Current Issue : April - June Volume : 2020 Issue Number : 2 Articles : 5 Articles
Background: Chronic kidney disease patients are at a greater risk for\nnephropathy requiring dialysis after percutaneous coronary intervention.\nSuch patients are usually deferred due to fear of â??Renalismâ?. Objectives\nThis study assesses the outcome of Low dose contrast protocol during PCI\nin CKD patients whose e-GFR < 60 ml/min/1.72 m and investigates a safety\nmargin for contrast use in these high-risk categories. (A) Methods: Patients\nwere into three groups according to CV/e-GFR ratio: Group low-dose:\nCV/e-GFR ratio < 2.0 Group (B) medium-dose: CV/e-GFR ratio > 2.0 and <\nMACD (5Ã? bodyweight\\s.creatinine). Group (C) high-dose: CV/e-GFR ratio\n> MACD. Results: A total of 73 patients were enrolled. Average age was\n54 } 8 years, 81.4% were male and 18.6% were females and 52% were diabetic.\nMean baseline e-GFR was 40 } 8.0 ml/min/1.73 m2. Contrast Volume\nused in group A was (58.26} 15.05) (n = 24), in group B (109.42 }\n17.11) (n = 26) and in group C (304.5 } 60.30) (n = 23), respectively. The\nincidences of CI-AKI in the 3 groups were 0%, 11.5% and 35%, respectively\n(p = 0.02). All-cause death 0%, 17% and introduction of maintenance hemo\ndialysis was 0%, 11.5% and 26%, respectively (p < 0.01). Conclusion: Low\ndose contrast protocol is safe, effective and easily applicable technique\nwithout CI-AKI or death. CV/e-GFR < 2 is a safe ratio and can be achieved\nwithout IVUS use with good outcomes....
Background: Research suggests that patients with end stage renal disease undergoing hemodialysis have a higher\nrate of depression and dietary non adherence leading to hospitalization and mortality. The purpose of this review\nwas to synthesize the quantitative evidence on the relationship between depressive symptoms and dietary non\nadherence among end stage renal disease (ESRD) patients receiving hemodialysis.\nMethods: A systematic review was undertaken. Three electronic databases were searched including PubMed,\nCINHAL and Web of Science. Only quantitative studies published between 2001 and 2016 were included in the\nreview.\nResult: A total of 141 publications were reviewed during the search process and 28 articles that fulfilled the\ninclusion criteria were included in the review. Eleven studies (39.3%) reported on the prevalence of depressive\nsymptoms or depression and its effect on patient outcomes. Ten studies (35.7%) focused on dietary adherence/non\nadherence in patients with ESRD and the remaining seven (25%) articles were descriptive studies on the\nrelationship between depressive symptoms and dietary non adherence in patients with ESRD receiving\nhemodialysis. The prevalence of depressive symptoms and dietary non adherence ranged as 6-83.49% and from\n41.1-98.3% respectively. Decreased quality of life & increased morbidity and mortality were positively associated\nwith depressive symptoms. Other factors including urea, hemoglobin, creatinine and serum albumin had also\nassociation with depressive symptoms. Regarding dietary non adherence, age, social support, educational status,\nbehavioral control and positive attitudes are important factors in ESRD patients receiving hemodialysis. Having\ndepressive symptoms is more likely to increase dietary non adherence.\nConclusion: Depressive symptoms and dietary non adherence were highly prevalent in patients with end stage\nrenal disease receiving hemodialysis therapy. Nearly all of the articles that examined the relationship between\ndepressive symptoms and dietary non adherence found a significant association. Future research using\nexperimental or longitudinal design and gold standard measures with established cut-points is needed to further\nexplain the relationship....
Background: Encapsulating peritoneal sclerosis is a rare but life-threatening\ncondition in peritoneal dialysis. It is associated with extensive thickening and\nfibrosis of the peritoneum resulting in recurrent small bowel obstructions and\nmalnutrition. Herein we present case series of encapsulating peritoneal sclerosis\ndiagnosed and treated in a large center of peritoneal dialysis in the State\nof Qatar followed by literature review to increase the awareness of physicians\nto it. Case Presentation: The data were collected retrospectively from 180\nperitoneal dialysis patients at Hamad General Hospital, Doha, Qatar, between\n2008 and 2016. The diagnosis of encapsulating peritoneal sclerosis was based\non clinical and radiological features. Seven patients (3.8%) were diagnosed\nwith encapsulating peritoneal sclerosis. The mean age of the patients was 49\nyears (range, 23 to 65 years). The mean duration of peritoneal dialysis was 6\nyears (range, 3 to 7 years). The mean peritonitis episodes were 1.8 (range 1 to\n4 episodes). Five patients were diagnosed with encapsulating peritoneal sclerosis\nafter stopping peritoneal dialysis, and two patients diagnosed while they\nwere on peritoneal dialysis treatment. Five patients are still alive and were\ntreated with oral prednisolone and tamoxifen. Two patients underwent adhesiolysis\nsurgery, one of them died due to recurrent sepsis and malnutrition.\nAnother patient died because of cardiac arrest during hemodialysis. The\noverall mortality rate was 28.5% in our series. Conclusions: Encapsulating\nperitoneal sclerosis is a rare and life-threatening peritoneal disease in chronic\nperitoneal dialysis patients. It requires high index of suspicion for early diagnosis\nand treatment....
Background: The commonly used recommended criteria for renal recovery are not unequivocal. This study compared\nfive different definitions of renal recovery in order to evaluate long-term outcomes of cardiac surgery associated acute\nkidney injury (CSA-AKI).\nMethods: Patients who underwent cardiac surgery between April 2009 and April 2013 were enrolled and divided into\nacute kidney injury (AKI) and non-AKI groups. The primary endpoint was 3-year major adverse events (MAEs) including\ndeath, new dialysis and progressive chronic kidney disease (CKD). We compared five criteria for complete\nrenal recovery: Acute Renal Failure Trial Network (ATN): serum creatinine (SCr) at discharge returned to within\nbaseline SCr + 0.5 mg/dL; Acute Dialysis Quality Initiative (ADQI): returned to within 50% above baseline SCr;\nPannu: returned to within 25% above baseline SCr; Kidney Disease: Improving Global Outcomes (KDIGO): eGFR\nat discharge ..........................................
Background: While the 23-valent pneumococcal polysaccharide vaccine (PPV23) is routinely used in Canada and\nsome other countries to prevent pneumococcal infection in adults with chronic kidney disease (CKD), patients\ndevelop a suboptimal antibody response to PPV23 due to their immune dysfunction. The 13-valent pneumococcal\nconjugate vaccine (PCV13) has superior immunogenicity in some categories of immunocompromised adults;\nhowever, its effect on the immune response in CKD patients has only been addressed by two recent studies with\nconflicting results. The effect of PPV23 or PCV13 on B cells in these patients has not been previously studied. We\nstudied the absolute numbers and proportions of B cells and subpopulations in two groups of adult patients with\nsevere CKD pre- and 7 days post-immunization with PCV13: pneumococcal vaccine naive and previously immunized\nwith PPV23 (over one year ago).......................
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