ABSTRACT
Purpose: Vascular endothelial growth factor inhibitors (anti?VEGF) have been shown to be effective in the treatment of diabetic macular edema. However, there is little information about the systemic effects of intraocular administration of anti?VEGF drugs in patients with coexistent diabetic nephropathy because it can produce adverse renal effects. Methods: This retrospective cohort study analyzed the effect of intravitreal anti?VEGF drugs (bevacizumab, ranibizumab, or aflibercept) on eFGR and microalbuminuria (MicA) in patients with diabetic macular edema and nonproliferative retinopathy without chronic kidney disease (CKD). Results: Sixty?six patients were included, 54.5% male and 45.5% female, with a mean age of 66.70 ± 11.6 years. The mean follow?up of patients with antiangiogenic treatment was 42.5 ± 28.07 months, and the mean number of injections was 10.91 ± 7.54. In 12.1% of the cases, there was a worsening of the glomerular filtration rate (eFGR) and a 19.7% worsening of the microalbuminuria (MicA). The number of injections was not related to the worsening of the eFGR (P = 0.74) or the MicA (P = 0.239). No relationship was found between the type of drug and the deterioration of the GFR (P = 0.689) or the MicA (P = 0.53). Conclusions: Based on the results, there is a small proportion of patients with increase in MicA and the decrease in eFGR after anti?VEGF therapy, and these was no associated with the number of injection or the drug type. Ophthalmologists should be aware of renal damage in order to do a close monitoring of renal function and proteinuria after intravitreal administration of anti?VEGF mainly in hypertensive patients.
ABSTRACT
Resumen La definición de la enfermedad renal crónica (ERC) es la disminución del filtrado glomerular (FG) por debajo de 60 ml/min/1.73 m2, durante tres o más meses, acompañada por anormalidades estructurales o funcionales. México reporta una incidencia de 467/1 000 00 casos de ERC. La modalidad de diálisis más utilizada es la diálisis peritoneal y la complicación más común es la peritonitis. Se obtuvo la prevalencia de peritonitis en pacientes con diálisis peritoneal del HCM en 2021, determinar las comorbilidades asociadas a la ERC, la diferencia entre diálisis automatizada y continua ambulatoria, sus desenlaces y la mortalidad global. Estudio observacional, descriptivo, transversal. Pacientes con diálisis peritoneal atendidos durante 2021 en nefrología del HCM. Se recolectaron y analizaron los datos, utilizando estadística descriptiva e inferencial determinado la prevalencia de peritonitis, las diferencias entre la modalidad de diálisis peritoneal y los episodios de peritonitis. Se analizaron 339 pacientes atendidos en el HCM, durante un año, la prevalencia de peritonitis fue de 0.2625 peritonitis/paciente/año, las comorbilidades fueron la hipertensión (70.5%) y la diabetes mellitus (65.19%), entre los grupos de diálisis peritoneal automatizada y diálisis peritoneal continua ambulatoria no hubo diferencia y la mortalidad general fue 6.48%. La peritonitis es la principal complicación en diálisis peritoneal, la prevalencia en el HCM esta por abajo de la media del país y del mundo siendo esta del 26.25%. Las Guías de la Sociedad Internacional de la Diálisis Peritoneal recomiendan mantener una prevalencia por abajo de 0.5 episodios de peritonitis por paciente por año.
Abstract The definition of the Chronic Kidney Disease (CKD) is the decrease in glomerular filtration rate (GFR) below 60 ml/min/1.73 m2, for 3 or more months, accompanied by structural or functional abnormalities. Mexico reports an incidence of 467/1,000,000 cases of CKD. The most used dialysis modality is peritoneal dialysis, and the most common complication is peritonitis. We obtained the prevalence of peritonitis in patients with peritoneal dialysis in HCM in 2021, to determine the comorbidities associated with CKD, the difference between automated and continuous ambulatory dialysis, its outcomes, and overall mortality. Observational, descriptive, cross-sectional study. Patients with peritoneal dialysis attended during 2021 in HCM nephrology. Data were collected and analyzed using descriptive and inferential statistics to determine the prevalence of peritonitis and the differences between the modality of peritoneal dialysis and the episodes of peritonitis. The prevalence of peritonitis was 0.2625 peritonitis/patient/year, and the comorbidities were hypertension (70.5%) and diabetes mellitus (65.19%), between the groups of Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis there was no difference, and the overall mortality was 6.48%. Peritonitis is the main complication in peritoneal dialysis, the prevalence of HCM is below the country and world average of 26.25%. International Guidelines recommend maintaining a prevalence below 0.5 episodes of peritonitis per patient per year.
ABSTRACT
A study of Lipid profile in CKD patient is subject of interest due to impact on the individual and society as dyslipidaemia is one of the traditional risk factors for CVD which is responsible for most of the morbidity & mortality in CKD patient. And its study can lead to therapeutical result affecting both short term and long-term outcomes. To identify and analyse lipid AIMS & OBJECTIVE - alteration in CKD patients and study the correlation between renal function and lipid abnormalities in CKD Our study is hospital METHODS – based descriptive observational study for duration of 18 months. Study included 100 patients RESULTS – in which mean age was 51.88 and male to female ratio of 1.5:1. Prevalence of Lipid Profile abnormalities seen as HDL decreased in 100% patient and Cholesterol, LDL, Triglyceride increased in 40%, 24%, 64% patients respectively Dyslipidaemia is common among pa CONCLUSION - tients with CKD and predominant lipid profile abnormalities were reduced HDL and elevated Triglycerides. Hence regular monitoring of lipid profile should be done in patients of CKD
ABSTRACT
Background: In chronic kidney disease (CKD), renal regulatory mechanisms may be insufficient to balance intestinal magnesium absorption hence insufficient to maintain homeostasis. But related data are relatively sparse and not readily available, especially in Bangladesh context. Aim of the study: The aim of the study was to assess the pattern of serum magnesium level in different stages of CKD patients. Material & Methods: This descriptive cross-sectional study was conducted in the Department of Medicine and the Department of Nephrology, Dhaka Medical College Hospital (DMCH) for nine months’ period. Approval for the study was taken from the ethical review committee of DMC before the commencement of the study. Diagnosed patients of chronic kidney disease (CKD) were approached for the inclusion of the study. Informed written consent was taken from each patient. All patients were subjected to detailed history taking, physical examination, and relevant investigations. For the study purpose, serum magnesium was done for all patients. Results: After compiling data from all participants, statistical analysis was performed using the statistical package for social science (SPSS) version 22 for windows, and a p < 0.05 was considered statistically significant. Mean age of the patients was 53 years with male predominance (male 64% vs female 36%). Of all, 6.7% of cases had hypomagnesemia and 55.3% had hypermagnesemia. The mean serum magnesium level was 2.68±0.81 mg/dl. Assessment of serum magnesium in a different stages of CKD showed that hypermagnesemia is associated with higher staging (p<0.05), and there is a negative correlation between lower e-GFR with serum magnesium ((r=-0.753, p<0.01). Conclusion: Nearly two-third of CKD patients were found with altered magnesium level in the form of hypomagnesemia or hypermagnesemia in this study. Serum magnesium was found increased in higher stages of CKD. That means serum magnesium level increases along with higher stage of the disease. Urinary magnesium excretion also decreases when eGFR of patient decreased.
ABSTRACT
Background: Chronic Kidney Disease (CKD) is a growing public health problem affecting millions of people worldwide. Along with its well-known systemic effects, CKD has been associated with various ocular abnormalities, including uveitis, macular edema, and retinal vascular changes. Early detection and management of these ocular complications can prevent significant visual loss and improve the quality of life of patients with CKD. This highlights the importance of regular ophthalmic examinations as part of the comprehensive management of CKD. The aim of this study was to evaluate the ocular status of chronic kidney disease. Material & Methods: This was an observational study. The present study was conducted on 150 Patients attending the Department of Ophthalmology at Dr. Sirajul Islam Medical College and Hospital Ltd, Dhaka, Bangladesh. The duration of the study was 2 years. All collected data was entered in MS Excel and Statistical analysis was done using the SPSS-24 version. Results: The study analyzed a population between the ages of 40-59 years, with a slight majority of women (52.67%) and moderate CKD (64.00%). The most common cause of CKD in the population was hypertension and diabetes (52.00%). 66.67% of 300 eyes had good vision (6/18 or better), while the remainder had impaired or legally blind vision (increasing as the severity of CKD increases). Ocular anterior segment findings showed that lid oedema and conjunctival pallor were present in 3.5% and 56.9% of the eyes, respectively. Dry eyes and cataract were present in 5.6% and 11.1% of the eyes, respectively. Hypertensive retinopathy was present in 48.00% of eyes in the moderate CKD group, and diabetic retinopathy was present in 32.00% of eyes in the severe and end-stage CKD groups. Maculopathy and vitreous hemorrhage were present in 12.67% and 6.33% of eyes in the end-stage CKD group. Of the 100 eyes with poor or blind visual acuity, 24 (24%) were affected by Maculopathy and 21 (21%) by Cystoid Macular Edema. The causes of visual impairment were also listed with their corresponding percentage. Conclusion: In CRF patients, eye exams can detect ocular problems. Early treatment prevents negative outcomes and those with a history of abnormal renal function need close monitoring due to increased risk of vision loss. Awareness of ocular complications is important, as well as thorough eye exams and control of diabetes and hypertension for maintaining eye health.
ABSTRACT
Hemodialysis is the most commonly used treatment modality for end stage renal disease. A 6 months observational study was conducted in the Dialysis unit of Kasturba Hospital, Manipal to study the clinical profile, quality of life with the help of KDQoL SF 36 questionnaire and factors affecting quality of life of hemodialysis patients. A total of 45 participants were included who initiated dialysis in the year 2018 and 2019 and were receiving dialysis in our hospital. Out of 45 participant 77.8% were males and 22.2% were females, the mean age was 55.29 (11.29) years. 23 patient-initiated dialysis in the year 2018 22 patients-initiated dialysis in the year 2019. The prevalence of hypertension, diabetes mellitus and cardiovascular diseases in this population were found to be 95.2%, 35.6% and 8.9% respectively. The mean scores of the sub scales were analyzed with the help of scoring manual and descriptive statistics. In the result it was found the hemoglobin, intradialytic weight gain were found to be positively correlated with the Physical component summary (PCS) and Mental component summary (MCS). Effects of kidney disease was found to be very strongly and positively correlated with dialysis vintage. In the result of the study due to its smaller population we cannot determine more factors which were affecting the Quality of life scores.
ABSTRACT
Vitamin D deficiency is one of the prominent nutritional deficiencies in India that needs special attention. The effects of hypovitaminosis D on skeletal and cardiovascular functions are well known. However, its effect on metabolic disorders like type 2 diabetes mellitus (T2DM) is still left unexplored. In the present study, our primary aim is to find out the potential effect of hypovitaminosis D in T2DM patients. The study was conducted on 250 T2DM patients mainly from Madhya Pradesh, India. Among them, 125 had hypovitaminosis D (case group) and were compared against the control group of 125 patients with normal serum vitamin D. We were mainly investigating the major T2DM-related complications including chronic kidney disease (CKD), coronary heart disease (CHD and recurrent infections. Major organ functions including liver, kidney, and cardiac functions were affected by hypovitaminosis D in T2DM patients when compared to control counterparts. We also noticed an association between hypovitaminosis D and the exacerbation of T2DM comorbidities. Our findings show the importance of maintaining normal serum vitamin D levels in T2DM patients to avoid further complications.
ABSTRACT
Background: To analyze the effects of oral alkali therapy on renal function, nutritional status and bone density in patients of diabetic kidney disease. Material & Methods: A randomized controlled trial was conducted on 60 patients of age>18 years with diabetic kidney disease who were not on dialysis and had plasma bicarbonate levels between 16 and 20 mmol/l. Patients were randomly divided into two groups: Test group (n=30) which received oral alkali therapy as sodium bicarbonate and control group (n=30) who did not receive oral alkali therapy. The patients were followed for 12 months to compare the improvement. Results: In comparison to controls, test group showed a significant improvement in the Hb (0.7 vs. 0.25, P =0.003), significantly less decrease in eGFR (-2.25 vs. -2.9, P=0.049), non-significant less increase in creatinine (-0.26 ± 0.4 vs. -0.43 ± 0.33, P=0.09), significant improvement in bicarbonate levels (7.5 vs. 1, p<0.0001), significant restoration of albumin (0.32 vs. 0.05, P<.0001), significant fall in iPTH levels (50 vs. 25, p=0.007) and ALP levels (32 vs. 12, p=0.015). Bone density (0.28 ± 0.17 vs. 0.01 ± 0.13, P<.0001) and clinical well-being VAS scores improved significantly among the cases (9.83 ± 5.65 vs. -1.67 ± 7.11, P<.0001). Conclusion: In conclusion, oral alkali therapy slows the rate of decline of renal function and the development of end stage renal disease in patients with advanced stages of CKD. This cheap and simple strategy, which is in line with current renal consensus documents, also improves the nutritional status of patients and bone density.
ABSTRACT
Traditional Chinese medicine （TCM） has certain advantages in the treatment of chronic kidney disease-mineral and bone disorder （CKD-MBD）. In recent years， there have been many studies on the treatment of CKD-MBD by Chinese medicinal compounds and monomers. As revealed by literature retrieval， the research on the mechanism of Chinese medicine in intervening in signaling pathways related to CKD-MBD was mainly based on self-made Chinese medicinal compounds， and the action pathways involved fibroblast growth factor 23/Klotho （FGF23/Klotho） signaling pathway， Wnt/β-catenin signaling pathway， receptor activator of nuclear factor-κB/receptor activator of nuclear factor-κB ligand/osteoprotegerin （RANK/RANKL/OPG） system， and other signaling pathways. TCM can improve calcium and phosphorus metabolism and bone metabolism disorder， and regulate inflammatory reaction， oxidative stress， apoptosis， and autophagy by regulating this series of signaling pathways for the treatment of CKD-MBD. This paper introduced the research results of these signaling pathways and the mechanism of TCM in the treatment of CKD-MBD in order to provide ideas and references for the related research of Chinese medicine in the treatment of CKD-MBD.
ABSTRACT
Abstract Background Two-Drug Regimens (2DR) have proven effective in clinical trials but real-world data, especially in resource-limited settings, is limited. Objectives To evaluate viral suppression of lamivudine-based 2DR, with dolutegravir or ritonavir-boosted protease inhibitor (lopinavir/r, atazanavir/r or darunavir/r), among all cases regardless of selection criteria. Patients and methods A retrospective study, conducted in an HIV clinic in the metropolitan area of São Paulo, Brazil. Per-protocol failure was defined as viremia above 200 copies/mL at outcome. Intention-To-Treat-Exposed (ITT-E) failure was considered for those who initiated 2DR but subsequently had either (i) Delay over 30 days in Antiretroviral Treatment (ART) dispensation, (ii) ART changed or (iii) Viremia > 200 copies/mL in the last observation using 2DR. Results Out of 278 patients initiating 2DR, 99.6% had viremia below 200 copies/mL at last observation, 97.8% below 50 copies/mL. Lamivudine resistance, either documented (M184V) or presumed (viremia > 200 copies/mL over a month using 3TC) was present in 11% of cases that showed lower suppression rates (97%), but with no significant hazard ratio to fail per ITT-E (1.24, p= 0.78). Decreased kidney function, present in 18 cases, showed of 4.69 hazard ratio (p= 0.02) per ITT-E for failure (3/18). As per protocol analysis, three failures occurred, none with renal dysfunction. Conclusions The 2DR is feasible, with robust suppression rates, even when 3TC resistance or renal dysfunction is present, and close monitoring of these cases may guarantee long-term suppression.
ABSTRACT
Background: Patients with chronic kidney disease (CKD) are at a common risk for contrast-induced acute kidney damage (CI-AKI) because of various complications. Intravenous N-acetylcysteine (NAC) in high doses (1200mg) is considered more effective than its conventional dose (600mg) to prevent CIN and related complications. Objective: The study aimed to compare the effectiveness of high dose versus standard dose of intravenous N-acetylcysteine (NAC) in the prevention of Acute Kidney Injury in patients with chronic kidney disease.Material & Methods:A total of 60 (sixty) patients diagnosed with CKD went to coronary angiography and/or percutaneous coronary intervention (PCI) were selected by simple random technique and categorized into two groups – Group A (30 patients) received high dose NAC (1200mg) and Group B (30 patients) – received standard dose NAC (600mg). For evaluation of renal damage serum creatinine level for at least >3 months, renal imaging revealed bilateral small echogenic kidneys, eGFR (<60 to 15ml/min/1.73m², measured by MDRD formula) and also by ACR >30 mg/gm, associated with IHD, admitted for percutaneous intervention (PCI) were taken in account. Statistical analysis was done by SPSS version 20 with taking 95% confidence interval. The quantitative data were expressed as mean and standard deviation and qualitative data were expressed as frequency distribution and unpaired t-test, Chi-square test, and Fisher exact analytic test were done.Results:The observed mean age group of the patients was 65 ± 8 years and 62 ± 7 years in group A and group B respectively with male predominance in both groups. Primary renal disease diabetic nephropathy (DN) more (36.66%) in group A than in group B (30.00%) but patients with Hypertensive nephropathy were the same (33.33%) in both groups. After interventions, S. Creatinine (mg/dl) level, e, GFR (ml/min/1.73m²), were statistically significant in cases of group A patients (P-value 0.001& 0.003 correspondingly) compared to group B Patients (P-value 0.075 & 0.001 respectively). Again, the mean of pre-intervention S. Creatinine was 1.7 ±0.5 in group A whereas this was 1.9 ± 0.8 (p-value, 0.599) in group B and after 48 hours of intervention this was 1.6 ± 0.5 and 2.0 ± 0.5 (p-value, 0.697) In group A and group B respectively. Overall, no patients were detected with nephropathy for high dose NAC whereas 27 (90%) out of 30 had developed CIN in standered dose.Conclusion:High-dose N-acetylcysteine (1200mg) is more potent and effective than the standard dose (600mg) in reducing contrast-induced acute kidney injury (CI-AKI) in patients with CKD.
ABSTRACT
Resumen Coronavirus 19 (COVID-19), es una enfermedad viral prevalente y diseminada a nivel mundial, considerada una pandemia con alta tasa de mortalidad. A la fecha no existen estudios que describan la influencia de las variables asociadas a la enfermedad en el estado fronterizo de Tamaulipas, México. El objetivo del presente estudio fue evaluar y analizar las características, complicaciones, tasas de letalidad y factores de riesgo asociados a mortalidad en paciente positivos a COVID-19 en el estado de Tamaulipas, a un año de la emergencia local. Se utilizó la frecuencia de casos observados en relación a características, complicaciones y comorbilidades para estimar prevalencias y tasas de letalidad. Se ajustó un modelo de regresión logística multivariada para estimar los factores de riesgo significativos y se utilizaron curvas de supervivencia de Kaplan-Meier para describir las comorbilidades más importantes. Los análisis indicaron una mayor infección en pacientes en edad productiva, con una probabilidad significativa de muerte a partir de los 40 años, más evidente en pacientes masculinos. Los riesgos asociados a la hospitalización, como intubación endotraqueal y neumonía, son factores muy importantes. Las comorbilidades con alta prevalencia (diabetes, hipertensión y obesidad) y enfermedad renal crónica (ERC) están asociados significativamente (P < 0.01) a mayor mortalidad por COVID-19 en pacientes positivos. El presente estudio demostró algunos patrones generales de prevalencia y tasas de letalidad por COVID-19, por lo que se sugieren particularidades en los factores asociados a mortalidad en la población de Tamaulipas que requieren atención en sus grupos vulnerables, sobre todo en posibles casos de rebrotes de la enfermedad.
Abstract Coronavirus 19 (COVID-19) is a prevalent and globally disseminated viral disease that has become a pandemic associated with a high case fatality rate. To date, there are no published studies that describe the influence of the variables associated with the disease, specifically in the border state of Tamaulipas, Mexico. The objective of the present study was to assess the characteristics, complications, fatality rates and risk factors associated to mortality in patients positive to COVID-19 in Tamaulipas, one year after the local emergency. Descriptive frequency of characteristics, complications for prevalence and case fatality rates were used. A multivariate logistic regression model was adjusted to estimate the meaningful risk factors, and Kaplan-Meier survival curves were used to describe the most important comorbidities. The analysis indicated higher infection rates in patients of productive age, with a significant death probability in male patients from the age of 40. The risks associated with hospitalization, such as endotracheal intubation and the presence of pneumonia are important risk factors. Comorbidities with high prevalence; diabetes, hypertension, obesity, and chronic kidney disease (CKD) were significantly associated (P < 0.01) with higher COVID-19 mortality risk in the assessed population. The present study demonstrated some COVID-19 general patterns on frequency and mortality rates. It also suggested particularities in factors associated to mortality in the Tamaulipas population, which require proper attention in vulnerable groups, especially in future outbreaks of the disease.
ABSTRACT
The estimation of the glomerular ?ltration rate (GFR), whose formulas are usually based on serum creatinine, is a fundamental data in clinical nephrology. The concept of “reference” or usual values adopted by health professionals is essential because of the paucity of research on the usual values of GFR in black Africa. The Modi?cation of Diet in Renal disease (MDRD) and Chronik Kidney disease-Epidemiology collaboration (CKDEpi) equations were determined in non-African populations. Usual values speci?c to the black African population by the evaluation of the formulas of Cockroft and Gault (CG), MDRD and CKD-Epi must be rigorous and are the subject of this study. The GFR was determined using the CG, MDRD and CKD-Epi formulas in a sample of 233 presumed healthy Senegalese adults (118 men, 115 women). SPSS and Excel 2016 software were used for statistical analysis. A value of P<0.05 was considered statistically signi?cant. The determination of the GFR by the Cockcroft method overestimates the CKD values by 10.24 (9.82 - 14.53) with p=0.001 and that of the MDRD by 7.47 (5.91 - 9.03) the CKD values with p=0.001. For a GFR measurement uncertainty of +/- 10%, the CG and CKD formulas cannot be superimposed with a low correlation coef?cient r = 0.52 and a coef?cient of determination R² = 0.28; whereas those of MDRD and CKD-Epi are on the other hand superimposable with r = 0.79 and R² = 0.63. Thus, the CKD-Epi formula should be preferred for determining the usual value of GFR in a healthy person.
ABSTRACT
Background:An increasing number of patients with chronic kidney disease (CKD) impact an increased need for hemodialysis. Inadequate hemodialysis affects morbidity in patients with CKD. Determination of the urea removal index can be accomplished by several invasive and non-invasive methods. The purpose of this study was to compare the urea reduction ratio (URR) and dialysis efficiency (Kt/V)calculated automatically by hemodialysis machines to assess the adequacy of hemodialysis in patients with CKD.Methods:A cross-sectional analysis study was conducted on 58 CKD patients with age ?18 years, conventional 5-hour hemodialysis sessions twice weekly, using single use-hollow fiber dialyzers, and who had been receiving hemodialysis for ?6 months in the hemodialysis unit atWangaya Hospital from April 2022 to May 2022. Study data were obtained from medical records then described and analyzed using the statistical package for the social sciences (SPSS)program.Results:The mean of URR was 70.74�.04, while the mean of Kt/Vdelivered by machine was 1.27�19. More hemodialysis patients received adequate hemodialysis based on URR parameters compared to Kt/V parameters (84.5% versus 1.7%). There was no significant difference between age, sex, body mass index (BMI), comorbidities, vascular access and duration of dialysis with adequacy hemodialysis. There was a significant difference between URR and Kt/V in the evaluation adequacy of hemodialysis (p=0.000). In addition, there was a positive correlation between URR and Kt/V in theevaluation adequacy of hemodialysis (r=0.592, p=0.000).Conclusions:The URR is a more accurate parameter, but the Kt/V delivered by machine can help the URR demonstrate the adequacy of haemodialysis patients with CKD.
ABSTRACT
Abstract The Department of Acute Kidney Injury (IRA) of the Brazilian Society of Nephrology prepared this document for the purpose of standardizing AKI terminology and dialysis modalities in the Portuguese language for Brazil. Several terms with similar meanings have been used in AKI and its dialysis modalities, causing confusion and disparities among patients, nephrologists, health institutions, private care companies, insurance companies and government entities. These disparities can impact medical care, hospital organization and care, as well as the funding and reimbursement of AKI-related procedures. Thus, consensual nomenclature and definitions were developed, including the definitions of AKI, acute kidney disease (AKD) and chronic kidney disease (CKD). Additionally, we addressed all dialysis modalities and extracorporeal procedures related to AKI, currently approved and available in the country. The Brazilian Society of Nephrology hopes that this Consensus can standardize the terminology and provide technical support to all involved in AKI care in Brazil.
Resumo O Departamento de Injúria Renal Aguda (IRA) da Sociedade Brasileira de Nefrologia elaborou o presente documento para fins de padronização da terminologia em IRA e modalidades dialíticas na língua portuguesa para o Brasil. Diversos termos com significados semelhantes têm sido empregados em IRA e suas modalidades dialíticas, causando confusão e disparidades entre pacientes, nefrologistas, instituições de saúde, empresas privadas de assistência, seguradoras e entidades governamentais. Essas disparidades podem impactar a assistência médica, a organização e o atendimento hospitalares, assim como o financiamento e reembolso dos procedimentos relacionados com a IRA. Assim, nomenclatura e definições consensuais foram elaboradas, incluindo-se as definições de IRA, doença renal aguda (DRA) e doença renal crônica (DRC). Adicionalmente, todas as modalidades dialíticas e os procedimentos extracorpóreos relacionados a IRA, atualmente aprovados e disponíveis no país, foram abordados. A Sociedade Brasileira de Nefrologia espera que este Consenso possa padronizar a nomenclatura e prover suporte técnico para todos os atores envolvidos na assistência à IRA no Brasil.
ABSTRACT
Background: Anemia is a common complication in chronic kidney disease (CKD), and is associated with a reduced quality of life, and increased morbidity and mortality. The mechanisms involved in ananaemiassociated with CKD are diverse and complex. They include a decrease in endogenous erythropoietin (EPO) production, absolute and/or functional iron deficiency, and inflammation with increased hepcidin levels, among others. Objective: The objective of our study was to investigate the prevalence and severity of anaemia in pre-dialysis patients, and chronic kidney disease patients in Bangladesh.Material & Methods:This was a case-control prospective study conducted with over 300 Bangladeshi non-patients as the control group A and 87 with different stages of chronic kidney disease (CKD) patients as the case group B in the department of Nephrology BSMMU from April’2004 to June 2006. The normal people who had no history of diabetes mellitus, hypertension, or CKD and were not on any medication were controlled and different stages of the CKD patients who had no history of blood transfusion, erythropoietin and parental iron infusion were cases.Results:Out of 300 normal populations male was 158(52.7%) and the female was 142(47.3%) and the mean haemoglobin level of the male was 13.94 g/dl and the female was 12.29 g/dl. Among males 24(15.2%) and females 55(38.7%) were anaemic and the overall prevalence of anaemia was noted at 26.3%. Of the total anaemic people, 25% was microcytic anemia. Out of 87 CKD patients, 56 (64%) were male and 31 (36%) were female. The overall prevalence of anaemia in CKD patients was 95.4%. The haemoglobin level was <11g/dl in 57.14% patients with CCr 30-59 ml/min/1.73m2 which increases to 87.5 % in patients with CCr 15-29 ml/min/1.73m2, which also increases to 94.2 % in patients with CCr<15 ml/min/1.73m2. Mean haemoglobin was observed at 8.6 g/dl, 9.54 g/dl and 11.25 g/dl in stage V, stage IV and stage III CKD patients respectively. Anaemia appeared at 43.53 ml/min/1.73 m2 of CCR.Conclusions:The results demonstrate that patient with reduced renal function is more likely to have anaemia and the prevalence and severity of anaemia increase with declining kidney function. CCr and TSAT is the important predictor of anaemia. In a significant number of the CKD, patient anaemia was associated with iron deficiency.
ABSTRACT
Background: Chronic kidney disease is becoming epidemic oftwenty-first century. With increasing burden of diabetes and hypertension, chronic kidney disease is becoming rampant in our country. Adverse outcome of CKD includes kidney failure, complications due to decreased kidney function and cardiovascular disease etc. Increasing morbidity and mortality of coronary artery disease in CKD patients make it necessary to develop further researches in these population. Aim and objectives of current study were to demonstrate the correlation of anemia with left ventricular hypertrophy in a cohort of CKD patients in a tertiary care centre.Methods: This study was done over one year on 100 patients of CKD (stage III to V), aged 15-80 years, who had elevated serum creatinine and reduced glomerular filtration rate, haemoglobin <11gm/dl withultrasonographic evidence of renal parenchymal disease grade >2. The patients were assessed based on clinical history and a number of laboratory parameters including blood urea, serum creatinine, calcium, inorganic phosphorus, serum electrolytes, iPTH level, Hb, Hct, glomerular filtration rate and left ventricular mass index.Results: There is a significant relationship between of anemia and left ventricular hypertrophy among chronic kidney disease patients. In our study, it was observed that left ventricle mass (left ventricular mass index) increases with increasing severity of anemia.Conclusions: Anemia is widely prevalent in our CKD patients. Severity of anemiais correlated to left ventricular hypertrophy in these patients. Hence correction of anemia early in these group of patients can halt or prevent cardiovascular morbidity and mortality.
ABSTRACT
Background: Chronic kidney diseaseis an increasing health problem worldwide Thus apart from the well-established risk factors for CKD such as diabetes and systemic hypertension, the possibility that environmental, demographic, and various other risk factors an influence in developing chronic kidney disease has been assessed in several studies. Hence, the present study aimed to study the clinical and laboratory profile of chronic kidney disease in non-diabetic and non-hypertensive patients Methods: The study was enrolled 100 patients diagnosed with chronic kidney disease without diabetes and systemic hypertension in the department of general medicine and department of nephrology in a tertiary care hospital, Pondicherry for 1 year. The baseline data such as socioeconomic status, history of self-consumption of natural medicine and NSAIDs, their occupations, location of their living place, and routine laboratory parameters were collected and analysed. Results: The socioeconomic status of the present study revealed that upper lower class was thepredominant status and the majority of the patients were housewives and farmers. 38% of the patients were exposed to insecticides that were associated with CKD (p=0.0327). 40% of the study population was victims of NSAID consumers (p=0.0236). 42% was consumed natural medication on their own for their illness 46 without any consultation (p=0.0324). The patients came from Cuddalore predominantly (22%). Conclusions: Insecticide exposure, self-consumption of NSAIDs, and natural medicine are the main causes that progress to CKD in the present study.
ABSTRACT
Background: Pulmonary hypertension (PH) is a recently recognized complication of chronic kidney disease (CKD), especially in end-stage renal disease. Cardiovascular disease is the most important cause of morbidity and mortality in CKD. This study was done to assess the prevalence of Pulmonary Hypertension in CKD patients and to assess the severity of Pulmonary Hypertension in different stages of CKD. The study Materials And Methods: was performed on 140 patients. At M. L. N. medical college prayagraj. All patients were evaluated by clinical, laboratory and imaging. All patients were subjected to echocardiography for assessment of Pulmonary arterial Hypertension. A total Results: of 140 patients were included. Mean age of statics was 55.61±11.65 years. Male: Female was 2.33:1. Out of 140 study subjects, PH was found in 45 patients (32.1%.). Amongst which 26 had mild PH, 13 moderate and 6 had severe PH. Prevalence of Severe PH was signi?cantly higher in stage 5 CKD subjects (23.5%) compared to stage 3(1.3%) & 4(2.3%). As CKD progresses Conclusion: the prevalence and severity of PH increases
ABSTRACT
Contexto: la nefropatía diabética es la primera causa de enfermedad renal crónica en el mundo, sin embargo, no existe información de la prevalencia de Enfermedad Renal Crónica (ERC) en estadios tempranos en México. Una tarea fundamental del primer nivel de atención es la detección oportuna de enfermedades y la ERC en pacientes diabéticos es subdiagnosticada en estadios tempranos al ser asintomática. Objetivo: determinar la frecuencia y la estadificación de ERC en pacientes con diabetes mellitus tipo 2 de larga evolución en una unidad de primer nivel de atención, en el estado de México. Metodología: estudio transversal descriptivo. Se incluyeron 263 pacientes calculados por fórmula de población finita y selección aleatoria simple. Se incluyeron pacientes con diabetes tipo 2, ≥ 5 años de evolución, sin encontrarse en terapia sustitutiva de la función renal que cumplieran los criterios de inclusión. Las variables de estudio: características sociodemográficas y la estimación de la tasa de filtración glomerular por la ecuación CKD-EPI fueron descritas en frecuencias y porcentajes para variables categóricas y las variables continuas se reportaron medias y de desviación estándar, la diferencia entre grupos fue establecida por medio de prueba de Chi cuadrado o prueba exacta de Fisher y distribución t de student, de acuerdo con el tipo de variable. Un valor de p Ë 0,05 fue considerado estadísticamente significativo. Resultados: la clasificación Kdigo presenta seis estadios y los resultados con respecto al grado de filtrado glomerular fueron: estadio 1 con 39,5 % (IC 95 %, 34,2-45,6), estadio 2 con 38,8 % (IC 95 %, 32,7-44,5), estadio 3a con 8 % (IC 95 %, 4,9-11,4), estadio 3b con 5,7 % (IC 95 %, 3,4-8,7), estadio 4 con 6,8 % (IC 95 %, 3,8-9,9) y el estadio 5 con 1,1 % (IC 95 % 0,0-2,7). El promedio de edad fue 69,26 ±11,01 en el grupo con ERC, en la segmentación por género estuvo: masculino en el grupo con ERC con 59,6 % y femenino con 40,3 %. Con respecto a comorbilidades, hipertensión arterial y tratamiento al analizarlas en grupos con ausencia de ERC y presencia de ERC fueron estadísticamente significativas, lo mismo en los resultados de laboratorio. Conclusiones: la prevalencia de sospecha de ERC en nuestra población es de 21 %, al menos 1 de cada 5 pacientes diabéticos con ≥ 5 años de evolución padecen una disminución del FG, sin embargo, no podemos considerarla ERC hasta que se valore la presencia de daño renal y corroborarlo a los tres meses.
Background: Diabetic nephropathy is the main cause of chronic kidney disease (CKD), however, there are no data available about the prevalence of chronic kidney disease in the early stages in Mexico. A key role in first level attention consists in performing timely screenings for diseases such as CKD. In most cases CKD is underdiagnosed in early stages, because it is asymptomatic. Purpose: To determine the frequency of CKD in long-standing diabetes type 2 Methods: This was a cross-sectional descriptive study. We included 263 patients with diabetes type 2 with at least 5 years of evolution, not undergoing renal function replacement therapy. The variables of this study were: sociodemographic characteristics and estimation of the glomerular filtration rate through the CKD-EPI equation. Categorical variables were summarized as frequencies and percentages. For continuous variables, mean and standard deviation were reported. The significance of differences between groups was assessed by Student's t-test or square chi or Fisher's exact test, and p-value ≤ 0.05 was considered statistically significant. Results: the KDIGO classification has 5 stages. The results regarding the degree of glomerular filtration: stage 1 with 39.5% (95% CI, 34.2-45.6) , stage 2 with 38.8% ( 95% CI, 32.77-44.5),stage 3a with 8% ( 95% CI, 4.9-11.4), stage 3b with 5.7% (95% CI, 3.4-8.7), grade 4 with 6.8% (95% CI, 3.8-9.9) and stage 5 with 1.1% (95% CI 0.0-2.7). The average age was 69.26 ± 11.01 in the group with CKD. Male gender predominated in the group CKD with 34 (59.6%) and 23 (40.3%), for female. Regarding comorbidities, hypertension arterial and treatment when analyzed for either absence or presence of CKD were statistically significant. The same findings can be obtained in laboratory results. Conclusion: The prevalence of suspected CKD in our population is 21%, at least 1 in 5 diabetic patients with ≥5 years of evolution suffer a decrease in GFR; however, we cannot consider it to be CKD until the presence of kidney damage is assessed and confirmed at 3 months.