جستجوی مقالات مرتبط با کلیدواژه « End-stage kidney disease » در نشریات گروه « پزشکی »

End-stage kidney disease (ESKD) is a global issue. Although the use of kidney replacement therapy measures has improved outcomes for patients with ESKD, the mortality rate remains significant. Identifying modifiable factors that affect patient outcomes can help improve their survival. The aim of this study was to investigate the factors affecting the clinical outcome of peritoneal dialysis patients.  

This prospective cohort study was conducted between 2018 and 2021.Participants: Patients aged between 18 and 75 years with a history of peritoneal dialysis (PD) for at least six months were included. Demographic data, kt/v ratio, medical history, serum levels of albumin, creatinine, triglycerides, total cholesterol, calcium, phosphorus, parathyroid hormone, hemoglobin, and ferritin were recorded before starting PD and during the follow-up period, along with clinical outcomes. To describe the data, the central index of mean, frequency, and relative frequency was used, and for analytical statistics, Chi-square test, analysis of variance, and Kruskal-Wallis were used.  

A total of 64 patients with a mean age of 51.78 ± 15.31 years were included. Of these, 27 (42.18%) had a history of diabetes mellitus, and 38 (59.37%) had a history of hypertension (HTN). 48 (75%) patients survived until the end of the study, while 47 (73.4%) participants experienced peritonitis. Our findings indicate that variables such as sex, marital status, weight, history of HTN, and serum levels of hemoglobin and ferritin significantly affect outcomes.  

We found that factors including sex, marriage, normal weight, HTN, normal hemoglobin, and ferritin can lead to better survival in PD patients. Recurrent peritonitis was the most crucial cause of PD to HD shifts.

 End-stage kidney disease (ESKD) is a major global public health problem. Knowledge of its epidemiology is crucial for its prevention and the optimal care.

 The objective was to study the epidemiological characteristics of patients on chronic hemodialysis, their outcomes and explore their perceptions of therapeutic modalities, through a prospective cohort.

 A prospective study conducted between February 2019 and January 2020, at two public hemodialysis centers in Oujda, Morocco.

 Around 183 patients were enrolled. The mean age was 53±17 years. The initial nephropathy was undetermined in 37% of cases and dominated by diabetes in 25.7%. About 43% of patients had pre-dialytic nephrology follow-up. Only 32% patients initiated their hemodialysis by an arterialvenous fistula (AVF). The mean hemoglobin rate was 10.3±1.8 g/dL. Moreover, 74 % of patients were under erythropoietin. Serum calcium, phosphorus, vitamin D, and parathormone were within target ranges in 67%, 52%, 61%, and 51% of cases, respectively. Since, 80% of patients were not clearly informed about therapeutic modalities. The majority of patients opted for kidney transplantation (KT), with two major constraints preventing its realization, consisting the lack of related living donors and financial resources. Besides, 29% of patients were hospitalized for cardiovascular and infectious causes during the study year. The survival rate at 1 and 5 years after the start of dialysis was 97.2% and 95% respectively.

 Early detection of chronic kidney diseases in high-risk people, their rigorous follow-up and early referral to the nephrologist would improve the quality of care. The promotion of KT and PD would better meet the hemodialysis patients’ needs with better outcomes and lower costs.

  Recurrence of glomerulonephritis (GN) after kidney transplant (Tx) may be associated with allograft loss. This study aimed to evaluate the frequency and prognosis of de novo or recurrent post-Tx GN.

  We reviewed 1305 kidney Tx biopsy samples obtained between 2006 and 2020. The biopsy specimens were divided into post-Tx GN (recurrent or de novo) and control groups (i.e., no detectable GN in biopsy). Demographic and baseline characteristics of the patients and kidney survival rates were analyzed.

From 1305 kidney transplanted biopsies, 350 repeated biopsies for transplant rejection were excluded. Among 955 analyzed biopsies, (mean age: 40.4 ± 13.48 years, mean transplantation duration:4.54 ± 3.98 years, 74.6% males), the frequency of GN was 10.78%. The most common recurrent post-Tx GN was IgA nephropathy (22.3%), followed by secondary focal segmental glomerulonephritis (FSGS, 19.4%), primary FSGS (19.4%), and membranous glomerulonephritis (17.5%). In the post-Tx GN group, the mean serum creatinine and proteinuria were 3.28 ± 1.97 mg/dL and 2730 ± 1244 mg/d at the biopsy time and 4.14 ± 1.86 mg/dL and 2020 ± 1048 mg/d, at the end of the study. There was a significant relationship between baseline serum creatinine and graft loss (P < .001). One-, five-, and ten-year graft survival rates were 97%, 81%, and 63% in the post- Tx GN, and 100%, 92%, and 59% in the control group. The median time to graft loss after biopsy, (graft survival after biopsy), was significantly lower in the post-Tx GN group (P < .000). The other accompanying factors had no significant impact on graft survival.

The median time to graft loss after biopsy was significantly lower in post-Tx GN. Baseline serum creatinine had a significant association with graft loss. Optimal management of recurrent or de novo GN should be a main focus of post-transplant care.

The pandemic of COVID-19 emerged in December 2019. Although numerous features of the illness have been investigated, the impact of disease on those patients with underlying diseases, is still a major problem. The aim of this multicenter, cohort study, was to determine the clinical manifestations of COVID-19 in peritoneal dialysis (PD) patients. Five hundred and five patients, receiving PD, were enrolled in this study, out of which 3.7% had coronavirus infection. Fever was the most common symptom (63.2%). The hospitalization rate was 10.5, 21.1% required admission to intensive care units (ICU) and the mortality rate was 21%. The most common cause of infection included close contact with the infected individuals and lower rates of protective equipment use. Although the incidence of COVID-19 among PD patients is low, the severity of the disease and the mortality rate are quite high. Vaccination and adherence to preventive measures are strongly recommended in PD patients.

Coronavirus disease 19 (COVID-19), has recently emerged as a great health challenge. The novel corona virus may affect the kidneys mainly as acute kidney injury (AKI). Also, the outcome of COVID-19 may be different in patients with underlying kidney disease. The aim of this study was to compare the outcome of COVID-19 in patients with and without underlying kidney disease.

This was a retrospective study on 659 hospitalized COVID-19 patients in six centers of Iran. Patients were classified into kidney (chronic kidney disease (CKD), end-stage kidney disease (ESKD) or kidney transplantation) and non-kidney groups. The clinical conditions and laboratory data were extracted from the charts. Outcome was defined as death during hospitalization or within 30 days of discharge.

Among 659 COVID-19 patients (mean age: 60.7 ± 16.4, 56% male), 208 were in the kidney group (86 ESKD, 35 kidney transplants, and 87 CKD patients). AKI occurred in 41.8%. Incidence of AKI was 34.7% in non-kidney, 74.7% in CKD, and 51.4% in kidney transplant patients (P < .001). Totally 178 patients (27%) died and mortality rate was significantly higher in CKD patients (50.6 vs. 23.4%, P < .001). AKI was associated with increased mortality rate (OR = 2.588, CI: 1.707 to 3.925). Initial glomerular filtration rate (GFR) < 44.2 mL/min and elevated lactate dehydrogenase (LDH) and C-reactive protein (CRP) had significant association with mortality.

We showed a higher mortality rate in COVID-19 patients with AKI and CKD. Low initial GFR and elevated LDH and CRP were associated with high mortality in COVID-19 patients.

A 22-year old man underwent kidney transplant two years ago. Following fever and cough, epigastric pain, convulsion, vomiting and PO intolerance he had been brought to the emergency room. During evaluation in addition to pulmonary involvement with SARS-COVID-19, brain, stomach and pancreas involvements with COVID-19 infection also were detected. Hemodialysis and specific treatments were initiated. After 16 days he could be discharged ultimately.

Chronic kidney disease (CKD) in children is a life-consuming ailment with a variable but progressive course. CKD, in particular, the end stage kidney disease (ESKD) affects multiple body systems complexed with secondary complications that significantly andadversely affect the growth, development and quality of life. Although uncommon in children, CKD poses unique challenges to the health care delivery system to manage the primary renal disorders and extrarenal manifestations of CKD along with a heavy socioeconomic burden. Despite the availability of better management tools, there is a rise in incidence and prevalence of pediatric CKD for which wide range short- and long-term planning is inevitable that will lure the medicos to acquire the advanced nephrological training and skills, besides providing quality infrastructure and sustained socio-economic support. Our review is aimed to provide recent advances regarding the evaluation and management of pediatric CKD and its complications.

Despite the high prevalence of restless legs syndrome (RLS) in hemodialysis patients, few studies have investigated the effect of pramipexole and gabapentin on the severity of RLS in these patients.

The study aimed to evaluate the effects of pramipexole and gabapentin on the treatment of RLS in end-stage chronic renal failure patients undergoing hemodialysis. Patients and

Using the diagnostic criteria the presence of RLS was investigated in all hemodialysis patients admitted to the dialysis ward of Bu Ali Sina and Velayat hospitals in Qazvin, Iran. Out of 162 patients, 96 patients had RLS and 60 patients with moderate to severe RLS were enrolled in the study. The selected patients were randomly divided into two groups including pramipexole (0.18 mg daily) and gabapentin (100 mg daily). The two groups were treated for 4 weeks.

The prevalence of RLS was 59% (96 out of 162 patients). After the intervention, the severity of RLS was significantly decreased in all patients and also in each of the pramipexole and gabapentin groups (P<0.001). Moreover, after the intervention, the rate of improvement in RLS severity in the pramipexole group (16.8 ± 6.5) was significantly higher than that in the gabapentin group (13.0 ± 7.3; P=0.036).

The findings of the study showed that the severity of RLS in hemodialysis patients undergoing 4 weeks of treatment with pramipexole or gabapentin was significantly reduced; in addition, the rate of improvement in RLS severity was higher in pramipexole group.

Fabry disease (FD) is a rare X-linked deficiency of lysosomal enzyme alpha-galactosidase (AGAL) resulting in accumulation of globotriaosylceramide (Gb-3) in the cells, with protean manifestations. Major organs affected are the kidneys, heart and nervous system. The diagnosis of FD is often delayed by many years. Enzyme replacement started early might reverse the organ damage while delayed initiation may only stabilize the disease progression.
We describe a patient in whom involvement of different organs unfolded at different times and a detailed review of history by the clinician led to the diagnosis. The importance of electron microscopy (EM) of renal biopsy is highlighted.
Patients with FD are often diagnosed late because the manifestations can be variable and spread over different time periods. Detailed history including family history and examining the renal biopsy by EM are crucial for early diagnosis.

Chronic kidney disease (CKD) and the resultant end stage renal disease (ESRD) are associated with significant mortality, morbidity, and cost for the individual patient and society. CKD is among the major contributors to years of life lost (YLL) due to premature mortality. Also, while the disability adjusted life years (DALY) for many conditions decreased between 1990 and 2010, the DALY for CKD has increased by 69%. In addition to the physical disability, CKD is associated with high prevalence (27.9%) of major depressive episodes, associated with limitations of employment, and a significant negative effect on quality of life (QOL). A major determinant of QOL is satisfaction with treatment choice. There is consensus among investigators that patients who are actively engaged in their own care experience improved health outcomes. The shared decision making (SDM) approach allows patients and providers the opportunity to work in partnership to make decisions that are congruent with the patient's values, preferences, and distinct situations. SDM has been associated with improved outcomes among patients with various chronic disease states. Mentoring, particularly by trained peers, has been used as an approach to enhance SDM in several chronic conditions, including cancer and cardiovascular disease. In this review, we will focus on care of patients with CKD as a model for the study of the impact of peer mentoring on SDM and choice of treatment for ESRD.