Burden Of End-stage Renal Disease Research Articles

The burden of end-stage renal disease in Khartoum, Sudan: cost of illness study

Background and purpose The incidence of end-stage renal disease (ESRD) in Sudan is increasing, affecting the economic status of patients, caregivers and society. This study aimed to measure ESRD’s costs, including direct and morbidity indirect expenditures, and to investigate any associated factors and financial consequences. Materials and methods This cross-sectional study used a standardized questionnaire to collect data from 150 ESRD patients who had been receiving dialysis for at least one year before the time of data collection at 13 specialized renal centres in Khartoum state. Data about sociodemographic, clinical, and economic factors were gathered, and their relationship to the cost of ESRD was examined using both bivariate (Man Whitney test, Kruskal Wallis test and Spearman correlation) and multivariate analytical procedures (multivariate linear regression). Results This study reported a median direct per capita ESRD cost of 38 600 SDG ($1 723.2 PPP) annually with an interquartile range of 69 319.3 SDG ($3 094.6 PPP). The median morbidity indirect cost was estimated to be 0.0 ± 3 352 SDG ($ 0.0 ± 149.6 PPP) per annum. In 28.8% of cases, the patients were their family’s primary income earner and over 85% were covered by medical insurance. Our study found that none of the study variables were significantly associated with the total cost of ESRD. Conclusion and limitations Our findings point out considerable direct out-of-pocket expenses and productivity losses for patients and their households. However, these results should be carefully applied for comparison between the different countries due to differences in the cost of medical interventions and insurance coverage. Further longitudinal studies and studies on health finance and insurance policies are recommended.

Systematic review of end stage renal disease in Pakistan: Identifying implementation research outcomes.

The aim of this study was to conduct a systematic review analysis to identify and evaluate the available literature on implementation science outcomes research in relation to End Stage Renal Disease (ESRD) in Pakistan. A systematic database search of PubMed, Web of Science, EMBASE, Cochrane Library, CINAHL, and Ovid was conducted through October 22nd, 2022, without any restrictions on publication dates. A screening and data extraction tool, Covidence, was used to evaluate the literature against our inclusion and exclusion criteria. Furthermore, a Mixed Methods Appraisal Tool (MMAT) was used to evaluate the selected studies. We identified four studies that presented findings of implementation outcomes research which were related to appropriateness, feasibility, and acceptability. Appropriateness was examined using knowledge scores (p = 0.022) and medication adherence scores (p < 0.05) that showed statistical significance between the control and intervention groups. Acceptability was assessed through a cross sectional quantitative descriptive study that evaluated the reasons for refusal and acceptance of treatment in a cohort of patients suffering from ESRD. Feasibility was examined in one cross sectional, and one mixed methods study that aimed to evaluate and understand the impact of initiating dialysis treatment and the feasibility of maintaining it in low-income families that care for children or adults with ESRD. The preliminary results of this review indicate a gap in the availability of implementation research studies about ESRD in Pakistan. The burden of ESRD, and the implementation methods by which it is treated is notable in Pakistan and requires evidence-based measures to be implemented to support the critical healthcare delivery platforms that provide treatment.

Burden of Chronic Kidney Disease in Californians with Sickle Cell Disease

Introduction: Chronic Kidney Disease (CKD) is a known complication of sickle cell disease (SCD). Data from contemporary adult cohorts estimating prevalence and burden of CKD in the aging sickle cell population are limited. We used administrative data from the Sickle Cell Data Collection (SCDC) program to estimate the burden of CKD in adults with SCD in California over a 10-year period. We also report mortality data and examine access to specialized care (hematology and nephrology) for SCD patients with and without CKD. Methods: This is a retrospective cohort study of Medicaid-enrolled individuals with SCD in California. Data sources included Medicaid claims, Emergency Department, hospitalization data from 2011 to 2020, and vital records data obtained from the California SCDC program. Individuals aged 18 years or older in 2011, meeting either the confirmed SCD case definition, defined as the presence of laboratory confirmation of SCD, or the SCDC probable case definition of 3 or more SCD-coded encounters during any 5-year period were eligible to be included. We ascertained individuals' CKD status (none versus any, the latter encompassing stages 1 through 5, unspecified stage, and End Stage Renal Disease (ESRD)), based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM diagnosis codes. Hematologist and nephrologist encounters were identified using the National Provider Identifier (NPI) of the rendering provider. Linked death records were used to identify deaths that occurred during the study period. Results: We identified 2,992 individuals with SCD who met inclusion criteria, with 2,311 (77.2%) in the non-CKD group and 681 (22.8%) in the CKD group. The mean age of the cohort at the mid-point of the study was 40.1 years. The CKD population was older in age, and the majority (67.9%) were 30-60-years of age, whereas the non-CKD cohort had majority (61.6%) in the 18-40-year age category. Males had a higher prevalence of CKD when compared to females (26.7% vs. 20.4%). The period prevalence of CKD increased from 8% in the 18-29 year group, to 17% in the 30-39 year group, 24% in the 40-49 year group, 44.6% in the 50- 59 year group and 51.1% for the &amp;gt; 60 years age group. The mean age at first recorded CKD code was 48 years, males were significantly (p&amp;lt;0.05) younger at their first recorded CKD code than females, at 46 and 49 years of age respectively. By first recorded CKD code, one third (33.4%) of individuals had stages 1-2, 39% had stages 3-5, and 4% had ESRD. In contrast, by the latest recorded CKD stage in the 10-year period, more than one-third (35%) had CKD stages 3-5, and 40% reached ESRD. By latest CKD stage, males had more ESRD (40.2%) than stage 3-5 (34.7%), while females had similar burden of ESRD and CKD 3-5 at 37.6% and 38.7% respectively. A total of 478 deaths (15.9%) occurred during the study period, with 50.8% of deaths occurring in the CKD cohort. The median age at death was 53 years for the CKD cohort and 43 years for the non- CKD cohorts, possibly indicating that CKD occurred in patients who did not die of other causes at a younger age. When examining access to care, the median number of visits per year with a hematologist was 0.11 and 0 for the CKD vs. entire cohort respectively. The median number of visits per year with a nephrologist for those with CKD was 0. The proportion of individuals with CKD who had zero visits per year with a hematologist or a nephrologist over the study period was 48% and 61% respectively. Individuals with CKD who died during the study period had a significantly lower number of mean annual visits with a hematologist than those who were alive (1.37 vs 1.23, p&amp;lt;0.001) at the end of the study period. Individuals with CKD who died during the study period had a higher number of visits with a nephrologist than those who were alive (1.56 vs. 2.23, p&amp;lt;0.05) at the end of the study period. Conclusion: CKD poses a significant burden on adults with SCD. In our cohort, males had a higher prevalence of CKD, and the prevalence of CKD increased with age. 40% of individuals with CKD had a latest recorded stage of ESRD. Half of the deaths that occurred during the study timeframe occurred in the CKD cohort. Californians with CKD and SCD had severe restrictions in access to both hematology and nephrology care. Further prospective studies are needed to understand the natural history of CKD in SCD and identify risk factors for progression.

Non-steroidal mineralocorticoid receptor antagonists in patients with chronic kidney disease and type 2 diabetes.

Chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) is a major health challenge associated with a disproportionately high burden of end-stage renal disease, cardiovascular disease and death. This review summarizes the rationale, clinical evidence and practical implementation for non-steroidal mineralocorticoid receptor antagonists (nsMRAs), a drug class now approved and recommended for patients with T2D and CKD at risk of cardiorenal disease progression. Three nsMRAs (finerenone, esaxerenone and apararenone) have been evaluated but finerenone is currently the only approved nsMRA for this indication. Two large-scale, placebo-controlled, Phase 3 studies evaluated finerenone added to a maximally tolerated dose of an angiotensin-converting enzyme inhibitor or an angiotensin II receptor blocker. Over >2 years of treatment, finerenone was associated with a significant reduction in composite endpoints of renal and cardiovascular outcomes versus placebo. Esaxerenone or apararenone have both shown significant improvements in albuminuria versus placebo. In general, nsMRAs were well tolerated. Hyperkalaemia was the most notable treatment-related adverse event and could generally be managed through serum potassium monitoring and dose adjustments. The nsMRAs are now an important component of recommended treatment for CKD associated with T2D, providing a significant reduction in the risk of cardiorenal progression beyond what can be achieved with glucose and blood pressure control.

Quality of Life in End-Stage Renal Disease Patients Undergoing Hemodialysis and Its Affecting Factors in a Hemodialysis Unit of General Hospital Denpasar

End-stage renal disease (ESRD) patients undergoing hemodialysis (HD) repeatedly can affect their quality of life (QOL). Its QOL value can vary according to the patient's characteristics amid health conditions that may make it difficult for them. This study aimed to analyze the QOL of ESRD patients undergoing HD and its affecting factors. This cross-sectional study was conducted in a Hemodialysis Outpatient Unit of General Hospital, Denpasar, Bali, from April to May 2021. A sample of 103 respondents was obtained by using the purposive sampling technique. Inclusion criteria were ESRD patients undergoing HD aged ≥8 years old, completing questionnaires thoroughly, and communicating well. Data was collected through the KDQOL-36 questionnaire to measure the QOL and medical records for completeness of patient identities. Data were analyzed using Spearman's ρ, η, Mann-Whitney, and an Independent sample t-test (CI 95%). Findings showed the majority of respondents were aged &lt;60 years (75.7%), had secondary education (41.7%), were working (50.5%), were diagnosed with ESRD, and undergoing HD &lt;3 Years (81.6%), the duration of each HD &gt;4 hours (85.4%), three times a week (91.3%), having a BMI &gt;29 kg/m2 (89.3%), and hypertension (42.7%). The respondents experienced major problems in their QOL on the burden of ESRD (33.50±24.64), physical (39.57±8.94), and mental component summary (52.62±10.39) dimensions. Respondent's characteristics, including education level, duration of each HD, and diagnosis with ESRD undergoing HD, contributed to their QOL (p &lt;0.05). The patient's QOL needs to be improved through the family and health worker's support.

Extracellular vesicles for ischemia/reperfusion injury-induced acute kidney injury: a systematic review and meta-analysis of data from animal models

BackgroundAcute kidney injury (AKI) induced by ischemia/reperfusion injury significantly contribute to the burden of end-stage renal disease. Extracellular vesicles (EVs), especially for stem/progenitor cell-derived EVs (stem/progenitor cell-EVs), have emerged as a promising therapy for ischemia/reperfusion injury-induced AKI. However, their regulatory effects remain poorly understood, and their therapeutic efficiency in clinical trials is controversial. Here, we performed this systematic review and meta-analysis to assess the stem/progenitor cell-EV efficacy in treating ischemia/reperfusion injury-induced AKI in preclinical rodent models.MethodsA literature search was performed in PubMed, Embase, Scopus, and Web of Science to identify controlled studies about the therapeutic efficiency of stem/progenitor cell-EVs on ischemia/reperfusion injury-induced AKI rodent models. The level of SCr, an indicator of renal function, was regarded as the primary outcome. Meta-regression analysis was used to reveal the influential factors of EV therapy. Sensitivity analysis, cumulative meta-analysis, and assessment of publication bias were also performed in our systematic review and meta-analysis. A standardized mean difference (SMD) was used as the common effect size between stem/progenitor cell-EV-treated and control groups, with values of 0.2, 0.5, 0.8, and 1.0 defined as small, medium, large, and very large effect sizes, respectively.ResultsA total of 30 studies with 985 ischemia/reperfusion injury-induced AKI rodent models were included. The pooled results showed that EV injection could lead to a remarkable sCr reduction compared with the control group (SMD, − 3.47; 95%CI, − 4.15 to − 2.80; P < 0.001). Meanwhile, the EV treatment group had lower levels of BUN (SMD, − 3.60; 95%CI, − 4.25 to − 2.94; P < 0.001), indexes for tubular and endothelial injury, renal fibrosis (fibrosis score and α-SMA), renal inflammation (TNF-α, IL-1β, iNOS, and CD68 + macrophages), but higher levels of indexes for tubular proliferation, angiogenesis-related VEGF, and reactive oxygen species. However, our meta-regression analysis did not identify significant associations between sCr level and cell origins of EVs, injection doses, delivery routes, and therapy and outcome measurement time (all P values > 0.05). Significant publication bias was observed (Egger’s test, P < 0.001).ConclusionStem/progenitor cell-EVs are effective in improving renal function in rodent ischemia/reperfusion injury-induced AKI model. These vesicles may help (i) reduce cell apoptosis and stimulate cell proliferation, (ii) ameliorate inflammatory injury and renal fibrosis, (iii) promote angiogenesis, and (iv) inhibit oxidative stress. However, the current systematic review and meta-analysis did not identify significant influential factors associated with treatment effects. More preclinical studies and thoughtfully designed animal studies are needed in the future.

Chronic Kidney Disease affecting the Characteristics of Blood Pressure: An Observational Study

Background: Chronic kidney disease (CKD) is a global public-health problem that affects millions of individuals. Despite widespread use of medicines to slow the course of CKD, the burden of end-stage renal disease in many affluent nations remains high. Hypertension is far more frequent in persons with CKD than it is in the general population, and it becomes worse as renal function declines. Controlling blood pressure, which is a controllable risk factor for this complication, may reduce the risk of cardiovascular events and decrease the decline of renal function. Objective: To asses the Characteristics of Blood Pressure in Chronic Kidney Disease. Materials and Methods:A cross-sectional Study was conducted at MS Ramaiah Medical College, Bangalore from 1st of January 2018 to 31st of July 2019. A total of 100 Cases were included in the study. Results:In our research, 10% of the participants were under the age of 30. In the research, 33% of the participants had Stage 3 CKD, 35% had Stage 4 CKD, and 32% had Stage 5 CKD. There was a significant difference in mean OSBP and mean ODBP with increasing CKD stage in the research. With rising CKD stage, mean OSBP and ODBP increased. Conclusion: Ambulatory BP measurements revealed a significant degree of overestimation (white coat HTN) and underestimate (masked HTN) of BP among patients with CKD, indicating that adopting ABPM may assist avoid mistakes in BP measurement as well as correct treatment of HTN in CKD.

End of Life Care in End-Stage Kidney Disease.

There is a rise in burden of end-stage renal disease globally and in India. The symptom burden, prognosis, and mortality in chronic kidney disease closely mimics that of cancer. However, the palliative and end of life care needs of these patients are seldom addressed. A consensus opinion statement was developed outlining the provision of end of life care in end-stage kidney disease. Recognition of medical futility, consensus on medical futility, and cessation of potentially inappropriate therapies and medications are the initial steps in providing end of life care. Conducting a family meeting, communicating prognosis, discussing various treatment modalities, negotiating goals of care, shared decision-making, and discussion and documentation of life sustaining treatment are essential aspects of end of life care provision. The provision of end of life care entails assessment and the management of end-stage kidney disease symptoms and the care extends beyond the death of the patient to their families in the bereavement period.

International Comparisons of Economic Burden of EndStage Renal Disease to the National Healthcare Systems

The global prevalence of chronic kidney disease (CKD) is between 11 to 13%. Renal replacement therapies (RRT) – which include dialysis and renal transplantation – consume a significant portion of a country’s health resources even though only 0.1% of all CKD patients are at stage 5, also known as end-stage renal disease (ESRD). The aim of this review was to compare the magnitude of the economic burden of ESRD on national healthcare systems of selected countries with high prevalence of ESRD including Malaysia. The quantity of interest in this review were total ESRD expenditures and its proportions to the national health systems' expenditure. It was identified that total ESRD expenditure contributes between 0.91% to 7.1% of national health system expenditure in countries selected for this review. In Malaysia, the public sector - through its various agencies at the federal and state levels, accounted for almost 70% of dialysis funding; the remaining 30% came from the private sector and out-of-pocket payments. The ESRD expenditures in Malaysia constitutes 4.2% of total health expenditure by the public sector, relatively high compared to other countries. This review will summarise findings of the currently available economic evaluations of RRT in Malaysia. Based on available evidence, estimated weighted cost of treating ESRD patient in Malaysia is MYR39,346 per patient per year (USD26,648, PPP 2016).

Renal Transplant Unit, National Institute of Solid Organ and Tissue Transplantation, Dow University of Health Sciences, Karachi, Pakistan: On a Road to Minimize ESRD Burden

End Stage Renal Disease (ESRD) is clinically defined as the progressive and irrevocable impairment of kidneys to perform life-sustaining functions and represents the final stage of Chronic Kidney Disease (CKD). With bulging morbidity and mortality and rampant rise in economic burden globally, ESRD is now recognized as a major public health issue. Certainly, it goes without saying that coming decades will observe a high prevalence of ESRD, and chronic non-communicable diseases such as hypertension and diabetes mellitus, with accumulating aging population as the driving force. This prognosticated upsurge in ESRD pool has been gauged to occur mainly in the developing countries.

Combined Thoracic-Kidney Transplantation Practices May Exacerbate Existing Geographic Disparities in Access to Deceased Donor Kidney Transplantation

The rate of combined thoracic-kidney transplantation (CTKT) continues to increase. Our allocation system affords these candidates priority over those listed for kidney alone, yet, there are no standard listing criteria for CTKT and practices may vary by center. It is not understood how CTKT impacts access to deceased donor kidney transplantation (DDKT). Here we examine state-level CTKT practices in relation to end stage renal disease (ESRD) burden. This retrospective study identified all patients that received DDKT and the subset of CTKT (heart or lung and DDKT) in 2014-2019 using the Scientific Registry of Transplant Recipients. Recipients were categorized by permanent state of residence at transplant and were excluded if residence was unknown or outside the U.S. Using the U.S. Renal Data System, ESRD burden was defined as 2014 period prevalence of ESRD among adult, transplant-eligible patients per million population (PMP) by state. Eligibility was determined using our institution's standard criteria. Spearman's correlation was used to evaluate state CTKT and DDKT counts. CTKT proportion was compared to ESRD Burden. 70372 DDKT were included, of which 810 were CTKT. CTKT and DDKT counts by state (Figure 1A-B) were highly correlated (r=0.89, p<0.001). However, state-level percent DDKT used for CTKT ranged from 0-2.8% (median 1, IQR 0.62, 1.39). States in the top quartile of CTKT proportion (red bars, Figure 1C) accounted for 51% of all CTKT (412/810). Moreover, 62% of these high CTKT proportion states (8/13) had an ESRD burden lower than the U.S. median (1503 PMP, IQR 974, 1783; Figure1D). These data demonstrate wide variability in proportion of CTKT by state despite correlation of CTKT and DDKT counts. States with high CTKT proportion and low ESRD burden may reflect more liberal listing practices. Our results suggest CTKT practices may exacerbate existing geographic disparities in access to DDKT.

Economic burden and cost-utility analysis of three renal replacement therapies in ESRD patients from Yunnan Province, China.

To compare the economic burden and cost-utility analysis of the renal replacement therapies, including hemodialysis (HD), peritoneal dialysis (PD), and allograft kidney transplantation (KT) among end-stage renal disease (ESRD) patients from Yunnan Province, China. Multistage stratified random sampling method was used to select presentative sample of 298 patients from four hospitals in Yunnan Province. The two-step model was applied to calculate a direct economic burden; the human capital approach was used to analyze the indirect economic burden. SF-36 scale was applied to assess the quality of life, while the improving score of quality of life was used to evaluate the cost-utility score. A total of 298 patients were analyzed, including 108 HD patients, 91 PD patients and 99 KT patients. The mean unit economic expenses of HD, PD, and KT were $11,783.6 ± 402.63, $11,059.8 ± 709.51, and $21,151.1 ± 11,419.57, respectively. Based on the cost-utility analysis, the cost of improving one unit of quality of life in KT, PD, and HD was $599.86, $1373.89 and $2021.20, respectively; a significant difference was observed between the KT group and the HD or PD group (P < 0.05). The economic burden of ESRD in Yunnan was substantial. The cost-utility was the best in the renal transplantation group. Kidney transplantation is still recommended as the first approach for patients with ESRD, followed by PD.

Community-Based Dialysis in Saskatchewan First Nations: A Grassroots Approach to Gaining Insight and Perspective From First Nations Patients With Chronic Kidney Disease.

Background:Renal replacement options or dialysis can be delivered in the home setting or hospital setting. Home dialysis offers a number of benefits over hospital-delivered dialysis. These advantages include improved quality of life, less travel, and fewer dietary restrictions. Despite the benefits, home-based dialysis therapies are significantly underutilized by First Nations with only 16.2% uptake versus 25.7% uptake in non-First Nations people in Saskatchewan. It is important to recognize that First Nations have a greater burden of end-stage renal disease including higher prevalence, younger age at diagnosis, increased severity of disease, mortality at an earlier age, and increased travel distance to access kidney services.Objective:The goal of this study is to identify the existing barriers to home peritoneal dialysis and provide insight for future programs in Saskatchewan First Nations communities in a culturally meaningful framework.Design:Through qualitative research utilizing sharing circles and individual interviews, barriers to utilizing home-based dialysis were identified.Setting:Four sharing circles were held and interviews were conducted with four First Nations dialysis patients.Participants:Total number of participants in sharing circles were 67. Sharing circles were composed of patients with chronic kidney disease, patients on hospital-based dialysis, patients on home-based peritoneal dialysis, family members, health care providers (nurses, physicians, dietitians, primary care director, and coordinators). Face-to-face interviews were conducted with four First Nations dialysis patients.Measurements:The data from the sharing circles and interviews were transcribed and analyzed by a PhD researcher using constructivist grounded theory, with elements of narrative inquiry to ascertain participants’ experiences of care. Data were coded and then grouped into categories using qualitative research software NVivo. Saturation of data was achieved.Methods:Documenting and recounting patient and community experience with chronic kidney disease through sharing circles involving patients, family members, and health care providers has been the central information base for this project. Qualitative interviews were conducted with patients who currently use home dialysis and those who travel to hospital for dialysis. Written consent was obtained from all participants. Information was gathered via audio recording of all sharing circles and interviews. Transcription of the interviews was completed with confidentiality maintained during transcription.Results:The main theme of our results was addressing the underutilization of home-based peritoneal dialysis in First Nations Communities. Five subthemes emerged from the main theme and included logistics, education and information, training and support, community support, and culture and leadership. Through sharing circles, a secondary theme of observations about living with chronic kidney disease and experiences of being on dialysis was explored.Limitations:A small number of First Nations communities were involved in this project, and although the data reached saturation, we cannot presume that the information is representative of all First Nations in Saskatchewan. There were a limited number of patients currently on home-based peritoneal dialysis, and therefore their perceptions may not be adequately captured. Participant characteristics (patient, caregiver, nurse, etc) were not captured when speaking in the sharing circles, and therefore participants are not classified when quoted.Conclusions:Strategies to help improve home-based dialysis included improved education, local support, integrated traditional medicine, cultural sensitivity, and leadership prioritization.

Microalbuminuria and Traditional Serum Biomarkers of Nephropathy among Diabetic Patients at Mbarara Regional Referral Hospital in South Western Uganda.

Background Diabetic nephropathy (DN) is a common finding in diabetic patients. Microalbuminuria is the earliest clinical evidence of DN. Early detection of microalbuminuria is very important; it allows timely interventions to prevent progression to macroalbuminuria and later end-stage renal disease (ESRD). Objectives To determine the prevalence of microalbuminuria in diabetic patients and establish its association with traditional serum renal markers in assessment of incipient nephropathy. Methods This cross-sectional study involved 140 participants with diabetes mellitus (DM) attending the diabetic clinic of Mbarara Regional Referral Hospital. Questionnaires were used to obtain participant data after obtaining written informed consent. Data collected included: age, sex, level of education, history of smoking and alcohol consumption, hypertension, body mass index, family history, and duration of DM. Morning spot urine samples were collected from each participant and blood drawn for analysis of other renal markers. Urine microalbumin was determined quantitatively using immunoturbidity assay (Microalbumin kit, Mindray). Serum creatinine and uric acid and glucose levels were determined by spectrophotometric methods. Results The overall prevalence of microalbuminuria was 22.9%. Using a simple and multiple linear regression model, serum creatinine (β = 0.010, 95% CI (0.005, 0.014), P = 0.0001) and glucose (β = 0.030, 95% CI (0.011, 0.048), P = 0.0017) levels were significantly associated with microalbuminuria. After adjusting for linearity, family history of DM was the only predictor of microalbuminuria (β = 0.275, 95% CI (0.043, 0.508), P = 0.002). Although microalbuminuria was weakly associated with eGFR (OR = 1.2, 95% CI (0.24, 5.96)), the relationship was not statistically significant (P = 0.824). Conclusion The prevalence of microalbuminuria in patients with diabetes in this study was high. The study suggests the need to screen for microalbuminuria early to reduce the possible burden of ESRD. When serum creatinine is used as a renal function marker among diabetic patients, it should be combined with microalbuminuria for better assessment of incipient nephropathy.

Etiology of Renal Replacement Therapy in Iran.

Introduction End-stage renal disease (ESRD) is one of the most common life-threatening diseases. In the past two decades, several factors were held responsible as the cause of this condition. The present study aimed to determine the causes of ESRD in the province of Khorasan Razavi, Iran. Materials and Methods This cross-sectional study was conducted on 2404 ESRD patients who referred to 39 hemodialysis centers in Khorasan Razavi province, Iran, and were registered in the Mashhad University of Medical Sciences (MUMS), between 2000 and December 2018. Sociodemographic data and causes of ESRD were extracted from data registry. Results The mean age at onset of hemodialysis for 2404 patients was 52.8 ± 16.4 years, and 57.1% of the patients were male. Clinical profile of hypertension (28.3%) and diabetes mellitus (24.8%) were the most common known causes of ESRD in our patients. Hypertension was more prevalent in male patients compared with females (30 vs 25%, respectively) while diabetes was more prevalent in females compared with males (25.4 vs 24.4%, respectively), p=0.009. Educational level was significantly associated with the cause of ESRD (p < 0.001). Age of onset of ESRD in hypertensive patients was significantly lower compared with diabetic patients (51.5 ± 16.3 vs 58.28 ± 12.9 years, respectively; p < 0.001). Conclusions In the current study, the most common causes of ESRD were hypertension and diabetes mellitus. Primary prevention of hypertension and diabetes and proper treatment must be considered to reduce the burden of ESRD in Iran.

Burden of End-Stage Renal Disease and Access to Kidney Transplant in the African American and Hispanic/Latino Population

Burden of End-Stage Renal Disease and Access to Kidney Transplant in the African American and Hispanic/Latino Population

Burden of end-stage renal disease and evolving challenges in kidney transplantation.

Burden of end-stage renal disease and evolving challenges in kidney transplantation.

Racial disparities in end-stage renal disease in a high-risk population: the Southern Community Cohort Study

IntroductionThe Southern Community Cohort Study is a prospective study of low socioeconomic status (SES) blacks and whites from the southeastern US, where the burden of end-stage renal disease (ESRD) and its risk factors are high. We tested whether the 2.4-fold elevated risk of ESRD we previously observed in blacks compared to whites was explained by differences in baseline kidney function.MethodsWe conducted a case-cohort study of incident ESRD cases (n = 737) with stored blood and a probability sampled subcohort (n = 4238) and calculated estimated glomerular filtration rate (eGFR) from serum creatinine. 86% of participants were enrolled from community health centers in medically underserved areas and 14% from the general population in 12 states in the southeastern United States. Incident ESRD after entry into the cohort was ascertained by linkage of the cohort with the US Renal Data System (USRDS).ResultsMedian (25th, 75th percentile) eGFR at baseline was 63.3 (36.0, 98.2) ml/min/1.73m2 for ESRD cases and 103.2 (86.0, 117.9) for subcohort. Black ESRD cases had higher median (25th, 75th) eGFR [63.3 (35.9, 95.9)] compared to whites [59.1 (39.4, 99.2)]. In multivariable Cox models accounting for sampling weights, baseline eGFR was a strong predictor of ESRD risk, and an interaction with race was detected (P = 0.029). The higher ESRD risk among blacks relative to whites persisted (hazard ratio: 2.58; 95% confidence interval: 1.65, 4.03) after adjustment for eGFR.ConclusionIn this predominantly lower SES cohort, the racial disparity in ESRD risk is not explained by differences in baseline kidney function.

Economic Burden of ESRD to the Malaysian Health Care System

IntroductionPrevalence of chronic kidney disease (CKD) in Malaysia is 9.07% of the total population, of which 0.36% are at stage 5 CKD or end-stage renal disease (ESRD). Public-private partnership has improved accessibility of renal replacement therapies (RRT), especially dialysis, in Malaysia, but the economic burden of the existing RRT financing mechanism, which is predominantly provided by the public sector, has never been quantified.MethodsPrimary data were collected through a standardized survey, and secondary data analysis was used to derive estimates of the ESRD expenditure.ResultsTotal annual expenditure of ESRD by the public sector has grown 94% within a span of 7 years, from Malaysian Ringgit [MYR] 572 million (US dollars [USD] 405 million, purchasing power parity [PPP] 2010) in 2010 to MYR 1.12 billion (USD 785 million, PPP 2016) in 2016. The total ESRD expenditure in 2010 constituted 2.95% of the public sector’s total health expenditure, whereas in 2016, the proportion has increased to 4.2%. Only 6% of ESRD expenditure was spent on renal transplantation, and the remaining 94% was spent on dialysis.ConclusionThe share of ESRD expenditure in total health expenditure for the public sector is considered substantial given only a small proportion of the population is affected by the disease. The rapid increase in expenditure relative to the national total health expenditure should warrant the relevant authorities about sustainability of the existing financing mechanism of ESRD and the importance to institutionalize more drastic preventive measures.

Outcomes of radiocephalic fistula created by nephrologists.

Arteriovenous fistula is considered as gold standard access for maintenance hemodialysis. Due to increasing burden of end-stage renal disease requiring dialysis, it is important for nephrologists to complement creation of arteriovenous fistula to meet the demand. This retrospective study was designed to assess the outcomes of arteriovenous fistula made by nephrologists at a tertiary care center from North India. The study included all radiocephalic arteriovenous fistula performed by nephrologists between November 2015 and January 2017. All arteriovenous fistulas were performed in patients whose duplex ultrasonography revealed both arterial and venous diameter of at least 2 mm. Data were collected with regard to age, gender, dialysis status, basic diseases, co-morbidities, and mineral bone disease parameters. The predictors of the primary and secondary patency rates were analyzed. Five hundred patients (age 39.3 ± 14.4 years; 82.4% males; 21.6% diabetics) were included. In total, 83 (16.6%) patients had primary failure and 31 (7%) patients had secondary failure. Diabetes was associated with poor primary and secondary patency rates. Mean survival among the patients without primary failure was 11 months. The primary patency rates at 3, 6, 12, 18, and 21 months were 82%, 78%, 73%, 70%, and 70%, respectively. To conclude, the outcomes of radiocephalic arteriovenous fistulas created by nephrologists are at par with historic outcomes.