Burden of Chronic Hemodialysis on the Ability to Work: Time for Action.

Background Understanding the factors that contribute to unemployment will help in the design of creative resolutions to enable hemodialysis patients to return to a productive life. Methods We examined employment among 625 patients aged 18 to 60 years who were on hemodialysis in 8 dialysis units. Results Overall employment was low among patients on chronic hemodialysis at 49.7%. Unemployment was significantly higher in women than in men (86.6% vs 17.1%, p < 0.0001). The employment rate was 70.5% for those with no diabetes and hypertension, 29.5% for those with diabetes, and 25.9% for those with diabetes and hypertension. Furthermore, the results of the Cox regression showed that the variables of gender, level of education, capability of driving, and diabetes were related to employment of patients. Conclusions The majority of patients on hemodialysis are unemployed or exit paid employment due to early retirement. Patients with diabetes and women are a vulnerable population with a higher unemployment rate.

The Effect of Body Mass Index on the Degree of Renal Interstitial Fibrosis and Tubular Atrophy - A Retrospective Case-Control Study.

Introduction The degree of interstitial fibrosis and tubular atrophy (IFTA) seen on kidney biopsy has long been used to judge the chronicity of kidney disease to predict renal disease outcomes and prognosis. It is an essential component incorporated in many renal disease prognostic classification systems on the native and renal allograft. The impact of increased body mass index on the body metabolism, and the human vascular system, including the functional unit of the kidney, the nephron, is well-addressed in the literature. In this study, we focus on evaluating the degree of IFTA concerning the patient's body mass index (BMI). Method All the specimens of nephrectomies performed in King Abdulaziz University Hospital for adults from January 2010 to February 2021 were evaluated for this study. A total of 125 cases were selected for the study. The glass slides were pulled and assessed for the degree of IFTA. The demographic data, and the patient's BMI, were collected from the hospital records. Results Subjects with high BMI showed a 1.62 (OR: 1.62, 95% CI: 0.62, 4.22) and 1.52 (AOR: 1.52, 95% CI: 0.56, 4.13) increased risk of high IFTA score compared with those with normal BMI. This study has proved that only at a BMI of 25 or more will there be a measurable, independent effect on the degree of IFTA. Conclusion Although a small number of hospital-based populations limits this study, it could prove the increased severity of IFTA in patients with high BMI. Its result may act as a spark that will drive extensive population-based studies that more precisely delineate the relationship between BMI and the degree of IFTA on different levels.

Atypical haemolytic uremic syndrome (aHUS) and membranoproliferative glomerulonephritis (MPGN), different diseases or a spectrum of complement-mediated glomerular diseases?

Historically, patients with kidney diseases caused by genetic or acquired dysregulation of the complement alternative pathway have been grouped into clinical syndromes, C3 glomerulopathy (C3GN/DDD) and thrombotic microangiopathy (TMA), specifically atypical haemolytic uremic syndrome (aHUS). Recent data suggested that these diseases share a common pathophysiology and that patients can transition between glomerulopathies in this spectrum. Histopathologically, the main difference cited is the immunofluorescence (IF) findings, with C3 predominance in C3 glomerulopathy (compared with immunoglobulins and complements in immune complex-mediated membranoproliferative glomerulonephritis (MPGN)) and negative IF in TMA. We report a case in which a patient presented with hypertension, seizures, proteinuria, renal impairment and immune complex-mediated MPGN on kidney biopsy. Months later, she presented with classical TMA. She failed to respond to steroids and plasma exchange therapy but subsequently made a remarkable haematological and renal recovery after eculizumab treatment, thus supporting an underlying complement dysregulation and a diagnosis of aHUS.

The Use of Incremental Peritoneal Dialysis in a Large Contemporary Peritoneal Dialysis Program.

BACKGROUND: The use of an incremental peritoneal dialysis (PD) strategy in a large contemporary patient population has not been described. OBJECTIVE: We report the use of this strategy in clinical practice, the prescriptions required, and the clearances achieved in a large center which has routinely used this approach for more than 10 years. DESIGN: This is a cross-sectional observational study. SETTING: A single large Canadian academic center. PATIENTS: This study collected data on 124 prevalent PD patients at a single Canadian academic center. METHODS AND MEASUREMENTS: The proportion of patients who achieve the clearance target on a low clearance or incremental PD prescription; the actual PD prescriptions and consequent total, peritoneal, and renal urea clearances [Kt/V] achieved; and patient and technique survival and peritonitis rate in comparison with national and international reports. RESULTS: Of the 124 prevalent PD patients in this PD unit, 106 (86%) were achieving the Kt/V target, and of these, 54 (44% of all patients) were doing so using incremental PD prescriptions. Fifty of these incremental PD patients were using automated PD (APD) with either no day dwell (68%) or less than 7 days a week treatment (12%) or both (20%). Patient survival in our PD unit was not different from that reported in Canada as a whole. Peritonitis rates were better than internationally recommended standards. LIMITATIONS: This is an observational study with no randomized control group. CONCLUSIONS: Incremental PD is feasible in a contemporary PD population treated mainly with APD. Almost half of the patients were able to achieve clearance targets while receiving less onerous and less costly low clearance prescriptions. We suggest that incremental PD should be widely used as a cost-effective strategy in PD.

MISE EN CONTEXTE: L'utilisation de stratégies de dialyse péritonéale (DP) incrémentale au sein d'une grande population contemporaine n'a pas encore été bien documentée. OBJECTIFS DE L'ÉTUDE: Cette étude est un compte rendu de l'utilisation de telles stratégies en pratique clinique, des prescriptions exigées ainsi que des clairances atteintes au sein des grands centres hospitaliers ayant intégré cette approche dans leur programme de soins depuis plus de dix ans. CADRE ET TYPE D'ÉTUDE: Une étude observationnelle transversale qui s'est tenue dans un seul grand centre hospitalier universitaire au Canada. PATIENTS: L'étude a porté sur un total de 124 patients prévalents pour la dialyse péritonéale dans un centre hospitalier universitaire canadien. MÉTHODOLOGIE: On a mesuré la proportion de patients ayant atteint les valeurs cibles de clairance rénale à la suite d'une ordonnance pour une dialyse péritonéale supplémentaire. On a également répertorié le nombre de prescriptions de dialyse péritonéales et conséquemment, les valeurs de clairance d'urée totale, péritonéale et rénale atteintes (Kt/V). Les taux de survie des patients, les taux de péritonites ainsi que les taux de succès de la procédure ont été comparés aux valeurs rapportées au niveau national ainsi qu'à l'international. RÉSULTATS: De la cohorte de 124 patients prévalents pour la dialyse péritonéale recensés dans l'unité de dialyse étudiée, 106 (86%) ont atteint la cible de Kt/V et de ceux-ci, 54 patients (44%) y sont parvenus par la prescription d'une dialyse péritonéale incrémentale. De ces 54 patients sous DP incrémentale, 50 étaient traités par dialyse péritonéale automatisée (DPA) tous les jours (68%), quelques jours par semaine (12%) ou les deux (20%). Les taux de survie des patients dans l'unité de dialyse étudiée ne présentaient aucune différence significative lorsque comparés au taux rapporté dans tout le Canada. Les taux de péritonites se sont avérés meilleurs que les standards recommandés à l'international. LIMITES DE L'ÉTUDE: Le fait que cette étude observationnelle n'ait pas été contrôlée de façon aléatoire par un groupe témoin constitue une limite. CONCLUSIONS: La dialyse péritonéale incrémentale est possible dans une population contemporaine de patients traités principalement par DPA. Près de la moitié des patients ont pu atteindre les valeurs cibles de clairance tout en recevant des prescriptions de faible clairance moins complexes et moins coûteuses. Nous suggérons que la DP incrémentale devrait être plus largement utilisée comme stratégie économique de dialyse péritonéale.