end-stage renal disease

The escalating longevity facilitated by medical advancements has led to a surge in elderly individuals grappling with chronic kidney disease (CKD) and progressing to end-stage renal disease (ESRD).

Our study addresses the paucity of research on octogenarians undergoing dialysis, a highly co-morbid and frail subset, particularly in the context of a resource-limited setting like India. Patients and

A retrospective observational study at Kasturba Medical College and Hospital in Manipal, India, examined 18 octogenarian dialysis patients from 2017 to 2022. Clinical details, including age, co-morbidities, dialysis patterns, and laboratory data, were collected. The Cox-proportional hazards model assessed factors influencing survival.

The majority-initiated dialysis in emergencies (72%), predominantly via central venous catheters. Hospitalizations post-dialysis were common (median 2.5). Survival rates at 1, 3, and 5 years were 61%, 54%, and 44%, respectively. Sudden cardiac death (64%) emerged as the predominant cause, with a significant impact of a higher Charlson comorbidity index on survival (HR 3.11; 95% CI [1.21-7.89]; P = 0.018).

Octogenarian dialysis patients, marked by substantial co-morbidities, exhibit reduced survival, particularly with higher comorbidity scores. Hospitalizations contribute significantly to morbidity. Our study underscores the need for nuanced care strategies tailored to this vulnerable population.

Familial Mediterranean fever (FMF) is an inherited disease characterized by fever and intermittent abdominal pain. Due to amyloid deposits in the kidneys and gastrointestinal tract, untreated FMF can lead to severe complications such as end-stage renal disease and malabsorption. The present study reports two brothers aged seven and five years, who presented with fever, abdominal pain, and anorexia. Based on their clinical history and ruling out other possible diagnoses, FMF was definitively diagnosed, and both patients underwent colchicine treatment.

IgA nephropathy (IgAN) is a common glomerular disease affecting individuals across the age spectrum. However, there are differences in the presentation and prognosis of IgAN between elderly and young adults. Elderly patients with IgAN tend to present with more severe kidney disturbances, worse baseline renal function, and a poorer prognosis compared to young adults. The Oxford classification contributes to the overall prognosis of IgAN in elderly patients by improving prognostic assessment, providing a better determinant of kidney survival, and combining histopathologic findings with clinical features. It offers a more comprehensive approach to understanding the disease course and predicting outcomes in elderly individuals with IgAN. Understanding these differences is a fundamental basis for pinpointing potential therapeutic targets to mitigate age-related renal pathology in IgAN patients.

End-stage renal disease patients on maintenance hemodialysis (ESRD-HD) are at very high risk for COVID-19 infections due to their older age and comorbidities such as diabetes and hypertension.

This study aimed to investigate the outcomes of COVID-19 in ESRD-HD patients.

This was a retrospective study conducted on ESRD-HD patients aged 18 years and older who were referred to Razi Hospitals in Ahvaz from February 2020 to May 2021 for hemodialysis and diagnosed with COVID-19. Patient information was extracted retrospectively from their medical records.

A total of 180 patients were examined. The average age of the patients was 61.5 years, and 118 (65.6%) were men. The most common underlying condition was hypertension (81.1%). The most prevalent clinical symptom was shortness of breath (70.6%), followed by cough (47.8%). Seventy-five patients (41.66%) were admitted to the intensive care unit (ICU), with an average stay of 5 days. Hypertension and ischemic heart disease were significantly more common among patients admitted to the ICU (P = 0.008 and 0.015, respectively). In-hospital mortality was 32.8%. Advanced age, fever, shortness of breath, cough, and the need for a ventilator were significant predictors of mortality in hospitalized ESRD patients with COVID-19 (P = 0.016, 0.033, 0.001, 0.012, and 0.011, respectively).

Our study demonstrated that ESRD-HD patients with COVID-19 are at high risk for ICU admission and mortality. Advanced age and clinical symptoms such as fever, shortness of breath, cough, and the need for a ventilator significantly predict in-hospital mortality in these patients.

Persons with End Stage Renal Disease (ESRD) experience poor quality of life due to poor physical function. After the transplant, his physical fitness did not improve, ultimately creating a vicious cycle of inactivity, increasing the risk of cardiovascular and other causes of death. A 39-year-old man was diagnosed with ESRD and underwent a renal transplant from a living donor. He underwent early post-operative rehabilitation from day one and continued until he was discharged. The study was conducted at Dr. Cipto Mangunkusumo National Hospital. Persons with ESRD showed significant improvement during the rehabilitation program. On the sixth day, he took a 4-meter walk test in 17.58 seconds and made a good impression. He was then discharged and continued remote rehabilitation until day 14. Physical inactivity leads to decreased survival, increased morbidity, and increased mortality. Early rehabilitation for post-renal transplantation may become a potential intervention to improve a person with ESRD's physical activity and quality of life, especially in Indonesia.

Patients with End-Stage Renal Disease (ESRD) often experience diminished physical function and exercise capacity, which can accelerate disease progression and further compromise their health. Research on the impact of Intradialytic Exercise (IDE) on the quality of life (QOL) for hemodialysis patients in Oman is limited. This study aims to assess the effect of an IDE program on hemodialysis patients in Oman, focusing on both biophysiological parameters and QoL. We employed a comparative observational study design involving two groups: one participating in the IDE program and the other serving as a non-participating comparison group from the Al-Seeb dialysis center in Oman. Biophysiological parameters were retrospectively evaluated three months before and after the implementation of IDE. Additionally, mean arterial pressure was measured both prior to the start of the IDE program and again at six months. QOL was assessed post-IDE using the Kidney Disease Quality of Life Short-Form 36 (KDQOL-36) for both groups. Data collection took place from June 2021 to February 2022. We utilized descriptive statistics, independent sample t-test, and chi-square test, analyzing the data with SPSS® software version 23. The study did not reveal any statistically significant differences in biophysiological parameters between the two groups (p=0.185). However, the exercise group demonstrated significantly higher scores on the physical component summary (M=59.86, SD=23.39) compared to the comparison group (M=44.86, SD=26.33, P=0.001). Although overall QOL scores and subscale scores were higher in the exercise group, these differences did not achieve statistical significance. This research sheds light on the effects of an IDE program on selected biophysiological parameters and quality of life among hemodialysis patients. While no significant differences were noted in biophysiological measures between the IDE group and the comparison group, improvements in physical health were evident, as indicated by higher KDQOL-36 scores in those participating in the exercise program.

Chronic kidney disease is a devastating disorder, which complicated the quality of life in affected patients. Determination the epidemiology of end stage renal disease (ESRD) seems necessary to decrease the occurrence of progressive renal damage in at risk patients. This study was performed to investigate the epidemiologic characteristics and treatment modalities of children with ESRD. A cross-sectional study was conducted on 115 children with ESRD admitted during 2020-2022 in a pediatric nephrology center in Southwest of Iran. All children were younger than 18 years and referred for renal replacement therapy (RRT). ESRD was defined as glomerular filtration rate less than 10-15 ml/min/1.73 m2 for at least 3 months. Information such as age of ESRD, gender, etiology of ESRD and type of RRT were obtained from their medical records. A total of 115 patients (53% male) were included. Mean age at the time of ESRD was 8.47 years. Males outnumbered females. The most common cause of ESRD was congenital abnormality of kidney & urinary tract (CAKUT) in 36.5% of patients, followed by hereditary disorders. The majority of patients were older than 5 years at the time of ESRD, with a significant correlation to the underlying disorder (P<0.001). Parental consanguinity was detected in 77% of patients, especially in hereditary disorders. RRT was performed in all patients, including hemodialysis in 71.3% and chronic ambulatory peritoneal dialysis in 28.7%, respectively. In conclusion, CAKUT was the most common cause of ESRD in our patient population. was the most common cause of ESRD in our patient population. Prenatal evaluation of all fetuses along with early neonatal screening of susceptible cases is suggested for preventing practice or slowing the progression of chronic kidney disease.

End-stage renal disease (ESRD) is a pervasive global health challenge with high mortality rates. This prospective study aimed to identify medical factors influencing mortality in ESRD patients.

Data from 149 ESRD patients registered at Imam Khomeini hospital in Kermanshah were analyzed. Only patients with a minimum of one-year follow-up were included. Univariate and multiple regression analyses were employed, and model evaluation utilized indicators such as the area under the receiver operating characteristic (ROC) curve, sensitivity, and specificity.

Among 149 ESRD patients, 88 (59.1%) were male, and 37 (24.7%) experienced mortality. The average age of deceased patients was 63.59±15.74 years. Chronic glomerulonephritis was the underlying cause in 72 (48.3%) participants. Multiple regression revealed that age, diabetes, and a history of heart failure significantly correlated with mortality. ESRD patients with diabetes faced a 2.47-fold increased risk of death (95% confidence interval: 1.10 - 5.55). The model exhibited an area under the curve (AUC) of 0.70, with sensitivity and specificity of 51.35% and 75%, respectively.

Given the chronic nature of ESRD and elevated mortality, particularly among diabetic patients, intensified monitoring efforts are crucial for the prevention and management of diabetes in this population.

Primary hyperoxaluria is a rare congenital autosomal recessive disorder disrupting the glyoxylate metabolism pathway in the liver. Type1 primary hyperoxaluria is caused by a deficiency in a specific liver enzyme namely, alanine glyoxylate-aminotransferase which catalyzes the conversion of glyoxylate to glycine. By the absence of this enzyme, glyoxylate is converted to oxalate and high oxalate level causes deposition of insoluble calcium oxalate crystals in different organs specifically kidneys. The disease usually manifested by recurrent nephrolithiasis and/or nephrocalcinosis leads to renal failure. This report describes an end-stage renal disease case of a 36-year-old Iranian woman without any history of nephrolithiasis who underwent kidney transplantation. She developed an early onset transplant kidney failure. The patient underwent kidney biopsy, which revealed oxalate nephropathy, accordingly the genetic study confirmed diagnosis of primary hyperoxaluria. This rare case shows how type 1 primary hyperoxaluria can develop after kidney transplantation without having any manifestation prior to transplantation

World Kidney Day is an annual, global awareness campaign that aims to raise awareness of the importance of kidney health and hopes to alleviate the global burden of kidney diseases. It is observed annually on the second Thursday of March. The campaign focuses on elucidating various aspects of kidney health, including prevention, early detection, and management of kidney diseases. It highlights the risk factors contributing to kidney disease, such as diabetes, hypertension, dyslipidemia, metabolic syndrome, and obesity. By raising awareness about these risk factors, World Kidney Day encourages individuals to make lifestyle modifications and promptly seek medical intervention to reduce their risk factors.

Renal involvement is common in systemic lupus erythematosus (SLE), and even without elevated serum creatinine, there is a high proportion of abnormal urine analysis in these patients. Lupus nephritis (LN) develops early in the course of the disease in 50% of SLE patients, and end stage renal disease (ESRD) occurs in 4.3-10.1%. We performed a keyword-based literature search and included 31 articles published from 2004 to 2023. Ethnic and racial differences may affect LN, including higher incidence of LN in Black, Hispanic and Asian compared with white patients. In addition, male sex, longer disease duration, smoking, low albumin globulin ratio, low complement, anti-double stranded DNA, high anti-Sm is associated with disease progression to LN. High serum creatinine (>1.5 mg/dL) at disease onset is the most commonly reported independent clinical laboratory predictor for ESRD in patients with SLE. Other factors indicating an increased risk for ESRD are higher chronicity index, high systolic blood pressure, black race, male sex, hypocomplementemia, class of LN (III, IV and V) and older age.

The current study aimed to assess some parameters of the cardiopulmonary exercise test (CPET) among end-stage renal disease patients who underwent dialysis. The ultimate goal is to improve disease management to achieve optimal quality of life and exercise capacity in this group of patients.

Through a cross-sectional design, the current study enrolled 46 dialysis patients by simple sampling between Jan 2019 and Jan 2020. Some CPET parameters such as AT, VO2, VO2/kg, SPO2, minute ventilation CO2 production/O2 consumption ratios (VE/VCO2 and VE/VO2, respectively), O2 pulse, heart rate reserve (HRR), breathing reserve (BR) and end-tidal carbon dioxide pressure (PETCO2) were focused.

Although a limited sample size, the current study showed that VO2/Kg, VE/VCO2, PETCO2, and SPO2 are the main parameters affected by dialysis as expected.

The current study suggests using cardiopulmonary rehabilitation for all chronic medical conditions such as chronic kidney disease and end-stage renal disease that increase the rate of metabolic acidosis.

 End-Stage Renal Disease (ESRD) is a severe nephrological condition that can lead to permanent kidney damage. Therefore, early disease diagnosis is key to preventing casualties. The gold standard method of diagnosis tends to evaluate changes in sodium, potassium, calcium, phosphorus, urea, creatinine, and parathormone hormones in blood after dialysis. However, serum evaluation is not always possible or easy for patients. Therefore, saliva evaluation has been proposed in recent years as an alternative.

 The current article aims to evaluate metabolite in the saliva of ESRD patients.

 In this descriptive-analytical study, 29 ESRD patients undergoing hemodialysis treatment were selected. Their saliva and serum samples were taken. The number of biochemical factors, including sodium, potassium, calcium, phosphorus, urea, creatinine, and parathormone hormone, was measured with an autoanalyzer device and related kits. Finally, the correlation of parameters in serum and saliva was examined using the Pearson test.

 The results showed a significant positive relationship between the levels of sodium, urea, and creatinine in serum and saliva samples (P < 0.05). On the other hand, there was no significant relationship between the serum and saliva levels of potassium, calcium, phosphorus, and PTH (P > 0.05).

 Due to the significant correlation between some prominent biochemical factors in saliva and serum after hemodialysis in ESRD patients, saliva could be considered a non-invasive diagnostic fluid for monitoring kidney disease in the future.

People with chronic kidney disease (CKD) experience chronic systemic inflammation. Although a relationship exists between inflammation and renal injury, the association between inflammatory markers and renal disease has not been well-studied. As inflammation may be a trigger or a result of chronic disease, the kidney needs to be investigated to determine whether it is a clearer target for the devastating effects of persistent inflammation. Here, we report the relation of C-reactive protein and mean platelet volume levels with renal functions in chronic kidney disease patients.

This study was an observational retrospective single-center study conducted on the record of CKD patients to detect the outcomes over a median follow-up time of three years. Demographic, clinical, laboratory, medication, and outcome data were obtained from the electronic data records of the hospital. We investigated the multivariable association of plasma levels of C-reactive protein and mean platelet volume with the progression of CKD in the study participants.

Elevated plasma levels of C-reactive protein (r=0.13, P<0.001) and mean platelet volume (r=0.23, P<0.001) were associated with a greater loss of kidney function over time. The presence of diabetes mellitus was detected to be a risk factor for CKD progression (P=0.04). An inverse relationship was detected between sodium and creatinine (P<0.001). In addition, a weak association was detected between uric acid and creatinine (P<0.001). 

Elevated plasma levels of C-reactive protein and mean platelet volume were associated with a decline in the estimated glomerular filtration rate in patients with CKD.

End-stage renal disease (ESRD) is a serious chronic disease that affects many organ systems. Skin manifestations that are commonly seen in ESRD can significantly impair the quality of life in these patients. Early recognition and management of mucocutaneous disorders can improve quality of life and decrease morbidity. This study aimed to evaluate the skin manifestations in ESRD patients undergoing hemodialysis.

In this cross-sectional study 150 patients undergoing hemodialysis in the Nephrology Department of Shahid-Beheshti Hospital in Babol were enrolled. The demographic and clinical data were assessed. Analysis was done by SPSS 22 and significance level was under 0.05.

The mean duration of hemodialysis was 8.7 months. The most common skin findings in patients include xerosis 84.7%, pallor 82.7%, pruritus 67.3%, hyperpigmentation 40%, purpura 28%. Skin infections were detected in 36% of patients (fungal 28%, bacterial 10.7%, and viral 5.3%). Nail, hair and mucosal changes were observed among 65.3%, 38% and 17.3% of patients respectively. No significant correlation was detected between skin findings and duration of dialysis.

The findings of the present study showed that skin manifestations are highly prevalent among patients with ESRD. Prompt diagnosis and management of the dermatological disorders may improve the quality of life in the affected patients.

Human intestine microbiota are known to be directly and indirectly altered during some diseases such as kidney complications. Bacteroides is considered as the main and the most abundant phylum among human gut microbiota, which has been classified as enterotype 1. This study aimed to assess the abundance of Bacteroides spp. in fecal flora of end-stage renal disease (ESRD) and chronic kidney disease (CKD) patients and compare it with the Bacteroides composition among fecal flora of healthy individual.

Fresh fecal samples were collected from 20 CKD/ESRD patients and 20 healthy individual without any kidney complications. The pure microbial DNA was extracted by QIAamp Stool Mini Kit from stool samples. MiSeq system was used to analyze the intestinal composition by next generation sequencing method.

A number of 651 bacterial strains were isolated and identified from 40 fecal samples of both patients and healthy groups. Bioinformatics analysis defined 18 different types of Bacteroides species which included 2.76% of all strains. Statistical analysis showed no significant difference between study groups (P>0.05). In both healthy and patient groups three species including B. dorei, B. uniformis, and B. ovatus have allocated the most abundance to themselves. The lowest abundance was related to B. eggerthii, A. furcosa and B. barnesiae among CKD/ESRD patients and A. furcosa, B. barnesiae, and B. coprocola had the lowest abundance among healthy people.

This study indicates despite all previous evidence of Bacteroides role in gut microbiota, it had no different distribution between healthy persons and CKD/ESRD patients.

Uremic pruritus is a common discomfort in end-stage renal disease patients on long-term hemodialysis. It negatively affects patients’ quality of life and is associated with increased mortality. The pathogenesis of uremic pruritus is complex. Aluminum is a toxic metal and common human allergen that causes an immune reaction in patients on hemodialysis. Aluminum is hypothesized to play a vital role in the pathogenesis of uremic pruritus. Controlling serum aluminum levels is still critical for patients on long-term hemodialysis.

To determine the prevalence of hyperaluminemia and assess its correlation with uremic pruritus in patients on long-term hemodialysis.

We conducted a case-control study on 90 patients on long-term hemodialysis at the dialysis units of Ain Shams university hospitals. We used the 5-D itch scale numerical rating system to determine the presence and severity of pruritus in our study participants. We collected blood samples to estimate blood urea nitrogen levels pre- and post-dialysis, as well as the measured urea reduction ratio, serum creatinine, hemoglobin level, intact parathyroid hormone, ionized calcium, serum phosphate levels, iron study and serum aluminum levels.

Our study showed no statistically significant differences between the pruritic and nonpruritic study groups (median values 9.78 [6.48–11.72] and 9.13 [6.3–10.4] for the pruritic and non-pruritic groups, respectively; P = 0.32).

The serum aluminum levels of our study participants were higher than the normal levels in humans. Patients in the pruritic group had higher levels than those in the non-pruritic group. However, aluminum levels were not significantly associated with either the presence or severity of pruritus in patients on long-term hemodialysis.