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ABSTRACTVaricella Zoster Virus (VZV) infection is a common childhood exanthematous disease, which in adults and immunocompromised people may result in severe neurologic complications. Up to one-third of infected subjects may have VZV clinical reactivation particularly if immunocompromised. Patients affected by end-stage renal disease on hemodialysis present immunodepression that contributes to their higher incidence of VZV infections and reactivation. While antiviral treatment in these patients shows low efficacy, the prevention of VZV through vaccination avoids the primary infection and the risk of reactivation. Two VZV vaccines are currently available: the live attenuate Zoster Vaccine (LZV) and a Recombinant Zoster Vaccine (RZV), with the latter appearing to provide greater efficacy. Given the higher incidence of VZV infection and reactivation, the lesser response to antivirals and the lower impact of VZ vaccine in hemodialysis patients in terms of side effects, a higher diffusion of VZV vaccination should be promoted by nephrologists in these patients in particular in those with future transplant opportunities.

Background: As a common side effect of SLE, lupus nephritis is an immunological complex glomerular nephritis (GN). Its pathogenesis involves a number of pathogenic pathways. The increased incidence of ESRD emphasizes the significance of early diagnosis in this challenging to control disease with unpredictable course that is caused by multiple combinations of genetic variants that compromise those mechanisms normally assuring immune tolerance to nuclear auto antigens. Aim of study: This study aimed to Measuring Level Urinary Epidermal Growth Factor (UEGF) in urine, Neutrophil gelatinase-associated Lipocaline (NG-AL) and measuring the level of complement (C1q, C3, C4) in serum for Lupus Nephritis patients by using ELISA method, this research included eighty female patients with SLE. Methodology: A cross section study of patients with Systemic lupus erythematosus was conducted. Imam AL Hasan Al Mujtaba Hospital in Karbala city during period from November 2022 to March 2023. Results: The findings of the present investigation have demonstrated a considerable reduction of UEGF concentration in Sever Lupus nephritis group, compeer with Moderate Lupus nephritis and other organ SLE group, the mean of UEGF was (145.97±45.55 ng/L) (195.78±60.38 ng/L) (339.15±85.59ng/L) respectively. The findings of this study have demonstrated a considerable rise in NGAL concentration in Sever Lupus nephritis group, compeer with Moderate Lupus nephritis and other organ SLE group, the mean of NGAL was (1027.53± 259.01 ng/ml) (768.82± 228.8) (715.89± 173.9 ng/ml) respectively. The findings of the current investigation showed a negligible decline in C1q in Sever Lupus nephritis group, compeer with Moderate Lupus nephritis and other organ SLE group, the mean of C1q was (8.04± 8.93 µg/ml) (8.44± 1.46 µg/ml) (9.43± 2.52 µg/ml) respectively. The result of C3 show un-Significant reduction in the concentration in the Sever Lupus Nephritis Patients compeer with Moderate Lupus nephritis and other organ SLE, The Mean concentration of C3 (0.79± 0.36 g/l) (0.85± 0.47g/l) (1.04± 0.35g/l) respectively. And the mean concentration of C4 as show un-Significant reduction in the concentration in the Sever Lupus Nephritis Patients compeer with Moderate Lupus nephritis and other organ SLE, The Mean concentration of C4 (0.14± 0.1g/l) (0.31± 0.17g/l) (0.38± 0.2g/l) respectively. Conclusions: Decrease both the level of UEGF expression and urinary excretion after kidney injury and the level of the complement system is a major factor in lupus nephritis-related kidney damage and Increase Neutrophil gelatinase-associated Lipocaline (NGAL) can serve as an early indicator for the diagnosis of acute renal damage. [ABSTRACT FROM AUTHOR]

Objective To investigate the attitudes and influencing factors of transplantation-related populations towards kidney xenotransplantation. Methods From June 2022 to January 2023, stratified random sampling was performed from patients awaiting kidney transplantation, patients after kidney transplantation, patients' relatives and medical students. Four hundred subjects were collected from each population and 1600 subjects were investigated using a self-designed questionnaire. Baseline data of the respondents, their attitudes towards kidney xenotransplantation and the reasons of rejecting kidney xenotransplantation were analyzed. The influencing factors of attitudes towards kidney xenotransplantation were also identified. Results A total of 1 493 valid questionnaires were collected, and the questionnaire retrieval rate was 93.31%. About 93.10% of the respondents accepted allogeneic kidney transplantation, and 66.78% had heard of kidney xenotransplantation. Seven hundred and ninety-five respondents suggested that they could accept kidney xenotransplantation "when kidney xenotransplantation and allogeneic kidney transplantation yielded the same results and risks". Six hundred and ninety-eight respondents indicated that they were "unable" or "uncertain" whether they could accept kidney xenotransplantation (χ² =16.409, P=0.001). Among these 698 respondents, the proportion of them who were willing to accept kidney xenotransplantation when they did not meet the conditions of allogeneic kidney transplantation was 10.9%. About 35.8% of respondents were willing to accept kidney xenotransplantation if it yielded less risk and better prognosis compared with allogeneic kidney transplantation. If the time of awaiting kidney xenotransplantation was shorter than that of allogeneic kidney transplantation, 21.2% were willing to accept kidney xenotransplantation. If the cost of kidney xenotransplantation was less than that of allogeneic kidney transplantation, 24.5% of them were willing to accept kidney xenotransplantation. The main reasons of rejecting kidney xenotransplantation included surgical risk and other unknown risks. Multivariate analysis showed that respondents residing in cities and towns for a long period of time, those who accept allogeneic kidney transplantation and those who have heard of kidney xenotransplantation showed more positive attitudes towards kidney xenotransplantation. Conclusions Different transplantation-related populations have different attitudes towards kidney xenotransplantation, and the overall attitudes are positive. Active promotion of kidney xenotransplantation research and carrying out relevant popular science education contribute to improving public attitudes towards the acceptance of kidney xenotransplantation. [ABSTRACT FROM AUTHOR]

Background: Haptoglobin (HP), a plasma glycoprotein, binds to free hemoglobin and prevents the loss of iron and kidney damage. The variations of HP gene affect its enzyme activity, resulting in varied antioxidant, angiogenic and anti-inflammatory properties. HP 2-2 genotype showed 3.84 fold increased risk for the development of CKD in Taiwan population. With this background, the present work focused to conduct a prospective case-control study in South Indian population to evaluate whether the HP variants are associated to nondialysis (ND) (CKD stages 1–4) and ESRD (CKD stage 5) conditions. Methods and results: Totally 392 CKD patients (nondialysis, ND; n = 170, end-stage renal disease, ESRD; n = 222) and 202 healthy individuals were enrolled. The blood samples collected from the patients were used to determine biochemical parameters and HP genotyping. Gene frequency and biochemical parameters were statistically analyzed for disease association. Results showed that HP 2-2 genotypes were significantly associated with ND and ESRD disease development compared to controls. Higher HP2-2 genotype frequency showed an increased hazard ratio for overall disease progression among ND patients (hazard ratio = 3.86; 95% CI 1.88 to 7.93; P = 0.0002). Survival analysis also showed that non-HP2-2 patients have a statistically significantly decreased risk for mortality compared to patients with the HP2-2 genotype (ESRD patients hazard ratio = 4.05; P = 0.04). Conclusion: The present study confirms that HP2-2 polymorphism is statistically associated with the risk of CKD incidence, progression, and mortality among South Indians. Concluding our results, the HP2-2 genotype could be an independent predictor of all-cause mortality and disease progression in patients with CKD. [ABSTRACT FROM AUTHOR]

The bioethics literature has paid little attention to matters of informed reproductive decision-making among women of childbearing age who have chronic kidney disease (CKD), including women who are on dialysis or women who have had a kidney transplant. Women with CKD receive inconsistent and, sometimes, inadequate reproductive counseling, particularly with respect to information about pursuing pregnancy. We identify four factors that might contribute to inadequate and inconsistent reproductive counseling. We argue that women with CKD should receive comprehensive reproductive counseling, including information about the possibility of pursuing pregnancy, and that more rigorous research on pregnancy in women with CKD, including women on dialysis or who have received a kidney transplant, is warranted to improve informed reproductive decision making in this population. [ABSTRACT FROM AUTHOR]

Introduction: Nutritional status is compromised in End-Stage Renal Disease (ESRD) patients on dialysis. In order to predict the clinical outcomes of these patients, the diagnosis of nutritional status becomes extremely important. However, data related to parameters assessing nutritional status are limited. Aim: The aim of this study was to assess the nutritional status of dialysis patients with ESRD at the renal care unit of a tertiary care hospital. Materials and Methods: A cross-sectional study was conducted at the renal care unit of a tertiary care hospital from January 2016 to July 2016. Fifty individuals were divided into two groups: 30 stable ESRD patients on Haemodialysis (HD) and 20 stable ESRD patients on Continuous Ambulatory Peritoneal Dialysis (CAPD). Data were collected using a questionnaire regarding nutritional assessment, which comprised medical history, food intake history, anthropometry, biochemical investigations, and Subjective Global Assessment (SGA). Based on the SGA analysis of nutritional status, the patients were divided into Categories A, B, and C. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 22.0. Results: A total of 50 subjects were included in the final analysis - 30 patients in the renal dialysis group and 20 patients in the CAPD group. Body Mass Index (BMI) was significantly higher in the HD group (21.78±2.86 kg/m²) than in the CAPD group (20.87±2.63 kg/m²). In the HD group, the majority were in Category B (60%). In the CAPD group, the majority were in Category B (70%). The mean anthropometric measurements were significantly higher in Category A, followed by B and C (p<0.001). There was no significant difference across groups in biochemical parameters, except for serum albumin levels, which were significant. Serum albumin levels were highest in Category A, followed by Category B, and Category C in reverse for S. Prealbumin (mg/dl). Conclusion: There is a significant number of ESRD patients who have malnutrition as an additional burden. These results suggest that low BMI and low calorie intake are harmful to ESRD patients on HD, causing severe malnutrition. Optimal calorie intake could reduce malnutrition in these patients. [ABSTRACT FROM AUTHOR]

Background: Autogenous Arterivenous (AV) access is the preferred choice for hemodialysis access in chronic kidney patients. Cimino fistulas are currently accepted as the best mode of vascular access for hemodialysis. The present study was planned to look for the presence of on table bruit and thrill and to know the postoperative outcome and patency. Material and Methods: This single center, prospective study was done in the department of vascular surgery at SMC, from January 2020 - January-2021. Dominance of hand was noted, and preference was given to non- dominant hand. Physical examination of the arterial system along with venous system was done. Preoperative color Doppler of upper limb veins and arteries was done in all the patients. Results: In study of 291 AV access, there were 161(55.3%) AV access which were successfully used for hemodialysis and 83(28.5%) were not. Arterial diameters was significantly found to be higher in those patients with patent AVFs. Conclusion: Creating and maintaining an autogenous AV access for hemodialysis is a complex process subject to patient specific characteristics and surgical expertise. This study suggests that patency rates and functional outcomes of dialysis access procedures are better in patients who are non-smokers, without comorbidities, without previous H/O AVF failure. [ABSTRACT FROM AUTHOR]

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.

Objective: To determine the frequency of catheter related bacterial infections among the patients on hemodialysis due to end stage renal disease. Study Design: Cross sectional study Place and Duration of Study: Department of Nephrology, Sharif Medical City Hospital, Lahore Pakistan, from 6 Months i.e., Jun 2021 to Oct 2021. Methodology: After meeting the inclusion and exclusion criteria 171 patients were enrolled. Tips of the catheters were removed by the surgeon and transferred to laboratory in a sterile container, while at least two blood culture samples were taken before removing the catheter. Catheter related bacterial infections were noted. Results: In this study the most common catheter related bacterial infection in ESRD cases on hemodialysis was blood stream tunnel infection noted in 48.5% patients followed by, infective endocarditis noted in 28.1%, echo vegetation in 26.3% patients, tunnel infection in 25.1% and exit site infection in 23.4% patients. Conclusion: The most common catheter related bacterial infection in ESRD cases on hemodialysis was blood stream tunnel infection followed by, infective endocarditis, echo vegetation, tunnel infection and exit site infection patients.

Introductioin : Intradialytic complications are still being debated among health workers in the Hemodialysis Unit in Hospitals, many factors can cause patients to experience complications during dialysis. This study aims to identify the factors that contribute to the incidence of intradialytic complications in order to minimize the incidence of complications. Methode : This study used a research design in the form of analytic descriptive with cross-sectional. The sampling technique was a consecutive sampling of 120 patients. The chi-square statistical test aims to examine differences in proportions. If the results of the bivariate test have p

Background: Cardiac involvement is common in end-stage renal disease patients. The presenting study aimed to evaluate the global and segmental longitudinal strain in patients with advanced uremic cardiomyopathy (AUCM) and compare it to dilated cardiomyopathy (DCM). Results: The mean global longitudinal strain (GLS) was significantly lower in AUCM (P value = 0.045). Comparing segmental strain showed a lower strain in mid inferoseptal (P value = 0.048), base and mid anterolateral (P value = 0.026, 0.001 respectively), base and mid anteroseptal (P value = 0.005, 0.009 respectively), base and mid inferior (P value = 0.015, 0.034 respectively) and mid anterior (P value = 0.015) in patients with AUCM compared with DCM. In both groups, the segmental strain increased from base to apex. Conclusions: Segmental and GLSs in advanced uremic cardiomyopathy were significantly lower than those of dilated cardiomyopathy. In both groups, the segmental strain increased from base to apex. [ABSTRACT FROM AUTHOR]

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SGLT-2i are the new standard of care for diabetic kidney disease (DKD), but previous studies have not included patients on kidney replacement therapy (KRT). Due to their high risk of cardiovascular, renal complications, and mortality, these patients would benefit the most from this therapy. Residual kidney function (RKF) conveys a survival benefit and cardiovascular health among hemodialysis (HD) patients, especially those on incremental hemodialysis (iHD). We retrospectively describe the safety and efficacy of SGLT2i regarding RKF preservation in seven diabetic patients with different clinical backgrounds who underwent iHD (one or two sessions per week) during a 12-month follow-up. All patients preserved RKF, measured as residual kidney urea clearance (KrU) in 24 h after the introduction of SGLT2i. KrU levels improved significantly from 4.91 ± 1.14 mL/min to 7.28 ± 1.68 mL/min at 12 months (p = 0.028). Pre-hemodialysis blood pressure improved 9.95% in mean systolic blood pressure (SBP) (p = 0.015) and 10.95% in mean diastolic blood pressure (DBP) (p = 0.041); as a result, antihypertensive medication was modified. Improvements in blood uric acid, hemoglobin A1c, urine albumin/creatinine ratio (UACR), and 24 h proteinuria were also significant. Regarding side effects, two patients developed uncomplicated urinary tract infections that were resolved. No other complications were reported. The use of SGLT2i in our sample of DKD patients starting iHD on a 1–2 weekly regimen appears to be safe and effective in preserving RKF. [ABSTRACT FROM AUTHOR]

Introduction: Patients with diabetes and heart failure (HF) can have varying outcomes depending on whether they also have End Stage Renal Disease (ESRD). This study aimed to compare the outcomes of patients with diabetes and HF with and without ESRD. Methods: Data from the National Inpatient Sample (NIS) 2016-2018 was analyzed to find hospitalizations for patients with HF as the main diagnosis and diabetes as a secondary diagnosis, with and without ESRD. Multivariable logistic and linear regression analysis was used to adjust for confounding factors. Results: In the total cohort of 12215 patients with a principal diagnosis of heart failure and secondary diagnosis of type 2 diabetes, the in-hospital mortality rate was 2.5%. Patients with ESRD had higher odds of in-hospital mortality (1.37x) compared to those without ESRD. The mean difference in length of stay was higher for patients with ESRD (0.49 days) and in total hospital charges (13360 US$). Patients with ESRD had higher odds of developing acute pulmonary edema, cardiac arrest, and requiring endotracheal intubation. However, they had lower odds of developing cardiogenic shock or requiring an intra-aortic balloon pump insertion. Conclusion: The results suggest that ESRD leads to higher in-patient mortality, length of stay, and total hospital charges for patients with diabetes admitted for HF. The lower incidence of cardiogenic shock and intra-aortic balloon pump insertion in patients with ESRD may be due to timely dialysis.

Aim:Primary glomerulonephritis (GN) is a rare disease that has many different subtypes and is a significant health problem. Patients with primary GN (PGN) often do not achieve a complete cure, typically require immunosuppressive therapy, and can have serious co-morbidities due to the disease, which often progresses to end-stage renal disease (ESRD). The current study aimed to investigate the epidemiological, clinicodemographic characteristics and long-term outcomes of PGN patients.Materials and Methods:The current study retrospectively evaluated the demographic characteristics and complaints as well as the physical examination and laboratory findings of PGN patients who were followed-up and treated in the nephrology department of our university hospital between January 2000 and June 2016.Results:Of the 485 included patients, 265 were male (55%) and 220 were female (45%). The median age at diagnosis was 38.5 years (range; 18-77). The most frequent indication for biopsy was nephrotic syndrome (53.2%). The most common histopathological diagnoses were IgA nephritis (33.2%), focal segmental GN (31.1%), and membranous GN (19.6%), respectively. It was observed that male gender (p=0.01), systemic hypertension (p=0.01) at the time of diagnosis, proteinuria (p=0.001) in the nephrotic range, and histological diagnosis of crescentic GN (p=0.001) contributed negatively to renal survival. The mean follow-up duration after diagnosis was 59.1±48.5 months. The median overall survival was 153 (range; 1-197) months. Survival was significantly lower in patients with ESRD compared to those without ESRD (p=0.003). On clinical follow up, 48 patients died (9.9%), and 94 patients (19.3%) progressed to ESRD.Conclusion:Clearly defining the etiology of PGN as well as determining the factors leading to ESRD may decrease morbidity and mortality.

Background: Patients with end stage renal disease under hemodialysis are at increased risk for morbidities and mortality. Cardiovascular diseases are independent risk for death among those patients. Echocardiography is a non-invasive method that helps identification of the problem and risk stratification.Aim of the work: The study aimed to determine whether left ventricular function differs in pre-dialytic compared with post-dialytic periods, and to recognize relationship between hemodialysis and left ventricular function.Patients and Methods: Patients undergoing hemodialysis in the duration between August 2022 and February 2023 in Alhussein University Hospitals were eligible to participate. They underwent echocardiographic assessment in 2 times; pre- and immediately after dialysis session.Results: Fifty patients undergoing regular hemodialysis were recruited in the study. Their mean age was 48.92 ± 6.93 years old. 70% of patients [35 patients] were males. All patients were hypertensive, while 46% of them [23 patients] were diabetic. We found that there was a slight improvement of both systolic and diastolic functions assessed by M-mode, Simpson method, 3D and Doppler study. however, none of this improvement was statistically significant.Conclusion: No significant change in both cardiac structure and function can occur immediately after the dialysis sessions. That is why longer follow up period is recommended for future research.

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.

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.

BackgroundCardiovascular disease is the major cause of mortality in end stage renal disease (ESRD) patients on dialysis and myocardial infarction constitutes almost 20% of such deaths. We assessed the trends, characteristics and in-hospital outcomes in patients with ESRD.MethodsWe used national inpatient sample (NIS) to identify patients with ESRD presenting with ST-segment elevation myocardial infarction (STEMI) for calendar years 2012-2016. Multiple logistic regression analysis and propensity matched data was used to compare outcomes for the purpose of our study.ResultsPatients on dialysis who presented with STEMI were less likely to be treated with emergent reperfusion therapies including percutaneous coronary intervention, bypass graft surgery and thrombolytics with in first 24 h. In propensity-matched cohort, the mortality was nearly double in patients who have ESRD compared to patients without ESRD (29.7% vs. 15.9%, p

Arterio-venous fistulas (AVFs) are recommended as the first line vascular access option in patients requiring hemodialysis in end-stage renal disease (ESRD). Prosthetic grafts have been used successfully as an alternative in cases where AVF is not feasible. We present a rare case of dissection of the prosthetic graft. Knowledge and recognition of this complication is important in making correct diagnosis and deciding appropriate treatment.

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.

A novel simple optical sensor based on fast protein liquid chromatography was developed and tested for monitoring end stage renal disease (ESRD) patients treated with continuous ambulatory peritoneal dialysis (CAPD). The device provides direct determination of proteins and lower molecular weight metabolites in effluent peritoneal dialysate using ultraviolet (UV) photometric detection at the wavelengths 285 nm or 260 nm with deep ultraviolet light-emitting diodes. The sensor was calibrated with bovine serum albumin and nucleotides standard solutions. Chromatograms of peritoneal dialysate samples taken from a group of 28 ESRD patients were processed and approximated by a set of split-Gaussian functions. All chromatograms show three overlapping peaks: the first one represents proteins; the other two peaks probably correspond to mid- and low molecular weight metabolites. Strong correlation was reveled between the area of the first peak and total protein concentration determined by a standard biochemical assay, this makes possible estimation of peritoneal protein loss with a reasonable precision less than 15%. The area of the second peak correlated with dialysate optical density at a wavelength 355–365 nm, associated with the UV absorption of advanced glycation end (AGE) products. The third peak correlated with the optical density of the eluate at a wavelength 255–265 nm, associated with the UV absorption of purines and pyrimidines. Thus, we demonstrated the possibility of estimation of proteins and lower molecular weight metabolites in effluent peritoneal dialysate with the compact and affordable chromatographic optical sensor. [ABSTRACT FROM AUTHOR]

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

Peritoneal dialysis (PD) is one of the options for renal replacement therapy (RRT) in the end stage renal disease (ESRD) patients. Compared to hemodialysis (HD), patients on PD experience a greater sense of well-being, an improved steady state in terms of extracellular fluid volume shifts and hemodynamics and it is preferred method for patients with problematic vascular access, bleeding tendencies, heart failure and elderly patients. In order to perform PD, a tunneled catheter should be placed through the abdominal wall and into peritoneal space, with positioning of the catheter within the most dependent portion of pelvis. Currently, there are several techniques available for PD catheter placement: open surgery, laparoscopic and percutaneous. We present for the first time in our country a case of 65 year old male patient to whom percutaneous onsite insertion of peritoneal catheter was performed. The idea is to emphasize that sometimes this should be a method of choice for RRT, especially in patients where general anesthesia should be avoid. Compared to other methods, percutaneous insertion is a simple procedure with no need for general anesthesia, and the benefits of quick recovery, earlier ambulation, and less delay in catheter placement. [ABSTRACT FROM AUTHOR]