BACKGROUND Hemodialysis is an advanced blood purification technique to manage kidney failure.However,for conventional hemodialysis,the high prevalence of dyslipidemia may cause cardiovascular diseases and an increase ...BACKGROUND Hemodialysis is an advanced blood purification technique to manage kidney failure.However,for conventional hemodialysis,the high prevalence of dyslipidemia may cause cardiovascular diseases and an increase in mortality.Moreover,toxins accumulating in the body over time may induce some complications.High flux hemodialysis can effectively improve disease indexes and clinical symptoms.AIM To investigate the efficacy of high flux hemodialysis in elderly patients with chronic kidney failure(CKF).METHODS A total of 66 elderly patients with CKF who were admitted to our hospital from October 2017 to October 2018 were included in the study.According to the therapies they received,the patients were divided into a study group and a control group with 33 patients in each group.The study group received high flux hemodialysis and the control group received conventional dialysis treatment.Kidney function,toxin levels in serum,and complications were compared in the two groups.RESULTS Before the treatment,there was no significant difference in kidney function,β2-microglobulin,or blood urea nitrogen between the two groups(P>0.05).In contrast,kidney function was better in the study group than in the control group after the treatment(P<0.05).In addition,the study group had significantly lower parathyroid hormone and serum cystatin C than the control group(P<0.05).The incidence of complications was 8.57%in the study group,which was lower than that of the control group(20.00%;P<0.05).CONCLUSION High flux hemodialysis may improve kidney function and reduce toxin levels in serum and the incidence of complications in elderly patients with CKF.展开更多
Objective:To establish a quantitative evaluation of the left ventricle's systolic function in patients with chronic kidney failure(CKF)by three-dimensional speckle-tracking echocardiography.Methods:Two-dimensional...Objective:To establish a quantitative evaluation of the left ventricle's systolic function in patients with chronic kidney failure(CKF)by three-dimensional speckle-tracking echocardiography.Methods:Two-dimensional and three-dimensional transthoracic echocardiography was performed on 30 patients with CKF.The ejection fraction,mass and global peak longitudinal strain,global circumferential strain,global area strain,and global radial strain of the left ventricle were calculated.Results:The ejection fraction,mass and global peak longitudinal strain(GLS),global circumferential strain(GCS),global area strain(GAS),and global radial strain(GRS)in the CKF group were significantly lower than those in the control group.Simultaneously,the GLS,GCS,GAS and GRS were well correlated with the ejection fraction.For patients with normal ejection fraction in the CKF group,the GLS,GCS,GAS and GRS were lower than those in the control group,while the left ventricular mass was significantly higher in CKF patients than in the control group.For patients with hypertension in the CKF group,ejection fraction,GLS,GCS,GAS and GRS calculated using three-dimensional echocardiography were significantly lower than those in patients with normal blood pressure;however,the myocardial mass was higher.Conclusions:The parameters(GLS,GCS,GAS and GRS)calculated using three-dimensional speckle-tracking software were lower in the CKF group.Simultaneously,the left ventricular mass was higher in CFK patients than in the control group,thus showing that the myocardial contraction function was impaired and that myocardial remodeling had occurred.展开更多
Objective Variations are present in common clinical practices regarding best practice in managing hyperkalaemia(HK),there is therefore a need to establish a multi-specialty approach to optimal renin angiotension-aldos...Objective Variations are present in common clinical practices regarding best practice in managing hyperkalaemia(HK),there is therefore a need to establish a multi-specialty approach to optimal renin angiotension-aldosterone system inhibitors(RAASi)usage and HK management in patients with chronic kidney disease(CKD)&heart failure(HF).This study aimed to establish a multi-speciality approach to the optimal use of RAASi and the management of HK in patients with CKD and HF.Methods A steering expert group of cardiology and nephrology experts across China were convened to discuss challenges to HK management through a nominal group technique.The group then created a list of 41 statements for a consensus questionnaire,which was distributed for a further survey in extended panel group of cardiologists and nephrologists across China.Consensus was assessed using a modified Delphi technique,with agreement defined as"strong"(≥75%and<90%)and"very strong"(≥90%).The steering group,data collection,and analysis were aided by an independent facilitator.Results A total of 150 responses from 21 provinces across China were recruited in the survey.Respondents were comprised of an even split(n=75,50%)between cardiologists and nephrologists.All 41 statements achieved the 75%consensus agreement threshold,of which 27 statements attained very strong consensus(≥90%agreement)and 14 attained strong consensus(agreement between 75%and 90%).Conclusion Based on the agreement levels from respondents,the steering group agreed a set of recommendations intended to improve patient outcomes in the use of RAASi therapy and HK management in China.展开更多
Introduction: The transition period from renal transplantation to dialysis is associated with high morbidity and mortality. The aim of this study is to describe the clinical and paraclinical characteristics, therapeut...Introduction: The transition period from renal transplantation to dialysis is associated with high morbidity and mortality. The aim of this study is to describe the clinical and paraclinical characteristics, therapeutic management and evolutionary profile of patients returning to dialysis after kidney graft failure. Material and Methods: This was a retrospective, descriptive study conducted in the Nephrology-Dialysis-Renal Transplant Department at university hospital IbnSina between January 1998 and December 2021. We included all renal transplant recipients who had experienced kidney graft dysfunction and returned to dialysis. Patients with a follow-up after return to dialysis of less than 1 year were excluded. Results: Among 166 renal transplant recipients, 20 returned to dialysis after a median renal graft life of 85.5 months [42 - 186], corresponding to a prevalence of 12%. The mean age of our patients was 38.7 ± 11.9 years, with a M/F sex ratio of 2.3. Dialysis was initiated urgently in 10 patients (50%). Hemodialysis was the most commonly used modality (75%). Central venous catheterization was used in 35% of cases, including tunneled catheters. General condition is impaired in all patients, with persistent hypertension in 70% of cases. Mean uremia was 2.35 ± 0.8 g/l, mean creatinine 116 ± 48.3 mg/l, giving a mean GFR of 5.1 ± 2.2 ml/min. Mean albuminemia was 32.9 ± 6 g/l and mean hemoglobinemia 8.6 ± 1.9 g/dl. During the first year of follow-up, none of the patients died. However, 13 patients required hospitalization, with a mean length of stay of 15 days. Eight patients were hospitalized for infections and 5 for renal graft intolerance syndrome. After a mean follow-up of 22 months, 6 patients were detransplanted following graft necrosis. Conclusion: Return to dialysis after RT is fraught with a high rate of complications. The management of these patients must be optimized to improve their vital prognosis and quality of life.展开更多
Introduction: The frequent late-stage diagnosis of chronic kidney disease (CKD) constrains the treatment choices for nephrologists. Renal biopsy (RB) is crucial for accurately identifying renal lesions. This key nephr...Introduction: The frequent late-stage diagnosis of chronic kidney disease (CKD) constrains the treatment choices for nephrologists. Renal biopsy (RB) is crucial for accurately identifying renal lesions. This key nephrological procedure, however, is invasive and not without potential complications. The purpose of this study was to evaluate the indications, frequency, and histological lesion profiles of renal biopsies in Togo. Materials and Methods: We conducted a descriptive cross-sectional study encompassing all renal biopsies performed in Togo from the inception of nephrology services to the present. Data were compiled from the medical records of the patients. Results: From 2015 to 2023, 68 high-quality renal biopsies were executed in Togo. The patients had an average age of 30.6 years, with a predominance of males (69.1%). The most common indication was nephrotic syndrome, accounting for 66.2% of cases. Histologically, glomerulopathies were predominant, representing 61.8% of lesions, followed by vascular nephropathies (25%) and tubulointerstitial nephropathies (13.2%). The most frequently observed primary glomerulopathy was focal segmental glomerulosclerosis (FSGS). Gross hematuria was the sole complication, occurring in 1.4% of the cases. Conclusion: RB is an evolving practice in Togo. Glomerulopathies are the most commonly observed lesions. The histological categorization of renal lesions is vital for clinicians in their diagnostic reasoning and approach.展开更多
Thrombotic microangiopathy(TMA)is an uncommon but serious complication that not only affects native kidneys but also transplanted kidneys.This review is specifically focused on post-transplant TMA(PT-TMA)involving kid...Thrombotic microangiopathy(TMA)is an uncommon but serious complication that not only affects native kidneys but also transplanted kidneys.This review is specifically focused on post-transplant TMA(PT-TMA)involving kidney transplant recipients.Its reported prevalence in the latter population varies from 0.8%to 14%with adverse impacts on both graft and patient survival.It has many causes and associations,and the list of etiologic agents and associations is growing constantly.The pathogenesis is equally varied and a variety of pathogenetic pathways lead to the development of microvascular injury as the final common pathway.PT-TMA is categorized in many ways in order to facilitate its management.Ironically,more than one causes are contributory in PT-TMA and it is often difficult to pinpoint one particular cause in an individual case.Pathologically,the hallmark lesions are endothelial cell injury and intravascular thrombi affecting the microvasculature.Early diagnosis and classification of PT-TMA are imperative for optimal outcomes but are challenging for both clinicians and pathologists.The Banff classification has addressed this issue and has developed minimum diagnostic criteria for pathologic diagnosis of PT-TMA in the first phase.Management of the condition is also challenging and still largely empirical.It varies from simple maneuvers,such as plasmapheresis,drug withdrawal or modification,or dose reduction,to lifelong complement blockade,which is very expensive.A thorough understanding of the condition is imperative for an early diagnosis and quick treatment when the treatment is potentially effective.This review aims to increase the awareness of relevant stakeholders regarding this important,potentially treatable but under-recognized cause of kidney allograft dysfunction.展开更多
BACKGROUND The Columbia classification identified five histological variants of focal segmental glomerulosclerosis(FSGS).The prognostic significance of these variants remains controversial.AIM To evaluate the relative...BACKGROUND The Columbia classification identified five histological variants of focal segmental glomerulosclerosis(FSGS).The prognostic significance of these variants remains controversial.AIM To evaluate the relative frequency,clinicopathologic characteristics,and medium-term outcomes of FSGS variants at a single center in Pakistan.METHODS This retrospective study was conducted at the Department of Nephrology,Sindh Institute of Urology and Transplantation,Karachi,Pakistan on all consecutive adults(≥16 years)with biopsy-proven primary FSGS from January 1995 to December 2017.Studied subjects were treated with steroids as a first-line therapy.The response rates,doubling of serum creatinine,and kidney failure(KF)with replacement therapy were compared between histological variants using ANOVA or Kruskal Wallis,and Chi-square tests as appropriate.Data were analyzed by SPSS version 22.0.P-value≤0.05 was considered significant.RESULTS A total of 401 patients were diagnosed with primary FSGS during the study period.Among these,352(87.7%)had a designated histological variant.The not otherwise specified(NOS)variant was the commonest,being found in 185(53.9%)patients,followed by the tip variant in 100(29.1%)patients.Collapsing(COL),cellular(CEL),and perihilar(PHI)variants were seen in 58(16.9%),6(1.5%),and 3(0.7%)patients,respectively.CEL and PHI variants were excluded from further analysis due to small patient numbers.The mean follow-up period was 36.5±29.2 months.Regarding response rates of variants,patients with TIP lesions achieved remission more frequently(59.5%)than patients with NOS(41.8%)and COL(24.52%)variants(P<0.001).The hazard ratio of complete response among patients with the COL variant was 0.163[95%confidence interval(CI):0.039-0.67]as compared to patients with NOS.The TIP variant showed a hazard ratio of 2.5(95%CI:1.61-3.89)for complete remission compared to the NOS variant.Overall,progressive KF was observed more frequently in patients with the COL variant,43.4%(P<0.001).Among these,24.53%of patients required kidney replacement therapy(P<0.001).The hazard ratio of doubling of serum creatinine among patients with the COL variant was 14.57(95%CI:1.87-113.49)as compared to patients with the TIP variant.CONCLUSION In conclusion,histological variants of FSGS are predictive of response to treatment with immunosuppressants and progressive KF in adults in our setup.展开更多
Background: Methylmalonic aciduria (MMA) is a genetic disorder of aminoacid metabolism, due to mutations in methylmalonyl-CoA mutase, which leads to the accumulation of methylmalonic acid in body fluids. Patients typi...Background: Methylmalonic aciduria (MMA) is a genetic disorder of aminoacid metabolism, due to mutations in methylmalonyl-CoA mutase, which leads to the accumulation of methylmalonic acid in body fluids. Patients typically present at the age of 1 month to 1 year with dehydration, renal impairment as well as neurologic manifestations viz. seizure, encephalopathy, strokes and disease in the globus pallidi. The case: a 26-year-old man presented with severe acute on top of chronic renal disease with serum creatinine at 590 umol/L and bilateral 8 cm kidneys with thin and echogenic cortex. He had: (a) hypernatremic dehydration, metabolic acidosis and high ammonia level with (b) a history of multiple similar attacks since the age of 8 months. Diagnosis of MMA was confirmed by high serum and urine enzymatic levels as well as genetic testing. His initial management included support with replacements of fluids, electrolytes, and bicarbonates as well as intravenous dextrose, vitamin B12 and broad-spectrum antibiotic (Meropenem) for his chest infection. Subsequently, he received 1) CARBAGLU (carglumic acid) for 7 days to lower his ammonia level to Conclusion: Untreated homozygous MMA variants, can achieve adulthood with significant renal disease yet their morbidity and mortality can be ameliorated with diet and specific therapy.展开更多
In this paper,the experience in the treatment of complications due to continuousambulatory peritoneal dialysis for chronic renal failure with traditional Chinese medicine(TCM)is reported.Modified Renshen Yangrong Tang...In this paper,the experience in the treatment of complications due to continuousambulatory peritoneal dialysis for chronic renal failure with traditional Chinese medicine(TCM)is reported.Modified Renshen Yangrong Tang(Ginseng Nutrition Decoction)wasused for anorexia and hypoproteinemia;modified Xiangsha Liujunzi Tang(Decoction ofCyperus and Amomum with Six Noble Ingredients)for abdominal pain and distension;modified Da Chaihu Tang(Major Bupleurum Decoction)for peritonitis;modifiedShenling Baizhu San(Powder of Ginseng,Poria and Atractylodes)for diarrhea due toinsufficiency of the spleen with abundance of dampness;Lizhong Tang(Decoction forRegulating the Function of Middle-jiao)and modified Sishen Wan(Pills of FourMiraculous Drugs)for insufficiency of both the spleen and the kidney;Siwu Tang(Decoction of Four Ingredients)added with other drugs for cutaneous pruritus,andGuishao Sijunzi Tang(Decoction of Four Noble Drugs added with Chinese Angelica Rootand white Peony Root)for renal anemia.The therapeutic principles of invigorating theliver and kidney,strengthening the bones and muscles,and promoting blood circulation toeliminate blood stasis were adopted in the treatment of renal osteopathy,and thetherapeutic principles of invigorating the liver and kidney,expelling phlegm and resolvingdampness,and promoting blood circulation to eliminate blood stasis in the treatment ofhyperlipemia.Shen Tekang capsules(capsules for improving the renal function)wasadministered to patients for strengthening the viability and improving the nutrition state,and the recipe for treating renal function failure(both formulated by the authors)forimproving the renal function so as to decrease the frequency and duration of dialysis.展开更多
1 Introduction Nigella sativa, known as black seed, has analgesic, anti-inflammatory, antioxidant and anticancer effects. It has been shown to reduce the development of kidney failure when given prior to the use of ne...1 Introduction Nigella sativa, known as black seed, has analgesic, anti-inflammatory, antioxidant and anticancer effects. It has been shown to reduce the development of kidney failure when given prior to the use of nephrotoxic drugs particularly due to its antioxidant action. However, as far as the authors could ascertain, there is no human study in literature showing these effects. Here we present a case of acute renal failure after the use of N. sativa, rather than exhibiting antioxidant or antidiabetic effects.展开更多
The therapeutic effects of Shenshuailing Kou Fu Ye (SKFY [symbol: see text], the Oral Liquid for Renal Failure) and Shenshuailing Guan Chang Ye (SGCY [symbol: see text], the Enema for Renal Failure) were evaluated in ...The therapeutic effects of Shenshuailing Kou Fu Ye (SKFY [symbol: see text], the Oral Liquid for Renal Failure) and Shenshuailing Guan Chang Ye (SGCY [symbol: see text], the Enema for Renal Failure) were evaluated in treatment of chronic renal failure, with coateg aldehyde oxystarch as the controls. The changes in the clinical symptoms, serum creatinine, blood urea nitrogen and creatinine clearance rate were observed. The total effective rate in the former was 90.46%, and the latter 60.43%.展开更多
Patients with inflammatory bowel disease(IBD)can develop extra-renal complications and as a result,suffer from end stage renal failure requiring kidney transplantation(KT).A brief review of available literature reveal...Patients with inflammatory bowel disease(IBD)can develop extra-renal complications and as a result,suffer from end stage renal failure requiring kidney transplantation(KT).A brief review of available literature revealed that IBD patients undergoing KT have shorter overall survival rates compared to their controls.Literature reporting steroid regimens and survival outcomes specific to IBD and post kidney transplant are scarce and these studies have small sample sizes thus making it difficult to draw accurate conclusions.Further research is required in the form of a randomized controlled study to clarify the effect and mechanism of steroid immunosuppression on the prognosis of renal transplant recipients and explore new treatment schemes.展开更多
Kidney transplantation after liver transplanta tion（KALT） offers longer survival and a better quality of life to liver transplantation recipients who develop chronic renal failure. This article aimed to discuss the ...Kidney transplantation after liver transplanta tion（KALT） offers longer survival and a better quality of life to liver transplantation recipients who develop chronic renal failure. This article aimed to discuss the efficacy and safety of KALT compared with other treatments. The medical records of 5 patients who had undergone KALT were retrospectively studied, together with a literature review of studies. Three of them developed chronic renal failure after liver transplanta tion because of calcineurin inhibitor（CNI）-induced neph rotoxicity, while the others had lupus nephritis or non-CNI drug-induced nephrotoxicity. No mortality was observed in the 5 patients. Three KALT cases showed good prognoses maintaining a normal serum creatinine level during entire follow-up period. Chronic rejection occurred in the other two patients, and a kidney graft was removed from one of them Our data suggested that KALT is a good alternative to dialysis for liver transplantation recipients. The cases also indicate that KALT can be performed with good long-term survival.展开更多
Objective:This study aimed to examine the effects of mindfulness meditation on trait mindfulness,perceived stress,emotion regulation,and quality of life in end-stage renal disease patients undergoing hemodialysis.Meth...Objective:This study aimed to examine the effects of mindfulness meditation on trait mindfulness,perceived stress,emotion regulation,and quality of life in end-stage renal disease patients undergoing hemodialysis.Methods:An experimental study with repeated measures design was conducted among a sample of 74 end-stage renal disease patients undergoing hemodialysis between January and May 2021 in the dialysis center at Jahra hospital,Kuwait.The patients were randomly assigned to the experimental(n?37)and control groups(n?37).The experimental group participated in 30-min mindfulness meditation sessions(three sessions a week for five weeks)held during their hemodialysis sessions;the participants in the control group were instructed to sit with their eyes closed and relaxed for 30 min three times a week for five weeks during hemodialysis sessions.The dependent variables of both groups were measured at baseline(T0),middle of intervention(T1),and end of intervention(T2)using the Mindful Attention Awareness Scale(MAAS),Perceived Stress Scale(PSS),Emotion Regulation Questionnaire(ERQ),and Kidney Disease Quality of Life(KDQOL-36)questionnaire.The study was registered in the ClinicalTrial.gov(Identifier:NCT05176730).Results:The repeated measures ANOVA(within-subject)results for the experimental group showed that mindfulness meditation had significantly decreased perceived stress by the end of the intervention.Also,mindfulness meditation improved mindfulness,emotion regulation,and kidney disease-related quality of life in the experimental group,and this improvement occurred significantly at both T1 and T2.The repeated measures ANOVA(within and between-subject)results showed that the experimental group,as compared to the control group,had lower perceived stress,higher trait mindfulness,higher emotional regulation,and higher kidney disease-related quality of life over time.Conclusions:The positive findings of this study offer health policy-makers and hospital administrators a promising tool to use with patients undergoing hemodialysis as a way to manage stress and improve quality of life.However,this study should be replicated in multiple settings with follow-up assessments.展开更多
BACKGROUND: Calcineur ininhibitor-related renal toxicity affects patient and graft survival in transplant recipients. This study aimed to determine whether sirolimus is effective and safe in treating renal insufficien...BACKGROUND: Calcineur ininhibitor-related renal toxicity affects patient and graft survival in transplant recipients. This study aimed to determine whether sirolimus is effective and safe in treating renal insufficiency related to tacrolimus after liver transplantation. METHODS: Tacrolimus for primary immunosuppression was used in 16 patients after liver transplantation. Patients with a creatinine level higher than 132.6 mu mol/L were eligible for conversion to sirolimus. Simultaneously, the dose of tacrolimus was decreased to half. Blood urea nitrogen, creatinine, tacrolimus level, liver function and rejection episodes were monitored dynamically. RESULTS: All patients showed improvement of renal function after conversion to sirolimus. Blood creatinine level was reduced from 146.8 +/- 92.4 to 105.3 +/- 71.3 mu mol/L (P<0.05). One patient had an acute rejection episode that was successfully treated with pulsed corticosteroids and low-dose tacrolimus. The side-effects of sirolimus included hyperlipidemia (4 patients) and leukocytopenia (2). CONCLUSION: Sirolimus can be safely used in liver transplant recipients suffering from tacrolimus-related renal insufficiency.展开更多
To investigate the prevalence and association of Helicobacter pylori (H. pylori) with end-stage renal disease (ESRD).METHODSSA comprehensive literature search was completed from inception until October 2016. Studies t...To investigate the prevalence and association of Helicobacter pylori (H. pylori) with end-stage renal disease (ESRD).METHODSSA comprehensive literature search was completed from inception until October 2016. Studies that reported prevalence, relative risks, odd ratios, hazard ratios or standardized incidence ratio of H. pylori among ESRD patients were included. Participants without H. pylori were used as comparators to assess the association between H. pylori infection and ESRD. Pooled risk ratios and 95%CI was calculated using a random-effect model. Adjusted point estimates from each study were combined by the generic inverse variance method of DerSimonian and Laird.RESULTSOf 4546 relevant studies, thirty-seven observational studies met all inclusion criteria. Thirty-five cross-sectional studies were included in the analyses to assess the prevalence and association of H. pylori with ESRD. The estimated prevalence of H. pylori among ESRD patients was 44% (95%CI: 40%-49%). The pooled RR of H. pylori in patients with ESRD was 0.77 (95%CI: 0.59-1.00) when compared with the patients without ESRD. Subgroup analysis showed significantly reduced risk of H. pylori in adult ESRD patients with pooled RR of 0.71 (95%CI: 0.55-0.94). The data on the risk of ESRD in patients with H. pylori were limited. Two cohort studies were included to assess the risk of ESRD in patients with H. pylori. The pooled risk RR of ESRD in patients with H. pylori was 0.61 (95%CI: 0.03-12.20).CONCLUSIONThe estimated prevalence of H. pylori in ESRD patients is 44%. Our meta-analysis demonstrates a decreased risk of H. pylori in adult ESRD patients.展开更多
<strong>Context:</strong> Due to the late referral of the pads to the nephrologist and the lack of medical follow-up, many patients are admitted with complications from kidney disease requiring the urgent ...<strong>Context:</strong> Due to the late referral of the pads to the nephrologist and the lack of medical follow-up, many patients are admitted with complications from kidney disease requiring the urgent start of hemodialysis sessions. <strong>Purpose:</strong> Study the profile of emergency hemodialysis patients in order to ease their management. <strong>Methods:</strong> This was a retrospective, descriptive and analytical study carried out at the Nephrology Department of the Teaching Hospital of Yopougon from January 1st to December 31st, 2016. This study included all patients who had received a first session of hemodialysis in an emergency context. <strong>Results:</strong> We collected 146 patients with an average age of 39.80 ± 14.55 years and a sex ratio of 0.6 for men. Before admission, patients were known as hypertensives (63.9%), followed by CKD (23.9%) and HIV-infected (8.2%). The main clinical signs were hypertension (64.3%), edema (44.5%) and coma (30.1%). Anemia was observed in 97.2% of cases and it was less than 8 g/dl in 57.5%. Kidney failure was chronic in 75.3% and acute in 24.6%. Chronic nephropathies were glomerular (54.1%), vascular (20.5%). The main indications for hemodialysis were encephalopathy (33.5%), severe uremia (28%), acute pulmonary edema (19.8%), persistent anuria (11.6%) and hyperkalemia (5.4%). The vascular approach was a catheter in 97.2% (femoral site in 53.4% and jugular in 43.8% and arteriovenous fistula in 2.7%). Death was observed in 17.8%. In univariate analysis, age > 65 years (p = 0.04), coma (p = 0.004) and acute kidney failure (p = 0.02) were associated with the risk of death, and in multivariate analysis, only coma (p = 0.024, OR = 5.88) seemed to be associated with mortality risk for our patients. <strong>Conclusion:</strong> Hemodialysis in an emergency situation is a common practice in the Teaching Hospital of Yopougon and mainly concerns patients with CKD.展开更多
Ever since the severe acute respiratory syndrome virus causing coronavirus disease 2019(COVID-19)struck the world,global health strategies have changed significantly.According to the Centers for Disease Control and Pr...Ever since the severe acute respiratory syndrome virus causing coronavirus disease 2019(COVID-19)struck the world,global health strategies have changed significantly.According to the Centers for Disease Control and Prevention,kidney transplant recipients are stratified as being high risk of developing fatal illness from COVID-19 infection.Kidney transplant is the gold-standard treatment for end-stage kidney disease subjects.During the pandemic,significant concerns have emerged regarding continuation of kidney transplant surgeries and management of kidney transplant recipients post-transplant.The added risk of immunosuppression in this cohort was and remains a theoretical concern,posing a potential risk of transplantation rather than benefit.This comprehensive review aims to cover most of the faced challenges in kidney transplantation in different stages of the pandemic.In addition,it will elucidate the epidemiology,nature,course of the disease,surgical consideration in donors and recipients as well as role of immunosuppression and management of COVID-19 infected kidney transplant recipients during these extraordinary circumstances.展开更多
<strong>Introduction:</strong> Hemodialysis is the most common end-stage renal disease treatment worldwide. Several factors may influence treatment outcomes. Adequacy (dose) of hemodialysis remains controv...<strong>Introduction:</strong> Hemodialysis is the most common end-stage renal disease treatment worldwide. Several factors may influence treatment outcomes. Adequacy (dose) of hemodialysis remains controversial;however, investigations on the effectiveness rate (Kt/V ≥ 1.2), which could reflect morbimortality, are preferred. <strong>Objective:</strong> This study aimed to describe the level of adequacy of hemodialysis among patients undergoing treatment in the city of Rio Grande (RS), Brazil. <strong>Method:</strong> In this prospective cohort study, 156 patients undergoing hemodialysis treatment between July 2016 and June 2017 in the two hemodialysis centers in the city of Rio Grande (RS), Brazil, were included. Frequency distribution as per Kt/V stratification was analyzed. Chi-square test was used to compare proportions. <strong>Results:</strong> Adequate hemodialysis (Kt/V ≥ 1.2) was observed in 105 patients (67%), 88% were from the municipality (mean age, 59 years), and 43% had visited the hospital before knowing about their kidney disease. Most of them were referred to a nephrologist (70%). Of the 156 patients, 114 patients (73%) remained in dialysis treatment, 10 (6%) underwent transplantation, 9 (6%) were transferred, and 23 (15%) died at the end of 12 months. <strong>Conclusion:</strong> Primary care should be expanded for early diagnosis of chronic kidney disease, improved venous access preparation, and increased number of patients with hemodialysis adequacy. Hemodialysis adequacy in patients undergoing treatment in the city of Rio Grande (RS), Brazil, needs to be improved.展开更多
<strong>Introduction:</strong><span style="font-family:Verdana;"> Cardiovascular disease has become a major concern for the nephrologist as it is the leading cause of morbidity and mortalit...<strong>Introduction:</strong><span style="font-family:Verdana;"> Cardiovascular disease has become a major concern for the nephrologist as it is the leading cause of morbidity and mortality in patients with chronic kidney disease, and affects all stages of the disease, including the earliest stages of the disease. The goal of this work was to determine the frequency of cardiovascular complications during chronic kidney failure.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Patients and methods:</span></b><span style="font-family:Verdana;"> This was a six-month, descriptive cross-sectional study from March 01 to August 31, 2018. It covered all patients with chronic kidney disease hospitalized in the ward during the study period. Included were all chronic kidney failure patients with at least one cardiac and/or vascular complication diagnosed either on clinical examination, and/or paraclinical examination (Electrocardiogram or cardiac ultrasound, vessel echodoppler, scan)</span><span style="font-family:Verdana;">.</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Res</span></b></span><b><span style="font-family:Verdana;">ults:</span></b><span style="font-family:Verdana;"> During the study period, 84 out of 378 patients or 22.22% had at least one cardiovascular complication. Cardiovascular complications were hypertrophy of the left ventricle with 49/84 (44 at Electrocardiogram and 5 at cardiac echodoppler), valvulopathy with 33.33%, stroke with 50% of cases, obliterating arterial disease of the lower limbs 25%, hypokinetic dilated cardiomyopathy with 9/36 cases and pericarditis with 2/36.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Cardiovascular complications affect both sexes and all ages. They were dominated by enlarged left ventricle, valvulopathy and dilated cardiomyopathy.</span>展开更多
文摘BACKGROUND Hemodialysis is an advanced blood purification technique to manage kidney failure.However,for conventional hemodialysis,the high prevalence of dyslipidemia may cause cardiovascular diseases and an increase in mortality.Moreover,toxins accumulating in the body over time may induce some complications.High flux hemodialysis can effectively improve disease indexes and clinical symptoms.AIM To investigate the efficacy of high flux hemodialysis in elderly patients with chronic kidney failure(CKF).METHODS A total of 66 elderly patients with CKF who were admitted to our hospital from October 2017 to October 2018 were included in the study.According to the therapies they received,the patients were divided into a study group and a control group with 33 patients in each group.The study group received high flux hemodialysis and the control group received conventional dialysis treatment.Kidney function,toxin levels in serum,and complications were compared in the two groups.RESULTS Before the treatment,there was no significant difference in kidney function,β2-microglobulin,or blood urea nitrogen between the two groups(P>0.05).In contrast,kidney function was better in the study group than in the control group after the treatment(P<0.05).In addition,the study group had significantly lower parathyroid hormone and serum cystatin C than the control group(P<0.05).The incidence of complications was 8.57%in the study group,which was lower than that of the control group(20.00%;P<0.05).CONCLUSION High flux hemodialysis may improve kidney function and reduce toxin levels in serum and the incidence of complications in elderly patients with CKF.
基金supported by grants from the Science and Technology Department of the Hubei Province Foundation(No.2019CFC895)2016 Wuhan Young and Middle-Aged Talent Plan Foundation.
文摘Objective:To establish a quantitative evaluation of the left ventricle's systolic function in patients with chronic kidney failure(CKF)by three-dimensional speckle-tracking echocardiography.Methods:Two-dimensional and three-dimensional transthoracic echocardiography was performed on 30 patients with CKF.The ejection fraction,mass and global peak longitudinal strain,global circumferential strain,global area strain,and global radial strain of the left ventricle were calculated.Results:The ejection fraction,mass and global peak longitudinal strain(GLS),global circumferential strain(GCS),global area strain(GAS),and global radial strain(GRS)in the CKF group were significantly lower than those in the control group.Simultaneously,the GLS,GCS,GAS and GRS were well correlated with the ejection fraction.For patients with normal ejection fraction in the CKF group,the GLS,GCS,GAS and GRS were lower than those in the control group,while the left ventricular mass was significantly higher in CKF patients than in the control group.For patients with hypertension in the CKF group,ejection fraction,GLS,GCS,GAS and GRS calculated using three-dimensional echocardiography were significantly lower than those in patients with normal blood pressure;however,the myocardial mass was higher.Conclusions:The parameters(GLS,GCS,GAS and GRS)calculated using three-dimensional speckle-tracking software were lower in the CKF group.Simultaneously,the left ventricular mass was higher in CFK patients than in the control group,thus showing that the myocardial contraction function was impaired and that myocardial remodeling had occurred.
文摘Objective Variations are present in common clinical practices regarding best practice in managing hyperkalaemia(HK),there is therefore a need to establish a multi-specialty approach to optimal renin angiotension-aldosterone system inhibitors(RAASi)usage and HK management in patients with chronic kidney disease(CKD)&heart failure(HF).This study aimed to establish a multi-speciality approach to the optimal use of RAASi and the management of HK in patients with CKD and HF.Methods A steering expert group of cardiology and nephrology experts across China were convened to discuss challenges to HK management through a nominal group technique.The group then created a list of 41 statements for a consensus questionnaire,which was distributed for a further survey in extended panel group of cardiologists and nephrologists across China.Consensus was assessed using a modified Delphi technique,with agreement defined as"strong"(≥75%and<90%)and"very strong"(≥90%).The steering group,data collection,and analysis were aided by an independent facilitator.Results A total of 150 responses from 21 provinces across China were recruited in the survey.Respondents were comprised of an even split(n=75,50%)between cardiologists and nephrologists.All 41 statements achieved the 75%consensus agreement threshold,of which 27 statements attained very strong consensus(≥90%agreement)and 14 attained strong consensus(agreement between 75%and 90%).Conclusion Based on the agreement levels from respondents,the steering group agreed a set of recommendations intended to improve patient outcomes in the use of RAASi therapy and HK management in China.
文摘Introduction: The transition period from renal transplantation to dialysis is associated with high morbidity and mortality. The aim of this study is to describe the clinical and paraclinical characteristics, therapeutic management and evolutionary profile of patients returning to dialysis after kidney graft failure. Material and Methods: This was a retrospective, descriptive study conducted in the Nephrology-Dialysis-Renal Transplant Department at university hospital IbnSina between January 1998 and December 2021. We included all renal transplant recipients who had experienced kidney graft dysfunction and returned to dialysis. Patients with a follow-up after return to dialysis of less than 1 year were excluded. Results: Among 166 renal transplant recipients, 20 returned to dialysis after a median renal graft life of 85.5 months [42 - 186], corresponding to a prevalence of 12%. The mean age of our patients was 38.7 ± 11.9 years, with a M/F sex ratio of 2.3. Dialysis was initiated urgently in 10 patients (50%). Hemodialysis was the most commonly used modality (75%). Central venous catheterization was used in 35% of cases, including tunneled catheters. General condition is impaired in all patients, with persistent hypertension in 70% of cases. Mean uremia was 2.35 ± 0.8 g/l, mean creatinine 116 ± 48.3 mg/l, giving a mean GFR of 5.1 ± 2.2 ml/min. Mean albuminemia was 32.9 ± 6 g/l and mean hemoglobinemia 8.6 ± 1.9 g/dl. During the first year of follow-up, none of the patients died. However, 13 patients required hospitalization, with a mean length of stay of 15 days. Eight patients were hospitalized for infections and 5 for renal graft intolerance syndrome. After a mean follow-up of 22 months, 6 patients were detransplanted following graft necrosis. Conclusion: Return to dialysis after RT is fraught with a high rate of complications. The management of these patients must be optimized to improve their vital prognosis and quality of life.
文摘Introduction: The frequent late-stage diagnosis of chronic kidney disease (CKD) constrains the treatment choices for nephrologists. Renal biopsy (RB) is crucial for accurately identifying renal lesions. This key nephrological procedure, however, is invasive and not without potential complications. The purpose of this study was to evaluate the indications, frequency, and histological lesion profiles of renal biopsies in Togo. Materials and Methods: We conducted a descriptive cross-sectional study encompassing all renal biopsies performed in Togo from the inception of nephrology services to the present. Data were compiled from the medical records of the patients. Results: From 2015 to 2023, 68 high-quality renal biopsies were executed in Togo. The patients had an average age of 30.6 years, with a predominance of males (69.1%). The most common indication was nephrotic syndrome, accounting for 66.2% of cases. Histologically, glomerulopathies were predominant, representing 61.8% of lesions, followed by vascular nephropathies (25%) and tubulointerstitial nephropathies (13.2%). The most frequently observed primary glomerulopathy was focal segmental glomerulosclerosis (FSGS). Gross hematuria was the sole complication, occurring in 1.4% of the cases. Conclusion: RB is an evolving practice in Togo. Glomerulopathies are the most commonly observed lesions. The histological categorization of renal lesions is vital for clinicians in their diagnostic reasoning and approach.
文摘Thrombotic microangiopathy(TMA)is an uncommon but serious complication that not only affects native kidneys but also transplanted kidneys.This review is specifically focused on post-transplant TMA(PT-TMA)involving kidney transplant recipients.Its reported prevalence in the latter population varies from 0.8%to 14%with adverse impacts on both graft and patient survival.It has many causes and associations,and the list of etiologic agents and associations is growing constantly.The pathogenesis is equally varied and a variety of pathogenetic pathways lead to the development of microvascular injury as the final common pathway.PT-TMA is categorized in many ways in order to facilitate its management.Ironically,more than one causes are contributory in PT-TMA and it is often difficult to pinpoint one particular cause in an individual case.Pathologically,the hallmark lesions are endothelial cell injury and intravascular thrombi affecting the microvasculature.Early diagnosis and classification of PT-TMA are imperative for optimal outcomes but are challenging for both clinicians and pathologists.The Banff classification has addressed this issue and has developed minimum diagnostic criteria for pathologic diagnosis of PT-TMA in the first phase.Management of the condition is also challenging and still largely empirical.It varies from simple maneuvers,such as plasmapheresis,drug withdrawal or modification,or dose reduction,to lifelong complement blockade,which is very expensive.A thorough understanding of the condition is imperative for an early diagnosis and quick treatment when the treatment is potentially effective.This review aims to increase the awareness of relevant stakeholders regarding this important,potentially treatable but under-recognized cause of kidney allograft dysfunction.
文摘BACKGROUND The Columbia classification identified five histological variants of focal segmental glomerulosclerosis(FSGS).The prognostic significance of these variants remains controversial.AIM To evaluate the relative frequency,clinicopathologic characteristics,and medium-term outcomes of FSGS variants at a single center in Pakistan.METHODS This retrospective study was conducted at the Department of Nephrology,Sindh Institute of Urology and Transplantation,Karachi,Pakistan on all consecutive adults(≥16 years)with biopsy-proven primary FSGS from January 1995 to December 2017.Studied subjects were treated with steroids as a first-line therapy.The response rates,doubling of serum creatinine,and kidney failure(KF)with replacement therapy were compared between histological variants using ANOVA or Kruskal Wallis,and Chi-square tests as appropriate.Data were analyzed by SPSS version 22.0.P-value≤0.05 was considered significant.RESULTS A total of 401 patients were diagnosed with primary FSGS during the study period.Among these,352(87.7%)had a designated histological variant.The not otherwise specified(NOS)variant was the commonest,being found in 185(53.9%)patients,followed by the tip variant in 100(29.1%)patients.Collapsing(COL),cellular(CEL),and perihilar(PHI)variants were seen in 58(16.9%),6(1.5%),and 3(0.7%)patients,respectively.CEL and PHI variants were excluded from further analysis due to small patient numbers.The mean follow-up period was 36.5±29.2 months.Regarding response rates of variants,patients with TIP lesions achieved remission more frequently(59.5%)than patients with NOS(41.8%)and COL(24.52%)variants(P<0.001).The hazard ratio of complete response among patients with the COL variant was 0.163[95%confidence interval(CI):0.039-0.67]as compared to patients with NOS.The TIP variant showed a hazard ratio of 2.5(95%CI:1.61-3.89)for complete remission compared to the NOS variant.Overall,progressive KF was observed more frequently in patients with the COL variant,43.4%(P<0.001).Among these,24.53%of patients required kidney replacement therapy(P<0.001).The hazard ratio of doubling of serum creatinine among patients with the COL variant was 14.57(95%CI:1.87-113.49)as compared to patients with the TIP variant.CONCLUSION In conclusion,histological variants of FSGS are predictive of response to treatment with immunosuppressants and progressive KF in adults in our setup.
文摘Background: Methylmalonic aciduria (MMA) is a genetic disorder of aminoacid metabolism, due to mutations in methylmalonyl-CoA mutase, which leads to the accumulation of methylmalonic acid in body fluids. Patients typically present at the age of 1 month to 1 year with dehydration, renal impairment as well as neurologic manifestations viz. seizure, encephalopathy, strokes and disease in the globus pallidi. The case: a 26-year-old man presented with severe acute on top of chronic renal disease with serum creatinine at 590 umol/L and bilateral 8 cm kidneys with thin and echogenic cortex. He had: (a) hypernatremic dehydration, metabolic acidosis and high ammonia level with (b) a history of multiple similar attacks since the age of 8 months. Diagnosis of MMA was confirmed by high serum and urine enzymatic levels as well as genetic testing. His initial management included support with replacements of fluids, electrolytes, and bicarbonates as well as intravenous dextrose, vitamin B12 and broad-spectrum antibiotic (Meropenem) for his chest infection. Subsequently, he received 1) CARBAGLU (carglumic acid) for 7 days to lower his ammonia level to Conclusion: Untreated homozygous MMA variants, can achieve adulthood with significant renal disease yet their morbidity and mortality can be ameliorated with diet and specific therapy.
文摘In this paper,the experience in the treatment of complications due to continuousambulatory peritoneal dialysis for chronic renal failure with traditional Chinese medicine(TCM)is reported.Modified Renshen Yangrong Tang(Ginseng Nutrition Decoction)wasused for anorexia and hypoproteinemia;modified Xiangsha Liujunzi Tang(Decoction ofCyperus and Amomum with Six Noble Ingredients)for abdominal pain and distension;modified Da Chaihu Tang(Major Bupleurum Decoction)for peritonitis;modifiedShenling Baizhu San(Powder of Ginseng,Poria and Atractylodes)for diarrhea due toinsufficiency of the spleen with abundance of dampness;Lizhong Tang(Decoction forRegulating the Function of Middle-jiao)and modified Sishen Wan(Pills of FourMiraculous Drugs)for insufficiency of both the spleen and the kidney;Siwu Tang(Decoction of Four Ingredients)added with other drugs for cutaneous pruritus,andGuishao Sijunzi Tang(Decoction of Four Noble Drugs added with Chinese Angelica Rootand white Peony Root)for renal anemia.The therapeutic principles of invigorating theliver and kidney,strengthening the bones and muscles,and promoting blood circulation toeliminate blood stasis were adopted in the treatment of renal osteopathy,and thetherapeutic principles of invigorating the liver and kidney,expelling phlegm and resolvingdampness,and promoting blood circulation to eliminate blood stasis in the treatment ofhyperlipemia.Shen Tekang capsules(capsules for improving the renal function)wasadministered to patients for strengthening the viability and improving the nutrition state,and the recipe for treating renal function failure(both formulated by the authors)forimproving the renal function so as to decrease the frequency and duration of dialysis.
文摘1 Introduction Nigella sativa, known as black seed, has analgesic, anti-inflammatory, antioxidant and anticancer effects. It has been shown to reduce the development of kidney failure when given prior to the use of nephrotoxic drugs particularly due to its antioxidant action. However, as far as the authors could ascertain, there is no human study in literature showing these effects. Here we present a case of acute renal failure after the use of N. sativa, rather than exhibiting antioxidant or antidiabetic effects.
文摘The therapeutic effects of Shenshuailing Kou Fu Ye (SKFY [symbol: see text], the Oral Liquid for Renal Failure) and Shenshuailing Guan Chang Ye (SGCY [symbol: see text], the Enema for Renal Failure) were evaluated in treatment of chronic renal failure, with coateg aldehyde oxystarch as the controls. The changes in the clinical symptoms, serum creatinine, blood urea nitrogen and creatinine clearance rate were observed. The total effective rate in the former was 90.46%, and the latter 60.43%.
文摘Patients with inflammatory bowel disease(IBD)can develop extra-renal complications and as a result,suffer from end stage renal failure requiring kidney transplantation(KT).A brief review of available literature revealed that IBD patients undergoing KT have shorter overall survival rates compared to their controls.Literature reporting steroid regimens and survival outcomes specific to IBD and post kidney transplant are scarce and these studies have small sample sizes thus making it difficult to draw accurate conclusions.Further research is required in the form of a randomized controlled study to clarify the effect and mechanism of steroid immunosuppression on the prognosis of renal transplant recipients and explore new treatment schemes.
文摘Kidney transplantation after liver transplanta tion（KALT） offers longer survival and a better quality of life to liver transplantation recipients who develop chronic renal failure. This article aimed to discuss the efficacy and safety of KALT compared with other treatments. The medical records of 5 patients who had undergone KALT were retrospectively studied, together with a literature review of studies. Three of them developed chronic renal failure after liver transplanta tion because of calcineurin inhibitor（CNI）-induced neph rotoxicity, while the others had lupus nephritis or non-CNI drug-induced nephrotoxicity. No mortality was observed in the 5 patients. Three KALT cases showed good prognoses maintaining a normal serum creatinine level during entire follow-up period. Chronic rejection occurred in the other two patients, and a kidney graft was removed from one of them Our data suggested that KALT is a good alternative to dialysis for liver transplantation recipients. The cases also indicate that KALT can be performed with good long-term survival.
基金funding from Jordan University of Science and Technology,Deanship of Research.
文摘Objective:This study aimed to examine the effects of mindfulness meditation on trait mindfulness,perceived stress,emotion regulation,and quality of life in end-stage renal disease patients undergoing hemodialysis.Methods:An experimental study with repeated measures design was conducted among a sample of 74 end-stage renal disease patients undergoing hemodialysis between January and May 2021 in the dialysis center at Jahra hospital,Kuwait.The patients were randomly assigned to the experimental(n?37)and control groups(n?37).The experimental group participated in 30-min mindfulness meditation sessions(three sessions a week for five weeks)held during their hemodialysis sessions;the participants in the control group were instructed to sit with their eyes closed and relaxed for 30 min three times a week for five weeks during hemodialysis sessions.The dependent variables of both groups were measured at baseline(T0),middle of intervention(T1),and end of intervention(T2)using the Mindful Attention Awareness Scale(MAAS),Perceived Stress Scale(PSS),Emotion Regulation Questionnaire(ERQ),and Kidney Disease Quality of Life(KDQOL-36)questionnaire.The study was registered in the ClinicalTrial.gov(Identifier:NCT05176730).Results:The repeated measures ANOVA(within-subject)results for the experimental group showed that mindfulness meditation had significantly decreased perceived stress by the end of the intervention.Also,mindfulness meditation improved mindfulness,emotion regulation,and kidney disease-related quality of life in the experimental group,and this improvement occurred significantly at both T1 and T2.The repeated measures ANOVA(within and between-subject)results showed that the experimental group,as compared to the control group,had lower perceived stress,higher trait mindfulness,higher emotional regulation,and higher kidney disease-related quality of life over time.Conclusions:The positive findings of this study offer health policy-makers and hospital administrators a promising tool to use with patients undergoing hemodialysis as a way to manage stress and improve quality of life.However,this study should be replicated in multiple settings with follow-up assessments.
文摘BACKGROUND: Calcineur ininhibitor-related renal toxicity affects patient and graft survival in transplant recipients. This study aimed to determine whether sirolimus is effective and safe in treating renal insufficiency related to tacrolimus after liver transplantation. METHODS: Tacrolimus for primary immunosuppression was used in 16 patients after liver transplantation. Patients with a creatinine level higher than 132.6 mu mol/L were eligible for conversion to sirolimus. Simultaneously, the dose of tacrolimus was decreased to half. Blood urea nitrogen, creatinine, tacrolimus level, liver function and rejection episodes were monitored dynamically. RESULTS: All patients showed improvement of renal function after conversion to sirolimus. Blood creatinine level was reduced from 146.8 +/- 92.4 to 105.3 +/- 71.3 mu mol/L (P<0.05). One patient had an acute rejection episode that was successfully treated with pulsed corticosteroids and low-dose tacrolimus. The side-effects of sirolimus included hyperlipidemia (4 patients) and leukocytopenia (2). CONCLUSION: Sirolimus can be safely used in liver transplant recipients suffering from tacrolimus-related renal insufficiency.
文摘To investigate the prevalence and association of Helicobacter pylori (H. pylori) with end-stage renal disease (ESRD).METHODSSA comprehensive literature search was completed from inception until October 2016. Studies that reported prevalence, relative risks, odd ratios, hazard ratios or standardized incidence ratio of H. pylori among ESRD patients were included. Participants without H. pylori were used as comparators to assess the association between H. pylori infection and ESRD. Pooled risk ratios and 95%CI was calculated using a random-effect model. Adjusted point estimates from each study were combined by the generic inverse variance method of DerSimonian and Laird.RESULTSOf 4546 relevant studies, thirty-seven observational studies met all inclusion criteria. Thirty-five cross-sectional studies were included in the analyses to assess the prevalence and association of H. pylori with ESRD. The estimated prevalence of H. pylori among ESRD patients was 44% (95%CI: 40%-49%). The pooled RR of H. pylori in patients with ESRD was 0.77 (95%CI: 0.59-1.00) when compared with the patients without ESRD. Subgroup analysis showed significantly reduced risk of H. pylori in adult ESRD patients with pooled RR of 0.71 (95%CI: 0.55-0.94). The data on the risk of ESRD in patients with H. pylori were limited. Two cohort studies were included to assess the risk of ESRD in patients with H. pylori. The pooled risk RR of ESRD in patients with H. pylori was 0.61 (95%CI: 0.03-12.20).CONCLUSIONThe estimated prevalence of H. pylori in ESRD patients is 44%. Our meta-analysis demonstrates a decreased risk of H. pylori in adult ESRD patients.
文摘<strong>Context:</strong> Due to the late referral of the pads to the nephrologist and the lack of medical follow-up, many patients are admitted with complications from kidney disease requiring the urgent start of hemodialysis sessions. <strong>Purpose:</strong> Study the profile of emergency hemodialysis patients in order to ease their management. <strong>Methods:</strong> This was a retrospective, descriptive and analytical study carried out at the Nephrology Department of the Teaching Hospital of Yopougon from January 1st to December 31st, 2016. This study included all patients who had received a first session of hemodialysis in an emergency context. <strong>Results:</strong> We collected 146 patients with an average age of 39.80 ± 14.55 years and a sex ratio of 0.6 for men. Before admission, patients were known as hypertensives (63.9%), followed by CKD (23.9%) and HIV-infected (8.2%). The main clinical signs were hypertension (64.3%), edema (44.5%) and coma (30.1%). Anemia was observed in 97.2% of cases and it was less than 8 g/dl in 57.5%. Kidney failure was chronic in 75.3% and acute in 24.6%. Chronic nephropathies were glomerular (54.1%), vascular (20.5%). The main indications for hemodialysis were encephalopathy (33.5%), severe uremia (28%), acute pulmonary edema (19.8%), persistent anuria (11.6%) and hyperkalemia (5.4%). The vascular approach was a catheter in 97.2% (femoral site in 53.4% and jugular in 43.8% and arteriovenous fistula in 2.7%). Death was observed in 17.8%. In univariate analysis, age > 65 years (p = 0.04), coma (p = 0.004) and acute kidney failure (p = 0.02) were associated with the risk of death, and in multivariate analysis, only coma (p = 0.024, OR = 5.88) seemed to be associated with mortality risk for our patients. <strong>Conclusion:</strong> Hemodialysis in an emergency situation is a common practice in the Teaching Hospital of Yopougon and mainly concerns patients with CKD.
文摘Ever since the severe acute respiratory syndrome virus causing coronavirus disease 2019(COVID-19)struck the world,global health strategies have changed significantly.According to the Centers for Disease Control and Prevention,kidney transplant recipients are stratified as being high risk of developing fatal illness from COVID-19 infection.Kidney transplant is the gold-standard treatment for end-stage kidney disease subjects.During the pandemic,significant concerns have emerged regarding continuation of kidney transplant surgeries and management of kidney transplant recipients post-transplant.The added risk of immunosuppression in this cohort was and remains a theoretical concern,posing a potential risk of transplantation rather than benefit.This comprehensive review aims to cover most of the faced challenges in kidney transplantation in different stages of the pandemic.In addition,it will elucidate the epidemiology,nature,course of the disease,surgical consideration in donors and recipients as well as role of immunosuppression and management of COVID-19 infected kidney transplant recipients during these extraordinary circumstances.
文摘<strong>Introduction:</strong> Hemodialysis is the most common end-stage renal disease treatment worldwide. Several factors may influence treatment outcomes. Adequacy (dose) of hemodialysis remains controversial;however, investigations on the effectiveness rate (Kt/V ≥ 1.2), which could reflect morbimortality, are preferred. <strong>Objective:</strong> This study aimed to describe the level of adequacy of hemodialysis among patients undergoing treatment in the city of Rio Grande (RS), Brazil. <strong>Method:</strong> In this prospective cohort study, 156 patients undergoing hemodialysis treatment between July 2016 and June 2017 in the two hemodialysis centers in the city of Rio Grande (RS), Brazil, were included. Frequency distribution as per Kt/V stratification was analyzed. Chi-square test was used to compare proportions. <strong>Results:</strong> Adequate hemodialysis (Kt/V ≥ 1.2) was observed in 105 patients (67%), 88% were from the municipality (mean age, 59 years), and 43% had visited the hospital before knowing about their kidney disease. Most of them were referred to a nephrologist (70%). Of the 156 patients, 114 patients (73%) remained in dialysis treatment, 10 (6%) underwent transplantation, 9 (6%) were transferred, and 23 (15%) died at the end of 12 months. <strong>Conclusion:</strong> Primary care should be expanded for early diagnosis of chronic kidney disease, improved venous access preparation, and increased number of patients with hemodialysis adequacy. Hemodialysis adequacy in patients undergoing treatment in the city of Rio Grande (RS), Brazil, needs to be improved.
文摘<strong>Introduction:</strong><span style="font-family:Verdana;"> Cardiovascular disease has become a major concern for the nephrologist as it is the leading cause of morbidity and mortality in patients with chronic kidney disease, and affects all stages of the disease, including the earliest stages of the disease. The goal of this work was to determine the frequency of cardiovascular complications during chronic kidney failure.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Patients and methods:</span></b><span style="font-family:Verdana;"> This was a six-month, descriptive cross-sectional study from March 01 to August 31, 2018. It covered all patients with chronic kidney disease hospitalized in the ward during the study period. Included were all chronic kidney failure patients with at least one cardiac and/or vascular complication diagnosed either on clinical examination, and/or paraclinical examination (Electrocardiogram or cardiac ultrasound, vessel echodoppler, scan)</span><span style="font-family:Verdana;">.</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Res</span></b></span><b><span style="font-family:Verdana;">ults:</span></b><span style="font-family:Verdana;"> During the study period, 84 out of 378 patients or 22.22% had at least one cardiovascular complication. Cardiovascular complications were hypertrophy of the left ventricle with 49/84 (44 at Electrocardiogram and 5 at cardiac echodoppler), valvulopathy with 33.33%, stroke with 50% of cases, obliterating arterial disease of the lower limbs 25%, hypokinetic dilated cardiomyopathy with 9/36 cases and pericarditis with 2/36.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Cardiovascular complications affect both sexes and all ages. They were dominated by enlarged left ventricle, valvulopathy and dilated cardiomyopathy.</span>
