Chronic Renal Disease Patients Research Articles

Comparison of SARS-CoV-2 vaccine induced antibody response among healthy individuals and chronic renal failure patients

AZD1222 (Covishield) COVID-19 vaccination response among healthy adults and chronic renal disease patients has been compared in this analysis. Compared to healthy individuals, vaccine induced immune response seems to be suboptimal after two doses of the vaccine in patients with chronic renal disease on hemodialysis. Infection following full course of vaccination can boost the vaccine induced antibody levels in both healthy individuals and patients with chronic renal disease. It is necessary to conduct comprehensive prospective research to further evaluate these conclusions made based on this preliminary data evaluation, and to find out its overall impact for future SARS-CoV-2 infection and its disease outcome.

Central venous catheter related Superior Vena Cava Syndrome after renal transplantation in two cases

Vena cava superior syndrome is a specific clinical disease; very important obstruction of the large central veins. Catheter-related deep vein thrombosis (DVT) and vena cava superior (VCS) syndrome are rare but serious complications that require specific care in these selected renal transplant recipient. Thrombosis formation, is a major complication of central venous catheter (CVC) attempts, however, arterial puncture, hematoma, and pneumothorax are more common complications. Mechanical complications of (CVC) have been reported in 5% to 19%. Incidences of CVC thrombosis have been reported in up to 66% of patients in venographic studies, however; VCS syndrome is a rare complication. After evaluating the catheter-related thrombosis risk, hemodialysis catheters were found to be the highest risk in comparison with other catheters. Catheter-related DVT and VCS syndrome are rare but serious complications require specific care in these renal transplant recipients. We report two cases of vena cava superior syndrome due to CVC thrombosis after kidney transplantation in two chronic renal disease patients with histories of previous catheter thrombosis.

Impact of Chronic Kidney Disease on Handgrip Strength: A Cross-Sectional Study in Ha’il, Saudi Arabia

Background: in chronic kidney disease (CKD) patients, there is a loss of muscle mass due to chronic inflammation, nutritional deficiencies, and metabolic acidosis, these factors lead to decreased physical fitnessand poor clinical outcomes. Handgrip strength (HGS) is an index for physical function, the aim of our study was to investigate the relationship between CKD and handgrip strength (HGS) in Ha'il, Saudi Arabia.
 Methods: We conducted a cross-sectional study consisting of 251 CKD patients in Ha'il, Saudi Arabia.132 males and 119 females, aged between 25 and 65 years. Renal function (creatinine, and blood urea nitrogen) and Hand grip strength (HGS) were recorded for all patients.
 Results: 3.2 kg/BMI for males and 1.8 kg/BMI for women were the average relative HGS (kg/BMI). In both sexes, HGS was inversely correlated with age and height and positively correlated with body weight and BMI, whereas the opposite was true for relative HGS.
 Conclusions: Relative HGS is an effective way to quantify muscle strength in chronic renal disease patients based on their body mass. As a result, relative HGS may be a valuable and cost-effective method for the detection of kidney disorders that are chronic in nature.

Baseline Ratio of Soluble Fas/FasL Predicts Onset of Pulmonary Hypertension in Elder Patients Undergoing Maintenance Hemodialysis: A Prospective Cohort Study.

BackgroundPulmonary hypertension (PH) is one of the most common complications associated with end-stage renal disease (ESRD). Though numerous risk factors have been founded, other risk factors remain unidentified, particularly in patients undergoing maintenance hemodialysis with elder age. Soluble Fas (sFas) and its ligand FasL (sFasL) have been reported in chronic renal disease patients; however, they have not been identified in the PH patients of elder hemodialysis patients. We aimed to determine the roles of sFas/sFasL in onset of PH in elder patients undergoing maintenance hemodialysis with ESRD.MethodsAltogether, 163 patients aged 68.00 ± 10.51 years with ESRD who undergoing maintenance hemodialysis in a prospective cohort and were followed-up for a median of 5.5 years. They underwent echocardiography examinations, liver function assessments, residual renal function, and serum ion examinations, before and after dialysis. Furthermore, levels of sFas and sFasL at baseline had also been measured. We compared demographic data, echocardiographic parameters, liver function, ions, and residual renal function as well as serum sFas and sFasL between the PH and non-PH groups. These parameters were correlated with systolic pulmonary artery pressure (sPAP) using Spearman’s correlation. Moreover, univariate and adjusted logistic regression analyses have also been conducted.ResultsThe incidence of PH in the elder dialysis patients was 39.1%. PH populations were demonstrated with significantly higher end-diastolic internal diameters of the left atrium, left ventricle, right ventricle (RV), and pulmonary artery, as well as the left ventricular posterior wall thickness (LVWP; all p < 0.05). A higher baseline serum sFas and sFasL levels have also been identified ( p < 0.001). They also showed lower fractional shortening and left ventricular ejection fraction (LVEF; p < 0.05). Following dialysis, the post-dialysis serum potassium concentration (K+) was significantly higher in the PH group ( p = 0.013). Furthermore, the adjusted regression identified that ratio of sFas/FasL (OR: 1.587, p = 0.004), RV (OR: 1.184, p = 0.014), LVPW (OR: 1.517, p = 0.007), and post-dialysis K+ (OR: 2.717, p = 0.040) was the independent risk factors for PH while LVEF (OR: 0.875, p = 0.040) protects patients from PH.ConclusionThe baseline ratio of sFas/sFasL, RV, LVPW, and post-dialysis K+ was independent risk factors for PH onset, while LVEF was a protective factor for PH.

Incidence of Chronic Kidney Disease Related Pruritus and its Relation with Sleep Quality among Patients on Hemodialysis in Pakistan

Due to injured kidneys, CKD is defined as a glomerular filtration rate of less than 60ml/min/1.73m2 for more than 3 months. The lethal stage of chronic CKDs is the last stage of renal disease, and its frequency has increased over the previous 30 years. Pruritus caused by chronic renal disease is an unpleasant illness that causes itching and reduces sleep quality. The goal of this study is to look at the characteristics of pruritus in people with CKD and how they relate with sleep quality among patients on maintenance hemodialysis. Place and Duration: In the department of Medicine &amp; Nephrology of Lahore General Hospital and Islamic International Medical College Trust Railway General Hospital, Rawalpindi for six-months duration from April 2021 to September 2021. Methods: 60 chronic renal disease patients were gathered from the nephrology department. Inclusion criteria included all patients with CKD who had pruritus and had sleep disturbance, while exclusion criteria included all patients who had rashes and pruritus that were not caused by CKD and were caused by other disorders. Age, gender, sleep pattern, disease severity, poor sleep quality, &amp; pruritus location were all investigated by all patients. Results: CKD-associated Pruritus was distributed as follows: 75 percent of all patients were 45 years old or older, whereas 25 percent were 45 years old or younger. Pruritus interfered with sleep in 41.7% of patients, but not in 58.3%, and 30.1 percent of patients were girls and 73.9 percent were men. About 55% of people with pruritus are severely affected, whereas 45% are not. The trunk accounts for 60% of pruritic patients, whereas the rest of the body accounts for 40%. There was a strong link between the degree of pruritus and gender, the afflicted region, and sleep. Conclusion: Pruritus, often known as "uremic pruritus," is the most common skin complaint in people with ESRD. Due to the lack of a clear relationship with uremia, a substantial association occurs in males over the age of 45, disrupts sleep, and predominates in the trunk area. Keywords: Pruritus, Chronic renal disease, Characteristics, Association variables

ROLE OF ENDOVASCULAR INTERVENTIONAL RADIOLOGY IN CHRONIC KIDNEY DISEASE PATIENTS: SINGLE CENTRE EXPERIENCE

BACKGROUND AND AIMS: To study different vascular interventional procedures done in patients with chronic kidney disease (CKD) and End Stage Renal Disease (ESRD) patients and management of vascular pathologies using interventional procedures wherever applicable. METHOD: A retrospective study of CKD/ESRD patients referred to the department of Interventional Radiodiagnosis for undergoing hemodialysis related or renal diagnostic/therapeutic interventions during 12 months period. In our study of 60 patie RESULTS: nts following procedures were performed,16 patients underwent central venous angioplasty for central venous stenosis,10 patients underwent permcath insertion for hemodialysis,9 patients underwent stulography/stuloplasty,15 patients underwent renal artery angiography/angioplasty of the native and transplant kidney respectively,8 underwent embolization for post biopsy vascular complication and 2 patients underwent Trans jugular kidney biopsy. The individual most common procedure in our hospital was central venousplasty (16 patients), however combined most common procedure was for establishing dialysis access (19 patients, stulography/stuloplasty and permcath insertion) Interventional CONCLUSIONS: Radiology has a major role in management of CKD/ESRD patients as described in this study done in a tertiary care centre.

Clinical presentation and outcomes of chronic kidney disease patients with COVID-19 admitted to the intensive care unit of a teaching hospital of Northern India during the third wave of the pandemic: A retrospective study.

Chronic kidney disease (CKD) patients have impaired immune status; that's why these patients are prone to develop infection-related complications. The current study compares non-haemodialysis chronic kidney disease and end-stage renal disease (NO-HD-CKD and ESRD, respectively) patient outcomes, the data of which is sparse. Patients diagnosed with COVID-19 infection through reverse transcriptase polymerase chain reaction (RT-PCR) were retrospectively studied using electronic health records. Patients were divided into three categories: non-chronic kidney disease (NO-CKD), NO-HD-CKD, and ESRD, and the outcome was assessed. Out of 745 patients, 92 (12.34%) had NO-HD-CKD and 31 (4.16%) had ESRD. CKD patients who were not on haemodialysis had higher rates of comorbidities and D-dimer and C-reactive protein (CRP) values compared to ESRD patients. The overall unadjusted mortality rate was found to be 17.44%, and it was 10.45% in case of NO-CKD patients, 58.69% for NO-HD-CKD patients, and 48.39% for ESRD patients. It was observed that patients having NO-HD-CKD had greater odds ratio of overall expiry in comparison to those without CKD in univariate analysis (OR: 1.58; 95% CI: 1.31-1.91). It was not significant in fully adjusted models (OR: 1.11; 95% CI: 0.88-1.40). During the third wave of COVID-19, we found higher mortality rates for cases with NO-HD-CKD and, to a lower extent, ESRD. However, patients with ESRD were observed to have good outcomes in comparison to those with NO-HD-CKD. Primary care physicians are the first point of contact for patients. Hence, it is critical for them to manage and to do proper referral of comorbid patients to higher centres.

Arterial stiffness and serum uric acid in predialysis chronic renal disease patients

Arterial stiffness and serum uric acid in predialysis chronic renal disease patients

Impact of renal disease on elective shoulder arthroplasty outcomes for glenohumeral osteoarthritis

BackgroundRenal disease including chronic renal disease and end-stage renal disease has been associated with the development of primary glenohumeral osteoarthritis. However, little is known about how renal disease affects outcomes after shoulder arthroplasty. Thus, the purpose of this study was to evaluate the impact of renal disease on outcomes of shoulder arthroplasty for glenohumeral osteoarthritis. MethodsThis was a retrospective review using the Nationwide Readmissions Database. Using International Classification of Diseases, 9th Revision, codes, patients who underwent shoulder arthroplasty (including total shoulder arthroplasty and reverse total shoulder arthroplasty) for primary glenohumeral osteoarthritis were identified. These patients were divided into 3 groups: no renal disease, predialysis chronic renal disease (including stages 1-5), and end-stage renal disease. Primary outcomes of interest included the risk of complications during index hospitalization as well as within 90 days of index surgery. Secondary outcomes included index hospitalization length of stay, cost, and discharge location. ResultsFrom 2010 to 2014, a total of 29,336 patients underwent shoulder arthroplasty for glenohumeral osteoarthritis. Of these 29,336, 27,928 (95.2%) patients had no renal disease, 1355 (4.6%) had predialysis chronic renal disease, and 53 (0.2%) patients had end-stage renal disease. Compared with patients with no renal disease, both predialysis chronic renal disease and end-stage renal disease patients had an increased risk of receiving blood transfusions (odds ratio [OR] = 2.04, P < .0001, and 5.37, P = .04, respectively) and experiencing any postoperative complication during the index hospitalization (OR = 2.31, P < .0001, and 3.94, P = .003, respectively). Specifically, predialysis chronic renal disease patients were at an increased risk for cardiac (OR = 1.96, P < .0001) and respiratory (OR = 1.55, P < .0001) complications as well as acute renal failure (OR = 14.70, P < .0001) postoperatively. End-stage renal disease patients were at an increased risk for cardiac (OR = 3.87, P = .003) complications as well as acute renal failure (OR = 10.35, P = .002) postoperatively. Within 90 days, end-stage renal disease patients had an increased risk of hospital readmission (OR = 8.01, P < .0001), dislocation (OR = 8.70, P = .039), and surgical site infection (OR = 19.06, P = .001). Finally, compared with patients with no renal disease, predialysis chronic renal disease and end-stage renal disease patients both had increased hospital length of stay and cost; predialysis chronic renal disease patients had an increased risk of discharge to a skilled nursing facility (OR = 1.39, P = .039). Discussion and ConclusionThis retrospective cohort study demonstrates that even predialysis chronic renal disease patients have worse outcomes compared with patients with no renal disease after shoulder arthroplasty for glenohumeral osteoarthritis. These findings serve to highlight the importance of close perioperative monitoring to prevent complications in a potentially overlooked patient population.

Upregulation of toll-like receptors 4 in peripheral mononuclear cells of chronic renal disease patients on hemodialysis is associated with poor cardiac function and increased mortality

Upregulation of toll-like receptors 4 in peripheral mononuclear cells of chronic renal disease patients on hemodialysis is associated with poor cardiac function and increased mortality

Associations between the serum magnesium and all-cause or cardiovascular mortality in chronic kidney disease and end-stage renal disease patients: A meta-analysis.

Background:Some studies have found that hypomagnesemia is associated with vascular calcification, atherosclerosis, and cardiovascular disease, which may lead to increased mortality in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) who need to maintain hemodialysis (HD). However, the conclusion of these studies remain controversial.Methods:Relevant literature was retrieved from the database of Cochrane library, PubMed, EMBASE, and CNKI until December 2020, without any language restrictions. The data was analyzed using the Stata 12.0 software.Results:A total of 31 studies were included, involving 205436 participants. The results showed that after multivariable adjusted, hypomagnesemia was significant associated with the risk of all-cause mortality in patients with CKD and end-stage renal disease (ESRD) (hazard ratios [HR] 1.955; 95% confidence interval (95% CI) 1.511-2.528; P = .000; hypomagnesemia vs normal magnesium or hypermagnesemia). In contrast, in patients with CKD and ESRD, hypermagnesemia was negatively correlated with all-cause mortality (HR 0.873; 95% CI 0.793-0.960; P = .005) (per unit increase). Moreover, in the adjusted model, it was observed that hypermagnesemia was significantly associated with a reduced risk of cardiovascular death (HR 0.598; 95% CI 0.094-1.102, P = .020). In addition, subgroup analysis found that hypomagnesemia was closely related to the increase of all-cause mortality in HD patients (HR 1.799; 95% CI 1.375-2.354; P = .000) (hypomagnesemia vs normal magnesium or hypermagnesemia).Conclusion:Our results show that hypomagnesemia is significantly associated with cardiovascular and all-cause mortality in maintenance HD patients. Further studies should be conducted to evaluate the benefits of magnesium correction in maintenance dialysis patients with hypomagnesemia.

Transudative and Exudative Pleural Effusion in Chronic Kidney Disease Patients: A Prospective Single-Center Study.

ObjectiveThe aim of the study is to assess the incidence of pleural effusion and to assess its etiology in admitted chronic kidney disease patients who were admitted secondary to various causes, i.e., fluid overload, sepsis, etc.Material and methodsA prospective cross-sectional observational study was conducted at the Department of Nephrology, The Kidney Centre Postgraduate Training Institute, Karachi. A total of 789 patients were admitted between August 2020-February 2021. This study comprised 280 adult chronic kidney disease (chronic kidney disease and end-stage renal disease patients who were on dialysis) patients having pleural effusion (either unilateral or bilateral) secondary to various causes. ResultsAmong 280 patients, the mean age was 55 years with 158 (56.4%) males and 122 (43.6%) females, diabetes (76%) was present in most of the patients along with hypertension (86.1%), and most of the patients were of stage IV and V. Transudative pleural effusion was present in 212 (75.7%) patients secondary to fluid overload and heart failure was the commonest cause while 68 (24.3%) patients had exudative pleural effusion with tuberculosis being the commonest etiology, 44 (15.7%) patients needed intervention while 236 (84.3%) were treated medically. The data was entered and analyzed on SPSS version 21 (IBM Corp, Armonk, USA). The cleaning and coding of data were done before analysis. Continuous variables were expressed in mean ± standard deviation, while the frequencies with percentages were obtained for categorical variables. The Chi-square test was applied to see the association between variables. A p-value of ≤ 0.05 was considered significant.ConclusionClarification of the cause of pleural effusion is essential. Early diagnosis and prompt treatment like thoracocentesis or in the case of patients on hemodialysis, adequate dialysis may be necessary.

PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN CHILDREN AND ADOLESCENTS: 15-YEARS' EXPERIENCE OF A TERTIARY CENTER.

Percutaneous endoscopic gastrostomy (PEG) is an important option for enteral nutrition for both children and adults. It is considered a safe, effective, and advantageous technique in comparison to other complementary feeding routes. It allows continuous feeding, the feeding of patients with swallowing disorders due to neurological causes or others, and the administration of non-palatable diets or medications, all with low rates of complications and mortality. This study aimed to evaluate the main indications and complications of PEG in pediatric patients. In addition, the impact on the nutritional status of patients undergoing PEG was also compared with weight, body mass index (BMI), and height according to references from the World Health Organization. This observational and retrospective study included 152 children and adolescents who underwent PEG between January/2003 and December/2018. Patients up to 18 years of age at the time of the procedure were included. Complications related to the procedure were classified as minor or major. Patients with PEG indication for nutritional supplementation were evaluated for weight gain, height, and BMI, using the Z score at the day of the procedure and six months, 1 year, and 2 years after the procedure. Indications for PEG were: swallowing disorder of neurological cause (67.1%), need for nutritional supplementation (25%), swallowing disorder of mechanical origin (6.6%), and indication of gastric decompression (1.3%). Minor complications occurred in 57.8% of patients and major complications in 9.8% of patients. The traction technique corresponded to 92.1% and puncture to 7.9%. The death rate was 1.3%. Thirty-eight patients had an indication for nutritional supplementation. In these patients, there was a gradual increase in both BMI and weight, reaching statistically significant differences (P=0.0340 and P= 0.0105, respectively). These differences were more evident in chronic renal disease patients. Height did not vary significantly (P=0.543). PEG proved to be an advantageous option as an auxiliary feeding method in pediatric patients. Dysphagia of neurological origin was the main indication followed by the need for nutritional supplementation. PEG has low frequency of major complications and mortality. This study also showed the importance of PEG in patients who need nutritional supplementation, as it enabled patients to move from undernutrition to normal weight ranges.

Inflammatory markers in chronic kidney disease and end stage renal disease patients.

Chronic kidney disease (CKD) is condition characterized by a gradual loss of kidney function, patient with CKD suffering from a variety of immune system defects. This study looked at Fas, T cell, BCl2, and P53 activity in people with CKD, end stage renal disease (ESRD), and stable controls. The CD4+ and CD8+ levels in ESRD patients' peripheral blood were slightly lower than those in CKD patients. The CKD and ESRD groups had slightly higher Fas and FasL mRNA expression and slightly lower BCl2 mRNA gene expression than the normal control group (P < 0.05). P53 mRNA gene expression was shown to be higher in the patients than in the controls (P < 0.01). ESRD patients have a significantly lower number of T-cell subsets than CKD patients this is related to a higher degree of apoptosis in these cells.

Prospective Comparison of 24-Hour Urine Creatinine Clearance with Estimated Glomerular Filtration Rates in Chronic Renal Disease Patients of African Descent.

Background: The 24-hour (24-h) creatinine clearance (CrCl) is the most common method for measuring GFR in clinical laboratories. However, the limitations of CrCl have resulted in the widespread acceptance of mathematically derived estimated glomerular filtration rate (eGFR) using Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in predicting eGFR. The aim of the study was to compare 24-h CrCl with eGFR derived from these formulae and to identify which could be the best alternative. Method: A prospective study was conducted involving 140 CKD patients. Creatinine and cystatin C concentrations were determined using the cobas 6000 analyzer. The eGFR was calculated using the CG formula, 4-variable MDRD and CKD-EPI equations, and Bland-Alman plots bias was determined. Results: The CG and MDRD formulas had mean eGFR values similar to CrCl and correlation coefficients (r) were highest for CG (0.906) and lowest for MDRD (0.799). The CG equation was in agreement with 24-h CrCl in all but stage V CKD while the MDRD equation compared well in all except Stage IV CKD. The CG equation was positively biased (0.9857) while the MDRD had a negative bias (−0.05). Conclusion: The Cockcroft-Gault formula provides a more accurate assessment of GFR than 24-h CrCl and would be recommended as a substitute to provide the best estimate of GFR in our population.

Anxiety And Depression in Chronic Kidney Disease (CKD) Patients in The Initial Phase of Hemodialysis Therapy

Anxiety and depression are psychological conditions that hemodialysis patients often suffer. Unresolved anxiety can cause depression. The research aims to determine the description of anxiety and depression in chronic renal disease (CKD) patients who undergo hemodialysis (HD) therapy in the initial phase. The study was a quantitative descriptive with a survey approach involving 43 HD patients for less than eight months. The research instrument implemented was the Hospital Anxiety and Depression Scale (HADS) questionnaire. The data were analyzed using descriptive analysis by presenting frequency and category distributions. The results discovered that 29 (62.8%) respondents suffered from anxiety; mild (32.6%), moderate (25.6%), and severe category (4.7%). Furthermore, 16 respondents (37.2%) experience depression; mild (20.9%), moderate (40.0.6%), and severe (2.3%) categories. Anxiety and depression are common symptoms among male and female respondents with direct vascular access, respondents with two times per week HD in the first two months of HD process, adult, pre and elderly and aoccupied respondents. Screenings are carried out routinely to detect anxiety and depression as early as possible and to provide interventions according to the needs of patients through nursing care approaches.

Impact of polypharmacy on all-cause mortality and hospitalization in incident hemodialysis patients: a cohort study.

Polypharmacy (PP) is common in end-stage chronic renal disease patients largely due to the presence of multiple comorbid conditions. Although PP is potentially harmful, its relationship with mortality and morbidity in hemodialysis patients currently remains unclear. Study design: cohort study. participants: one hundred and fifty-two initial hemodialysis patients (male, 88 patients; mean age, 70.3years) were enrolled between February 2015 and March 2018 at Nobeoka Prefectural Hospital and Chiyoda Hospital. patients were divided into 2 groups according to PP (6 or more drug prescriptions or less) during admission and discharge for the initiation of hemodialysis. all-cause mortality and hospitalization during the mean 2.8-year follow-up. hazard ratios (HRs) were estimated using Cox's model for the relationships between PP and clinical outcomes and adjusted for potential confounders. The group with 5 or less drug prescriptions was set as a reference. The number of prescribed drugs per patient averaged 7.4 at admission and 7.0 at discharge for initial hemodialysis. One hundred (65.8%) and 94 patients (61.8%) had PP at admission and discharge, respectively. During the follow-up, 20 patients died and 71 were hospitalized. PP at admission did not correlate with outcomes, whereas that at discharge correlated with all-cause hospitalization. PP at discharge may be associated with clinical outcomes. However, it remains unclear whether PP is the direct cause of outcomes or is simply a marker for an increased risk of outcomes.

Pathophysiological Implications of Imbalances in Fibroblast Growth Factor 23 in the Development of Diabetes.

Observational studies have associated the increase in fibroblast growth factor (FGF) 23 levels, the main regulator of phosphate levels, with the onset of diabetes. These studies open the debate on the plausible existence of undescribed diabetogenic mechanisms derived from chronic supraphysiological levels of FGF23, a prevalent condition in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. These maladaptive and diabetogenic responses to FGF23 may occur at different levels, including a direct effect on the pancreatic ß cells, and an indirect effect derived from the stimulation of the synthesis of pro-inflammatory factors. Both mechanisms could be mediated by the binding of FGF23 to noncanonical receptor complexes with the subsequent overactivation of signaling pathways that leads to harmful effects. The canonical binding of FGF23 to the receptor complex formed by the receptor FGFR1c and the coreceptor αKlotho activates Ras/MAPK/ERK signaling. However, supraphysiological concentrations of FGF23 favor non-αKlotho-dependent binding of this molecule to other FGFRs, which could generate an undesired overactivation of the PLCγ/CN/NFAT pathway, as observed in cardiomyocytes and hepatocytes. Moreover, the decrease in αKlotho expression may constitute a contributing factor to the appearance of these effects by promoting the nonspecific activation of the PLCγ/CN/NFAT to the detriment of the αKlotho-dependent Ras/MAPK/ERK pathway. The description of these mechanisms would allow the development of new therapeutic targets susceptible to be modified by dietary changes or by pharmacological intervention.

The Effectiveness of Durante Hemodialysis Packed Red Cells (PRC) Transfusion on Hemoglobin Levels

Renal Disease was a chronic disease that the most attacking people in Indonesia. Damage to this vital organ in the human body greatly affected a person's health condition, one of which was anemia. This study aimed to determine the effectiveness of Durante hemodialysis PRC transfusions on hemoglobin levels. The method used was Pre-experimental design, with the One group pre-post test design approach. With a sample of 49 patients who underwent regular hemodialysis at RSUD dr. Iskak Tulungagung. Data were obtained by direct observation. Processed by computerized methods with a statistical t-test, the significance level (α) was 0.05. The study results showed that the hemoglobin levels of the pre-Durante hemodialysis PRC transfusion patients were 4-5 mg/dl (53.06%), and the hemoglobin levels of the post-Durante hemodialysis PRC transfusion patients were 6.1-7 mg/dl (34.69%). The results of statistical tests showed that there was an increase in hemoglobin levels in patients who received Durante hemodialysis PRC transfusion by 1.22 mg/dl because p-value = 0.000 &lt; 0.05 (α) means that there was an effect. It could be concluded that the delivery of Durante hemodialysis PRC transfusion could help increase hemoglobin levels. This finding was very helpful for chronic Renal Disease patients undergoing hemodialysis, who have been using erythropoietin preparations because PRC transfusions were cheaper and more effective when compared to using erythropoietin preparations

The effectiveness of oral protein supplementation in malnourished peritoneal dialysis patients

Objectives: Malnutrition is a common problem in chronic renal disease patients during pre-dialysis and dialysis, leading to increased cardiovascular diseases and mortality. This study aimed to evaluate the efficacy of supplemental protein supplementation on malnutrition in peritoneal dialysis patients. Methods: Eighty-four stable adult peritoneal dialysis patients included in this study. In addition to the standard diets, oral nutritional product (372 calories, 61 g protein, 30 g glutamine, and 30 g arginine/100 g powder sachet twice a day) gave to patients. Before the study and after three months from the supportive therapy; anthropometric measurements with serum urea, creatinine, total protein, albumin, cholesterol, KtV, body mass index was analyzed. Results: The mean age of peritoneal dialysis patients was 60 (46-78) years. Serum urea levels from 96 ± 44 to 109 ± 42 mg/dL (p = 0.007), total protein levels from 5.85 ± 0.68 to 6.18 ± 0.66 g/dL (7.8%, p = 0.007), albumin levels increased from 3.02 ± 0.27 to 3.32 ± 0.34 g/dL (11.7%, p = 0.003) increased significantly after an average of 0.43 g/kg protein and 178 cal/day energy support. Conclusions: Albumin is an indicator of malnutrition related mortality. Therefore, using of protein nutritional products in addition to standard treatment may be beneficial for malnourished peritoneal dialysis patients.