Factores de riesgo asociados a progresión de Enfermedad Renal Crónica en Hospital de Pamplona, Norte de Santander / Risk factors associated with CKD progression in Pamplona Hospital, Norte de Santander, Colombia

Resumen Introducción: la enfermedad renal crónica (ERC) provoca cambios irreversibles en la función del riñón o en su estructura alrededor de 3 meses . Se considera en salud pública como un grave problema, dado a su comportamiento y potencial letalidad. Objetivo: determinar los factores de riesgo asociados a la progresión de la enfermedad renal crónica en pacientes atendidos en el Hospital San Juan de Dios del municipio de Pamplona, Norte de Santander durante el período 2019 - 2021. Metodología: estudio de corte transversal, analítico, retrospectivo. Se estudiaron y analizaron características sociodemográficas y clínicas mediante métodos de estadística descriptiva e inferencial, se construyó un modelo multivariado de regresión logística con nivel de significancia de 0,05. Resultados: la prevalencia de la ERC estadio 3A fue del 74,9%. Del total de pacientes incluidos en la investigación, 186 (53,7%) tuvieron reporte de progresión. El modelo multivariado indicó que ser mujer está asociado a la progresión de la enfermedad renal cuando se ajusta por TFG (OR 1,07 (IC 1,03-1,12; p = <0,001)), la edad (OR 1,07 (IC 1,03-1,11; p = <0,001)), creatinina (OR 25,2 (IC 5,10-125,1); p = <0,001)) y albuminuria (OR 1,00 (IC 0,99 - 1,01); p= <0,001)). Conclusión: se hace necesario en un futuro estudio involucrar variables de adherencia al tratamiento, así como el tiempo de evolución de la patología y algunos elementos como hábitos, estilos de vida y calidad del control.

Abstract Introduction : Chronic kidney disease (CKD) is considered in public health as a serious problem, given its behavior and lethal potential, this is defined as irreversible changes in kidney function or its structure that last at least 3 months. Objective : To determine the risk factors associated with the progression of CKD in patients treated at the Hospital San Juan de Dios in the municipality of Pamplona Norte de Santander for the period 2019 - 2021. Methodology : Cross-sectional, analytical, retrospective study. Sociodemographic and clinical characteristics were studied and analyzed using descriptive and inferential statistical methods, a multivariate logistic regression model was constructed with a significance level of 0.05. Results : The prevalence of stage 3a chronic kidney disease (CKD) was 74.9%. Out of the total patients included in the research, 186 (53.7%) showed evidence of progression. The multivariate model indicated that being female is associated with the progression of renal disease when adjusted for glomerular filtration rate (GFR) (OR 1.07 (IC 1.03-1.12; p < 0.001)), age (OR 1.07 (IC 1.03-1.11; p < 0.001)), creatinine (OR 25.2 (IC 5.1-125.1); p < 0.001)), and albuminuria (OR 1.00 (IC 0.99-1.01); p < 0.001)). Conclusions: It is necessary in a future study to involve variables of adherence to treatment and treatment, as well as the time of evolution of the pathology and some elements such as habit, lifestyles and quality of control.

Cardiac Function Evaluation in Different Stages of Chronic Kidney Disease

Background : In patients with Chronic Kidney Disease (CKD), cardiovascular physiological alteration occurs a lot and it becomes the most common cause of death in these patients. Aims and Objective : to study the prevalence, correlation and association of Left Ventricular Diastolic Dysfunction (LVDD), Systolic Dysfunction (LVSD) and Left Ventricular Hypertrophy (LVH) with Left Ventricular Mass Index (LVMI) in relation to different stages of CKD patients. Materials and Methods : it was a cross-sectional observational study involving 60 patients of established CKD patients after consideration of inclusion and exclusion criteria; tools used were estimated Glomerular Filtration Rate (eGFR) calculation for the staging of CKD and 2D echocardiography for grading and calculation of diastolic dysfunction, systolic dysfunction and LVMI. The data were analyzed by standard statistical methods. Results : Most patients (41.6%) had grade II diastolic dysfunction seen mainly in stage IV patients and grade III dysfunction occurred in 66.7% of stage V patients. There was a significant association between systolic dysfunction and advanced stages of CKD. LVMI showed a progressive increase from stage I disease to stage V disease. Conclusion : With advanced stages of CKD, there was a statistically significant increase in LVDD, LVMI and a statistical decrease in systolic function.

Association between chronic kidney disease stages and changes in ambulatory blood pressure monitoring parameters / Associação entre estágios da doença renal crônica e alterações dos parâmetros da monitorização ambulatorial da pressão arterial

Abstract Introduction: Blood pressure (BP) assessment affects the management of arterial hypertension (AH) in chronic kidney disease (CKD). CKD patients have specific patterns of BP behavior during ambulatory blood pressure monitoring (ABPM). Objectives: The aim of the current study was to evaluate the associations between progressive stages of CKD and changes in ABPM. Methodology: This is a cross-sectional study with 851 patients treated in outpatient clinics of a university hospital who underwent ABPM examination from January 2004 to February 2012 in order to assess the presence and control of AH. The outcomes considered were the ABPM parameters. The variable of interest was CKD staging. Confounding factors included age, sex, body mass index, smoking, cause of CKD, and use of antihypertensive drugs. Results: Systolic BP (SBP) was associated with CKD stages 3b and 5, irrespective of confounding variables. Pulse pressure was only associated with stage 5. The SBP coefficient of variation was progressively associated with stages 3a, 4 and 5, while the diastolic blood pressure (DBP) coefficient of variation showed no association. SBP reduction was associated with stages 2, 4 and 5, and the decline in DBP with stages 4 and 5. Other ABPM parameters showed no association with CKD stages after adjustments. Conclusion: Advanced stages of CKD were associated with lower nocturnal dipping and greater variability in blood pressure.

Resumo Introdução: A avaliação da pressão arterial (PA) tem impacto no manejo da hipertensão arterial (HA) na doença renal crônica (DRC). O portador de DRC apresenta padrão específico de comportamento da PA ao longo da monitorização ambulatorial da pressão arterial (MAPA). Objetivos: O objetivo do corrente estudo é avaliar as associações entre os estágios progressivos da DRC e alterações da MAPA. Metodologia: Trata-se de um estudo transversal com 851 pacientes atendidos nos ambulatórios de um hospital universitário que foram submetidos ao exame de MAPA no período de janeiro de 2004 a fevereiro de 2012 para avaliar a presença e o controle da HA. Os desfechos considerados foram os parâmetros de MAPA. A variável de interesse foi o estadiamento da DRC. Foram considerados como fatores de confusão idade, sexo, índice de massa corporal, tabagismo, causa da DRC e uso de anti-hipertensivos. Resultados: A PA sistólica (PAS) se associou aos estágios 3b e 5 da DRC, independentemente das variáveis de confusão. Pressão de pulso se associou apenas ao estágio 5. O coeficiente de variação da PAS se associou progressivamente aos estágios 3a, 4 e 5, enquanto o coeficiente de variação da pressão arterial diastólica (PAD) não demonstrou associação. O descenso da PAS obteve associação com estágios 2, 4 e 5, e o descenso da PAD, com os 4 e 5. Demais parâmetros da MAPA não obtiveram associação com os estágios da DRC após os ajustes. Conclusão: Estágios mais avançados da DRC associaram-se a menor descenso noturno e a maior variabilidade da pressão arterial.

Mind the gap in kidney care: translating what we know into what we do / Atenção às lacunas no cuidado renal: traduzindo o que sabemos em ações

Abstract Historically, it takes an average of 17 years for new treatments to move from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. Now is the time to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions are diagnosed worldwide, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because it is often silent in the early stages. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from the patient to the clinician to the health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.

Resumo Historicamente, são necessários, em média, 17 anos para que novos tratamentos passem da evidência clínica para a prática diária. Considerando os tratamentos altamente eficazes disponíveis atualmente para prevenir ou retardar o início e a progressão da doença renal, esse período é demasiadamente longo. Agora é o momento de reduzir a lacuna entre o que sabemos e aquilo que fazemos. Existem diretrizes claras para a prevenção e o manejo dos fatores de risco comuns para doenças renais, como hipertensão e diabetes, mas apenas uma fração das pessoas com essas condições é diagnosticada mundialmente, e um número ainda menor recebe tratamento adequado. Da mesma forma, a grande maioria das pessoas que sofrem de doença renal não têm conhecimento de sua condição, pois ela costuma ser silenciosa nos estágios iniciais. Mesmo entre pacientes que foram diagnosticados, muitos não recebem tratamento adequado para a doença renal. Levando em consideração as graves consequências da progressão da doença renal, insuficiência renal ou óbito, é imperativo que os tratamentos sejam iniciados precocemente e de maneira adequada. As oportunidades para diagnosticar e tratar precocemente a doença renal devem ser maximizadas, começando no nível da atenção primária. Existem muitas barreiras sistemáticas, que vão desde o paciente até o médico, passando pelos sistemas de saúde e por fatores sociais. Para preservar e melhorar a saúde renal para todos em qualquer lugar, cada uma dessas barreiras deve ser reconhecida para que soluções sustentáveis sejam desenvolvidas e implementadas sem mais demora.

Bone aluminum accumulation in the current era / Acúmulo de alumínio no tecido ósseo na era atual

In the last few years, evidence from the Brazilian Registry of Bone Biopsy (REBRABO) has pointed out a high incidence of aluminum (Al) accumulation in the bones of patients with CKD under dialysis. This surprising finding does not appear to be merely a passive metal accumulation, as prospective data from REBRABO suggest that the presence of Al in bone may be independently associated with major adverse cardiovascular events. This information contrasts with the perception of epidemiologic control of this condition around the world. In this opinion paper, we discussed why the diagnosis of Al accumulation in bone is not reported in other parts of the world. We also discuss a range of possibilities to understand why bone Al accumulation still occurs, not as a classical syndrome with systemic signs of intoxication, as occurred it has in the past.

Nos últimos anos, evidências do Registro Brasileiro de Biópsia óssea (REBRABO) apontaram uma alta incidência de intoxicação por alumínio (Al) no tecido ósseo de pacientes com DRC em diálise. Essa surpreendente informação parece representar não apenas um acúmulo passivo deste metal, visto que dados prospectivos do REBRABO sugerem que a presença de Al no tecido ósseo pode estar independentemente relacionada a eventos cardiovasculares adversos maiores. Essas informações contrastam com a percepção mundial do controle epidemiológico dessa condição. Neste artigo de opinião, discutimos por que o diagnóstico de acúmulo ósseo de Al não é relatado em outras partes do mundo, e também discutimos uma gama de possibilidades para entender por que nós acreditamos que o acúmulo de Al no tecido ósseo ainda ocorre, não como se apresentava no passado, ou seja, como uma síndrome com sinais e sintomas sistêmicos de intoxicação.

Analysis of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as inflammatory biomarkers in chronic kidney disease: impact of parathyroidectomy / Análise das relações neutrófilo/linfócito e plaqueta/linfócito como marcadores inflamatórios na doença renal crônica: impacto da paratireoidectomia

Abstract Introduction: Secondary hyperparathyroidism (SHPT) is one of the causes for inflammation in CKD. We assessed the impact of parathyroidectomy (PTX) on neutrophil-to-lymphocyte (N/L) and platelet-to-lymphocyte (P/L) ratios in SHPT patients. Methods: A total of 118 patients [hemodialysis (HD, n = 81), and transplant recipients (TX, n = 37)] undergoing PTX between 2015 and 2021 were analyzed. Results: There was a significant reduction in calcium and PTH levels in both groups, in addition to an increase in vitamin D. In the HD group, PTX did not alter N/L and P/L ratios. In the TX group, there was a reduction in N/L and P/L ratios followed by a significant increase in total lymphocyte count. Conclusion: N/L and P/L ratios are not reliable biomarkers of inflammation in SHPT patients undergoing PTX. Uremia, which induces a state of chronic inflammation in dialysis patients, and the use of immunosuppression in kidney transplant recipients are some of the confounding factors that prevent the use of this tool in clinical practice.

Resumo Introdução: O hiperparatireoidismo secundário (HPTS) é uma das causas de inflamação na DRC. Avaliamos o impacto da paratireoidectomia (PTX) nas relações neutrófilo/linfócito (N/L) e plaqueta/linfócito (P/L) em pacientes com HPTS. Métodos: Foram analisados 118 pacientes [hemodiálise (HD, n = 81) e transplantados (TX, n = 37)] submetidos à PTX entre 2015 e 2021. Resultados: Houve redução significativa de cálcio e PTH nos dois grupos, além de elevação de vitamina D. No grupo HD, a PTX não mudou as relações N/L e P/L. Já no grupo TX, houve redução nas relações N/L e P/L acompanhadas de elevação significativa do número de linfócitos totais. Conclusão: As relações N/L e P/L não são marcadores fidedignos de inflamação em pacientes com HPTS submetidos à PTX. A uremia, que induz um estado de inflamação crônica em pacientes dialíticos, e o uso de imunossupressão em pacientes transplantados renais são alguns dos fatores de confusão que impedem o uso dessa ferramenta na prática clínica.

Prevalence-of-depression-and-anxiety-in-end-stage-kidney-disease-patients-on-maintenance-hemodialysis

Introduction: Patients with Chronic Kidney Disease(CKD) are thought to be highly susceptible to emotional problems because of the chronic stress related to disease burden, dietary restrictions, functional limitations, associated co- morbidities, adverse effects of medication, changes in self-perception and fear of death. ToAims and Objective : evaluate the prevalence of depression and anxiety with their effect on quality of life in end stage kidney disease patients on maintenance hemodialysis. This is a cross sectional observational study conductedMaterial and Methods : between January and March 2024 at Department of Nephrology, D.Y. Patil University, School of Medicine, Nerul, Navi Mumbai. 30 adults of either sex with chronic kidney disease on maintenance dialysis were included in the study. Patients not willing to participate were excluded. PHQ-9 questionnaire is used to screen for depression and Scoring GAD-7 for anxiety severity in patients with end-stage renal disease. Minimal depression in PHQ-9 scoring was found in 16Results : (53.33%) cases and mean was 5.07+3.85 and minimal Anxiety level (GAD-7 Scoring) was found in 21 (70.00%) cases and mean was 3.83+3.68. CKD patients undergoing hemodialysis need early psychiatric evaluation and anyConclusion : interventions if indicated.This will improve their overall quality of life.

Caracterización de la situación problémica en un estudio psicosocial con pacientes con enfermedad renal crónica

Introducción: La enfermedad renal crónica es un problema de salud a nivel mundial, su manifestación más grave, la insuficiencia renal crónica, incide en el contexto cubano y determina el crecimiento de pacientes en hemodiálisis. El objetivo del texto es valorar los principales resultados del diagnóstico y caracterización de la situación problémica en un estudio de carácter psicosocial con pacientes con Insuficiencia Renal Crónica en la sala de Hemodiálisis del municipio Florida, de la provincia de Camagüey. Método: Es una investigación-acción participativa de corte experimental, que se desarrolla entre enero 2023 y diciembre del 2024 la cual constituye salida del proyecto de investigación Sistema de acciones psicosociales para el perfeccionamiento de la atención integral a los pacientes con enfermedades no transmisibles. El universo está constituido por 56 pacientes y la muestra por 22, que reciben tratamiento depurador y conservador, 22 familiares y 12 profesionales del servicio. El instrumento de investigación por excelencia fue la encuesta a participantes. Resultados: La edad de los pacientes no es definitiva de un grupo etario; predominan los hombres; se constata un elevado por ciento de pacientes con poca tolerancia a la adherencia al tratamiento e insuficiente desarrollo de las habilidades psicosociales y declaran la necesidad de poseer conocimientos para lograr estados de salud que conlleven a la sobrevida. Discusión: No existe coincidencia con lo constatado en la determinación de los grupos etarios de prevalencia para la enfermedad, pero los especialistas insisten en que la enfermedad no es privativa de un período de vida específico; reconocen la importancia del conocimiento de los factores de riesgo por el paciente para la prevención, promoción y educación en salud y resaltan la necesidad de la comunicación y la empatía entre el personal de salud y el paciente, para lograr resultados y estados emocionales favorables ante la enfermedad y el tratamiento.

Introduction: Chronic kidney disease is a global health problem. Its most serious manifestation, chronic kidney failure, affects the Cuban context and determines the growth of patients on hemodialysis. The objective of the text is to evaluate the main results of the diagnosis and characterization of the problematic situation in a psychosocial study with patients with Chronic Renal Failure in the Hemodialysis room of the Florida municipality, of the county of Camagüey. Method: It is an experimental participatory action research, which takes place between January 2023 and December 2024, which constitutes the output of the research project System of psychosocial actions for the improvement of comprehensive care for patients with non-communicable diseases. The universe is made up of 56 patients and the sample is made up of 22, who receive purifying and conservative treatment, 22 family members and 12 service professionals. The research instrument par excellence was the participant survey. Results: The age of the patients is not definitive of an age group; men predominate; A high percentage of patients are found to have low tolerance for adherence to treatment and insufficient development of psychosocial skills and declare the need to possess knowledge to achieve health states that lead to survival. Discussion: There is no coincidence with what was found in the determination of the prevalence age groups for the disease, but specialists insist that the disease is not exclusive to a specific period of life; recognize the importance of the patient's knowledge of risk factors for prevention, promotion and health education and highlight the need for communication and empathy between health personnel and the patient, to achieve favorable results and emotional states in the face of the disease and treatment.

Chronic Kidney Disease of Unknown Etiology in A Tertiary Care Center at Tertiary Care Teaching Hospital

Background: Unknown etiology chronic kidney disease (CKDu) is a kind of chronic kidney disease (CKD) that is common in certain rural communities worldwide. It is unique due to its multifactorial origin and clinicopathologic features, which are mostly associated with many environmental contaminants. A thorough definition is required in order to precisely identify the instances, aid in clinical diagnosis, and make it easier to screen individuals in impacted regions. Methods: It is a two-year prospective observational research conducted at the Tertiary Care Teaching Hospital's Department of General Medicine. Research technique organizes all the study's components in a manner that makes sense and increases the likelihood of producing reliable results. It has a significant impact on the validity and reliability of the study's conclusions. Results: Out of 90 patients, 30 qualified candidates were found. Anemia affected around 66.6% of the patients. 6.7% of patients had a history of CVD, and 6.7% had a history of CVA. Of the patients, 20% used NSAIDS. The majority of the patients in our research had shrinking kidneys and were in stages 4 and 5 of CKDu. Just 30% of patients were in stages 1-3 of the CKDu, which are depicted, while 70% of patients were in stages 4 and 5. Conclusion: In conclusion, chronic kidney disease is becoming more and more of a health concern in India as it is realized that those without traditional risk factors like diabetes mellitus and hypertension are frequently affected by the condition.

Fracture Prevention in Kidney Disease

The number of patients with chronic kidney disease (CKD) who are progressing to end-stage renal failure is growing at an alarming rate. Among this population, one of the signicant morbidities is a marked increase in fracture risk, which can be as high as 46.3 per 1000 person-years. This elevated risk is primarily due to metabolic bone changes associated with CKD, which often result in weakened bones and an increased susceptibility to fractures. A key factor in preventing fractures in these patients is addressing mineral imbalances, particularly vitamin D deciency, which is common in CKD. Ensuring that patients maintain adequate levels of vitamin D and other essential minerals is crucial for bone health. However, some patients do not respond adequately to traditional mineral supplementation. For these individuals, alternative therapies such as denosumab, a medication that helps to strengthen bone by inhibiting bone resorption, should be considered. This review investigates the specic fracture risks faced by dialysis patients and provides a comprehensive guide for effective fracture management in this vulnerable population. By implementing targeted strategies to address mineral imbalances and exploring viable alternative treatments, healthcare providers can signicantly improve the quality of life and outcomes for patients with CKD.

Enfermedad renal crónica por glomeruloesclerosis focal y segmentaria asociada a VIH en adolescente / Chronic kidney disease due to focal and segmental glomerulosclerosis associated with HIV in an adolescent

RESUMEN Las enfermedades glomerulares más frecuentes asociadas al síndrome nefrótico (SN) en adultos son la glomerulonefritis membranosa (GM) y la glomeruloesclerosis focal y segmentaria (GEFS), relacionada a VIH e infrecuente en adolescentes. Nuestro objetivo es describir un caso de GEFS asociado a VIH además de la coexistencia de amiloidosis y evidenciar su mejoría con el tratamiento terapia antirretroviral de gran actividad (TARGA). Adolescente femenina de 14 años ingresa a emergencia por un tiempo de enfermedad de una semana tras presentar oliguria y anasarca; al mes reingresa por exacerbación del cuadro edematoso, se le diagnosticó artritis reumatoidea juvenil (ARJ). Se realizó biopsia renal y exámenes de secundarismos siendo positiva a VIH. En conclusión, es inusual encontrar esta glomerulopatía en una adolescente, por ello es necesario considerar inicialmente la presencia de secundarismos en adolescentes, evidenciando la mejoría de la GEFS asociada a infección de VIH con un tratamiento TARGA.

ABSTRACT The most frequent glomerular diseases associated with nephrotic syndrome (NS) in adults are membranous glomerulonephritis (MG) and focal segmental glomerulosclerosis (FSGS), related to HIV and infrequent in adolescents. Our objective is to describe a case of FSGS associated with HIV and the coexistence of amyloidosis and to demonstrate its improvement with highly active antiretroviral therapy (HAART). A 14-year-old female adolescent was admitted to the Emergency Department for 1 week of illness after presenting oliguria and anasarca; a month later she was readmitted due to exacerbation of edematous symptoms and was diagnosed with juvenile rheumatoid arthritis (JRA). A renal biopsy was performed and secondarism tests were positive for HIV. In conclusion, it is unusual to find this glomerulopathy in an adolescent, so it is necessary to consider initially the presence of secondary disease in adolescents, showing the improvement of FSGS associated with HIV infection with HAART treatment.

Identification of the Interleukin-6 Polymorphism (-174) in the Saliva of Hemodialysis Patients

Background: Chronic Kidney Disease is prevalent in the general population and is associated with high morbidity and mortality and its pathogenic mechanisms are related to pro-inflammatory cytokines, such as Interleukin 6 (IL-6). It is known that polymorphisms associated with IL-6 can trigger a different immune response in the individual and therefore be a determining factor in the progression of the disease. The idea of using saliva as an analysis matrix for diagnostic methods suggests that the methodology may be viable due to the easy way collection of these fluids and the amount of information in saliva molecular constituents. Aims: To identify the relationship between IL-6 polymorphism (-174) in dialysis patients using saliva. Methodology: 53 individuals were assessed, divided into a test group: 27 on hemodialysis; and a control group: 26 healthy individuals. Saliva samples were collected, DNA was extracted, and genotyping was performed using Real Time-Polymerase Chain Reaction (RT-PCR). For statistical analysis, the c2 was performed on categorical data. Results: The genotype frequency identified was 33.33% GC, 59.25% GG and 7.42% CC for the hemodialysis group and 19.23% GC, 50% GG and 30.77% CC for the healthy group(p=0.0806). Conclusion: It was possible to verify the presence of the IL-6 (-174) polymorphism in saliva. Nonetheless, the predominance of GG was not significant, corroborating with other studies, that also indicate no relation between IL-6 Polymorphism and CKD. In this study, it was not possible to correlate hemodialysis patients with the polymorphism studied, but more studies about this subject are necessary, mainly in countries with diverse population, as Brazil.

Examining the relationship between chronic kidney disease, dyslipidaemia, and dysglycemia: a prospective study

Background: Chronic kidney disease (CKD) results in profound lipid disorders, which stem largely from dysregulation of high-density lipoproteins (HDL) and triglyceride-rich lipoprotein metabolism. Objectives were to evaluate the correlation between chronic kidney disease, dyslipidaemia and dysglycemia. Methods: In-patient and outpatient department (OPD) of department of medicine, COM and JNM Hospital, Kalyani. Cases are defined as patients (>20 years of age) with a diagnosis of CKD (non-oedematous). The controls are defined as age and gender-matched patients (>20 years) attending medicine OPD/indoor without diagnosis of CKD. Results: Among the CKD cases, 30 individuals were diagnosed as overtly diabetic, whereas in the control group, 22 participants had fasting blood sugar (FBS) levels equal to or exceeding 126 mg/dl. The mean FBS was 111 mg/dl (standard deviation (SD) 44 mg/dl) in the CKD group and 91 mg/dl (SD 31 mg/dl) in the control group. The difference in FBS levels between the CKD patients' group and the control group was statistically significant (p value=0.001). Conclusions: Hyperglycaemia is also significantly associated with CKD in form of increased fasting blood sugar (47% among cases as compared to 30% in control) and increased post-prandial blood sugar (49% in cases as compared to 36% in controls). Dyslipidaemia occurs in CKD cases (39% among CKD cases and in 24% of controls) in the form of increased triglycerides (TG), LDL and low HDL.

Antiplatelet Therapy and Kidney Function in Non-Dialysis Chronic Kidney Disease: A Two-Centre Observational Study in Nigeria

Antiplatelet therapy used in preventing cardiovascular events in chronic kidney disease may be associated with higher risks of bleeding, low efficacy from fewer occlusive atherosclerotic disease), attenuation of the inflammatory process, and changes in the haemogram. We prospectively determined the kidney function, the haemogram, and the lipid profile of participants with and without antiplatelet therapy. The population with a mean age of 69.21 ± 11.73 years, had more women (65.88%), p=0.001. Participants' age was positively correlated with the CKD stage, p<0.001. Bleeding was more common with clopidogrel than aspirin and, less common with advancing CKD. Cardiovascular events were more common in CKD stage 5. The men had higher eGFR but lower platelet count and platelet neutrophil ratio (PNR) than the women, p=0.004, p<0.001, and p<0.001 respectively. The eGFR, bicarbonate, and HDL cholesterol were higher with versus without antiplatelets, p=0.04, p<0.001, and p=0.001 respectively. The platelet count and PNR were higher with antiplatelet therapy and with higher CKD stage, p<0.001 and p<0.001 and, p<0.001 and p<0.001 respectively. Higher platelet count (OR-0.410, 95% CI-0.02-1.04), lower uric acid levels (OR-0.550, 95% CI-0.271-0.948), higher HDL-C (OR-0.486, 95% CI-0.093-1.013), lower LDL-C (OR-0.572, 95% CI-0.082-1.002) and lower triglycerides (OR-1.274, 95% CI-0.755-1.493) were independently associated with antiplatelet therapy. The benefits of antiplatelet therapy in CKD are anchored on its anti-inflammatory, lipid-lowering, and kidney function-improving effects, these synergistically lead to lower cardiovascular events. The increased risk and consequences of bleeding, and reductions in leucocytes and erythrocytes population should be borne in mind to prevent heightening morbidity and mortality rates.

Calcifilaxis, factores de riesgo, tratamiento y evolución. Estudio retrospectivo de 39 pacientes / Calciphylaxis, risk factors, treatment and outcomes. Retrospective study of 39 patients

Resumen Introducción : La calcifilaxis es un trastorno vascular grave caracterizado por depósito de calcio en túnica me dia arteriolar, trombosis y necrosis cutánea. Se describió en pacientes con insuficiencia renal (CU), aunque puede producirse en su ausencia (CNU). Sus factores de riesgo están en estudio y su diagnóstico puede ser complejo. Su mortalidad se estimaba en 60-80%, aunque trabajos recientes indican que ha disminuido (40%). Métodos : Estudio retrospectivo entre el 1/1/2011 y el 31/12/2019. Se revisaron los antecedentes, las ca racterísticas clínicas, los hallazgos de laboratorio e histopatológicos, y la evolución de todos los pacientes con diagnóstico de calcifilaxis evaluados en el Hospital Italiano de Buenos Aires. Resultados : Se incluyeron 39 pacientes. El 61.5% (24) eran hombres y 38.5% (15) fueron casos de CNU. De éstos, 82% presentaba hipertensión arterial, 66% obesidad y 46% diabetes. El 49% recibía anticoagulantes dicumarínicos. Todos los pacientes con CNU y 75% con CU presentaron úlceras de fondo necrótico, localizadas con mayor frecuencia en las piernas. En 72% de los casos el diagnóstico histológico se efectuó con una toma de biopsia. En todos, el tratamiento fue multimodal y la mortalidad al año fue de 42%. Conclusión : Observamos una elevada proporción de pacientes con CNU, en relación con lo comunicado en la literatura, y la mitad recibía anticoagulantes di cumarínicos. El diagnóstico histológico se efectuó por biopsia en la mayor parte de los casos, para lo cual la toma quirúrgica de la muestra, la tinción con Von Kossa y la evaluación por un patólogo experto fueron claves.

Abstract Introduction : Calciphylaxis is a serious vascular dis order characterized by calcification of tunica media, in timal hyperplasia, thrombosis, and skin necrosis. It was described in patients with renal failure (UC), although it can occur in its absence (NUC). Its risk factors are under study and its diagnosis can be complex. Over a decade ago, its mortality was estimated at 60-80%. Recent stud ies indicate that it has decreased (40%). Methods : A retrospective study was carried out in the period between January 1, 2011 and December 31, 2019. The past medical record, clinical characteristics, labo ratory and histopathological findings, and evolution of all patients with calciphylaxis evaluated at the Hospital Italiano de Buenos Aires were reviewed. Results : Thirty-nine patients were included. Sixty-one percent were men and 39% were NUC cases. Eighty-two percent had arterial hypertension, 66% obesity and 46% diabetes. Of those, 49% received coumarin anticoagulants. All patients with NUC and 75% with UC presented ulcers with necrosis, located more frequently on the legs. In 72% of the cases the histological diagno sis was made with one biopsy. In all the treatment was multimodal and mortality at one year was 42%. Conclusion : We observed a high proportion of pa tients with NUC, in relation to what is reported in the literature, and that half received vitamin K antagonists. The histological diagnosis was made with one biopsy in most of the cases, as the surgical technique for taking the sample, the Von Kossa staining and the evaluation by an expert pathologist were the key of it.

Incremento del riesgo hemorrágico en pacientes con fibrilación auricular y enfermedad renal crónica en hemodiálisis tratados con anticoagulantes. Serie de cuatro centros / Increased risk of bleeding in patients with atrial fibrillation and chronic kidney disease on hemodialysis treated with anticoagulants. A four center series

Resumen Objetivo: El objetivo de este estudio fue estimar si el uso de anticoagulantes se asociaba con una diferencia en la frecuencia de trombosis de cualquier sitio, hemorragia mayor y mortalidad en adultos con coexistencia de ambas patologías. Método: Se realizó un estudio de cohorte retrospectivo en cuatro centros de alta complejidad. Se incluyeron mayores de 18 años con ERC en hemodiálisis y FA no valvular, con indicación de anticoagulación (CHA2DS2VASc ≥ 2). El desenlace primario fue la ocurrencia de sangrado mayor, evento trombótico (accidente vascular cerebral, infarto agudo al miocardio o enfermedad tromboembólica venosa) o muerte. Se realizó ajuste por variables de confusión por regresión logística. Resultados: De los 158 pacientes incluidos, el 61% (n = 97) recibieron anticoagulante. El desenlace principal se encontró en el 84% de quienes recibieron anticoagulación y en el 70% de quienes no la recibieron (OR: 2.12, IC95%: 0.98-4.57; luego del ajuste OR: 2.13, IC95%: 1.04-4.36). De los desenlaces mayores se presentaron sangrado en el 52% vs. el 34% (OR: 2.03; IC95%: 1.05-3.93), trombosis en el 35% vs. el 34% (OR: 1.03; IC95%: 0.52-2.01) y muerte en el 46% vs. el 41% (OR: 1.25; IC95%: 0.65-2.38). Conclusiones: Los resultados de este estudio sugieren un incremento en el riesgo de sangrado en los pacientes con FA y ERC en hemodiálisis que reciben anticoagulación, sin disminución del riesgo de eventos trombóticos ni de muerte.

Abstract Objective: The aim of this study was to estimate whether the consumption of anticoagulants was associated with a difference in the frequency of thrombosis of any site, major bleeding and mortality, in adults with both diseases. Method: A retrospective cohort study was carried out in four high complexity centers. Patients older than 18 years with CKD on hemodialysis and non-valvular AF, with an indication for anticoagulation (CHA2DS2VASc ≥ 2), were included. The primary outcome was the occurrence of: major bleeding, thrombotic event (cerebrovascular accident, acute myocardial infarction or venous thromboembolic disease) or death. Adjustment for confounding variables was performed using logistic regression. Results: From 158 patients included, 61% (n = 97) received an anticoagulant. The main outcome was found in 84% of those who received anticoagulation and 70% of those who did not (OR: 2.12, 95%CI: 0.98-4.57; after the adjusted analysis OR: 2.13, 95%CI: 1.04-4.36). Separate outcomes were bleeding in 52% vs. 34% (OR: 2.03; 95%CI: 1.05-3.93), thrombosis in 35% vs. 34% (OR: 1.03; 95%CI: 0.52-2-01) and death in 46% vs. 41% (OR: 1.25; 95%CI: 0.65-2.38). Conclusions: The results of this study suggest an increased risk of bleeding in patients with AF and CKD on hemodialysis receiving anticoagulation, without a decrease in the risk of thrombotic events or all-cause mortality.

Renal osteodystrophy and clinical outcomes: a prospective cohort study / Osteodistrofia renal e desfechos clínicos: um estudo de coorte prospectivo

Abstract Introduction: Renal osteodystrophy (ROD) refers to a group of bone morphological patterns that derive from distinct pathophysiological mechanisms. Whether the ROD subtypes influence long-term outcomes is unknown. Our objective was to explore the relationship between ROD and clinical outcomes. Methods: This study is a subanalysis of the Brazilian Registry of Bone Biopsies (REBRABO). Samples from individual patients were classified as having osteitis fibrosa (OF), mixed uremic osteodystrophy (MUO), adynamic bone disease (ABD), osteomalacia (OM), normal/minor alterations, and according to turnover/mineralization/volume (TMV) system. Patients were followed for 3.4 yrs. Clinical outcomes were: bone fractures, hospitalization, major adverse cardiovascular events (MACE), and death. Results: We enrolled 275 participants, of which 248 (90%) were on dialysis. At follow-up, 28 bone fractures, 97 hospitalizations, 44 MACE, and 70 deaths were recorded. ROD subtypes were not related to outcomes. Conclusion: The incidence of clinical outcomes did not differ between the types of ROD.

Resumo Introdução: Osteodistrofia renal (OR) refere-se a um grupo de padrões morfológicos ósseos que decorrem de mecanismos fisiopatológicos distintos. É desconhecido se os subtipos de OR influenciam desfechos em longo prazo. Nosso objetivo foi explorar as relações entre OR e desfechos. Métodos: Este estudo é uma subanálise do Registro Brasileiro de Biópsias Ósseas (REBRABO). As amostras de cada paciente foram classificadas em osteíte fibrosa (OF), osteodistrofia urêmica mista (MUO), doença óssea adinâmica (ABD), osteomalácia (OM), alterações normais/menores, e pelo sistema Remodelação / Mineralização / Volume (RMV). Os pacientes foram acompanhados por 3,4 anos. Os eventos clínicos foram: fraturas ósseas, hospitalizações, eventos cardiovasculares adversos maiores (MACE), e óbito. Resultados: Analisamos 275 indivíduos, 248 (90%) deles estavam em diálise. No acompanhamento, 28 fraturas ósseas, 97 hospitalizações, 44 MACE e 70 óbitos foram registrados. Os subtipos de OR não foram relacionados aos desfechos clínicos. Conclusão: A incidência de desfechos clínicos não diferiu entre os tipos de OR.

Patients with Chronic Kidney Disease: Clinical Presentation, Outcome, and Tuberculosis Occurrence

Background: Tuberculosis (TB) is a significant global public health concern, surpassing HIV/AIDS in mortality. Despite advancements, the prevalence and death rates of pulmonary TB have declined, while extra-pulmonary TB has unexpectedly risen. This observational study in Burla, India. Methods: The duration of this study was from April 2021 to September 2022 and included CKD patients from a tertiary care hospital. The observational, cross-sectional design evaluated clinical data, sociodemographic factors, and TB diagnoses in a sample of 220 individuals, considering a population size of 3.5 million in western Odisha. Results: The study revealed a high vulnerability of Chronic Kidney Disease (CKD) patients to TB, with a predominant male incidence in the 30-60 age group. Lower socioeconomic status correlated with higher TB diagnoses. Advanced CKD stages, particularly grade-4 and grade-5, were associated with increased TB susceptibility. Dialysis-requiring CKD patients demonstrated heightened vulnerability. Tubercular pleural effusion was prevalent in extra-pulmonary TB cases. Common symptoms include fever, breathlessness, and cough. Symptomatic patients with TB were prevalent, with fever being the primary symptom. Conclusion: The study concludes that CKD patients face heightened susceptibility to pulmonary and extra-pulmonary TB. Advanced CKD stages, male gender, and lower socioeconomic status were associated with increased TB risk. Tubercular pleural effusion emerged as a common form of extra-pulmonary TB. Routine screening is crucial for early detection and effective management. Future perspectives should focus on refining screening protocols and fostering collaboration between nephrology and infectious disease specialists to enhance TB management in CKD patients.

Swedana Therapy A Hope For Medopradoshaja Vikara W.S.R. Chronic Kidney Disease (CKD) Patients

Swedana (sudation) therapy is a process which has a dual role in panchkarma as well as pradhan karma in relevance to panchkarma and the treatment of various vata-kaphaja and medopradoshaja vikara. Swedana helps to relief stiffness heaviness and coldness of the body and makes the body to perspire. It removes toxins from the body through hair follicles present all over the skin .The perspiration brought about by the swedana is more than the normal. Swedana is preventive, supportive as well as therapeutic. Acharya charak has mentioned the root of origin of swedavaha srotas (channels) lies in Meda (fat, lipids, Adipose tissue) and lomakoop (minute pores of the skin located around base of hair follicles). Sweda is considered to be excreta (Mala) of meda dhatu. The root of origin of medovaha srotas (channels) are Vrikka (kidney) and vapvahana(peritoneal membrane). The Vrikka (kidney) is originated from prasada bhag of Rakta (Blood) and meda. In Chronic kidney disease (CKD), the hemodynamics of the kidney is hampered which leads to accumulation of toxins and un?ltered excretory wastes. So with the help of swedana the hemodynamics of kidney and the body is improved which facilitates the expulsion of accumulated toxins through activation of sweat glands to produce more sweat. It causes apana vata anulomana which further facilitates micturition. In this article you will come to know the relevance of swedana in chronic kidney disease (CKD) patients.