagulase-negative staphylococci. The patients' in-hospital survival rate was 82.4%; their vascular access survival rate was 75.5%; their 1-year survival rate was 78.4%, and their 1-year recurrence rate was 20.2%. Congestive heart failure was associated with an increased 1-year mortality. Other variables exhibited no significant relationship with patients' in-hospital mortality, 1-year mortality or recurrence.Conclusion: The characteristics and outcomes of infectious spondylodiscitis in HD patients were elucidated. Most of the demographic and clinical variables, evaluated upon admission, did not predict mortality or recurrence.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Introduction: Cardiovascular risk factors are prevalent in Haemodialysis (HD) patients. Aim: To assess the effect of HD on lipid peroxidation marker (Malondialdehyde (MDA)), lipid atherogenic ratios, and peripheral inflammatory markers in HD patients. Materials and Methods: A cross-sectional case-control study was conducted on 60 patients on regular HD attending nephrology unit of Luxor general hospital between June 2016 and May 2017, (33 males/27 females) and 30 healthy controls (17 males/13 females) were enrolled. Blood samples were obtained for estimation of lipid profile, MDA, and complete blood counts. One-way analysis of variance (ANOVA) was used for comparisons between groups, receiver operator characteristic curve was performed to obtain the cut-off value of MDA, sensitivity, specificity, and area under the curve was used to discriminate between HD patients and controls. The correlation study was used to measure the relationship between variables. Logistic Regression (Odd's Ratio) was performed for calculation of cardiac risk factors for heart attack in HD cases. Results: HD patients had significantly low WBCs (p=0.010) and lymphocyte counts (p<0.00001); with insignificant difference between pre- and post-HD. HD-patients had significantly higher cholesterol (p=0.019), triglycerides, VLDL-c, MDA (p<0.00001) and non-HDL-c (p=0.002) all increased significantly post-HD. Inversely, HDL-c was significantly lower in HD-patients and decreased significantly in post-HD (p<0.00001). HD-patients had significantly higher indexes for (TC/HDL, LDL/HDL, VLDL/ HDL, TG/HDL, Non-HDL/HDL) (p<0.00001), monocyte: HDL ratio (p=0.003) and Platelet: Lymphocyte Ratio (PLR) (p=0.042) all significantly increased post-HD. Inversely; HD-patients had significant lower LDL/VLDL (p<0.00001) and Lymphocyte: Monocyte Ratio (LMR) (p=0.0003) with insignificant difference between pre- and post-HD. However, Neutrophil: Lymphocyte Ratio (NLR) (p=0.095), monocyte count (p=0.626) showed insignificant difference. MDA was correlated with TG, VLDL, non-HDL/HDL, and TG/HDL; but multivariate regression analysis indicates inter-related variables and none was considered independent risk factor. Conclusion: HD worsens oxidative stress caused by uraemia and accentuates lipid peroxidation and dyslipidemia present in HD patient. Lipid peroxidation and dyslipidemia are probable independent modifiable risk factor that contributes to high morbidity and mortality by promoting cardiovascular complications. [ABSTRACT FROM AUTHOR]

Objective:To compare the effect of hemodialysis and peritoneal dialysis on the prognosis and safety of patients with end-stage renal disease (ESRD). Methods:246 patients with dialysis in our hospital from January 2010 to April 2016 were selected and divided into two groups: hemodialysis group and peritoneal dialysis group, the survival and incidence of complications were compared between the two groups. Results:The causes of death in both groups were heart failure, gastrointestinal bleeding, severe infection, cerebral infarction, and the fatality rate and cause of death showed no statistically significant difference (P>0.05). The 1-year, 3-year and 5-year survival rates of ESRD patients in the peritoneal dialysis group were significantly higher than those of the hemodialysis group (P<0.05), no statistical difference was found in the 7-year survival rate between two groups (P>0.05). For the first time in over 60 years of age in patients with end-stage renal disease, the 1-year, 3-year, 5-year and 7-year survival rates were significantly lower than those of the hemodialysis group(P<0.05). The incidence of heart failure, arteriovenous fistula occlusion of hemodialysis group were higher than those of the peritoneal dialysis group (P<0.05), the incidence of peritonitis in peritoneal dialysis group was higher than that of the hemodialysis group (P<0.05), the total complication rate in the hemodialysis group was higher than that of the peritoneal dialysis group (P<0.05). Conclusion:Hemodialysis and peritoneal dialysis had their own advantages and disadvantages, we should choose the mode of dialysis for patients with end-stage renal disease, reduce the complications, improve the quality of life and the survival rate. [ABSTRACT FROM AUTHOR]

Objectives: To study hematological profile in geriatric cases undergoing hemodialysis and compare with non-geriatric. Study Design: Descriptive Cross Sectional Study. Setting: Department of Nephrology & Medicine, Rawal Institute of Health Sciences Islamabad. Study Duration: 12 months (June 2016-June 2017). Material and Methods: Adult patients (>18years) diagnosed as end stage renal disease (ESRD), undergoing maintenance hemodialysis for >3 months included after ethical approval and consent. Group A had 88 geriatric ESRD cases (>65 years); group B had 88 non-geriatric (<65 years). Data analyzed by SPSS version 17. Hematological profile and other variables compared between two groups by Chi-Square and t-test (significant p<0.05). Results: Among 166 ESRD cases (69% males and 31% females), mean age was 54.9+10.6 years. Anemia present in 89% (group A) vs. 74% (group B; p=0.012). Mean hemoglobin was 8.57+2.00 (group A) vs. 9.27+2.39 (group B; p=0.035). Mean platelets count was lower among geriatrics; however leukocyte counts comparable between two groups. Mean eGFR was 7.95+2.68 (group A) vs. 9.16+4.04 (group B; p=0.020). Diabetes and hypertension were frequent in geriatric group (p<0.05). No difference in hepatitis B, C and congestive cardiac failure observed. BMI was 26.74+5.87 (group A) vs. 22.43+4.83 (group B; p<0.0001). Lack of social support observed in 25% (group A) vs. 9% (group B). Conclusion: Anemia is frequent observation in ESRD hemodialysis cases. Geriatric ESRD hemodialysis cases have significantly low hemoglobin levels than non-geriatric. Hence, suggested that old age to be considered as an additional risk factor for anemia in ESRD hemodialysis cases. Geriatric ESRD hemodialysis cases should undergo frequent anemia screening and timely intervention. Iron supplementation, dietary modification, erythropoietin administration and blood transfusion as per indication needs to be individualized in geriatric cases to improve hematological parameters and quality of life. [ABSTRACT FROM AUTHOR]

Controlled fluid intake is an important aspect of living with end stage renal disease (ESRD), and is complicated by depression, the most common mental health issue affecting individuals with ESRD. Factors that mitigate the deleterious effects of depression are underexplored. This study sought to identify potential mediators between depression and fluid adherence in 107 individuals with ESRD aged 50 years and older by comparing four logistic regression models. Age was associated with an increase in fluid adherence (adjusted odds ratio [AOR]=1.08, 95% confidence interval [CI]=1.02-1.14), whereas depression was associated with a decrease in fluid adherence (AOR=0.82, 95% CI=0.67-0.99), but when self-efficacy was entered into the model, the association between depression and fluid adherence weakened. Findings suggest that self-efficacy and age are important factors in fluid adherence, and self-efficacy can potentially mediate the negative effects of depression in older adults with ESRD. [ABSTRACT FROM AUTHOR]

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

The purpose of the current study was to assess the uniqueness of the condition of kidney transplant recipients in comparison to a sample of matching healthy peers in relation to body-image dissatisfaction and identification, quality of life and psychological distress. Participants were 45 kidney transplant recipients who were under follow-up care at a Transplant Unit of a major Medical Center, and a sample of 45 matching healthy peers. Measures were taken using self-report questionnaires [Body-Image Ideals Questionnaire (BIIQ), Body Identification Questionnaire (BIQ), Brief Symptoms Inventory (BSI), and the SF-12]. The major findings were the following: (i) kidney transplant recipients reported lower levels of quality of life and higher levels of PsD when compared to their healthy peers; (ii) no difference in body-image dissatisfaction was found between the two studied groups; (iii) significant correlations between body-image dissatisfaction quality of life and PsD were found only in the kidney transplant recipients. The kidney transplantation condition has a moderating effect in the association between body-image dissatisfaction PsD but not in the association between body-image dissatisfaction and quality of life; (iv) kidney transplant recipients experienced higher levels of body identification than did their healthy peers. Taken together, these findings highlight the unique condition of kidney transplant recipients, as well as the function that body-image plays within the self. [ABSTRACT FROM AUTHOR]

Purpose: Infectious spondylodiscitis is a serious disease that can lead to permanent neurological deficit. Because there were only a few case reports or series featuring infectious spondylodiscitis in chronic dialysis patients, we investigated the epidemiology and outcome in the chronic dialysis patients versus general population. Materials and methods: We retrospectively identified chronic dialysis patients admitted for infectious spondylodiscitis between January 2002 and December 2015. A total of 105 chronic dialysis patients were included, and we performed a 1:2 case-control match on propensity score in non-dialysis patients with infectious spondylodiscitis. The demographic features, clinical manifestation, infection focus, and disease outcome were recorded. Results: A total of 302 patients entered the final analysis. Chronic dialysis patients less frequently had fever (34.3%), and in the majority, bacterial entry was through dialysis vascular access (30.5%). Methicillin-resistant Staphylococcus aureus (MRSA) comprised the majority of causative pathogen. The chronic dialysis group had longer hospital stay, higher in-hospital mortality, and higher 1-year mortality. The odds ratio of in-hospital mortality was 2.20 compared with the non-dialysis group. Conclusions: The study highlighted poorer outcome and high frequency of resistant Staphylococcus of infectious spondylodiscitis in chronic dialysis patients. Therefore, high vigilance, prompt recognition, and empiric coverage of MRSA will be important in the management of infectious spondylodiscitis in chronic dialysis patients. [ABSTRACT FROM AUTHOR]

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

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

Most complications associated with the use of arteriovenous fistula (AVF) access site for hemodialysis can be prevented by adopting a daily self-care plan for AVF access site. Therefore, the aim of this study was set to assess the knowledge, attitude and practice (KAP) about self-care of AVF access site amongst end stage renal disease (ESRD) patients who are on maintenance hemodialysis. Methods: This comparative cross sectional study with quantitative approach was carried out in hemodialysis unit of Shalamar Institute of Health Sciences, Lahore for the month of July, 2017. All patients with ESRD, on maintenance hemodialysis through an AVF access for at least last 30 days, were included in the study. Each patient was given a questionnaire comprising of 21 questions during his/her routine dialysis. Knowledge of ESRD patients was categorized into poor (<50%), average (50-70%) and good (> 70%). Results: Out of 138 patients, 94% had good knowledge about AVF self-care and 99% had good attitude about AVF access care. However a few practices like daily AVF thrill checkup, pre-hemodialysis AVF site washing and pre and post hemodialysis disinfection were not in correspondence with the level of knowledge representing a discrepancy between knowledge and practice in some aspects of the of the AVF care. Knowledge scores when compared between different age groups, greater proportion of patients between age of 45-65 (p<0.017) possessed good knowledge as compared to age groups of 25-45, 65-85 years. Conclusion: Despite good understanding and adequate attitude, few practices were not being followed in parallel to the knowledge acquisition. Therefore, regular reminder and periodic evaluation of practical aspects of AVF care is recommended for each ESRD patient visiting for hemodialysis. [ABSTRACT FROM AUTHOR]

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

Aim: The aim of this study was to compare the Helicobacter pylori (HP) eradication regimens in patients with end stage renal disease. Background: In patients undergoing hemodialysis, the pathologic changes seen in the stomach may be the result of high serum levels of gastrin, delayed gastric emptying or HP infection. Methods: Our study was a randomized clinical trial in which 120 patients with ESRD (Patients who undergo hemodialysis) confirmed HP infection, were divided to four groups having 2-week eradication regimens; Group I: LCA (lansoprazole 30 mg- BD,clarithromycin 250 mg-BD, amoxicillin 500 mg-BD), Group II: LCM (lansoprazole 30 mg-BD,clarithromycin 250 mg-BD, metronidazole 500 mg-BD), Group III: LCAM (lansoprazole 30 mg-BD,clarithromycin 250 mg-BD,amoxicillin 500 mg-BD, metronidazole 500 mg-BD) and Group IV: Sequential (lansoprazole 30 mg-BDfor two weeks; first week: amoxicillin 500 mg-BD and second week: clarithromycin 250 mg-BD, metronidazole 500 mg-BD).6 weeks after treatment, Urea Breath Test (UBT) was performed for all patients. Results: The mean age of patients was 43.1±11.2 years. 55.8% of patients were male. The success rates of HP eradication in 4 groups were76.7%, 70%, 90% and 90%, respectively. HP eradication rates were not statistically different among the regimens (p=0.11). There were not significant differences among the groups regarding demographic and anthropometric variables. Conclusion: The results showed there was no significant difference between the success rates of HP eradication regimens for ESRD patients. According to approved regimen for 90% eradication rate, with a lower number of medications and given the less risk of side effects and drug interactions, the sequential regimen is the best. [ABSTRACT FROM AUTHOR]

Home hemodialysis (HD) has been supported by health authorities in many countries due to its nature of providing more freedom to the patients and the possibility to individualize the treatment. The treatment method is notable as a feasible dialysis option due to increase in life quality and improvement in the clinical findings of patients. However, pediatric home HD (HHD) is infrequently performed. In this study, we aimed to share our first year experience with HHD in a 15-year-old male patient. A 15-year-old male patient who had been receiving chronic peritoneal dialysis (CPD) for 13 years due to ESRD was transferred to chronic HD treatment due to treatment-resistant hypervolemia, hypertension, anemia and hyperphosphatemia associated with CPD failure. The education period was started with the consent of patient and his family and no problem was observed except short-term fear during the entry of a needle. Following the education period in the hospital, the treatment of the patient was continued at home. At the end of the first year of HHD treatment, increase in growth percentile and academic success, regression in the symptoms related to uremia, and also decrease in the use of medication and hospitalization were observed. Our patient felt better and had increased appetite, better growth scores and higher academic success, indicating that HHD could be a successful renal replacement treatment technique with its control of uremia-related symptoms and the decrease in medication needs of the patient. [ABSTRACT FROM AUTHOR]

Background: We examined the association of dialysis facility characteristics with payment reductions and change in clinical performance measures during the first year of the United States Centers for Medicare & Medicaid Services (CMS) End Stage Renal Disease Quality Incentive Plan (ESRD QIP) to determine its potential impact on quality and disparities in dialysis care.Methods: We linked the 2012 ESRD QIP Facility Performance File to the 2007-2011 American Community Survey by zip code and dichotomized the QIP total performance scores-derived from percent of patients with urea reduction rate > 65, hemoglobin < 10 g/dL, and hemoglobin > 12 g/dL-as 'any' versus 'no' payment reduction. We characterized associations between payment reduction and dialysis facility characteristics and neighborhood demographics, and examined changes in facility outcomes between 2007 and 2010.Results: In multivariable analysis, facilities with any payment reduction were more likely to have longer operation (OR 1.03 per year), a medium or large number of stations (OR 1.31 and OR 1.42, respectively), and a larger proportion of African Americans (OR 1.25, highest versus lowest quartile), all p < 0.05. Most improvement in clinical performance was due to reduced overtreatment of anemia, a decline in the percentage of patients with hemoglobin ≥ 12 g/dL; for-profits and facilities in African American neighborhoods had the greatest reduction.Conclusions: In the first year of CMS pay-for-performance, most clinical improvement was due to reduced overtreatment of anemia. Facilities in African American neighborhoods were more likely to receive a payment reduction, despite their large decline in anemia overtreatment. [ABSTRACT FROM AUTHOR]

Background and aims Statin is not beneficial for dialysis patients but moderate to high intensity statin is beneficial for patients after acute myocardial infarction (MI). The aim of this study was to evaluate the effect of moderate to high intensity statin on mortality, cardiovascular outcomes in dialysis patients after acute MI. Methods Data on dialysis patients were retrieved from the National Health Insurance Research Database in Taiwan. Dialysis patients admitted for MI were selected and divided into two groups according to statin prescription or not after MI. All-cause mortality and cardiovascular outcomes after a 4-year follow-up were analyzed after propensity score matching (PSM). Results We identified 790 patients who received moderate to high intensity statin therapy and 1788 patients who did not receive any statins after acute MI and clinical outcomes were analyzed after 1:1 PSM. The benefit of statin on mortality therapy appeared from 1 year to the end of the 4-year follow-up period after hospitalization (statin group versus non-statin group: 22.9% vs . 31.1% at 1 year (HR: 0.70; 95% CI: 0.58–0.85); 48.0% vs. 55.1% at the end of the 4 years (HR: 0.76; 95% CI: 0.67–0.88)). In addition, the impact of statin therapy was stronger in patients with shock at admission ( p = 0.035). There were no differences in any individual cardiovascular outcome or adverse event. Conclusions Moderate to high intensity statin therapy might lower all-cause mortality in dialysis patients after acute MI, especially those with shock, but not influence cardiovascular outcomes and any adverse events. [ABSTRACT FROM AUTHOR]

Polycystic kidney disease (PKD) is a systemic disorder which adds majority of renal patients to end stage renal disease. Autosomal dominant polycystic kidney disease (ADPKD) is more prevalent and leading cause of dialysis and kidney transplant. Linkage analysis revealed some closely linked loci, two of which are identified as PKD1, PKD2 and an unidentified locus to ADPKD. This study was performed using PCR and automated DNA sequencing in 84 cases and 80 controls to test potential candidature of PKD2 as underlying cause of PKD by in silico and statistical analyses. Two associated symptoms, hypertension (19%) and liver cyst (31%) havemajor contribution to PKD. Gender-based analysis revealed that familial female patients (27%) and familialmale patients (33%) are more hypertensive. Liver cyst, the second major contributing symptom presented by large percentage of sporadic males (46%). Genetic screening of all 15 exons of PKD2 revealed eight pathogenic (c.854_854delG, c.915C>A, c.973C>T, c.1050_1050delC, c.1604_1604delT, c.1790T>C, c.2182_2183delAG, c.2224C>T) and eight likely pathogenic (g.11732A>G, c.646T>C, c.1354A>G, g.39212G>C, c.1789C>A, c.1849C>A, c.2164G>T, c.2494A>G)DNA sequence variants. In our study, 27.38% (23/84) cases shown pathogenic / likely pathogenic variants in PKD2 gene. Some regions of PKD2 prone for genetic variation suggested to be linked with disease pathogenesis. This noticeable hot spot regions hold higher frequency (50%) of pathogenic / likely pathogenic genetic variants constituting single nucleotide variants than large deletion and insertion that actually represents only 41.08% of coding sequence of PKD2. Statistically significant association for IVS3-22AA genotype was observed with PKD, while association of IVS4+62C>Twas found insignificant. [ABSTRACT FROM AUTHOR]

Background/purpose Approximately half of patients with systemic lupus erythematosus (SLE) develop lupus nephritis (LN), a major cause of morbidity and early mortality in that disease. Prolonged renal inflammation is associated with irreversible kidney damage which confers a 30% risk of end stage renal disease (ESRD), making early, aggressive treatment mandatory. Failure to achieve therapeutic response or recurrence of renal flare often prompts repeat biopsy. However, the role of repeat biopsy in determining long-term renal prognosis remains controversial. For this reason repeat biopsies are usually not utilized unless clinical evidence of refractory or recurrent disease is already present, despite known mismatches between clinical and biopsy findings. The current study quantifies the degree to which histopathologic worsening between first and second biopsies and duration between them predicts ESRD and death. Methods Medical records of 141 LN patients with more than one biopsy were obtained from a single large urban medical center. Cases were attained using billing codes for diagnosis and procedures from 1/1999–1/2015. Biopsy worsening was defined as unfavorable histopathologic classification transitions and/or increased chronicity; if neither were present, the patient was defined as non-worsening. We used Cox proportional hazard models to study the relationship between ESRD and survival adjusting for covariates which included age at first biopsy, gender, race, initial biopsy class, and initial induction therapy. Results Of 630 patients screened, 141 had more than one biopsy. Advancing chronicity was detected in 48 (34.0%) and a renal class switch to worse grade of pathology was found in 54 (38.3%). At least one of these adverse second biopsy features was reported in 79 (56.0%) patients. Five years following initial biopsy, 28 (35.4%) of those with worsening histopathology on second biopsy developed ESRD, compared to 6 (9.7%) of non-worsening patients and 10 (12.7%) of patients with worsening histopathology had died compared to 2 (3.2%) of non-worsening patients. Biopsy worsening was associated with a significantly greater 15-year risk of ESRD (Hazard Ratio 4.2, p = 0.0001) and death (Hazard Ratio 4.3, p = 0.022), adjusting for age, gender, race, biopsy class, and treatment. Time between first and second biopsies was < 1 year in 32 patients, 1–5 years in 81, and > 5 years in 28. Over a 15-year period, those with < 1 year between first and second biopsies (presumably enriched for patients with early clinical signs of progression) had a significantly greater risk of ESRD (Hazard Ratio 13.7, p < 0.0001) and death (Hazard Ratio 16.9, p = 0.0022) after adjusting for age, gender, race, biopsy class, and treatment. Conclusion A repeat renal biopsy demonstrating worsening pathology increases the risk of ESRD and death more than four-fold compared to non-worsening patients. Given known potential mismatch between biopsy and clinical data, repeat biopsies may add important information and justify changes in treatment not considered on clinical grounds. Earlier detection of poor prognostic signs in those without early clinical deterioration might improve outcomes in enough patients to reconsider cost effectiveness of routine repeat biopsy. [ABSTRACT FROM AUTHOR]

Background and Aims: The patients with end stage renal disease (ESRD) are at greater risk of acquiring chronic hepatitis B or C and subsequently development of liver disease. The aim of the study was to assess liver fibrosis by transient elastography (TE) and look for factors associated with change in liver stiffness measurement (LSM) with one session of hemodialysis (HD).Methods: Consecutive ESRD patients on maintenance hemodialysis (MHD) with suspected liver disease were enrolled. They underwent LSM by TE before and after one session of HD. Bioelectric impedance analysis was done to evaluate the volume status at the time of TE.Results: Sixty-eight patients with mean age of 40 ± 14 years were included. There was a significant reduction in LSM after HD (18.5 [95% CI 14.8-23.1] vs. 11.2 [95% CI 8.8-13.7] kPa, p < 0.001), with a mean LSM reduction of 7.2 [95% CI 5.25-9.19] kPa. On stratification in two groups by net ultrafiltration during HD (> or < 2.5 liters [L]), change in LSM was substantially higher in patients when total fluid removed was > 2.5 L (8.6 [95% CI 5.7-11.5] vs. 5.1 [95% CI 2.9-7.5], p = 0.05). In 18 patients who underwent liver biopsy, LSM after HD performed better at detecting significant fibrosis, with area under receiver operating characteristics curve 0.71 [95% CI 0.46-0.97], versus 0.64 [95% CI 0.38-0.90], respectively. An LSM value of 12.2 kPa after HD was 71% sensitive and 74% specific for detection of significant fibrosis (≥ F2), while values less than 9 kPa ruled out significant fibrosis with a sensitivity and specificity of 37 and 100%, respectively.Conclusion: LSM by TE decreases significantly after HD in patients with ESRD on long-term MHD. Hence, TE should be done after HD for accurate assessment of liver fibrosis. [ABSTRACT FROM AUTHOR]

Background: Diabetic nephropathy (DN) is a progressive kidney disease caused by the damage to the capillaries in the kidneys’ glomeruli. Uric acid is the end product of purine catabolism and is excreted in the urine. Uric acid can serve as an inflammatory factor and is attributed to bring about endothelial dysfunction. The causal role of uric acid in the development of diabetic nephropathy is unknown. This study aimed to evaluate the association of serum uric acid level and low levels of estimated glomerular filtration rate (eGFR) which is an indicator of renal disease progression in patients with Type II (T2D) diabetes mellitus. Methods: A cross sectional analytical observational study was conducted on 150 patients with T2D. Since the study was an observational study it involved no medical intervention. Venous blood samples were obtained in fasting state for determination of random blood sugar, serum creatinine, uric acid, (HbA1c) hemoglobin A1c (reference range 3.8-5.5%); and blood urea nitrogen (BUN). Using MDRD formula eGFR was calculated as = 186 x [serum creatinine]-1.154 x [Age] -0.203 x 0.742. The association of renal disease with T2D and the grading of the patients into different stages of renal failure was analysed by eGFR values. Results: Hundred and fifty diagnosed cases of T2D were included in the present study. The mean age of the study population was 63 ± 12.2. No significant age and gender related variation in serum uric acid level was noted in the study population. The prevalence of Hyperuricemia was 19.33%. The mean BMI was significantly higher among hyperuricemic subjects in comparison with normouricemic patients. Hyperuricemia was evident in 75% (n=18) of the subjects with diabetic nephropathy. Stage IV and stage V patients were associated with significantly very high (p < 0.01) uric acid levels. Conclusions: Serum uric acid has a significant positive association with diabetic nephropathy ultimately resulting in end stage renal disease. Treatment intervention is out of the scope of this study. [ABSTRACT FROM AUTHOR]

Background and aims Previous studies show that serum bilirubin has potent antioxidant effect and is associated with protection from kidney damage and reduce cardiovascular events. The aim of this study was to examine the association of serum total bilirubin level and mortality in uremia patients who underwent hemodialysis. Methods This is a nationwide retrospective long-term cohort study. Patients were registered in the Taiwan Renal Registry Data System (TWRDS) from 2005 to 2012. A total of 115,535 hemodialysis patients were surveyed and those with valid baseline total bilirubin (TB) data were enrolled. All-cause mortality was the primary outcome. Results A total of 47,650 hemodialysis patients followed for 27.6 ± 12 months, were divided into 3 groups according to different baseline serum total bilirubin levels (0.1–0.3, 0.3–0.7, 0.7–1.2 mg/dL). Mean age was 61.4 ± 13.6 years, 50% were male, 13% were hepatitis B carriers, and 20% were hepatitis C carriers. Primary outcome was the 3-year mortality. The TB level 0.7–1.2 mg/dL group had high mortality, statistically significant hazard ratio of mortality was 1.14 (crude HR, 95% 1.07–1.20, p < 0.01), and adjusted HR was 1.18 (model 1, 95% CI 1.11–1.25), 1.21 (model 2, 95% CI 1.14–1.29, p < 0.01), 1.44 (model 3, 95% CI 1.06–1.96, p < 0.01), respectively. Sensitivity test showed that after excluding 14,899 patients with hepatitis B or C, or abnormal liver function, the highest level of TB associated with higher significant mortality was still robust. Conclusions In our study, high TB level is associated with mortality in uremia patients undergoing long-term hemodialysis, but further studies of the different effects of unconjugated or conjugated bilirubin on hemodialysis patients are needed. [ABSTRACT FROM AUTHOR]

Systemic inflammation in end-stage renal disease is an established risk factor for mortality and a catalyst for other complications, which are related to a premature aging phenotype, including muscle wasting, vascular calcification, and other forms of premature vascular disease, depression, osteoporosis, and frailty. Uremic inflammation is also mechanistically related to mechanisms involved in the aging process, such as telomere shortening, mitochondrial dysfunction, and altered nutrient sensing, which can have a direct effect on cellular and tissue function. In addition to uremia-specific causes, such as abnormalities in the phosphate-Klotho axis, there are remarkable similarities between the pathophysiology of uremic inflammation and so-called "inflammaging" in the general population. Potentially relevant, but still somewhat unexplored in this respect, are abnormal or misplaced protein structures, as well as abnormalities in tissue homeostasis, which evoke danger signals through damage-associated molecular patterns, as well as the senescenceassociated secretory phenotype. Systemic inflammation, in combination with the loss of kidney function, can impair the resilience of the body to external and internal stressors by reduced functional and structural tissue reserves, and by impairing normal organ crosstalk, thus providing an explanation for the greatly increased risk of homeostatic breakdown in this population. In this review, the relationship between uremic inflammation and a premature aging phenotype, as well as potential causes and consequences, are discussed. [ABSTRACT FROM AUTHOR]

Introduction: We first described the syndrome of rapid onset end stage renal disease (SORO-ESRD), acute yet irreversible renal failure, in 2010. Objective: The impact of SORO-ESRD renal allograft survival remains speculative and we plan to study this question. Methods: A retrospective analysis of individual adult patient-level serum creatinine trajectories of ESRD patients on maintenance hemodialysis for >90 days at Mayo Clinic, Rochester, 2001-2013. Results: Of 1461 ESRD patients, 149 (10%) patients including 13 renal transplant recipients (RTRs) satisfied the diagnosis of SORO-ESRD - 4 males, 9 females, 12 Caucasians/one other, age 45 (18-83) years. Serum creatinine was 1.4 (0.8-1.7) mg/dL in the last year before hemodialysis initiation. Initial hemodialysis access was a dialysis catheter in all 13 patients. AKI precipitating SORO-ESRD followed acute rejection (4), postoperative (2), tubulo-interstitial nephritis (2), unknown (2), infection/sepsis (1), contrast nephropathy (1), BKV nephropathy (1), and cardio-renal syndrome (1). Renal allograft survival was 1469 (277-4939) days (4 years). Renal allograft biopsies were available in 9/14 (69%) RTRs - Four showed acute rejection, two of which followed interruption of immunosuppression, three revealed acute tubular necrosis and four others also showed chronic transplant glomerulopathy. Time on hemodialysis was 856 (129-1630) days (2.4 years). 5/13 RTRs with SORO-ESRD (38%) died - 3 (60%) following cardiac arrest, 2 (40%) after stopping hemodialysis. 4/13 (31%) were re-transplanted in the period of this study. Conclusion: SORO-ESRD contributed significantly to late renal allograft loss and return to hemodialysis with 100% initial dialysis catheter rate. Potentially preventable causes of AKI leading to SORO-ESRD were identified. The application of experience gained from such studies would help reduce late renal allograft loss and the need for re-transplantation. This would further help reduce the yawning gap between need and availability of donor kidney organs both here in the United States and around the world. Larger studies are warranted. [ABSTRACT FROM AUTHOR]

Introduction. According to scientific reports, lack of oral hygiene, as well as disturbances in the calcium-phosphate and iron metabolism disorders are the main causes of periodontitis. The analysis of factors influencing the development and treatment of periodontitis should be conducted parallel in the medical and psychological domain. Aim. The aim of this study was to determine the dependency between the community periodontal index of treatment needs (CPITN) and the beliefs about pain control and biochemical parameters of the iron, calcium and phosphate metabolism. Material and methods. The study was conducted on a group of 124 hemodialysis patients with chronic renal failure aged from 24 to 90 (M=65.47; SD=15.65). The urea reduction rate (URR) was 71.24% and an average dose of dialysis (Kt/V) was 1.35. In the research time the indicators such as the values of serum levels of calcium and phosphorus, transferrin, ferritin, and iron were under control. Patients were diagnosed using the periodontal index of treatment needs (CPITN) and beliefs about pain control questionnaire (BPCQ) in Polish adaptation done by Z. Juczyński. In order to evaluate intergroup differences, the Kruskal-Wallis H test was used. Results. The hemodialysis patients with stage 2 or stage 3 periodontitis (according to CPITN) had the highest levels of transferrin and the lowest levels of ferritin (Table 3.). In contrast, the patients with stage 4 CPITN had the lowest level of transferrin and the highest level of ferritin. No statistically significant differences were observed between the five stages according to the community periodontal index of treatment needs (CPITN) in relation to the three domains of the beliefs about pain control questionnaire (BPCQ). Conclusions. The hemodialyzed patients with the most advanced periodontitis (stage 4 according to CPITN) had the lowest transferrin serum levels and the highest ferritin serum levels. They did not differ in pain control beliefs associated with the community periodontal index of treatment needs (CPITN). [ABSTRACT FROM AUTHOR]

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