Demand For Renal Replacement Therapy Research Articles

Kidney Transplantation in Nigeria: A Single Centre’s Early Surgical Experience and Outcomes

With the rise in the population of patients with End-stage Renal Disease (ESRD) in Nigeria, there is an increased demand for Renal Replacement Therapy (RRT) including kidney transplantation (KT). We present our initial surgical experience and early outcomes with KT at a Nigerian transplant center over 2 years. A 2-year retrospective review of patients who underwent KT was done. Data of both kidney donors and recipients were recorded in designed proformas. Extracted information included demographic characteristics, side of open donor nephrectomy (ODN), recipient anatomy, surgical techniques and postoperative outcomes. Data were analyzed using SPSS version 21. A total of 210 patients had KT during the period under review<em>. </em>Donors had an age range of 19 to 53 years with a mean of 30.8 3 ± 8.43 years while recipients aged between 9 and 73 years with a mean of 45.97 ± 13.71 years. There were 190 (90.5%) male and 20 (9.5%) female donors. One hundred fifty-four recipients were males (73.3%) and 56 (26.7%) were females. Left ODN was performed in 152 (72.4%) of cases and the commonest indication for right ODN was multiple left renal arteries. The allograft was placed in the right iliac fossa in 187 (89.0%) recipients with the external iliac artery preferred for anastomosis with the allograft renal artery in end-to-side fashion in 182 (86.7%) cases. The internal iliac artery was used in end-to-end fashion anastomosis in 28 (13.3%) of cases. Ureteroneocystostomy using the Modified Lich-Gregoir technique over a double-J stent was performed in all but 5 patients who had uretero-ureterostomies. Significant peri-operative hemorrhage necessitating blood transfusion was experienced in 9 donors and 26 recipients. There was a low complication rate in kidney donors. Allograft renal artery thrombosis, venous thrombosis, and arterial pseudo-aneurysms were encountered in 3, 2 and 4 recipients respectively. Kidney transplantation can be safely and routinely carried out in Nigeria. The early surgical outlook of both kidney donors and recipients was found to be excellent in this study.

Still finding ways to augment the existing management of acute and chronic kidney diseases with targeted gene and cell therapies: Opportunities and hurdles.

The rising global incidence of acute and chronic kidney diseases has increased the demand for renal replacement therapy. This issue, compounded with the limited availability of viable kidneys for transplantation, has propelled the search for alternative strategies to address the growing health and economic burdens associated with these conditions. In the search for such alternatives, significant efforts have been devised to augment the current and primarily supportive management of renal injury with novel regenerative strategies. For example, gene- and cell-based approaches that utilize recombinant peptides/proteins, gene, cell, organoid, and RNAi technologies have shown promising outcomes primarily in experimental models. Supporting research has also been conducted to improve our understanding of the critical aspects that facilitate the development of efficient gene- and cell-based techniques that the complex structure of the kidney has traditionally limited. This manuscript is intended to communicate efforts that have driven the development of such therapies by identifying the vectors and delivery routes needed to drive exogenous transgene incorporation that may support the treatment of acute and chronic kidney diseases.

Optimisation of Patient Flow and Scheduling in an Outpatient Haemodialysis Clinic

The demand for renal replacement therapy (RRT) from the growing number of patients suffering from chronic kidney disease (CKD) and end stage renal disease (ESRD) in Nigeria is reported to be on the rise. However, dialysis clinics are few with limited facilities to meet the increasing demand leading to congestion, long waiting time and increased length of stay (LOS) in dialysis clinics. This paper presents an optimisation model for scheduling patient flow in an outpatient haemodialysis clinic. The objective is to minimize patient LOS using Genetic Algorithm (GA), implemented in Python programming language with Spyder Integrated Development Environment (IDE). The model was tested using data obtained from a haemodialysis clinic, in Lagos, Nigeria. The model generated optimum LOS values (193.01, 275.02 and 390.01) minutes compared to the mean LOS values at the haemodialysis clinic (235.50, 296.62 and 424.50) minutes for the 3-hour, 4-hour and 6-hour dialysis sessions. Furthermore, a simulation experiment of patient flow in a typical haemodialysis clinic was performed by gradual variations in patient arrival rates, λ. Simulation results at (λ=0.1,0.2,0.3,0.4) revealed mean LOS (minutes) as (312.85 ± 73.45, 348.18 ± 84.89, 342.18 ± 81.30, 305, 28 ± 63.67) respectively. The optimisation model was effective in reducing patient LOS.

Meeting the Demand for Renal Replacement Therapy during the COVID-19 Pandemic: A Manufacturer's Perspective.

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Epidemiology of Chronic Kidney Disease in Children: A Report from Lithuania.

Background and Objectives: The data on the prevalence of chronic kidney disease (CKD) in the pediatric population are limited. The prevalence of CKD ranges from 56 to 74.7 cases per million of the age-related population (pmarp). The most common cause of CKD among children is congenital anomalies of the kidney and urinary tract (CAKUT). With progressing CKD, various complications occur, and end-stage renal disease (ESRD) can develop. The aim of the study was to determine the causes, stage, prevalence, and clinical signs of CKD and demand for RRT (renal replacement therapy) among Lithuanian children in 2017 and to compare the epidemiological data of CKD with the data of 1997 and 2006. Materials and Methods: The data of 172 Lithuanian children who had a diagnosis of CKD (stage 2–5) in 1997 (n = 41), in 2006 (n = 65), and in 2017 (n = 66) were retrospectively analyzed. Physical development and clinical signs of children who had CKD (stage 2–5) in 2017 were assessed. Results: The prevalence of CKD stages 2–5 was 48.0 pmarp in 1997; 88.7 in 2006; and 132.1 in 2017 (p < 0.01). Congenital and hereditary diseases of the kidney in 1997 accounted for 66% of all CKD causes; in 2006, for 70%; and in 2017, for 79%. In 2017, children with CKD stages 4 or 5 (except transplanted children) had hypertension (87.5%) and anemia (50%) (p < 0.01). Children under ≤2 years with CKD were at a 3-fold greater risk of having elevated blood pressure (OR = 3.375, 95% CI: 1.186–9.904). Conclusions: There was no change in the number of children with CKD in Lithuania; however, the prevalence of CKD increased due to reduced pediatric population. CAKUT remains the main cause of CKD at all time periods. Among children with CKD stages 4 or 5, there were more children with hypertension and anemia. In children who were diagnosed with CKD at an early age hypertension developed at a younger age.

Acute Peritoneal Dialysis With Percutaneous Catheter Insertion for COVID-19–Associated Acute Kidney Injury in Intensive Care: Experience From a UK Tertiary Center

IntroductionDuring the coronavirus disease 2019 (COVID-19) pandemic in 2020, high rates of acute kidney injury (AKI) in critically unwell patients are being reported, leading to an increased demand for renal replacement therapy (RRT). Providing RRT for this large number of patients is proving challenging, and so alternatives to continuous renal replacement therapies (CRRT) in the intensive care unit (ICU) are needed. Peritoneal dialysis (PD) can be initiated immediately after percutaneous insertion of the catheter, but there are concerns about impact on ventilation and RRT efficacy. We sought to describe our recent experience with percutaneous catheter insertion and peritoneal dialysis in patients in the ICU with COVID-19 infection.MethodPatients were selected according to local protocol, and catheters were inserted percutaneously by experienced operators using a Seldinger technique. Sequential Organ Failure Assessment (SOFA) score and ventilation requirements were recorded at the time of insertion and 24 hours later. Procedural complications, proportion of RRT provided by PD, renal recovery, and RRT parameters (serum potassium and maximum base excess) during PD were assessed.ResultsPercutaneous PD catheters were successfully inserted in 37 of 44 patients (84.1%) after a median of 13.5 days (interquartile range [IQR] = 10.0, 20.3 days) in the ICU. No adverse events were reported; SOFA scores and ventilation requirements were comparable before and after insertion; and adequate RRT parameters were achieved. The median proportion of RRT provided by PD following catheter insertion was 94.6% (IQR = 75.0, 100%).ConclusionPeritoneal dialysis provides a safe and effective alternative to CRRT in selected patients with AKI and COVID-19 infection requiring ventilation on intensive care.

Challenges in the provision of kidney care at the largest public nephrology center in Guatemala: a qualitative study with health professionals

BackgroundChronic kidney disease (CKD) is increasing worldwide, and the majority of the CKD burden is in low- and middle-income countries (LMICs). However, there is wide variability in global access to kidney care therapies such as dialysis and kidney transplantation. The challenges health professionals experience while providing kidney care in LMICs have not been well described. The goal of this study is to elicit health professionals’ perceptions of providing kidney care in a resource-constrained environment, strategies for dealing with resource limitations, and suggestions for improving kidney care in Guatemala.MethodsSemi-structured interviews were performed with 21 health professionals recruited through convenience sampling at the largest public nephrology center in Guatemala. Health professionals included administrators, physicians, nurses, technicians, nutritionists, psychologists, laboratory personnel, and social workers. Interviews were recorded and transcribed in Spanish. Qualitative data from interviews were analyzed in NVivo using an inductive approach, allowing dominant themes to emerge from interview transcriptions.ResultsHealth professionals most frequently described challenges in providing high-quality care due to resource limitations. Reducing the frequency of hemodialysis, encouraging patients to opt for peritoneal dialysis rather than hemodialysis, and allocating resources based on clinical acuity were common strategies for reconciling high demand and limited resources. Providers experienced significant emotional challenges related to high patient volume and difficult decisions on resource allocation, leading to burnout and moral distress. To improve care, respondents suggested increased budgets for equipment and personnel, investments in preventative services, and decentralization of services.ConclusionsHealth professionals at the largest public nephrology center in Guatemala described multiple strategies to meet the rising demand for renal replacement therapy. Due to systems-level limitations, health professionals faced difficult choices on the stewardship of resources that are linked to sentiments of burnout and moral distress. This study offers important lessons in Guatemala and other countries seeking to build capacity to scale-up kidney care.

Supporting the Establishment of New Home Dialysis Programs Through the Explore Home Dialysis Program

IntroductionThe globally increasing prevalence of chronic kidney disease has resulted in an ever-growing demand for renal replacement therapy. Although programs are present around the world, there is a paucity of immersive educational programs that train clinicians and administrators to develop new home dialysis programs. Explore Home Dialysis (EHD) is a program created to fill this gap.MethodsWe present the results of the evaluation of the EHD program. Our team interviewed 23 clinicians and administrators who participated in the EHD program. We also assessed country-specific needs and challenges associated with home dialysis.ResultsThe 4 main findings include (i) the evaluation of the effectiveness of the EHD program; (ii) the need for an educational program to train individuals on how to deploy home dialysis programs; (iii) evidence that such an educational program is beneficial to participants and for the establishment of new home dialysis programs; and (iv) the identification of barriers to the development of home dialysis programs in countries represented in this study. The data show an increased demand, with strong patient and provider interest in establishing new programs, interest in accessing resources to train clinical and administrative staff in how to run a home dialysis program, and positive feedback about the EHD program in general.ConclusionsThe data from this study were used in the next iteration of the EHD program, to inform clinicians about challenges in the deployment of new home dialysis programs, and to present educational resources that need to be developed in the future.

Acute Kidney Injury in Tropical Countries

Acute kidney injury (AKI) in tropical countries is strikingly different from that in countries with a temperate climate. Tropical regions are characterised by year-round high temperatures and the absence of frost, which supports the propagation of infections that can potentially cause AKI. The aetiology and presentation of AKI reflects the ethnicity, socioeconomic factors, and ecological conditions in tropical countries. Apart from infections, other causes of AKI include exposure to animal toxins, ingestion of plant toxins or chemicals, poisoning, and obstetric complications. The low income status, poor access to treatment, and sociocultural practices (use of indigenous medicines) contribute to poor outcomes of patients with AKI. The exact aetiologic diagnosis often cannot be made due to lack of appropriate laboratory services. The epidemiology of AKI in tropical regions is changing over time. Renal replacement therapy is inaccessible to the majority and late presentation with delayed treatment add to the risk for future development of chronic kidney disease. AKI is often the primary cause of chronic kidney disease in the developing world, which increases demand for renal replacement therapy and transplantation. Most causes of AKI in developing countries are preventable and strategies to improve the public health and increased access to effective medical care are the need of the hour. This review offers comprehensive ideas about epidemiology, aetio-pathogenesis, clinical presentation, diagnosis, treatment, and prevention of community-acquired AKI in the tropics, with special reference to the Indian subcontinent. AKI is an under-recognised cause of morbidity and mortality in developing countries and even small, simple interventions could have an impact on its outcome.

Projecting demands for renal replacement therapy in the Northern Territory: a stochastic Markov model.

Objective The aim of the present study was to evaluate the potential effects of different health intervention strategies on demand for renal replacement therapy (RRT) services in the Northern Territory (NT). Methods A Markov chain simulation model was developed to estimate demand for haemodialysis (HD) and kidney transplantation (Tx) over the next 10 years, based on RRT registry data between 2002 and 2013. Four policy-relevant scenarios were evaluated: (1) increased Tx; (2) increased self-care dialysis; (3) reduced incidence of end-stage kidney disease (ESKD); and (4) reduced mortality. Results There were 957 new cases of ESKD during the study period, with most patients being Indigenous people (85%). The median age was 50 years at onset and 57 years at death, 12 and 13 years younger respectively than Australian medians. The prevalence of RRT increased 5.6% annually, 20% higher than the national rate (4.7%). If current trends continue (baseline scenario), the demand for facility-based HD (FHD) would approach 100000 treatments (95% confidence interval 75000-121000) in 2023, a 5% annual increase. Increasing Tx (0.3%), increasing self-care (5%) and reducing incidence (5%) each attenuate demand for FHD to ~70000 annually by 2023. Conclusions The present study demonstrates the effects of changing service patterns to increase Tx, self-care and prevention, all of which will substantially attenuate the growth in FHD requirements in the NT. What is known about the topic? The burden of ESKD is projected to increase in the NT, with demand for FHD doubling every 15 years. Little is known about the potential effect of changes in health policy and clinical practice on demand. What does this paper add? This study assessed the usefulness of a stochastic Markov model to evaluate the effects of potential policy changes on FHD demand. What are the implications for practitioners? The scenarios simulated by the stochastic Markov models suggest that changes in current ESKD management practices would have a large effect on future demand for FHD.

Uncovering the rising kidney failure deaths in India.

Uncovering the rising kidney failure deaths in India.

Balanced crystalloids for septic shock resuscitation.

Timely fluid administration is crucial to maintain tissue perfusion in septic shock patients. However, the question concerning which fluid should be used for septic shock resuscitation remains a matter of debate. A growing body of evidence suggests that the type, amount and timing of fluid administration during the course of sepsis may affect patient outcomes. Crystalloids have been recommended as the first-line fluids for septic shock resuscitation. Nevertheless, given the inconclusive nature of the available literature, no definitive recommendations about the most appropriate crystalloid solution can be made. Resuscitation of septic and non-septic critically ill patients with unbalanced crystalloids, mainly 0.9% saline, has been associated with a higher incidence of acid-base balance and electrolyte disorders and might be associated with a higher incidence of acute kidney injury. This can result in greater demand for renal replacement therapy and increased mortality. Balanced crystalloids have been proposed as an alternative to unbalanced solutions in order to mitigate their detrimental effects. Nevertheless, the safety and effectiveness of balanced crystalloids for septic shock resuscitation need to be further addressed in a well-designed, multicenter, pragmatic, randomized controlled trial.

Sodium bicarbonate versus isotonic saline solution to prevent contrast-induced nephropathy : a systematic review and meta-analysis

Introduction: Contrast-induced nephropathy is one of the main causes of acute kidney injury and increased hospital-acquired morbidity and mortality. The use of sodium bicarbonate for nephroprotection has emerged as a preventative strategy; however, its efficacy is controversial compared to other strategies, such as hydration using 0.9% saline solution. Objective: To compare the effectiveness of sodium bicarbonate vs. hydration using 0.9% saline solution to prevent contrast-induced acute kidney injury. Methods: A systematic review of studies registered in the Cochrane, Pubmed, Medline, Lilacs, ScielO and Embase databases was conducted. Randomized controlled studies that evaluated the use of 0.9% saline solution vs. sodium bicarbonate to prevent contrast-induced nephropathy were included. Results: A total of 22 studies (5,686 patients) were included. Sodium bicarbonate did not decrease the risk of contrast-induced nephropathy (RD= 0.00; 95% CI= -0.02 to 0.03; p= 0.83; I2= 0%). No significant differences were found in the demand for renal replacement therapy (RD= 0.00; 95% CI= -0.01 to 0-01; I2= 0%; p= 0.99) or in mortality (RD= -0.00; 95% CI= -0.001 to 0.001; I2= 0%; p= 0.51). Conclusions: Sodium bicarbonate administration is not superior to the use of 0.9% saline solution for preventing contrast-induced nephropathy in patients with risk factors, nor is it better at reducing mortality or the need for renal replacement therapy.

Does home haemodialysis produce better outcomes for patients?

Demand for renal replacement therapy (dialysis and transplantation) is projected to rise by approximately 5% every year until at least 2030. Therefore, particular attention should be paid to areas in which significant increases in demand are likely to lead to further pressure on services. There is evidence to support higher patient survival rates in home haemodialysis compared with those that receive hospital- or satellite-based haemodialysis. Jenny Miller explain why home haemodialysis may be at least as effective as and less costly than hospital or satellite unit haemodialysis.

Combatting renal ciliopathies

A hallmark of many ciliopathies are renal cysts, ultimately disrupting kidney architecture and resulting in end-stage renal disease as the most common cause of mortality. Yet despite being the largest demand for renal replacement therapy (ie. dialysis, kidney transplantation) in young patients, the exact etiology of nephronophthisis (NPHP) and polycystic kidney disease is still largely unknown. Many gene products associated with NPHP and related disorders do not directly affect cilia, but appear to be important in tubular architecture, lumen formation, and polarized exocytosis. Personalized therapy to delay disease progression is beginning to explore gene replacement therapy, through use -for example- of induced pluripotent stem cells (iPSCs). For patients with nonsense mutations in ciliopathy genes, read-through drugs such as PTC124 and modified aminoglycosides might hold future promise. Furthermore, several drug screens in cell-based, zebrafish, and murine models have suggested new pathways preserving kidney function. Although much of this work has yet to be validated in human patients, this overview will discuss the approaches currently being employed in the context of improving ciliopathy treatment options.

Ingresos atendidos en la unidad de hospitalización del servicio de nefrología en un hospital de tercer nivel

IntroductionIn the last decade, Spain has undergone significant socioeconomic, demographic, and healthcare changes that may be reflected in attendance rates in the nephrology department of our hospital. The objective of this study was to determine the factors associated with hospital attendance and healthcare burden in the nephrology inpatient unit of the Hospital of Zaragoza. Material and methodsWe performed a descriptive, retrospective, cross-sectional study of 5,374 admissions (hospital attendance) and analyzed the healthcare burden (number of vascular access procedures performed) in the past 16 years. ResultsHospital attendance. Of a total of 2,028 patients, there were 5,374 admissions in the last 16 years. Among admissions, 59.0% were men and 41.0% were women. The mean age of admitted patients was 72.3±17.3 years. The proportion of hospital admissions in persons aged less than 65 years was 28.3% and that of persons aged more than 65 years was 71.7%. A total of 70.4% of admissions were from health area III, while 29.6% were from other health areas. Healthcare burden. 74.4% of admitted patients were included in a mean of seven diagnosis-related groups and 2,419 vascular access procedures were performed. Of the total number of vascular access procedures, 65% were carried out in patients from health area III and the remaining 35% were performed in patients from other sites or sectors. DiscussionA review of the workflow in the intervention unit of our department revealed that a large proportion of patients from other health areas attended our center to undergo vascular access procedures. Among the patients aged less than 65 years old referred from other health areas, there was a clear, but non-significant, demand for renal replacement therapy. When admissions were grouped by processes, we found that the mean weighted procedure was<1 weight higher than expected. The causes may be population dispersion, the geographical size, and the age of patients in our health area.

Does home haemodialysis produce better outcomes for patients?

Demand for renal replacement therapy (dialysis and transplantation) is projected to rise by approximately 5% every year until at least 2030. Therefore, particular attention should be paid to areas in which significant increases in demand are likely to lead to further pressure on services. There is evidence to support higher patient survival rates in home haemodialysis compared with those that receive hospital- or satellite-based haemodialysis (i.e. a smaller renal unit based in a community hospital closer to the patient's home). Furthermore, studies suggest that home haemodialysis is at least as effective as and less costly than hospital or satellite unit haemodialysis. Therefore, there is a greater requirement for expanding the provision of home haemodialysis, and to make this treatment option available to a wider range of patients.

THE AUSTRALIAN AND NEW ZEALAND DIALYSIS WORKFORCE STUDY IN THE INTERNATIONAL CONTEXT

Given increasing demand for renal replacement therapy, this study sought to identify of key workforce issues facing dialysis units, based on a "snapshot" of the current workforce. A web-based survey of all dialysis unit managers in Australia and New Zealand, in October 2008, about their workforce. A significant minority of dialysis staff in most regions were not registered nurses. Many renal registered nurses worked part-time. Staff/patient ratios in dialysis units varied significantly by region, reflecting the relative prevalence of home therapies. Most dialysis units were generally adequately staffed. The proportion of registered nurses with specific renal qualifications varied significantly by region. The changing character of the workforce in the dialysis unit in the future will require clarification of the relationships between different categories of dialysis staff. Specialty education for nurses needs to be oriented to equipping staff to be effective in their changing work environment.

Changing trends in renal replacement therapy

Delivery of renal replacement therapy (RRT) is changing with more emphasis on dialysis modalities. Renal services in the UK have expanded considerably due to increasing demand for RRT and an understanding of the drivers of this trend is needed to prepare for the future.

Budget Impact Analysis of Expanding Access to Renal Replacement Therapy for End-Stage Renal Disease Patients under Universal Coverage in Thailand

OBJECTIVES: To estimate the amount of government health budget required for the extension of universal access to renal replacement therapy (RRT) for beneficiaries of the universal health care coverage (UC) scheme in Thailand. Ability to bear the increasing budget of the government and appropriate measures to cope with anticipated costs of including RRT in the benefit package were also investigated. METHODS: Literature review on demand for RRT at both domestic and international levels, and the estimate of costs for haemodialysis and continuous peritoneal dialysis in Thailand. From the government perspective, several scenarios of budget requirements according to the estimated costs for RRT and possible rationing criteria were calculated. RESULTS: The government would spend approximately more than five billion Baht during the first year of implementation, if there is neither strategy to reduce the costs for RRT nor appropriate selection criteria for end-stage renal disease patients. The budget for universal access to RRT would increase to 74,355 million Baht in the sixteenth year of implementation if the government played passive roles in controlling costs of the program. The budget required would reduce to 58% of the estimate if the government introduced the rationing criteria for patients aged less than 60 years. CONCLUSIONS: The policy on the extension of access to RRT should be considered carefully by the government because of its financial impact on the government health budget. Appropriate interventions including effective measures to control costs of RRT, strategies to reduce the incidence of end-stage renal disease, and the rationing criteria for access to RRT are needed if the decision to implement the policy is made.