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Introduction Methods Results Discussion Medial femoral cutaneous (MFC) sensory nerve action potentials (SNAPs) can be easily recorded using distal stimulation. This study aimed to identify a new parameter using MFC SNAPs for the early electrophysiological diagnosis of length‐dependent axonal polyneuropathy (LDAP) associated with uremic neuropathy.Patients with chronic renal failure who were referred to the electrodiagnostic laboratory due to symptoms suggesting polyneuropathy were included. Assessments encompassed neurological examination, Michigan Neuropathy Screening Instrument (MNSI), and Semmes–Weinstein monofilament test. Antidromic radial, median, ulnar, MFC, sural, and superficial peroneal sensory; median, ulnar, tibial, and peroneal motor nerve conduction studies were performed. Sural‐to‐radial amplitude ratio (SRAR) and sural‐to‐medial femoral cutaneous amplitude ratio (SMFCAR) were calculated, and their diagnostic sensitivities were compared with the age and sex matched healthy controls.Thirty‐two chronic renal failure patients (mean age 60.0 ± 9.6 years) and 37 controls (60.6 ± 9 years) were included. MNSI indicated clinical polyneuropathy in 59.4% of patients, while sural SNAP amplitude was diagnostic in 78%. Median SRAR and SMFCAR values were significantly lower in patients than controls (p < .001 for both). The cut‐off values for SMFCAR and SRAR were <1.82 and <0.30, respectively, both with a sensitivity of 59% and a specificity of 94%.Sural SNAP is the most sensitive parameter in the diagnosis of LDAP. SMFCAR is not superior to SRAR. If the sural SNAP amplitude is normal, SMFCAR can serve as an alternative to SRAR in dialysis patients with bilateral arteriovenous fistulae or in those unable to undergo radial NCS. [ABSTRACT FROM AUTHOR]

Background: The survival of pediatric chronic kidney disease (CKD) patients has improved in recent decades due to advances in dialysis and transplantation. However, cardiovascular disease (CVD) emerges as the main cause of mortality in patients with CKD. Objectives: To estimate cardiovascular risk in children with CKD at least 1 year after kidney transplantation. In addition, the possible association of cardiovascular risk with classic biochemical markers and potential new markers of this outcome was investigated. Methods: An observational ambidirectional (retrospective capture of risk factors and prospective study of outcomes) research including 75 patients who underwent renal transplant between 2003 and 2013 with postoperative follow‐up of at least 1 year was conducted. The outcome variables adopted were the LV mass Z‐score and the presence of coronary calcification on computed tomography using calcium Agatston score. Result: Only one patient had an elevated calcium score, and three children (4%) had an LV mass Z‐score ≥ 2.0. After multivariable analysis, only gender, serum triglyceride, and serum renalase concentration remained significantly associated with LV mass. Conclusion: The low incidence of cardiovascular changes in the population studied confirms the benefit of transplantation for the cardiovascular health of children. Nevertheless, long‐term follow‐up of these patients is recommended, given the limited duration of kidney function provided by transplantation and the high likelihood of further dialysis and kidney transplants being required in these children. [ABSTRACT FROM AUTHOR]

Chronic kidney disease is a significant cause of morbidity and mortality worldwide. In recent years, Galectin-3 has been put forward as a potential biomarker of chronic kidney disease progression. This review aims to assess the clinical utility of Galectin-3 in various pathological processes leading up to chronic kidney disease such as diabetes and lupus nephritis. We conducted a systematic search on PubMed from inception to September 2023, using the search term ("Galectin-3" OR "gal-3") AND ("renal" OR "kidney"). Galectin-3 has been shown to be both pro-fibrotic and protective against renal fibrosis through various mechanisms such as apoptotic body clearance and modulation of the Wnt pathway. Studies have found associations between raised Galectin-3, incidence and progression of chronic kidney disease. In lupus nephritis, Galectin-3 may serve as a biomarker for lupus nephritis activity. Although Galectin-3 inhibits cystogenesis, there is no correlation between total kidney volume and Galectin-3 in polycystic kidney disease. The role of Galectin-3 in staging and prognostication of renal cell carcinoma is yet to be determined. Galectin-3 has potential in predicting chronic kidney disease progression, in combination with other biomarkers. However, more trials are required given that present studies demonstrate conflicting results on the relationship between Galectin-3 and clinical outcomes in chronic kidney disease patients of varying aetiologies. [ABSTRACT FROM AUTHOR]

Background: Chronic renal failure poses a significant global health challenge, exerting a substantial burden on both patients and their caregivers. Hemodialysis, a common treatment for end-stage renal disease, imposes extensive physical, emotional, and financial pressures on caregivers, often leading to a high care burden. This study uniquely examines the impact of peer support groups on reducing the care burden among caregivers of patients receiving hemodialysis in an Iranian healthcare setting, an aspect that has not been extensively explored before. Methods: A parallel-controlled clinical trial was conducted involving 60 caregivers, divided into intervention and control groups. The intervention group participated in an 8-session peer support program tailored to their identified needs, including coping with stress, social isolation, and financial challenges. The Zarit Care Burden Interview Scale was used to measure care burden before and after the intervention. Results: The study revealed statistically significant reductions in care burden, particularly in physical, social, and emotional dimensions, among caregivers in the intervention group compared to the control group. The total care burden score showed a marked decrease, indicating the effectiveness of the peer support intervention. While economic challenges remained a concern, the intervention had a limited impact in this domain. Conclusion: This study demonstrates that peer support groups significantly alleviate the care burden experienced by caregivers of patients receiving hemodialysis, improving their well-being across several dimensions. The findings highlight the importance of integrating peer support strategies into healthcare programs for chronic disease management and underscore the need for supplementary economic support measures to comprehensively address caregivers' needs. Future research should explore the scalability and long-term sustainability of such interventions and address the unique economic challenges faced by these caregivers. Trial registration: This study was registered in the Iranian Registry of Clinical Trials (IRCT) under the registration number IRCT20220724055540N1 on 11/08/2022. [ABSTRACT FROM AUTHOR]

Background : Prognostic models that identify individuals with chronic kidney disease (CKD) at greatest risk of developing kidney failure help clinicians to make decisions and deliver precision medicine. It is recognised that people with CKD usually have multiple long-term health conditions (multimorbidity) and often experience frailty. We undertook a systematic review to evaluate the representation and consideration of multimorbidity and frailty within CKD cohorts used to develop and/or validate prognostic models assessing the risk of kidney failure. Methods: We identified studies that described derivation, validation or update of kidney failure prognostic models in MEDLINE, CINAHL Plus and the Cochrane Library—CENTRAL. The primary outcome was representation of multimorbidity or frailty. The secondary outcome was predictive accuracy of identified models in relation to presence of multimorbidity or frailty. Results: Ninety-seven studies reporting 121 different kidney failure prognostic models were identified. Two studies reported prevalence of multimorbidity and a single study reported prevalence of frailty. The rates of specific comorbidities were reported in a greater proportion of studies: 67.0% reported baseline data on diabetes, 54.6% reported hypertension and 39.2% reported cardiovascular disease. No studies included frailty in model development, and only one study considered multimorbidity as a predictor variable. No studies assessed model performance in populations in relation to multimorbidity. A single study assessed associations between frailty and the risks of kidney failure and death. Conclusions: There is a paucity of kidney failure risk prediction models that consider the impact of multimorbidity and/or frailty, resulting in a lack of clear evidence-based practice for multimorbid or frail individuals. These knowledge gaps should be explored to help clinicians know whether these models can be used for CKD patients who experience multimorbidity and/or frailty. Systematic review registration: This review has been registered on PROSPERO (CRD42022347295). [ABSTRACT FROM AUTHOR]

Objective: To perform a systematic review with meta‐analysis to assess recent scientific evidence on the association between periodontitis and systemic parameters/conditions in individuals with chronic kidney disease (CKD). Materials and Methods: The search for studies was performed in MedLine/PubMed, Scopus, Web of Science, and BIREME databases. Reference lists of selected articles were also searched. Studies with different epidemiological designs evaluating the influence of exposure to periodontitis on serum markers and mortality in individuals with CKD were eligible for inclusion. Three independent reviewers performed the article selection and data extraction. The assessment of methodological quality used the adapted Newcastle Ottawa Scale. Random effects meta‐analysis was performed to calculate association measurements and 95% confidence intervals. Results: In total, 3053 records were identified in the database search, with only 25 studies meeting the eligibility criteria and, of these, 10 studies contributed data for meta‐analysis. Using a random‐effects model, periodontitis was associated with hypoalbuminemia (PRunadjusted = 2.47; 95%CI:1.43–4.26), with high levels of C‐reactive protein (PRunadjusted = 1.35; 95%CI%:1.12–1.64), death from cardiovascular disease (RRunadjusted = 2.29; 95%CI:1.67–3.15) and death from all causes (RRunadjusted = 1.73; 95%CI:1.32–2.27). Conclusions: The findings of this review validated a positive association between periodontitis and serum markers and mortality data in individuals with CKD. [ABSTRACT FROM AUTHOR]

Background: Despite a meticulous multidisciplinary team approach, limb salvage remains uncertain even after the initial forefoot amputation in patients with end-stage diabetes. Which of many factors strongly influence the early failure of the limb salvage strategy remains unknown. This study aimed to analyze perioperative independent risk factors for major amputation within 1 year following first-time diabetic forefoot amputation. Methods: Perioperative variables of 808 diabetic forefoot amputations performed in a tertiary referral center specialized for organ transplantation and end-stage diabetes were analyzed. Major amputations were performed in 104 patients (12.9%) throughout follow-up, and 77 (74%) of 104 patients had their major amputation within 1 year. Cox proportional hazards were examined to assess the risk factors for major amputation performed within 1 year. Results: In univariate analysis, 18 possible risk factors significantly differed between patients with and without early major amputation. In stepwise multivariable analysis, chronic renal failure (CRF), peritoneal dialysis, and bilateral initial amputation were strong risk factors for early major amputation, with hazard ratios of 2.973 (95% CI 1.805-4.896, P <.0001), 2.558 (95% CI 1.113-5.881, P =.027), and 2.515 (95% CI 1.318-4.798, P =.005), respectively. Conclusion: Regardless of kidney transplantation (KT) status, CRF strongly predicts >20% chance of major amputation within 1 year after the first diabetic forefoot amputation. [ABSTRACT FROM AUTHOR]

Background and purpose: Peak width of skeletonized mean diffusivity (PSMD) is an MRI-based biomarker that may reflect white matter lesions (WML). PSMD is based on skeletonization of MR DTI data and histogram analysis. Both chronic renal failure (CRF) and WML may be affected by multisystemic small-vessel disorder. We aimed to explore the relationship between PSMD and estimated glomerular filtration rate (eGFR). Methods: Fifty followed-up CRF patients matched for age, sex, hypertension and smoking status were enrolled and classified into a progressive group (n = 16) and stable group (n = 34) based on eGFR levels. Longitudinal and horizontal differences of PSMD were compared between the progressive and stable groups at the initial and follow-up time points. Pearson's correlation was used for correlation of eGFR with PSMD and WML (per Fazekas scale score). ROC was used to measure the sensitivity of PSMD and WML score to changes of eGFR. Results: At the follow-up time point, PSMD of the progressive group was significantly higher than at the initial time point (p < 0.001), and PSMD of the progressive group was significantly higher than stable group (p < 0.001). PSMD and eGFR were significantly correlated. AUC curves explored that PSMD (PSMD changes at the follow-up and initial time points) and follow-up PSMD was better for the classification of progressive and stable groups. Conclusion: PSMD has significant correlation with eGFR, PSMD can reveal a close relationship between WML and CRF. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) affects adults' population and has a high morbidity and mortality rate. CKD represents an important public health problem that affects cardiovascular disease and impacts the quality of life. CKD is defined as the presence of kidney damage or an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 mt2, persisting for 3 months or more, irrespective of the cause. Aim: This paper aimed to explore the prevalence of chronic renal failure and its related factors in the Southern region of KSA. Methodology: An observational descriptive retrospective study was conducted between September and November 2023. Patients suffering from chronic renal failure in the South region of KSA were the target respondents. Data collection included socio-demographics characteristics of the patients, history of chronic renal failure disease, and history of other chronic disease as well. Results: All of 163 patients diagnosed with CKD had hypertension, 70.4% of them were diagnosed with hypertension for almost more than 10 years, 36% suffered from diabetes, 98.8% did not suffer from allergies, and 10.4% did suffer from ischemic heart disease. Conclusion: The associated risk factors of chronic renal failure among Saudi patients in the Southern region mainly endangered those aged from 50 to 70 years old. As people age, screening for risk factors of CKD becomes a priority for all healthcare professionals; screening will achieve earlier detection and provide greater possibility to control predisposing risk factors to delay further deterioration in kidney function. Among the several identified risk factors, hypertension has been the most common, classically in essential hypertension [ABSTRACT FROM AUTHOR]

Objective: In this study we aimed to investigate correlation between computed tomography (CT) histogram analysis of kidney parenchyma and renal functional status. Material and Method: Renal parenchyma CT densities were measured by using a region of interest (ROI) from both cortex and medulla, who had a non-contrast CT of abdomen (120 kV) and serum creatinine level in the same day in a cohort of 225 patients (115 female, 110 male). Serum creatinine levels were within normal limits in 186 and high in 39 of patients. ROI histogram data was analyzed by using Matlab® program which calculated the median, mean, maxiumum, minimum, standard deviation, variance, entropy, size % L, size % U, size % M, kurtosis, skewness and uniformity values. Results: Age and gender were significantly different among the groups (age p <0.001, gender p =0.002). Significant correlations was noted between serum creatinine level and kidney medulla mean (r=-0.22, p <0.001), maximum (r =-0,16, p <0.05), median (r =-0.17, p <0.001), size % L (r =-0.14, p <0.05) and entropy (r =-0.13, p <0.05) values as well as size %U (r =-0.14, p <0.05), size %M (r =0.14, p <0.05) density from kidney cortex. There was significant difference among patients with normal and high creatinine levels in terms of median (p =0.011), mean (p =0.004), size %M (p =0.032), and uniformity (p =0.045) values from kidney medulla as well as entropy (p =0.036) value from cortex. Conclusion: There is a negative correlation between serum creatinine levels and renal parenchyma CT densities particulary from medulla. Decreased renal function should be predicted by calculating the histogram analysis of kidney from cortex or medulla in a non-enhanced abdomen CT. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the efficacy of oral roxadustat plus L-carnitine for dialysis-induced anemia in patients with chronic renal failure (CRF). Methods: This was a retrospective analysis of 46 patients conducted on 100 CRF cases with dialysisinduced anemia treated at Xinjiang Armed Police Crops Hospital from March 2020 to March 2023. The participants were randomly distributed into study (n = 54) and control groups (n = 46). The control group received oral roxadustat (100 mg for patients weighing 45 - 60 kg, and 120 mg for patients = 60 kg, thrice per week), while the study group was administered roxadustat in combination with L-carnitine (2 g injected using the dialysis machine before the end of each session). Anemia indices, and iron metabolism indices in the two groups were assessed before treatment and 3 months after treatment. Adverse effects were compared between groups. Results: The study group showed significantly higher red blood cell count, haemoglobin level as well as haematocrit after treatment compared to control group (p > 0.05). Also, total iron binding capacity, and serum iron and ferritin levels were significantly higher in the study group than in the control group (p < 0.05). Conclusion: Roxadustat combined with L-carnitine significantly reduces anemia and improves iron metabolism without increasing adverse reactions. However, there is a need for additional studies to assess the therapeutic potential of this combined regimen. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) has considerable effects on the quality of life of female patients. Receiving the diagnosis and beginning renal replacement therapy (RRT) has a great personal impact on patients. The purpose of this study was to describe the experience of female patients with CKD at an ambulatory dialysis unit regarding diagnosis, life changes, and initiation of RRT. A qualitative exploratory study was conducted based on a social contructivism framework. Participants were recruited using purposeful sampling. In total, 18 women who received treatment for CKD with RRT were included. The women were attending the Ambulatory Dialysis Unit at a hospital belonging to the public health system of Madrid (Spain). Unstructured and semi-structured in-depth interviews, researchers' field notes, and women's personal letters were used. A systematic text condensation analysis was performed. The criteria used to control trustworthiness were credibility, transferability, dependability, and confirmability. Two themes emerged from the data: (a) A turning point in their lives, and (b) The emotional journey of beginning RRT. The diagnosis of CKD and the beginning of treatment implies changing routines and adapting to a new life with CKD. The first dialysis and puncture of the arteriovenous fistula is a major experience. Support from other CKD patients with more experience is perceived as a necessity and a tool to share their experiences and resolve doubts among peers. The diagnosis and initiation of RRT leads to numerous changes in the lives of women with CKD, which may influence the acceptance of treatment. [ABSTRACT FROM AUTHOR]

Introduction- Autonomic dysfunction commonly presents with Chronic Renal Failure. Its pathophysiology is obscure. Autonomic dysfunction contributes to cardiovascular morbidity and mortality and can be evaluated with heart rate variability (HRV). AIM- To evaluate the correlation of chronic kidney disease duration with Heart Rate Variability parameters to better understand autonomic dysfunction in chronic renal failure Materials and Method The present cross sectional observational study was carried out in Department of Physiology at King George’s Medical University, Lucknow UP from April 2019 to march 2020, on 92 patients of chronic kidney disease. Heart rate variability of the subjects was assessed from five-minute digitalized Electrocardiography. The Coefficient of correlation (r value) of heart rate variability parameters (both time and frequency domain) with respect to duration of CKD were calculated. The data was analyzed for changes in HRV parameters in relation to CKD duration. Results The analysis showed Time domain HRV parameters had negative Coefficient of correlation (-r value) with respect to CKD duration indicating deteriorating autonomic balance with CKD duration. Frequency domain parameters showed differential change. The relative low frequency (LF) component showed + r value. The high frequency (HF) showed -r values. The LF mainly corresponds to sympathetic and HF Parasympathetic arm of Autonomic Nervous System. The result emphasize that CKD duration causes relative increased sympathetic and decreased parasympathetic effect (sympathovagal imbalance). Conclusion: This study showed that CKD duration have negative impact on HRV parameters implying deterioration of autonomic system. [ABSTRACT FROM AUTHOR]

Abstract Background Chronic renal failure poses a significant global health challenge, exerting a substantial burden on both patients and their caregivers. Hemodialysis, a common treatment for end-stage renal disease, imposes extensive physical, emotional, and financial pressures on caregivers, often leading to a high care burden. This study uniquely examines the impact of peer support groups on reducing the care burden among caregivers of patients receiving hemodialysis in an Iranian healthcare setting, an aspect that has not been extensively explored before. Methods A parallel-controlled clinical trial was conducted involving 60 caregivers, divided into intervention and control groups. The intervention group participated in an 8-session peer support program tailored to their identified needs, including coping with stress, social isolation, and financial challenges. The Zarit Care Burden Interview Scale was used to measure care burden before and after the intervention. Results The study revealed statistically significant reductions in care burden, particularly in physical, social, and emotional dimensions, among caregivers in the intervention group compared to the control group. The total care burden score showed a marked decrease, indicating the effectiveness of the peer support intervention. While economic challenges remained a concern, the intervention had a limited impact in this domain. Conclusion This study demonstrates that peer support groups significantly alleviate the care burden experienced by caregivers of patients receiving hemodialysis, improving their well-being across several dimensions. The findings highlight the importance of integrating peer support strategies into healthcare programs for chronic disease management and underscore the need for supplementary economic support measures to comprehensively address caregivers’ needs. Future research should explore the scalability and long-term sustainability of such interventions and address the unique economic challenges faced by these caregivers. Trial registration This study was registered in the Iranian Registry of Clinical Trials (IRCT) under the registration number IRCT20220724055540N1 on 11/08/2022.

Abstract Background Prognostic models that identify individuals with chronic kidney disease (CKD) at greatest risk of developing kidney failure help clinicians to make decisions and deliver precision medicine. It is recognised that people with CKD usually have multiple long-term health conditions (multimorbidity) and often experience frailty. We undertook a systematic review to evaluate the representation and consideration of multimorbidity and frailty within CKD cohorts used to develop and/or validate prognostic models assessing the risk of kidney failure. Methods We identified studies that described derivation, validation or update of kidney failure prognostic models in MEDLINE, CINAHL Plus and the Cochrane Library—CENTRAL. The primary outcome was representation of multimorbidity or frailty. The secondary outcome was predictive accuracy of identified models in relation to presence of multimorbidity or frailty. Results Ninety-seven studies reporting 121 different kidney failure prognostic models were identified. Two studies reported prevalence of multimorbidity and a single study reported prevalence of frailty. The rates of specific comorbidities were reported in a greater proportion of studies: 67.0% reported baseline data on diabetes, 54.6% reported hypertension and 39.2% reported cardiovascular disease. No studies included frailty in model development, and only one study considered multimorbidity as a predictor variable. No studies assessed model performance in populations in relation to multimorbidity. A single study assessed associations between frailty and the risks of kidney failure and death. Conclusions There is a paucity of kidney failure risk prediction models that consider the impact of multimorbidity and/or frailty, resulting in a lack of clear evidence-based practice for multimorbid or frail individuals. These knowledge gaps should be explored to help clinicians know whether these models can be used for CKD patients who experience multimorbidity and/or frailty. Systematic review registration This review has been registered on PROSPERO (CRD42022347295).

Abstract There is an urgent need to pinpoint novel targets for drug discovery in the context of chronic kidney disease (CKD), and the proteome represents a significant pool of potential therapeutic targets. To address this, we performed proteome-wide analyses using Mendelian randomization (MR) and colocalization techniques to uncover potential targets for CKD. We extracted summary-level data from the ARIC study, focusing on 7213 European American (EA) individuals and 4657 plasma proteins. To broaden our analysis, we incorporated genetic association data from Icelandic cohorts, thereby enhancing our investigation into the correlations with chronic kidney disease (CKD), creatinine-based estimated glomerular filtration rate (eGFRcrea), and estimated glomerular filtration rate (eGFR). We utilized genetic association data from the GWAS Catalog, including CKD (765,348, 625,219 European ancestry and 140,129 non-European ancestry), eGFRcrea (1,004,040, European ancestry), and eGFR (567,460, European ancestry). Employing MR analysis, we estimated the associations between proteins and CKD risk. Additionally, we conducted colocalization analysis to evaluate the existence of shared causal variants between the identified proteins and CKD. We detected notable correlations between levels predicted based on genetics of three circulating proteins and CKD, eGFRcrea, and eGFR. Notably, our colocalization analysis provided robust evidence supporting these associations. Specifically, genetically predicted levels of Transcription elongation factor A protein 2 (TCEA2) and Neuregulin-4 (NRG4) exhibited an inverse relationship with CKD risk, while Glucokinase regulatory protein (GCKR) showed an increased risk of CKD. Furthermore, our colocalization analysis also supported the associations of TCEA2, NRG4, and GCKR with the risk of eGFRcrea and eGFR.

Objective: The study assessed the quality of life (QoL) and coping strategies of patients on hemodialysis in selected hospitals in Ilorin, Kwara State. Methods: The study was a descriptive cross-sectional design using a quantitative strategy. A multistage sampling technique was adopted to select 80 participants. The data were collected using an adapted questionnaire including four sections: sociodemographic characteristics, hemodialysis stressor scale consisting of four stressors, Jaloweic Coping Scale consisting of eight coping strategies, and QoL consisting of four items. The data were analyzed using SPSS version 23. Results: Findings from the study revealed that 50% of the participants were between the ages of 18 and 39 years, 40% of the participants have been on hemodialysis for 1–2 years, whereas 52.5% had hypertension as a comorbidity. A total of 12.5%, 63.8%, and 23.8% of the respondents were categorized as experiencing low, moderate, and high stress due to hemodialysis, respectively. QoL of the respondents revealed that 49.4% had no problem in self-care dimension. Average monthly income (χ2 = 16.36, P = 0.04) was observed to be significantly associated with coping strategies, whereas religion (χ2 = 11.14, P = 0.03) and frequency of hemodialysis (χ2 = 10.26, P = 0.04) were significantly associated with coping helpfulness. Conclusion: All participants experienced stress at varying degrees. Hemodialysis results in marked changes in the quality of patients’ life, since it includes a number of modifications and restrictions, which affects patients’ health functioning. This study revealed a wide range of information on the psychological and physiological stressors of people under hemodialysis.

Abstract Background The recent global pandemic due to severe acute respiratory syndrome coronavirus-2 resulted in a high rate of multi-organ failure and mortality in a large patient population across the world. As such, a possible correlation between acute kidney injury (AKI) and increased mortality rate in these patients has been suggested in literature. Methods This is a two-year retrospective study of critically ill adult patients infected with COVID-19 that were admitted to the intensive care unit (ICU) on ventilatory support. Two groups of patients were identified in this study, those who were directly admitted to the ICU or those who were initially admitted to the Medical Floor and were later transferred to the ICU due to either worsening respiratory status or change in their hemodynamic conditions. Within each group, three subgroups were created based on the status of AKI, namely, those who did not develop AKI, those who developed AKI, and those who with previous history of dialysis dependent AKI. Results The AKI subgroup had the highest mortality rate in the ICU and Floor patients. Of note, those patients who were directly admitted to the Floor and were later transferred to the ICU for worsening conditions also experienced a higher mortality rate if they had developed AKI during their course of hospital stay. Conclusions This study identified a statistically significant higher mortality in patients who developed AKI than those who did not develop AKI among critically ill patients. Trial registration Clinicaltrials.gov registration number NCT05964088. Date of registration: July 24 2023.

Abstract Background While numerous studies have reported associations between low dietary potassium intake and adverse clinical outcomes, methods to estimate potassium intake, mainly self-reported dietary measures and urinary potassium excretion, entail certain limitations. Self-reported measures are subject to underreporting and overreporting. Urinary potassium excretion is affected by multiple factors including renal function. Revealing the degree of bias inherent in these measures would help accurately assess potassium intake and its association with disease risk. We aim to summarize evidence on the strength of the associations between potassium intake estimated from 24-h urinary potassium excretion and potassium intake estimated from self-reported dietary measures or objective quantification methods in populations with different kidney function levels and age groups. We also aim to identify factors that affect the association strength. Methods We will search for potentially eligible studies that examined associations between self-reported potassium intake, 24-h urinary potassium excretion, and objectively quantified potassium intake, using MEDLINE (PubMed), Embase, Web of Science, and Scopus. Studies on children, adolescents, adults, and the elderly are eligible. Studies of patients on dialysis will be excluded. Collective study results, including a meta-analysis, will be synthesized if an adequate number of studies examining similar dietary potassium intake estimation methods are found. Analyses will be performed separately according to age groups and renal function. For the meta-analysis, fixed-effects or random-effect models will be employed depending on the degree of study heterogeneity to combine across studies the correlation coefficient, ratio, or standardized mean difference for potassium intake, comparing dietary potassium intake based on self-reported or objectively quantified methods and intake based on 24-h urinary potassium excretion. The degree of heterogeneity among included studies will be examined by calculating I 2 statistics. To investigate sources of study heterogeneity, random-effects meta-regression analyses will be performed. Discussion Revealing the strength of the association between dietary and urinary measures in populations with different levels of kidney function and age groups will enhance researchers’ and clinicians’ ability to interpret studies that utilize these measures and help establish a more solid evidence base for the role of potassium intake in changing chronic disease risk. Identifying factors that modify the associations between these measures may aid in developing predictive models to estimate actual potassium intake. Systematic review registration PROSPERO CRD42022357847.

Abstract Background Understanding the trend of utilization of renal dialysis in Saudi Arabia (SA) is fundamental as it provides a general overview of renal care. The practice of renal dialysis assists in identifying challenges, opportunities, and potential areas for improvement in the provision of the services. Objectives This research investigated the utilization of renal dialysis services in SA by exploring the number of renal dialysis centers, hemodialysis machines (HD), and peritoneodialysis patients. Methods The dataset for this study was derived from a collaboration between the General Authority of Statistics (GaStat) and the Ministry of Health (MoH), focusing on indicators for renal dialysis centers and patients across health sectors in 2021. Analysis was conducted using MS Excel 365 and IBM SPSS Version 29, incorporating multiple regression techniques. The health sector was treated as the dependent variable. At the same time, the number of hemodialysis (HD) machines and the counts of HD and peritoneal dialysis patients were considered independent variables. Results Around 275 renal dialysis centers, over 8000 HD machines, 20,440 HD patients, and 1,861 peritoneal patients were tallied from two resources. The findings revealed a negative relationship between the health sector and several renal dialysis centers and peritoneodialysis patients, as demonstrated by p

Objective To retrospectively explore the prognostic factors of uremic maintenance hemodialysis （MHD） patients with novel COVID-19 infection. Methods A total of 556 MHD patients on regular follow-ups were recruited. Baseline profiles and laboratory tests were recorded prior to contracting COVID-19 infection. Results There were 312 males and 244 females with an age of （52.37 ± 14.81） year and an MHD duration of （61.02 ± 43.90） months. Diabetic kidney disease（DKD） was a primary disease （n = 101, 18.1%） with top three complications of diabetes mellitus （DM）（n = 135, 16.3%）, cardiovascular disease （CVD）（n = 48, 6.6%） and stroke （n = 3, 0.5%）. Hemodialysis （n = 192, 34.5%） and peritoneal dialysis （PD）（n = 364, 65.5%） were performed. DM, hemodialysis, age and serum sodium level were risk factors for mortality after COVID-19 infection. And serum prealbumin level was a protective factor. Multivariate regression analysis revealed that MHD and age were independent risk factors for mortality. Cardiovascular disease, MHD, age and blood glucose level were risk factors for severe pneumonia after COVID-19 infection. And serum albumin level was a protective factor. Conclusion CVD and hyperglycemia are independent risk factors for severe pneumonia while age is an independent risk factor for severe pneumonia and mortality. Generally MHD patients have a higher risk of mortality than PD counterparts.

Objective: The current study aimed to compare the renal effects of Empagliflozin with Linagliptin combined with Metformin in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease. Materials and Methods: We conducted a randomized clinical trial on diabetic patients aged over 18 years with chronic renal failure and an EGFR between 20 to 60 ml/minutes/1.73 m2 corrected with the MDRD equation. Between January and December 2023, a total of 150 cases in Imam Hossein Hospital were randomized into two study arms of 75 cases receiving Empagliflozin (10 mg/day) and metformin or Linagliptin (5mg/day) and metformin for 6 months. The primary outcome was a change in chronic kidney disease (CKD) stage, while serum creatinine, fasting blood sugar (FBS), proteinuria, and blood pressure were evaluated at baseline, 3 and 6 months later. Results: The mean age of participants was 62.20 (± 4.45) years and 50% of them were females. Study indices including serum creatinine (P: 0.001), estimated glomerular filtration rate (eGFR) (P: 0.001), FBS (P: 0.001), HgA1c (P: 0.001), proteinuria (P: 0.001), and blood pressure (P: 0.001) reduced significantly over time in both groups. After adjustment for potential confounders, Empagliflozin reduced the level of serum creatinine independent of other factors. Conclusion: Empagliflozin significantly reduces the level of serum creatinine compared to Linagliptin in patients with T2DM and chronic renal failure.

Discussed based on the network interactive platform of structured care for patients with chronic renal failure (CRF) in the process of hemodialysis. This study seeks to elucidate the application value of structured nursing, deployed through network interaction platforms, in sustaining patients undergoing maintenance hemodialysis. A total of 62 patients diagnosed with Chronic Renal Failure (CRF) between April 2022 and August 2023 were randomly allocated into two distinct care groups: conventional and structured nursing care based on a web-interactive platform. Both cohorts were comparatively analyzed with respect to psychological states, quality of life within therapeutic interventions, and relationships with complications. Renal function indicators, including Creatinine Clearance (Ccr), Serum Creatinine (SCr), and Blood Urea Nitrogen (BUN), were subjected to Pearson analysis to appraise their predictive value in prognostication, while Receiver Operating Characteristic (ROC) curve analysis was constructed to further discern their diagnostic precision. Post-intervention, notable improvements were observed in the emotional states of patients in both cohorts, with the structured care group exhibiting significantly lower Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores (p< 0.05). Furthermore, patients under the web-interactive structured nursing regimen demonstrated superior overall adherence, a reduced incidence rate of complications, and markedly higher scores in quality of life assessments compared to those under conventional care (p< 0.05). The derived cut-off values for Ccr, SCr, and BUN were 32.5 ml/min, 251.5 umol/L, and 14.5 mmol/L, respectively, with sensitivities and specificities pegged at 0.645% and 0.645% for Ccr, 0.774% and 0.548% for SCr, and 0.774% and 0.774% for BUN. The corresponding areas under the ROC curve (AUC) for each parameter were 0.816, 0.653, and 0.856, respectively. Comprehensive hemodialysis care for patients with chronic renal failure can improve self-care ability to improve quality of life and reduce the incidence of complications, which has great potential for clinical progress and is worthy of further research. [ABSTRACT FROM AUTHOR]

ABSTRACT Hypotension is a common complication during hemodialysis that develops due to high ultrafiltration rate and sometimes requires intravenous fluid replacement. Intradialytic hypotension may reduce the effectiveness of dialysis and contributes to hemodialysis‐related morbidity and mortality. Adrenal insufficiency is one of the causes of hypotension in the community. Our case was diagnosed with end‐stage renal failure and was undergoing routine hemodialysis with a central venous catheter 3 days a week. Upon the patient's hypotension attacks during the dialysis sessions and hypoglycemia attacks in the follow‐ups, the morning cortisol was 6.2 μg/dL. Adrenocorticotropic hormone was 39 pg/mL, and testosterone was 0.0442 ng/mL. Adrenocorticotropic hormone stimulation test was performed on the patient with 250 mcg tetracosactide. The patient did not show adequate cortisol response, was detected to have partial empty sella on pituitary magnetic resonance imaging, and was diagnosed with secondary adrenal insufficiency, and then the hemodialysis hypotension improved with prednisolone treatment. We present a case of adrenal insufficiency, which is a rare cause of hypotension in patients on routine hemodialysis. [ABSTRACT FROM AUTHOR]

Objective People living with chronic kidney disease (CKD) and receiving hemodialysis (HD) have impaired respiratory muscle strength and endurance. The objective of this study was to systematically review the effects of inspiratory muscle training (IMT) on respiratory muscle strength, functional capacity, lung function, quality of life, endothelial function, and oxidative stress in people living with CKD and receiving HD. Methods An electronic search was conducted from inception to June 2023. Randomized controlled trials that evaluated the effects of IMT on respiratory muscle strength, functional capacity, lung function, endothelial function, quality of life, or oxidative stress in adults living with CKD and receiving HD, compared with control, placebo IMT, or conventional physical therapy, were included. Results Eight studies were included, totaling 246 people. The meta-analysis showed that IMT increased the maximum inspiratory pressure (MIP) by 22.53 cm H2O, the maximum expiratory pressure (MEP) by 19.54 cm H2O, and the distance covered in the 6-minute walk test by 77.63 m. Changes in lung function and quality of life were not observed. It was not possible to quantitatively analyze data on endothelial function and oxidative stress. Conclusion IMT improves MIP, MEP, and functional capacity in people living with CKD and receiving HD. IMT did not demonstrate significant results for lung function and quality of life. Effects on endothelial function and oxidative capacity remain uncertain. Impact Inspiratory muscle training improves MIP, MEP, and functional capacity in people living with CKD and receiving HD, compared with conventional physical therapy or controls or placebo intervention. Increases in functional capacity in this population are extremely important because of the relationship with the survival of these people. [ABSTRACT FROM AUTHOR]

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Introduction and purpose: Digoxin, a cardiac glycoside derived from Digitalis lanata, has stood as a cornerstone in the treatment of various cardiovascular disorders for centuries. This study aims to delve into the demographic aspects, clinical characteristics, and outcomes associated with Digoxin poisoning. By drawing upon a dataset involving 22 patients hospitalized for Digoxin intoxication at the Clinical Department of Toxicology and Cardiology in Lublin, Poland, spanning from April 2014 to December 2023, our investigation seeks to provide an understanding of this issue. Brief description of the state of knowledge: Despite the efficacy of Digoxin, the potential risk of intoxication, especially in the elderly, necessitate a comprehensive examination. Age-related changes, such as declining renal function, electrolyte imbalances, comorbidities and polypharmacy affect how drugs like Digoxin work. The symptoms of Digoxin poisoning can manifest in various organ systems such as cardiovascular, gastrointestinal, nervous system, highlighting the importance of prompt recognition to seek medical attention. Methods and results: In our study, we analyzed data from 22 patients hospitalized due to Digoxin intoxication, focusing on demographic aspects, clinical characteristics and outcomes. The cases of Digoxin poisoning were categorized according to several factors, including the quantity and nature of substances consumed, the cause of intoxication, gender, age brackets, health conditions, peak serum Digoxin levels, length and outcomes of hospitalization. Conclusions: Our study provides insights into the characteristics and outcomes of patients hospitalized due to Digoxin intoxication. The findings underscore the association of Digoxin poisoning, and emphasize the importance of monitoring serum levels to prevent adverse outcomes. As Digoxin continues to be relevant in treating cardiovascular conditions, our study calls for careful management and monitoring. [ABSTRACT FROM AUTHOR]

Background: The recent global pandemic due to severe acute respiratory syndrome coronavirus-2 resulted in a high rate of multi-organ failure and mortality in a large patient population across the world. As such, a possible correlation between acute kidney injury (AKI) and increased mortality rate in these patients has been suggested in literature. Methods: This is a two-year retrospective study of critically ill adult patients infected with COVID-19 that were admitted to the intensive care unit (ICU) on ventilatory support. Two groups of patients were identified in this study, those who were directly admitted to the ICU or those who were initially admitted to the Medical Floor and were later transferred to the ICU due to either worsening respiratory status or change in their hemodynamic conditions. Within each group, three subgroups were created based on the status of AKI, namely, those who did not develop AKI, those who developed AKI, and those who with previous history of dialysis dependent AKI. Results: The AKI subgroup had the highest mortality rate in the ICU and Floor patients. Of note, those patients who were directly admitted to the Floor and were later transferred to the ICU for worsening conditions also experienced a higher mortality rate if they had developed AKI during their course of hospital stay. Conclusions: This study identified a statistically significant higher mortality in patients who developed AKI than those who did not develop AKI among critically ill patients. Trial registration: Clinicaltrials.gov registration number NCT05964088. Date of registration: July 24 2023. [ABSTRACT FROM AUTHOR]

Background: While numerous studies have reported associations between low dietary potassium intake and adverse clinical outcomes, methods to estimate potassium intake, mainly self-reported dietary measures and urinary potassium excretion, entail certain limitations. Self-reported measures are subject to underreporting and overreporting. Urinary potassium excretion is affected by multiple factors including renal function. Revealing the degree of bias inherent in these measures would help accurately assess potassium intake and its association with disease risk. We aim to summarize evidence on the strength of the associations between potassium intake estimated from 24-h urinary potassium excretion and potassium intake estimated from self-reported dietary measures or objective quantification methods in populations with different kidney function levels and age groups. We also aim to identify factors that affect the association strength. Methods: We will search for potentially eligible studies that examined associations between self-reported potassium intake, 24-h urinary potassium excretion, and objectively quantified potassium intake, using MEDLINE (PubMed), Embase, Web of Science, and Scopus. Studies on children, adolescents, adults, and the elderly are eligible. Studies of patients on dialysis will be excluded. Collective study results, including a meta-analysis, will be synthesized if an adequate number of studies examining similar dietary potassium intake estimation methods are found. Analyses will be performed separately according to age groups and renal function. For the meta-analysis, fixed-effects or random-effect models will be employed depending on the degree of study heterogeneity to combine across studies the correlation coefficient, ratio, or standardized mean difference for potassium intake, comparing dietary potassium intake based on self-reported or objectively quantified methods and intake based on 24-h urinary potassium excretion. The degree of heterogeneity among included studies will be examined by calculating I2 statistics. To investigate sources of study heterogeneity, random-effects meta-regression analyses will be performed. Discussion: Revealing the strength of the association between dietary and urinary measures in populations with different levels of kidney function and age groups will enhance researchers' and clinicians' ability to interpret studies that utilize these measures and help establish a more solid evidence base for the role of potassium intake in changing chronic disease risk. Identifying factors that modify the associations between these measures may aid in developing predictive models to estimate actual potassium intake. Systematic review registration: PROSPERO CRD42022357847. [ABSTRACT FROM AUTHOR]

Background: Understanding the trend of utilization of renal dialysis in Saudi Arabia (SA) is fundamental as it provides a general overview of renal care. The practice of renal dialysis assists in identifying challenges, opportunities, and potential areas for improvement in the provision of the services. Objectives: This research investigated the utilization of renal dialysis services in SA by exploring the number of renal dialysis centers, hemodialysis machines (HD), and peritoneodialysis patients. Methods: The dataset for this study was derived from a collaboration between the General Authority of Statistics (GaStat) and the Ministry of Health (MoH), focusing on indicators for renal dialysis centers and patients across health sectors in 2021. Analysis was conducted using MS Excel 365 and IBM SPSS Version 29, incorporating multiple regression techniques. The health sector was treated as the dependent variable. At the same time, the number of hemodialysis (HD) machines and the counts of HD and peritoneal dialysis patients were considered independent variables. Results: Around 275 renal dialysis centers, over 8000 HD machines, 20,440 HD patients, and 1,861 peritoneal patients were tallied from two resources. The findings revealed a negative relationship between the health sector and several renal dialysis centers and peritoneodialysis patients, as demonstrated by p < 0.05 in multiple regression analysis. Conclusion: The number of renal dialysis centers influences the availability of HD machines, affecting the number of HD and peritoneodialysis patients. Most national patients preferred MoH over other semi-governmental and private sectors, and vice versa for non-Saudis. [ABSTRACT FROM AUTHOR]

Objective: To explore the risk factors for severe infection and the influencing factors of adverse cardiovascular events in patients with chronic renal failure in the uremic stage undergoing hemodialysis maintenance therapy. Methods: Sixty patients with chronic renal failure and uremia admitted to our hospital from October 2021 to October 2023 were selected as the study subjects, and all patients received maintenance hemodialysis treatment. Group patients according to the number of severe infections and adverse cardiovascular events. The infection group (n=20), non infection group (n=40), and adverse cardiovascular event group (n=22), non adverse cardiovascular event group (n=38). Analyze the general clinical situation of all patients, with severe infection and adverse cardiovascular events as dependent variables, and incorporate them into a logistic regression model to analyze the independent influencing factors of severe infection and adverse cardiovascular events. Results: There were significant differences in age, diabetes, dialysis time, heart failure, indwelling venous catheter, hemoglobin, Hs CRP, albumin and fasting blood glucose between the infected group and the non infected group (P<0.05); Age, diabetes, indwelling venous catheter, Hs CRP and fasting blood glucose were independent risk factors for severe infection in patients with chronic renal failure in uremic stage undergoing hemodialysis maintenance treatment (P<0.05); There were significant differences in primary disease, hypertension, diabetes, hyperlipidemia, smoking history, hyperphosphatemia, dialysis time, Hs-CRP, LDL-C between the adverse cardiovascular event group and the non adverse cardiovascular event group(P<0.05); Hypertension, hyperlipidemia, hyperphosphatemia, Hs CRP, and dialysis time are independent risk factors for adverse cardiovascular events in patients with chronic renal failure in the uremic stage undergoing hemodialysis maintenance therapy(P<0.05). Conclusion: Age, diabetes, indwelling venous catheter, Hs CRP, and fasting blood glucose are independent risk factors for severe infection in patients with chronic renal failure in uremic stage undergoing hemodialysis maintenance treatment. Hypertension, hyperlipidemia, hyperphosphatemia, Hs CRP, and dialysis time are independent risk factors for adverse cardiovascular events. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the prevalence of hearing loss in a sample of patients with chronic renal failure undergoing renal replacement therapy in a population belonging to the outpatient clinic of the Nephrology service at the ISSEMyM Toluca Medical Center, Estado de Mexico. MATERIALS AND METHODS: An observational, cross sectional and analytical study was carried out from June 2022 to March 2023 on a beneficiary population who attended the outpatient consultation of Audiology, Otorhinolaryngology and Nephrology at the ISSEMyM Toluca Medical Center, Estado de Mexico, with chronic renal failure in renal replacement therapy. RESULTS: There were included 178 patients; bilateral sensorineural hearing loss was the most frequent diagnosis (65%); prevalence of hearing loss in general in this study was of 26.4%, indicating a relatively high association of hearing loss with chronic kidney disease. CONCLUSIONS: Patients with chronic renal failure in replacement therapy have hearing loss; the most frequent is bilateral sensorineural hearing loss. [ABSTRACT FROM AUTHOR]

Introduction: End-stage renal disease is a major risk factor for cardiovascular morbidity and mortality, which can be partially eliminated by kidney transplantation. Systolic heart failure might be considered contraindication for kidney transplant, although some patients demonstrate myocardial recovery post-transplant. We aimed to identify and characterize the phenomenon of reverse myocardial remodeling in kidney transplanted patients. Methods: The study is a retrospective cohort of patients undergoing kidney transplants between 2016 and 2019 (n = 604) at Rabin Medical Center. Patients were assessed according to availability of two echocardiographic examinations: pre- and post-kidney transplant. The change in estimated ejection fraction (EF) and possible predictors of myocardial recovery were examined. Results: Data of 293 patients was available for the final analysis. Eighty-one (28%) patients had a LVEF improvement equal to or above 5%, whereas 36 (12%) patients had a LVEF improvement of 10% or more post-transplantation. Twenty-five patients (8.5%) had moderate or severe systolic heart failure with LVEF reduced to 40% or less at baseline. 13 of them (52%) had a LVEF improvement of ≥5%, and 10 patients (40%) had an improvement of ≥10% in their EF. Cox regression analyses identified female gender as the only independent variable associated with LVEF improvement of at least 10%. Conclusion: Renal transplantation might lead to improved LV systolic function in some patients. [ABSTRACT FROM AUTHOR]

Introduction: Hemodialysis treatment using standard dialysate bicarbonate concentrations cause transient metabolic alkalosis possibly associated with hemodynamic instability. The aim of this study was to perform a detailed comparison of high and low dialysate bicarbonate in terms of blood pressure, intradialytic hemodynamic parameters, orthostatic blood pressure, and electrolytes. Methods: Fifteen hemodialysis patients were examined in a single‐blind, randomized, controlled, crossover study. Participants underwent a 4‐h hemodialysis session with dialysate bicarbonate concentration of 30 or 38 mmol/L with 1 week between interventions. Blood pressure was monitored throughout hemodialysis, while cardiac output, total peripheral resistance, stroke volume, and central blood volume were assessed with ultrasound dilution technique (Transonic). Orthostatic blood pressure was measured pre‐ and post‐hemodialysis. Findings: With similar ultrafiltration (UF) volume (2.6 L), systolic blood pressure (SBP) tended to decrease more during high dialysate bicarbonate compared to low dialysate bicarbonate; the mean (95% confidence interval) between treatment differences in SBP were: 8 (−4; 20) mmHg (end of hemodialysis) and 7 (0; 15) mmHg (post‐hemodialysis). Stroke volume decreased whereas total peripheral resistance increased significantly more during high dialysate bicarbonate compared to low dialysate bicarbonate with mean between treatment differences: Stroke volume: 12 (1; 23) mL; Total peripheral resistance: −2.9 (−5.3; −0.5) mmHg/(L/min). Cardiac output tended to decrease more with high dialysate bicarbonate compared to low dialysate bicarbonate with mean between treatment difference 0.7 (0.0; 1.4) L/min. High dialysate bicarbonate caused alkalosis, hypocalcemia, and lower plasma potassium, whereas patients remained normocalcemic with normal pH during low dialysate bicarbonate. Orthostatic blood pressure response after dialysis did not differ significantly. Discussion: The use of high dialysate bicarbonate compared to low dialysate bicarbonate was associated with hypocalcemia, alkalosis, and a more pronounced hypokalemia. During hemodialysis with UF, a better preservation of blood pressure, stroke volume, and cardiac output may be achieved with low dialysate bicarbonate compared to high dialysate bicarbonate. [ABSTRACT FROM AUTHOR]

Objective: The study assessed the quality of life (QoL) and coping strategies of patients on hemodialysis in selected hospitals in Ilorin, Kwara State. Methods: The study was a descriptive cross-sectional design using a quantitative strategy. A multistage sampling technique was adopted to select 80 participants. The data were collected using an adapted questionnaire including four sections: sociodemographic characteristics, hemodialysis stressor scale consisting of four stressors, Jaloweic Coping Scale consisting of eight coping strategies, and QoL consisting of four items. The data were analyzed using SPSS version 23. Results: Findings from the study revealed that 50% of the participants were between the ages of 18 and 39 years, 40% of the participants have been on hemodialysis for 1-2 years, whereas 52.5% had hypertension as a comorbidity. A total of 12.5%, 63.8%, and 23.8% of the respondents were categorized as experiencing low, moderate, and high stress due to hemodialysis, respectively. QoL of the respondents revealed that 49.4% had no problem in self-care dimension. Average monthly income (χ² = 16.36, P = 0.04) was observed to be significantly associated with coping strategies, whereas religion (χ² = 11.14, P = 0.03) and frequency of hemodialysis (χ² = 10.26, P = 0.04) were significantly associated with coping helpfulness. Conclusion: All participants experienced stress at varying degrees. Hemodialysis results in marked changes in the quality of patients' life, since it includes a number of modifications and restrictions, which affects patients' health functioning. This study revealed a wide range of information on the psychological and physiological stressors of people under hemodialysis. [ABSTRACT FROM AUTHOR]

Background: Uremic stomatitis is often unfamiliar to healthcare professionals. This study presents five cases of uremic stomatitis, providing a comprehensive analysis of their demographic distribution, clinicopathological features, and management strategies based on existing literature. Methods: Data were collected from centers across Brazil, Argentina, Venezuela, and Mexico. Electronic searches were conducted in five databases supplemented by manual scrutiny and gray literature. Results: The series consisted of three men and two women with a mean age of 40.2 years. Lesions mostly appeared as white plaques, particularly on the tongue (100%). The median blood urea level was 129 mg/dL. Histopathological analysis revealed epithelial changes, including acanthosis and parakeratosis, with ballooned keratinocytes in the suprabasal region. Oral lesions resolved subsequent to hemodialysis in three cases (75%). Thirty-seven studies comprising 52 cases of uremic stomatitis have been described hitherto. Most patients were male (65.4%) with a mean age of 43.6 years. Clinically, grayish-white plaques (37.3%) and ulcers/ulcerations (28.9%) were common, particularly on the tongue (30.9%). Hemodialysis was performed on 27 individuals. The resolution rate of oral lesions was 53.3%. Conclusion: Earlier recognition of uremic stomatitis, possibly associated with long-term uremia, holds the potential to improve outcomes for patients with undiagnosed chronic kidney disease. [ABSTRACT FROM AUTHOR]

Objective: The current study aimed to compare the renal effects of Empagliflozin with Linagliptin combined with Metformin in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease. Materials and Methods: We conducted a randomized clinical trial on diabetic patients aged over 18 years with chronic renal failure and an EGFR between 20 to 60 ml/minutes/1.73 m2 corrected with the MDRD equation. Between January and December 2023, a total of 150 cases in Imam Hossein Hospital were randomized into two study arms of 75 cases receiving Empagliflozin (10 mg/day) and metformin or Linagliptin (5mg/day) and metformin for 6 months. The primary outcome was a change in chronic kidney disease (CKD) stage, while serum creatinine, fasting blood sugar (FBS), proteinuria, and blood pressure were evaluated at baseline, 3 and 6 months later. Results: The mean age of participants was 62.20 (± 4.45) years and 50% of them were females. Study indices including serum creatinine (P: 0.001), estimated glomerular filtration rate (eGFR) (P: 0.001), FBS (P: 0.001), HgA1c (P: 0.001), proteinuria (P: 0.001), and blood pressure (P: 0.001) reduced significantly over time in both groups. After adjustment for potential confounders, Empagliflozin reduced the level of serum creatinine independent of other factors. Conclusion: Empagliflozin significantly reduces the level of serum creatinine compared to Linagliptin in patients with T2DM and chronic renal failure. [ABSTRACT FROM AUTHOR]

Objectives: This descriptive cross-sectional study explores the demographic characteristics, social dysfunction, and depression levels. Methods: To achieve the stated goals, 39 chronic renal failure patients chosen in accidental sampling method in Al Nasiriya city, Imam Hussain Teaching Hospital during the period from April 1, 2023, to September 1, 2023. Utilizing two domains of the General Health Questionnaire (GHQ-28) which they are depression and social dysfunction. Results: The study reveals a diverse demographic profile, with a slight majority of females and a varied age distribution. The assessment of mental health highlights concerning levels of symptomatic experiences related to social failure and depression. In the social dysfunction, participants express moderate levels of thoughts such as worthlessness, hopelessness, and suicidal ideation. The analysis of daily functioning and satisfaction indicates both symptomatic and asymptomatic experiences, emphasizing the complexity of managing daily tasks. The assessment of depression reveals a substantial portion of participants experiencing symptomatic manifestations, suggesting a noteworthy presence of depressive symptoms within the studied population. The correlation analysis between social dysfunction and depression indicates a minimal and statistically nonsignificant relationship. This suggests that social dysfunction may not be a strong predictor of depressive symptoms within this study, emphasizing the need for a more comprehensive investigation into the intricate interplay between social aspects and depression. Factors such as individual resilience, coping mechanisms, social support, and cultural influences may contribute to the observed variability in responses. Discussion: findings of the study highlight the importance of focusing on demographic factors in understanding mental health outcomes. There is an urgent need for intervention targeting chronic renal failure patients in social functioning domain as the prevalence of symptomatic experiences were high related to social failure and depression. Such conclusions stress the complexity of individuals' subjective experiences and emphasize the importance of comprehensive mental health support tailored to the specific challenges identified in the study. [ABSTRACT FROM AUTHOR]

Feline immunodeficiency virus (FIV) is a lentivirus in the family Retroviridae that infects domestic cats resulting in an immunodeficiency disease featuring a progressive and profound decline in multiple sets of peripheral lymphocytes. Despite compelling evidence of FIV-associated immunopathology, there are conflicting data concerning the clinical effects of FIV infection on host morbidity and mortality. To explore FIV-associated immunopathogenesis and clinical disease, we experimentally inoculated a cohort of four specific pathogen-free kittens with a biological isolate of FIV clade C and continuously monitored these animals along with two uninfected control animals for more than thirteen years from the time of inoculation to the humane euthanasia endpoint. Here, we report the results obtained during the late asymptomatic and terminal phases of FIV infection in this group of experimentally FIV-infected cats.

Chronic renal failure (CRF) is a severe syndrome affecting the urinary system for which there are no effective therapeutics. In this study, we investigate the effects and mechanisms of aminophylline in preventing CRF development. A rat model of chronic renal failure is established by 5/6 nephrectomy. The levels of serum creatinine (SCR), urinary protein (UPR), and blood urea nitrogen (BUN) are detected by ELISA. Histological evaluations of renal tissues are performed by H&E, Masson staining, and PAS staining. Functional protein expression is detected by western blot analysis or immunofluorescence microscopy. Glomerular cell apoptosis is determined using the TUNEL method. Results show that Aminophylline significantly reduces the levels of SCR, UPR, and BUN in the CRF model rats. Histological analyses show that aminophylline effectively alleviates renal tissue injuries in CRF rats. The protein expression levels of nephrin, podocin, SIRT1, p-AMPK, and p-ULK1 are greatly increased, while p-mTOR protein expression is markedly decreased by aminophylline treatment. Additionally, the protein level of LC3B in CRF rats is significantly increased by aminophylline. Moreover, aminophylline alleviates apoptosis in the glomerular tissues of CRF rats. Furthermore, resveratrol promotes SIRT1, p-AMPK, and p-ULK1 protein expressions and reduces p-mTOR and LC3B protein expressions in CRF rats. Selisistat (a SIRT1 inhibitor) mitigates the changes in SIRT1, p-AMPK, p-ULK1, p-mTOR, and LC3B expressions induced by aminophylline. Finally, RAPA alleviates renal injury and apoptosis in CRF rats, and 3-MA eliminates the aminophylline-induced inhibition of renal injury and apoptosis in CRF rats. Aminophylline suppresses chronic renal failure progression by modulating the SIRT1/AMPK/mTOR-mediated autophagy process.

Background: Interleukin-18 (IL-18), also known as interferon-gamma inducing factor is a protein which in humans is encoded by the IL18 gene, it is a member of the IL 1 family and has a molecular weight of 18 kDa. Innate and adaptive immunity can be regulated by IL-18, and disorders involving its dysregulation might result in inflammatory or autoimmune conditions. Aim of the Work: To distinguish between acute kidney injury (AKI) and chronic renal failure (CRF), this research investigates the utility of IL-18 as a novel biomarker and examines how age affects its level. Materials and Methods: Three hundred participants were included and divided into three groups using the following methodology. Group I consisted of 100 control subjects who were split up by age and gender. Group II consisted of 100 AKI patients who were divided into two groups and subgroups based on age and gender. Group III, which consisted of 100 CRF (hemodialyzed patients), was divided into two groups and subgroups, as patients with acute renal injury and previously healthy people. Patients’ blood was drawn to conduct a laboratory investigation blood urea, serum creatinine, sodium, potassium, pH, GFR and PCO2. Results: Patients with CRF had higher serum levels of IL-18 than patients with AKI, regardless of gender, and both groups of patients had levels of IL-18 that rise with age. Conclusion: IL-18 is a reliable indicator for the differentiation between AKI and CRF patients receiving hemodialysis and its level correlates with age independent with gender.

Patients diagnosed with CKD in Indonesia have increased from 2% in 2013 to 3.8% in 2018. Polypharmacy is commonly found in CKD patients, especially in CKD patients with comorbidities. CKD with comorbidities will make the treatment more complex and expensive. This study was conducted to assess the relationship between polypharmacy and drug interactions in CKD patients. Data analysis was carried out descriptively on CKD patients at "X" Hospital in the period October to December 2022 and data were displayed in the form of tables and graphs. The results showed that the majority of patients with chronic kidney disease (CKD) were aged 46-65 years with 42 patients (50.0%). Chronic kidney disease (CKD) patients who get prescriptions for more than 5 drugs are 80 (95.2%) patients. Comorbidities that often occur in chronic kidney disease (CKD) patients are hypertension with 62 (19.62%) patients, diabetes mellitus with 29 (9.18%) patients, and coronary heart disease with 27 (8.54%) patients. From 84 patients, there were 626 potential drug interactions including 152 (24.28%) drug interactions with minor severity, 434 (69.33%) drug interactions with moderate severity, and 40 (6.39%) drug interactions with major severity. CKD patients who have one or more comorbidities will increase the risk of polypharmacy and an increased risk of drug interactions.

Patients with chronic renal failure must undergo lifelong treatment. The condition raises treatment-related responsibilities and may affect their treatment adhesion. The aim of this study was to determine the correlation between the burden of medication and the level of medication adherence among chronic kidney failure patients at Sleman Regional Hospital in Yogyakarta. This study took the form of observational study with a cross-sectional design. Data were collected using LMQ (Living with Medicine Questionnaire) and Visual Analog Sacle (VAS) overall burden to determine the burden and MARS (Medication Adherence Rating Scale) to determine medication adherence level. The samples in this study were 60 patients from all patients undergoing hemodialysis who met the inclusion criteria. Sampling was taken using a consecutive sampling technique with inclusion criteria of patients willing to complete the questionnaire and patients diagnosed with chronic renal failure aged ≥18 years. To determine the relationship between medication burden and medication adherence, data was examined using the Spearman test. The results of this study showed that 40 patients (66.7%) had moderate medication burden and 50 patients (83%) had moderate medication adherence. There was a significant correlation between the LMQ score and MARS (correlation-coefficient = 0.581, p=0.000) and a significant correlation between the VAS score and MARS (correlation-coefficient= 0.651, p=0.000). Thus, it can be concluded that there is a positive relationship between treatment burden and the level of treatment compliance, where the higher the burden, the higher the level of compliance in chronic kidney failure patients.

Abstract Background Chronic kidney disease (CKD) requires accurate prediction of renal replacement therapy (RRT) initiation risk. This study developed deep learning algorithms (DLAs) to predict RRT risk in CKD patients by incorporating medical history and prescriptions in addition to biochemical investigations. Methods A multi-centre retrospective cohort study was conducted in three major hospitals in Hong Kong. CKD patients with an eGFR

Abstract Background Ammonium excretion decreases as kidney function decreases in several species, including cats, and may have predictive or prognostic value in patients with chronic kidney disease (CKD). Urine ammonia measurement is not readily available in clinical practice, and urine anion gap (UAG) has been proposed as a surrogate test. Objectives Evaluate the correlation between urine ammonia‐to‐creatinine ratio (UACR) and UAG in healthy cats and those with CKD and determine if a significant difference exists between UAG of healthy cats and cats with CKD. Animals Urine samples collected from healthy client‐owned cats (n = 59) and those with stable CKD (n = 17). Methods Urine electrolyte concentrations were measured using a commercial chemistry analyzer and UAG was calculated as ([sodium] + [potassium]) − [chloride]. Urine ammonia and creatinine concentrations had been measured previously using commercially available enzymatic assays and used to calculate UACR. Spearman's rank correlation coefficient between UAG and UACR was calculated for both groups. The UAG values of healthy cats and cats with CKD were assessed using the Mann‐Whitney test (P

Objective:To investigate the effect of Yishen Huoxue decoction combined with Bailing capsule on renal function, calcium and phosphorus metabolism and T lymphocyte subsets in patients with chronic renal failure.Methods:102 patients with chronic renal failure in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, from May 2020 to March 2022 were selected, and randomly divided into control group (conventional western medicine treatment) and observation group (Yishen Huoxue decoction combined with Bailing capsule on the basis of the control group) by random number table method, 51 cases in each group.Both groups were treated for 8 weeks.The curative effect and the changes of traditional Chinese medicine syndrome score, renal function, calcium and phosphorus metabolism and T lymphocyte subsets before and 8 weeks after treatment were compared between the two groups.Results:The observation group’s total effective rate at 8 weeks after treatment was 92.16%（47/51), which was higher than 74.51%（38/51) of the control group（P＜0.05) .After 8 weeks of treatment, the traditional Chinese medicine main symptom score and secondary symptom score in the two groups were decreased, and compared to the control group, the observation group was lower (P＜0.05) .After 8weeks of treatment, serum creatinine, urea nitrogen and 24 h proteinuria in the two groups were lower than those before treatment, and the observation group was lower than those in the control group (P＜0.05) .After 8 weeks of treatment, CD8+ was decreased in the two groups, and the observation group was lower than the control group (P＜0.05), while CD4+, CD3+, CD4+/CD8+ were increased compared with those before treatment, and the observation group was higher than the control group (P＜0.05) .After 8 weeks of treatment, the blood phosphorus and calcium phosphorus product decreased in both groups, and compared to the observation group, the control group was higher（P＜0.05) .The blood calcium was increased, and compared to the control group, the observation group was higher（P＜0.05) .Conclusion: Yishen Huoxue decoction combined with Bailing capsule in the treatment of patients with chronic renal failure can improve renal function, improve calcium and phosphorus metabolism and T lymphocyte subsets, and relieve their clinical symptoms, the curative effect is definite and worthy of clinical reference and application. [ABSTRACT FROM AUTHOR]