Availability Of Renal Replacement Therapy Research Articles

Characteristics of need and availability of renal replacement therapy for patients with chronic kidney disease in Azerbaijan

Introduction and Aim: In recent years, there has been an increase in the number of patients with renal pathology in most of the cases without severe symptoms and with significant changes in kidney function, when there is a need for renal replacement therapy (RRT). The objective is to analyze the need and availability of renal replacement therapy in patients with chronic kidney disease. Materials and Methods: Statistical data from the State Statistical Committee of the Republic of Azerbaijan, and Republican Clinical Urological Hospital named after Academician M.J. Javad-Zadeh were used. The dialysis centers and the average load per center in Azerbaijan for the period from 2014-2019 are analyzed. Results: The provision of dialysis machines in Azerbaijan is 7.1%, in economic regions it is on average 7.7%. The highest provision is in the Nakhichevan (10.9%), Ganja-Gazakh (10.1%), and Apsheron (8.9%) economic regions. In the Republican Clinical Urological Hospital named after Academician M. Javad-zade, the need for hemodialysis centers exceeds by 31.6%. Conclusion: With an increase in the number of dialysis machines, there is an increase in the average load per dialysis center. In the economic regions of the republic, the actual number of hemodialysis machines the need meets the standard (>50%).

Cystinosis.

Cystinosis is a very rare autosomal recessive lysosomal storage disorder with an incidence of 1 : 150,000 - 1 : 200,000, and is caused by mutations in the CTNS gene encoding the lysosomal membrane protein cystinosin, which transports cystine out of the lysosome into the cytoplasm. As a result, accumulation of cystine occurs in almost all cells and tissues, especially in the kidneys, leading to multiple organ involvement. Introduction of drug therapy with cysteamine in the mid 1980s, along with the availability of renal replacement therapy in childhood, have dramatically improved patient outcome. Whereas patients used to die without therapy with end-stage renal failure during the first decade of life, nowadays most patients live well into adulthood without renal replacement therapy, and several reach 40 years. There is robust evidence that early initiation and sustained lifelong therapy with cysteamine are both essential for morbidity and mortality. The rarity of the disease and the multi-organ involvement present an enormous challenge for those affected and the providers of care for this patient group.

‘Kidney Health for All’ - Implications for India

‘Kidney Health for All’ - Implications for India

НЕОНАТАЛЬНОЕ ОСТРОЕ ПОВРЕЖДЕНИЕ ПОЧЕК: ИНФОРМИРОВАННОСТЬ ВРАЧЕЙ ОТДЕЛЕНИЙ РЕАНИМАЦИИ НОВОРОЖДЕННЫХ И ВРАЧЕЙ ДРУГОГО ПЕДИАТРИЧЕСКОГО ПРОФИЛЯ

Neonatal acute kidney injury (AKI) is common in newborns in critical condition in the intensive care units and significantly reduces the chances of recovery. The analysis of attitudes to this problem and the practical experience of pediatric doctors working with newborns regarding the risks of development and outcomes of AKI is an important step in improving the prognosis of the disease. Objective of the study: determination of awareness of the problem of neonatal AKI. Materials and methods of research: the study was carried out in the form of a sociological survey (questionnaire) of doctors (n=63) working in neonatal intensive care units (NICU) (n=34, 54%), and pediatricians not associated with work in the NICU (n=29, 46%). The questionnaire contained 34 questions. 51% of the respondents (n=32) were under 40 years old, 49% – over 40 years old (n=31). Results: there is a lack of awareness of specialists regarding definitions, diagnostics, treatment tactics, prognosis of the disease, as well as insufficient availability of treatment facilities for access to nephrological and dialysis care. 29% (95% CI 14–44%, n=10) NICU doctors and 21% (95% CI 6–36%, n=6) doctors from other departments were unaware of the existing AKI classifications in newborns (p=0,615). 62% (95% CI 46–78%, n=21) of NICU staff and 55% (95% CI 37–73%, n=16) by doctors of other specialties (p=0,785) reported that nephrology counseling was available. The availability of renal replacement therapy was reported by 27% (95% CI 12–42%, n=9) by NICU doctors and 35% (95% CI 18–52%, n=10) by doctors from other departments (p=0,678). Only 52 (83%) (95% CI 74–92%) doctors believe that the child should be examined by a nephrologist. Conclusion: it is necessary to raise awareness among doctors about neonatal AKI.

Renal Replacement Therapy Practices in India: A Nationwide Survey.

IntroductionRenal replacement therapy (RRT) is utilized for patients admitted with acute kidney injury and is becoming indispensable for the treatment of critically ill patients. In low middle income and developing country like India, the epidemiological date about the practices of RRT in various hospitals setups in India are lacking. Renal replacement therapy although is being widely practiced in India, however, is not uniform or standardized. Moreover, the use of RRT beyond traditional indications has not only increased but has shifted from the ambit of the nephrologist and has come under the charge of intensivists.Aims and objectivesThe goal of the study was to record perceptions and current practices in RRT management among intensivists across Indian intensive care units (ICUs).Materials and methodsA questionnaire including questions about hospital and ICU settings, availability of RRT, manpower availability, and RRT management in critically ill patients was formed by an expert panel of ICU physicians. The questionnaire was circulated online to Indian Society of Critical Care Medicine (ISCCM) members in October 2019.ResultsThe facilities in government setups are scarce and undersupplied as compared to private or corporate setups in terms of ICU bed strength and availability of RRT. High cost of continuous renal replacement therapy (CRRT) makes their use restricted.ConclusionResources of RRT in our country are limited, more in government setup. Improvement of the existing resources, training of personnel, and making RRT affordable are the challenges that need to be overcome to judiciously utilize these services to benefit critically ill patients.How to cite this articleSodhi K, Philips A, Mishra RC, Tyagi N, Dixit SB, Chaudhary D, et al. Renal Replacement Therapy Practices in India: A Nationwide Survey. Indian J Crit Care Med 2020;24(9):823–831.

Renal Replacement Therapy Tactics in Russian Regions with an Average Population Density

The lecture details the current understanding of renal replacement therapy and current advances in this field. The current diagnostic and treatment algorithms have been clarified, allowing timely assistance to the population with chronic kidney disease. I tried to identify the main milestones on the way to increasing the availability of renal replacement therapy in our country, where many regions have a very large area and low population density. Obviously, much effort remains to be done to achieve a good level of security and accessibility of renal replacement therapy for our population. I hope that this manuscript will serve to some extent the aims that have been set.The study did not have sponsorship. The author has declared no conflicts of interest

System approach in improving mediko-preventive care to the patient with nephrological profile in Kharkiv region

In the work described the experience of organization medical care for patients with kidney pathology in the Kharkov region. The stages of the development of specialized nephrological care in a large regional center are presented, the structure and features of the formation of the nephrological service are described. Data on prevalence, incidence and disability of the population of the region due to chronic kidney disease are presented. The indicators of availability of renal replacement therapy are analyzed. The advantages of organization of a specialized nephrological service with the concentration of all methods of renal replacement therapy on the basis of a specialized nephrourological center are described.

Renal Replacement Therapy in Eritrea.

Historically, communicable diseases in addition to maternal, perinatal, and malnutrition have accounted for the greatest burden of morbidity and mortality in many developing countries. This spectrum however has recently begun to shift toward chronic noncommunicable diseases, including diabetes and hypertension. Although great strides have been made in the diagnosis and care of chronic kidney disease in the industrialized world, the availability of renal replacement therapy and kidney transplantation is unequivocally lower in Africa than in any other region of the world. Here, we provide a critical assessment of the growing prevalence of kidney disease and current treatments in Eritrea, a young, developing country located in Northeast Africa.

Frequency of the malignant neoplasms in population commencing renal replacement therapy (RRT) in the years 2001-2015 – one-unit experience

Summary Introduction. The incidence of malignant neoplasms in population of patients initiat- ing renal replacement therapy (RRT) is rising last years, which is related to the aging of general population and to the increasing availability of renal replacement therapy to renal patients, including those with neoplastic diseases. Aim. The aim of this work was to analyse the frequency of malignant neoplasms in the group of patients starting renal replacement therapy. Material and methods. The retrospective analysis of the medical records in years 2001-2015 at the Dialysis Unit in the Priest J. Popieluszko Bielanski Hospital in Warsaw. Results. The RRT was started in 669 patients (F-270, M-399) and 84 of them (12.5%) had malignant neoplasm at the RRT start. The largest group - 23 persons (27.4%) were patients with the neoplasm of lymphatic system, most of them with multiple myeloma. Conclusions. The incidence of malignancies at the commencing of chronic RRT in the 669 consecutive patients at our dialysis unit, was 12.5%, in this the malignancies of lymphatic system were 3.4% (23/669) - 3.3% (9/270) and 3.5% (14/399) in woman and man, respectively.

Life span and outcomes in patients with malignant neoplasms commencing renal replacement therapy (RRT) in the years 2001-2015 – one-centre experience

Introduction. The growing availability of renal replacement therapy (RRT) may rise the incidence of malignant neoplasms at commencement of chronic dialysis. The prognosis for such patients has not been studied extensively. Aim. To analyse the life span and outcomes of patients commencing RRT with a coexisting malignant neoplasm. The secondary aim was to analyse the causes of death in this population. Material and methods. The retrospective search of medical records from years 2001-2015 at the Diaverum Dialysis Unit (former Non-Public Health Care Unit “Centre of Dialysis and Diagnostics”) at the Priest J. Popieluszko Bielanski Hospital in Warsaw. Results. Out of the 669 patients (F-270, M-399) who commenced chronic RRT (intention to treat) during the 174 months analysed, 84 (12.5%) had malignant neoplasm timeand/or cause-related to the RRT commencement. The outcomes were available in 64 patients on HD at the end of observation (20 patients were lost to follow-up – 5 discontinued HD, 5 partly recovered renal function, and 10 moved to another unit). Died 57 patients on the chronic haemodialysis therapy program (HD), 1 has been transplanted, and 6 continued the treatment started 1-84 months earlier. Conclusions. Chronic haemodialysis should be initiated also in patients presenting with neoplastic disease whenever the indications to that treatment exist. In these patients the life expectancy can be quite long.

Overview of Paediatric Renal Care Activities and Availability of Renal Replacement Therapy for Children at Mulago Hospital, Uganda

Introduction :The range of activities undertaken by any renal team will depend on many factors. One of the common challenges encountered in Mulago hospital is management of kidney failure in a child.Objective :to outline activities of the renal team with specific reference to RRT.Methodology:members of the renal team were interviewed for their activities, and ward records spanning a period of 3 years were reviewed, for information on children who had had RRT.Results:activities of the renal team included: training, sensitization of the public, research, and nursing care of patients on dialysis. Nineteen (19) children had had RRT, fourteen (14) had been put on PD; 4 on Haemodialysis (HD); and 1 child had a kidney transplant in India. All children with Acute Tubular Necrosis recovered normal kidney functions by the end of RRT; 3 out of the 4 children with rapidly progressive Glomerulonephritis progressed to CKD.Conclusion :Renal Replacement Therapy for children is happening at a very low level. The renal team is engaged predominantly in conservative management of kidney failure and in preventive activities.

Current status of end-stage renal disease care in India and Pakistan

India and Pakistan are the two largest and most populous countries in South Asia. The burden of noncommunicable disease (NCD) has increased in recent years and it is estimated that over 40% of all deaths are due to NCD. The exact magnitude of the burden of chronic kidney disease or end-stage kidney disease is not known. A population-based study calculated the end-stage renal disease (ESRD) incidence at 152 per million population. Diabetic kidney disease is the commonest cause of ESRD in India. CKD of undertermined etiology forms a large proportion as well. Environmental factors have been postulated in its causation. The majority of nephrology-related services are concentrated in expensive private sector hospitals. Economic issues limit the availability of renal replacement therapy to large sections of the population. Hemodialysis and peritoneal dialysis are equally expensive. Dialysis prescriptions are not optimized. Renal transplant is the most suitable option for a majority of patients, but is dependent on living donors. The Indian government has included kidney disease as a priority area, and is setting up facilities to provide subsidized dialysis for the whole population. A national transplant program envisions the setting up of a nationwide organ procurement network.

The distant organ effects of acute kidney injury

Despite the availability of renal replacement therapy, acute kidney injury (AKI) is associated with high mortality and morbidity. In humans, it is difficult to determine whether AKI is a cause or consequence of excess morbidity. In animal models, however, it is increasingly clear that AKI induces distant organ dysfunction. Identified pathways include inflammatory cascades, apoptosis, the induction of remote oxidative stress, and differential molecular expression. Specifically, growing evidence implicates renal injury as an instigator and multiplier of pulmonary, cardiac, hepatic, and neurologic dysfunction. Accurate identification of these pathways will be critical in developing targeted therapies to improve outcomes in AKI. The purpose of this review is to summarize both clinical and preclinical studies of AKI and its role in distant organ injury.

Acute renal failure (AFR) in developing countries: which factors actually influence survival

Acute renal failure, a relatively common clinical condition, is still associated with a high mortality rate in both developed and developing countries despite the differences in the epidemiology, clinical characteristics and therapeutic modalities offered to affected patients. The various modalities of renal replacement therapy are still largely inaccessible, unaffordable and unavailable in most parts of sub-Saharan Africa, hence the need to judiciously utilise available resources. Consequently we studied patients with acute renal failure to critically appraise the factors that influence survival and determine the usefulness or otherwise of available renal replacement therapies (Acute HD and Acute PD). A total of 46 (34 (73.9%) males and 12 (26.1%) females) patients satisfied the inclusion criteria. Their ages ranged between 15 and 76 years (mean +/- SD; 38.2 +/-16.3 years). The commonest causes were gastro-enteritis (cholera) and septicaemia in 36.9% and 30.5% respectively. Twenty six (56.5%) of all the patients survived while the remaining 20 (43.5%) died. Twenty four (52.2%) patients had different complications of which pulmonary oedema was singularly found to significantly influence survival. Other factors that were found to significantly influence survival included availability of renal replacement therapy, the aetiology of ARF; gender; age of the patients and the duration of oliguria. We further compared the patients managed with haemodialysis with those managed with peritoneal dialysis and found no difference(s) in the age; duration of oliguria or hospitalisation; survival figures; effect of pulmonary oedema and the aetiology of ARF. However, the number of sessions for HD and the duration of PD significantly influenced survival. We conclude that ARF is still associated with a high mortality rate and prompt institution of available renal replacement therapy and aggressive management of complications would assist in reducing the trend.

Earthquakes and pediatric nephrology: are we prepared?

Sirs, With the recent Haiti earthquake causing significant morbidity and mortality [1], it is now time to look back and analyse our readiness for disaster management. Contrary to our expectations and understanding, earthquakes are common natural disasters from a global point of view. As updated on the home page of the US Geological Survey Earthquake Hazards Program (http://earthquake. usgs.gov/), earthquakes with a magnitude 4.0 or greater occur every day all over the world [2]. Because the number of casualties in a large earthquake is much higher than in other natural disasters, crush syndrome has been recognized to be the most frequent cause of acute kidney injury (AKI) after an earthquake. Kidney failure has been identified by the Centers for Disease Control and Prevention as one of the most urgent public health concerns in Haiti following the 7.0-magnitude earthquake on 12 January 2010 [3]. Historically, recognition and better understanding of acute renal failure was obtained following crush injuries in patients in wartime London in 1940 [4]. The main problems handled by pediatric nephrologists are prevention of AKI (by fluid management), management of AKI (due to sepsis, crush injury and infections), management of hyperkalemia, and renal replacement therapy. Proper and timely transportation of the victims with AKI and those with end stage renal disease (ESRD) to the centre with availability of renal replacement therapy is also required. The logistics of medical supply availability is also an issue [5]. In the face of an imminent emergency situation, dialysis facilities, the AKI and the ESRD community, and emergency response organizations need to execute carefully designed plans, with a well-designed timeline for disaster preparation and response [6]. The experience of the Haitian earthquake identified that the organization of effort was not up to par. Use of the Pediatric Nephrology List Serve by Andrew Aronson allowed for global communication outside of Haiti, but did not allow for communication within Haiti. Having “eyes on site” was important to access the needs of the pediatric population. Constant communication with Dr. Emilo Mena Castro in Santo Domingo in the Dominican Republic allowed for close coverage of care. Utilization of Dr. Castro as a pediatric port of call for the identification of the needs of children with AKI and for distribution of equipment for treatment of AKI was important. Intra-island and intra-Haitian communication was lacking, making it difficult to identify who was in need and where they were located. Further, the lack of available equipment for creatinine or potassium analysis also contributed to care delivery difficulty. It was learned that many pediatric nephrologists throughout the world were willing and ready to help in any way. Local communication and intra-country communication is important to assess and deliver care when needed. S. K. Sethi (*) Division of Pediatric Nephrology, Department of Pediatrics, PGIMER and associated RML Hospital, New Delhi, India 110001 e-mail: sidsdoc@gmail.com

The early development of the kidney and implications for future health

The kidney is a relative newcomer among the organ systems for which relevance of the developmental origins hypothesis has been explored. Nephrology is a young discipline, to which epidemiologic principles have only been recently applied, and although the availability of renal replacement therapy in westernized countries has created a large group of people with end stage renal disease who can be studied in retrospect, attention has only recently focused on the vastly greater numbers of people with earlier stages of chronic kidney disease, and their accentuated cardiovascular risk. Development of the human kidney is influenced by genetic and epigenetic factors, by maternal nutritional status, maternal stature and the intrauterine environment, the length of gestation, the neonatal course and by postnatal nutrition. Many factors that influence kidney development also influence other developing organ systems. This paper summarizes some of the current knowledge and the implications of kidney development for future health, much of which have also been described in other recent reviews.

Renal replacement therapy in Iran.

Corresponding Author: Mitra Mahdavi-Mazdeh, MD Management Center for Transplantation and Special Diseases, Vanak Sq, Tehran, Iran Tel: +98 21 8864 4515 Fax: +98 21 8864 4516 E-mail: mmahdavi@tums.ac.ir Dialysis and kidney transplantation are the only treatment options available for patients suffering from end-stage renal disease (ESRD). More than 1 million patients are on renal replacement therapy (RRT) worldwide, and it is forecasted that their population will be doubled within the next decade. There is a clear direct relationship between a nation’s gross national product and the availability of RRT. Approximately, 90% of patients with ESRD come from developed nations.(1-3) Conversely, for the vast majority of patients who live in developing countries (roughly 85%), dialysis and transplantation are unaffordable.(4) Generally, a series of influencing factors dictate the gross diversity in making decisions about the rates and modalities of the RRT. There are different reported incidences of ESRD in different countries, on the one hand, and significant variations in the culture, socioeconomic status, dialysis costs and quality, reimbursement structures, and discrepancy between the demand and supply of organs for transplantation, on the other hand.

Highlights of the epidemiology of renal replacement therapy in Central and Eastern Europe

In the past 15 years, dramatic political and economic changes have occurred in Central and Eastern Europe (CEE) which also had a positive impact on the availability of renal replacement therapy. The aim of the present study was to analyse the progress achieved in the new millennium. Data from 18 CEE countries collected during two independent surveys (1999 and 2002) were validated using information from national and ERA-EDTA registries, and analysed. The data collected from 18 CEE countries clearly document further development and improvement of renal replacement therapy in this region of Europe. In 63% of countries, the incidence rate had become comparable with that observed in more developed European countries. The two main modalities of dialysis, i.e. haemodialysis and peritoneal dialysis, are used. The frequency of the use of PD varies between 0.5% and nearly 37%. Privatization of dialysis units has started in 18 CEE countries. Currently between 2.5% (Russia) and 90% (Hungary) of patients are treated in non-public centres. Renal transplantation is quite well developed in half of the CEE states. In the states on the territory of the former Soviet Union, substantial progress in renal replacement therapy was achieved in the Baltic states, but the development in Byelorussia and Russia is still unsatisfactory. The availability and outcome of renal replacement therapy in the majority of states in CEE have become comparable with what is seen in more developed Western Europe. Nevertheless, large differences exist between individual countries. In particular, definite improvement is urgent in Byelorussia and Russia.

Preventing end-stage renal disease: The potential impact of screening and intervention in developing countries

There are about 1 million people in the world that are alive just because they have access to one form or another of renal replacement therapy (RRT) [1]. Ninety percent of them live in the developed countries, or, as they are defined by the World Bank (WB), highincome countries, where the average gross income is in excess of $10 000 per capita. There is a clear, direct relationship between gross national product (GNP) and availability of RRT. Dialysis treatment absorbs 0.7 to 1.8% of the health care budget in European countries, while the dialysis population represents 0.02 to 0.05% of the whole population [2]. In the Eastern European countries, the so-called former Soviet block, the prevalence rate of RRT is half or less than in countries of the European Union; also the average GNP in those countries is half or less than in Western Europe [3,4]. It is hard to believe that the epidemiology of renal diseases differs that much in the two areas of Europe. Simply put, RRT is so costly that there is minimal probability for the vast majority of the world’s population to take advantage of it. The future perspectives are gloomy. A forecast analysis predicts that in 10 years there will be 2 million people on RRT, and even developed countries will be strained by the rising costs [1]. The major causes of end-stage renal disease in North America and in many developed countries are diabetes and hypertension, which together account for almost 60% of dialysis patients [5]. On the other hand, high blood pressure and diabetes mellitus contribute in a significant way to the rising burden of global morbidity and mortality associated with cardiovascular diseases. The prevalence of both conditions is rising significantly not only in developed countries, but also in developing ones [6]. The shift from an active life as farmers to a less-active lifestyle associated with urbanization, and an increased consumption of sugar and fat, are among the factors responsible for the rise of obesity and related diseases [6]. Data gathered from clinical studies and randomized trials in developed countries have demonstrated that prevention of progression of cardiovascular and renal diseases is feasible. Reduction of high blood pressure and proteinuria with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, control of blood glucose and lipids, along with non-pharmacologic measures, such as smoking cessation, physical activity, and body weight control, offer an indisputable protection against cardiovascular and renal diseases [7]. The Commission for the Global Advancement of Nephrology (COMGAN) of the International Society of Nephrology, established in 1993, has focused its attention on education and training of staff in developing countries and has developed the Renal Sister Center Program. A COMGAN Research Committee has been established with the general aim to provide opportunities for research in emerging countries in which Western expertise can be applied to local problems. We believe that, with some effort, prevention of the progression of renal disease with the combination of pharmacologic and non-pharmacologic approaches can be exported to less-developed countries. Screening programs can be implemented with simple, cheap, and reliable tests, such as measurement of body weight, blood pressure, blood glucose, and dipstick urinalysis for protein. Examples already exist. In India [8] and Bolivia [9] a large number of people can already be screened with affordable means. The impact on renal and cardiovascular morbidity and mortality of relatively simple measures, such as blood pressure reduction, good glycaemic control, and smoking cessation, is great and significant at any targeted level reached [10]. Moreover, quite soon drug patents should expire for antihypertensive agents that have specific protective effects against both renal and cardiovascular diseases, such as angiotensin-converting enzyme inhibitors, making it feasible to implement Correspondence and offprint requests to: Giuseppe Remuzzi, MD, Mario Negri Institute for Pharmacological Research, Via Gavazzeni 11, I-24125 Bergamo, Italy. Email: gremuzzi@marionegri.it