Covid-19 (sars-cov-2 infection) information for patients with predialytic chronic kidney disease / Informações para pacientes com doença renal crônica pré-dialítica sobre Covid-19 (infecção pelo SARS-CoV-2)

ABSTRACT Patients with Chronic Kidney Disease are among those individuals at increased risk for developing more serious forms of Covid-19. This increased risk starts in the pre-dialysis phase of the disease. Providing useful information for these patients, in language that facilitates the understanding of the disease, can help nephrologists and other healthcare professionals to establish a more effective communication with these patients and help minimize contagion and the risks of serious illness in this population.

RESUMO Pacientes com Doença Renal Crônica estão entre os indivíduos de risco aumentado para desenvolvimento de formas mais sérias de Covid-19. Esse risco aumentado inicia-se já na fase pré-dialítica da doença. Fornecer informações úteis para esses pacientes, em linguagem que facilite o entendimento da doença, pode ajudar nefrologistas e outros profissionais de saúde a estabelecerem uma comunicação mais efetiva com esses pacientes e ajudar a minimizar o contágio e os riscos de doença grave nessa população.

Periodontal Health of Pre-Dialysis Chronic Kidney Disease Patients in a Northeast Peninsular Malaysia Tertiary Hospital

@#Introduction: Chronic kidney disease (CKD) is associated with periodontal disease due to its hyperinflammatory state. Limited studies have explored the prevalence of periodontal disease among CKD patients in Malaysia. Objective: To assess the periodontal status of pre-dialysis CKD patients in Hospital Universiti Sains Malaysia. Methods: A total of 46 pre-dialysis CKD patients who attended the nephrology clinic at Hospital Universiti Sains Malaysia were enrolled in this study. Periodontal examination was performed using the periodontal probing depth (PPD), clinical attachment loss (CAL) and plaque index. Results: The majority of the CKD patients were Malay (95.7%) and 80.4% were males. The mean age of the patients was 58.5 years. Using PPD measurement, 37 (74.0%) of the patients had mild periodontitis, 9 (20.0%) had moderate periodontitis and 3 (6.0%) had no periodontitis. Based on CAL measurement, 12 (26%) patients had mild periodontitis, 29 (63.0%) had moderate periodontitis and 5 (11%) had severe periodontitis. The mean (standard deviation [SD]) value of mild and moderate-to-severe periodontitis by PPD measurement were 4.26 (0.26) and 5.24 (0.36), respectively. The mean of mild and moderate-to-severe periodontitis by CAL measurement were 2.66 (0.62) and 4.98 (0.73), respectively. There was no correlation between the periodontal parameters and estimated glomerular filtration rate (PPD: r = −0.160, P = 0.914; CAL: r = −0.135, P = 0.372; plaque index: r = 0.005, P = 0.974). Conclusion: This study revealed a greater prevalence and severity of chronic periodontitis among CKD patients. Thus, the periodontal health of CKD patients’ needs to be screened and monitored.

Arterial stiffness and its impact on prognosis in patients with stage 3-5 chronic kidney disease(pre-dialysis) / 中国实用内科杂志

OBJECTIVE: To assess the impact of arterial stiffness on prognosis in patients with chronic kidney disease(CKD)stages 3-5(pre-dialysis).METHODS: 141 patients suffered from chronic kidney disease(CKD)stages 3-5 pre-dialysis were enrolled in this study between April 2006 and November 2010.Automatic pulse wave velocity(PWV)measuring system was used to examine carotid-femoral pulse wave velocity(CFPWV).According to CFPWV level,we divided the patients into elevated CFPWV group(CFPWV ≥12 m/s)and the normal group(CFPWV<12 m/s).Patients were followed up for the occurrence of cardiovascular event,cardiovascular death and all-cause death.Kaplan-Meier methods were used for survival analysis and Cox's proportional hazard regression model were used to analyze risk factors.RESULTS: Two groups were followed-up(93.72±47.93)months.The incidences of cardiac-cerebral vascular event,cardiac-cerebral vascular death and all-cause death were higher in high CFPWV level groups(62.2%vs.21.6%,56.7%vs.15.7%,64.4%vs.19.6%,P<0.05).The level of CFPWV was higher in patients with cardiac-cerebral vascular event,cardiac-cerebral vascular death and all-cause death than those without those events[(15.31±3.41)m/s vs.(12.08±2.94)m/s,(15.66±3.40)m/s vs.(12.14±2.88)m/s,(15.38±3.38)m/s vs.(11.97±2.87)m/s,P<0.01].Kaplan-Meier curve for overall survivals and cardiac-cerebral vascular event free survivals showed a significant distinct between high and normal CFPWV level groups,suggesting that the incidence of cardiac-cerebral vascular events,cardiac-cerebral vascular mortality and all-cause mortality were significantly higher in high CFPWV level group than in normal CFPWV group(P=0.000).Multivariate Cox regression analysis revealed that increased CFPWV and commencing dialysis were the independent risk factors for cardiac-cerebral vascular event,increased CFPWV and CRP and decreased ALB and commencing dialysis were the independent risk factors for cardiac-cerebral vascular mortality and all-cause mortality(P<0.05).CONCLUSION: The levels of CFPWV in pre-dialysis chronic kidney disease(CKD)stage 3-5 patients increases significantly.The incidence of cardiac-cerebral vascular events,cardiac-cerebral vascular mortality and all-cause mortality are significantly higher in elevated CFPWV group than those of normal group in patients with CKD G3-5.The elevated CFPWV is one of independent risk factors of cardiac-cerebral vascular event,cardiac-cerebral vascular mortality and all-cause mortality in patients with pre-dialysis chronic kidney disease.

Oral Manifestation and Caries Experience in Pre-Dialysis Chronic Kidney Disease Patients

@#Patients with chronic kidney disease (CKD) are prone to develop oral lesions due to the disease process or the therapy or both. The systemic problems started to develop in the pre-dialysis stages of CKD. Oral lesions and caries experience are the non-traditional risk factors in progression of CKD. This research was conducted to study and compare the oral manifestation and caries experience of pre-dialysis patients and healthy subjects in Hospital Universiti Sains Malaysia (HUSM). Fifty-eight patients, which consist of 29 pre-dialysis patients and 29 controls were recruited. CKD patients (stage III and IV) who attended nephrology clinic and CKD Resource Centre Unit of HUSM were selected. The control group consisted of healthy patients without any systemic disease who attended dental clinic of HUSM. The patients were examined for the oral manifestation. The decayed, missing, filled teeth (DMFT) index were also recorded. Oral lesions were present in 96.6% of pre-dialysis patients and 51.7% of control group (p < 0.001). The significant oral manifestations in pre-dialysis patients were xerostomia, halitosis, abnormal taste, mucosa pallor, enamel hypoplasia, gingival enlargement and abnormal lip pigmentation. There was significant difference in caries experience between pre-dialysis patients and healthy controls but no correlation between estimated glomerular filtration rate (eGFR) and caries experience in the predialysis patients. Thus, dental screening needs to be done to control the problems. Future studies with multicentred and larger sample size are warranted to explore the magnitude of this problem.

Research in predialysis education for dialysis timing in patients with end-stage renal disease / 中国实用护理杂志

Objective To investigate the predialysis education on dialysis timing of patients with end-stage renal disease (ESRD). Methods 129 patients with chronic renal failure (CRF) and serum creatinine(Scr)＞442μmol/L, endogenous creatinine clearance rate (Ccr)＜20 ml/min were randomly divided into the experimental group(70 cases) and the control group(59 cases), the experimental group received predialysis education, the control group received routine care.The basic situation, dialysis timing, depression and quality of life on the 6th,12th months after dialysis were assessed. Results There was no significant difference in age, sex, education background, health care payment manners, employment, serum creatinine, endogenous creatinine clearance rate before education.For the timing of dialysis, Ccr for the experimental group was (9.49 ± 0.77)ml/min, Ccr for the control group was (4.54 ±1.79) ml/min,the difference was significant, depression and quality of life between two groups after 6,12 months of dialysis was also statistically different. Conclusions Strengthening predialysis education is conducive to a timely start of dialysis and can effectively improve the quality of life in patients with ESRD.

Arterial stiffness and associated factors in non-diabetic pre-dialysis patients with chronic kidney disease / 中华肾脏病杂志

Objective To study the arterial stiffness in non-diabetic pre-dialysis chronic kidney disease (CKD) patients and to explore the associated factors. Methods Automatic pulse wave velocity (PWV) measuring system was used to examine carotid-femoral pulse wave velocity (CFPWV) as the parameters reflecting central elastic large arterial elasticity. Vascular calcification was quantitatively evaluated by plain radiographic film of abdomen, pelvis and hands. Blood pressure, biochemical parameters and intact parathyroid hormone (iPTH) were routinely detected. Stepwise multiple linear regression analysis was used to assess the associated factors of arterial stiffness. Results Ninety-six non-diabetic pre-dialysis CKD patients and 30 healthy people were enrolled in this trial. CFPWV in stage 3, 4 and 5 CKD patients was significantly higher than that in healthy controls [(11.63±2.39) m/s, (11.70±2.80) m/s, (12.88±2.49) m/s vs (9.70±1.66)m/s , all P<0.05]. Stepwise multiple regression analysis demonstrated that age, mean arterial pressure, vascular calcification and iPTH were independent impact factors of CFPWV. Conclusions Arterial stiffness of large artery increases in non-diabetic pre-dialysis CKD patients. Age, mean arterial pressure, vascular calcification and iPTH are independent impact factors of CFPWV.

Efficacy of erythropoietin in renal function of pre-dialysis patients with chronic renal failure / 대한내과학회지

BACKGROUND: Anemia is one of the most important risk factors for cardiovascular morbidity and mortality in patients with chronic renal failure. The most effective treatment modality for anemia is erythropoietin injection. Besides erythropoietic effect, erythropoietin has multiple beneficial effects such as anti-oxidant, anti-hypoxic, anti-apoptotic and vasculogenetic effects, and prevents tubular lesions and interstitial fibrosis. Despite lots of advantages of erythropoietin therapy, the number of patients treated with this agent is modest, particularly during the pre-dialysis chronic renal failure. We conducted a clinical trial to evaluate the effects of erythropoietin on renal function in the anemic pre-dialysis patients with chronic renal failure. METHODS: Data of 23 pre-dialysis patients with chronic renal failure were analyzed retrospectively 6 months prior, and prospectively 6 months after the initiation of erythropoietin therapy. Erythropoietin was admitted at a dose of 3000 IU weekly with supplementary iron. RESULTS: The average hematocrit and hemoglobin rose from 22.1+/-2.5%, 7.4+/-0.8 g/dL to 28.4+/-4.2%, 9.6+/-1.5 g/dL, respectively. When linear regression analysis was applied to pre- and post-erythropoietin glomerular filtration rate and 1/Cr, mean rate of decline of glomerular filtration rate were significantly delayed (p=0.039) but that of 1/Cr had a tendency to be delayed but was not statistically meaningful (p=0.099). CONCLUSIONS: Treatment of the anemia with low dose erythropoietin in pre-dialysis patients with chronic renal failure is relatively safe and may slow the rate of renal function deterioration.

Efficacy of low dose recombinant human erythropoietin treatment in patients with pre-dialysis chronic renal failure / 대한내과학회지

BACKGROUND: Anemia is a most common complication of chronic renal failure and erythropoietin has proven to be a effective treatment for anemia in dialysis patient. However, in patients with pre-dialysis chronic renal failure, Use of erythropoietin is usually limited because of its high cost and frequent administration. The purpose of this study was to evaluate the efficacy of low dose erythropoietin treatment in patient with pre-dialysis chronic renal failure. METHODS: We administered erythropoietin 2000U weekly to 25 patients with pre-dialysis chronic renal failure untill hemoglobin and hematocrit reached to 11g/dl, 33% respectively. After then we administered erythropoietin 1000U weekly as a maintenance dose. We measured the level of hemoglobin, hematocrit, reticulocyte count, serum creatinine, BUN, serum iron, ferritin, total iron binding capacity every two weeks for 12 months. RESULTS: 1) In 25 patients treated for 16 weeks, hemoglobin and hematocrit level increased from 8.2g/dl,24.2% to 8.8g/dl,28.2%(p< 0.05) respectively. After 28 weeks treatment, 23 patients(92%) reached target hemoglobin and hematocrit value(11g/dl,33%). 2) Serum iron level increased from 180.2ug/dl to 165.1ug/dl(p< 0.05) after 16 weeks treatment. But there were no significant changes in serum ferritin and total iron binding capacitiy. 3) There was no significant change in reciprocal serum creatinine value before and after erythropoietin treatment. 5) There was no significant side effect except mild exacerabation of hypertension(2 cases) during erythropoietin treatment. CONCLUSION: This result show that relatively low dose erythropoietin treatment in patient with pre-dialysis chronic renal failure can be used as a effective treatment for anemia despite of slow and gradual response.