End-stage Renal Disease Failure Research Articles

Investigation of the thyroid function in end-stage renal failure disease in a Baquba teaching hospital/Diyala governorate - Iraq

Renal failure is the inability of the kidneys to excrete nitrogenous waste products, resulting in their retention in the bloodstream. Several correlations exist between renal and thyroid functions; however, end-stage renal failure is unlikely to be influenced by thyroid hormone function and is connected to a higher prevalence of hypothyroidism. The purpose of this study is to ascertain how thyroid status and renal function relate to renal failure patients. Serum creatinine and urea levels were tested in 50 healthy persons and 100 patients with renal failure illness. The acquired data showed that, in comparison to the control group, the average levels of creatinine and urea were significantly higher. The sick group recorded (122.98 mg/dL and 6.55 mg/dL) and (28.38 mg/dL and 0.75 mg/dL) in comparison to the control group, which has urea and creatinine values within the virtually normal range, respectively. In contrast, TSH levels showed no significant differences and have values within the normal range of TSH values, with 2.33 mIU/L for the experimental group and 2.0 mIU/L for the control group. In contrast, T4 values of the experimental group showed significantly lower levels than the control group, with 83.42 ng/dL compared to 103.77 ng/dL. T3 values, however, showed no significant changes and remained within the normal range of 1.75 to 1.64 nmol/L. In addition, the results demonstrated significant differences in the mean levels of anti-TPO, anti-Tg, and anti-TSHR antibodies. The anti-Tg showed a significant decrease in mean values, which were 28.89 IU/ml and 79.49 IU/ml compared to the control group ranges of 34.41 and 86.68 IU/mL. Finally, anti-TSHR showed a significant increase in the mean, which was 1.24 IU/L compared to 1.18 IU/L in the control group.

To Evaluate the Epidemiology, Etiology, Risk Factors and Treatment Management in Chronic Kidney Disease in Children, Adult and Geriatric Patients in a Tertiary Care Teaching Hospital in Nellore

Chronic renal failure is a life-threatening disease to society. The study was conducted from October 2021 to June 2023 the study was done in the Nephrology inpatient ward, Vijaya Super Speciality Hospital, Pogathota Nellore, Andhra Pradesh. The study design is a cross-sectional for epidemiology and prospective observational study-1 for etiology, II-risk factors, III-treatment management. The sample size are 381 subjects in that children are 51 subjects, adult 171 subjects and geriatric are 159 subjects. The male are 199 volunteers and the female are 182 volunteers with chronic kidney disease (CKD). The result of this study was the epidemiology factor more in adults (45%) when compared to children (13%) and geriatrics (42%). In the sex parameters are less affected to females (48%) and males (52%) are more affected with chronic kidney disease. The etiology causes in children are glomerulonephritis, adults diabetes mellitus (DM) and geriatrics pyelonephritis these are the main causes for chronic renal disease when compared to other etiological causes. Risk factors in children are congenital defects, adult are diabetes mellitus and geriatric are kidney disease these are the risk factors to the renal failure patients. In treatment management, hemodialysis is the most effective treatment to adults when compared to children’s and geriatric eng stage renal failure disease. The conclusion of this study initially may rectify causes and risk factors of the patients may not high prevalent in end-stage renal failure disease it not cause hemodialysis therapy and renal transplantation in children, adults and geriatric patients.

Parathyroid Cancer—A Rare Finding during Parathyroidectomy in High Volume Surgery Centre

Background and Objectives: Parathyroid cancer is a very rare endocrine tumor, especially in patients with secondary hyperparathyroidism due to end stage renal disease failure. This pathology is difficult to diagnose preoperatively because it has nonspecific clinical manifestations and paraclinical aspects. Our study of the literature identified 34 reported cases of parathyroid carcinoma over the last 40 years in patients undergoing dialysis. We present our experience as illustrative of the features of clinical presentation and histopathological findings of parathyroid carcinoma and assess its management considering the recent relevant literature. Materials and Methods: From January 2012 to November 2022, 650 patients with secondary hyperparathyroidism undergoing dialysis were treated at our academic Department of General Surgery and only two cases of parathyroid carcinoma were diagnosed on histopathological examination. Results: All patients presented with symptomatic hypercalcemia, with no clinical or imaging suspicion of malignant disease and were surgically treated by total parathyroidectomy. Histopathological examination revealed morphologic aspects of parathyroid carcinoma in two cases and immunostaining of Ki-67 was performed for diagnostic confirmation. Postoperative follow-up showed no signs of recurrence and no oncological adjuvant treatment or surgical reinterventions were needed. Conclusions: Parathyroid neoplasia is a particularly rare disease, that remains a challenge when it comes to diagnosis and proper management. Surgical approach is the only valid treatment to remove the malignant tissue and thus improve the patient's prognosis. Medical and oncologic treatment may be beneficial to control hypercalcemia in case of tumor recurrence.

Study of the Anti-Diuretic Hormone (ADH) on End Stage Renal Failure Disease (ESRD) Pre-Hemodialysis in Iraqi Patients

Chronic renal disease (CRD) is a pathophysiologic process with multiple etiologies, resulting in the inexorable attrition of Nephron number and function and frequently leading to end-stage renal disease (ESRD). In turn, ESRD represents a clinical state or condition in which there has been an irreversible loss of endogenous renal function, of a degree sufficient to render the patient permanently dependent upon renal replacement therapy (dialysis of transplantation) in order to avoid life threatening uremia, reflecting a dysfunction of all organ systems as a result of untreated or under treated acute or chronic renal failure. The current study was involved 80 patients, the age range within 25-70 years, selected sample of patients who attend Iraqi center of kidney dialysis, Baghdad Teaching Hospital and Al-Yarmok Teaching Hospital. All the patient's body mass index [BMI] were measured serum anti diuretic hormone ADH was assessed using enzyme linked immunosorbent kit [Elisa] while urea, creatinine, albumin, hemoglobin were determined by spectrophotometer (PD-303), and sodium, potassium, chloride were determined by Electrolyte analyzer 9180.These patients were divided in two group B (40 patients) as pre dialysis with ESRD, and group A (40) healthy control. Results showed non-significant elevations in ADH levels in the patient group compared with the control group, while highly significant increase in urea, creatinine and albumin levels in in the patient group compared with the control group, also highly significant decrease in hemoglobin comparing with the control group. Also, it was observed non-significant decrease in sodium, non-significant increase in potassium and highly significant increase in chloride when comparing with the control group.

Effect of Anti Diuretic Hormon (ADH) in Kidney Function on Post Hemodialysis End Stage Renal Failure Disease (ESRD) Iraqi Patients

Chronic renal disease (CRD) is a patho-physiologic process with multiple etiologies, resulting in the inexorable attrition of Nephron number and function and frequently leading to end-stage renal disease (ESRD). In turn, ESRD represents a clinical state or condition in which there has been an irreversible loss of endogenous renal function, of a degree sufficient to render the patient permanently dependent upon renal replacement therapy (dialysis of transplantation) in order to avoid life threatening uremia. The current study was applied on 80 patients, the age range within 25-70 years, selected sample of patients who attend Iraqi center of kidney dialysis, Baghdad Teaching Hospital and Al-Yarmok Teaching Hospital . All the patients body mass index [BMI] were measured. Serum anti diuretic hormone ADH was assessed using enzyme linked immunosorbent kit [Elisa], and urea, creatinine, albumin, hemoglobin were determined by spectrophotometer (PD-303), and sodium, potassium, chloride were determined by Electrolyte analyzer. The study patients were divided into two groups : GA include the healthy subjects as a control and GB include the post dialysis ESRD patients . The results showed a highly significant increase in ADH , Urea and Creatinine levels in GB when compared with the control and highly significant decrease in albumin and hemoglobin levels in GB when compared with the control. Non -significant decrease in sodium and potassium levels in GB when compared with the control, while highly significant increase in chloride level in GB when compared with the control.

Incidence of Nephrotoxicity Among Patients Initiated on Vancomycin and Β-lactam Combination Therapies

Abstract Background Vancomycin and β-lactam combinations are used to provide empiric coverage in hospitalized patients. Recent literature has illustrated an increased incidence of nephrotoxicity with such combinations, predominantly with piperacillin-tazobactam and vancomycin. The objective of this study is to evaluate the incidence of nephrotoxicity among patients receiving vancomycin and piperacillin-tazobactam vs., cefepime, or aztreonam. Methods A retrospective, observational, cohort study was conducted at Hahnemann University Hospital in adult patients who received vancomycin plus piperacillin-tazobactam, cefepime, or aztreonam for at least 48 hours between June 2013 and August 2016. Patients were excluded if they had chronic kidney disease Stage III or higher or on continuous renal replacement therapy. The following data were collected: demographics, renal function, number of concomitant nephrotoxic agents, total duration of combination therapy, and vancomycin levels. The primary outcome was the incidence of nephrotoxicity according to the Risk Injury Failure End Stage Renal Disease (RIFLE) criteria. Secondary outcomes were the total length of hospital (LOS) and intensive care unit (ICU) LOS. Statistical analyses were conducted using the Analysis of Variance and the Chi-square test. Results A total of 757 charts were reviewed of which 203 were included in the analysis; 69 in the piperacillin-tazobactam arm, 74 in the cefepime arm, and 60 in the aztreonam arm. The incidence of nephrotoxicity as assessed by the RIFLE criteria was higher in the piperacillin-tazobactam arm (41%) compared with cefepime (15%) and aztreonam arms (17%); P = 0.052. Majority of patients with nephrotoxicity experienced injury according to the RIFLE criteria. No differences were found in the total LOS, ICU LOS, or duration of nephrotoxicity. Patients who experienced nephrotoxicity in the piperacillin-tazobactam arm occurred earlier upon antibiotic initiation at 48 hours compared with the other arms extending past 72 hours; P = 0.004. Conclusion There was a trend towards more patients experiencing nephrotoxicity in the piperacillin-tazobactam arm compared with the other groups. Clinicians should remain vigilant when utilizing combination therapy. Disclosures T. Bias, Merck: Grant Investigator, Research grant. The Medicines Company: Speaker’s Bureau, Speaker honorarium.

Oral prostacycline analog and clopidogrel combination provides early maturation and long-term survival after arteriovenous fistula creation: A randomized controlled study.

Vascular access is used as a lifeline for hemodialysis in patients with end stage renal disease failure (ESRD). Failure of arteriovenous fistula (AVF) maturation is still high. The purpose of this study was to research the effects of clopidogrel in combination with oral iloprost, a synthetic analog of prostacyclin PGI2. Ninety-six diabetic ESRD patients were divided into two groups. In the first group (Group 1, N = 50), clopidogrel (75 mg daily dose) and an oral prostacycline analog (200 mg daily dose) were administered. In the second group (Group 2, N = 46), placebo was given. All patients took study medication 7–10 days prior to surgery. A Doppler ultrasound (USG) was performed for measurement of arterial and venous diameters, and peak systolic velocity of arterial flow based on subsequent fistula adequacy. Autogenous AVFs were constructed in forearm as distally as possible in all patients. Both groups were followed-up for a year. In the placebo group, early AVF thrombosis was detected in two patients (4.3%). AVF maturation failure was noted in 14 patients (30.4%) in placebo group and in four patients (8%) in clopidogrel plus oral prostacycline analog group in the early postoperative period (P = 0.001). The mean maturation time was 38 ± 6.5 and 53 ± 12.8 days in study and placebo groups, respectively (P = 0.023). The mean blood flow was 352 ± 94 mL/min in placebo group and 604 ± 125 mL/min in study group (P = 0.001). The arterial end diastolic velocity was 116 ± 14 cm/s in study group and 72 ± 21 cm/s in placebo group (P = 0.036) 1 year after the surgery. Our data indicated that clopidogrel and oral prostacycline analog combination is effective and safe for the prevention of primary AVF failure in hemodialysis patients and decreased acute and chronic thrombotic events.

013 Inflammatory imbalance assessed by Fetuin-A and CRP level is a Ssrong predictor of outcome in acute coronary syndromes-from fast-MI registry

Fetuin-A is an ubiquitary anti-inflammatory protein that counteracts CRP effects and has a protective effect against inflammation and myocardial ischemia. Low fetuin-A has been found to be associated with cardiovascular death in patients with end-stage renal failure disease. Low fetuin-A combined with high CRP level may be used to severe inflammatory imbalance and to predict outcome in acute coronary syndromes (ACS). We measured admission plasma fetuin-A and CRP level in 748 consecutive patients (65 ± 13 years, sex, 389 with ST and 337 without ST elevation) included in the ACS French registry (Fast MI) and correlated these data with the outcome. Tertile was used to define low fetuin-A (tertile 1) and high CRP level (tertile 3). Results: Plasma fetuin-A and CRP concentrations at admission averaged 95 ± 27 mg/L and 11 ± 16UI, respectively with low fetuin-A defined as <69 mg/L and high CRP level as 25UI. At one year follow up (n = 726, 97%), cardiovascular mortality (n = 50, 7%) was 16% (18/111), 9% (21/250) and 3% (11/365) in patients with low fetuin-A/high CRP (n = 111), either low fetuin or high CRP (n = 250) and high fetuin-A/low CRP (n = 365), respectively. By multivaritate analysis low fetuin-A/high CRP level remained independently predictive of outcome (OR = 3.4 [1.6–7.3], p = 0.001, Figure 1) after adjustment to ST elevation, GRACE score and medical treatment. In contrast, CRP and fetuin-A alone failed to predict outcome. Inflammatory imbalance assessed by combining fetuin-A and CRP values is an important predictor of cardiovascular death in ACS patients.

Fetuin-A Is an Independent Predictor of Death after ST-Elevation Myocardial Infarction

Fetuin-A inhibits inflammation and has a protective effect against myocardial ischemia. Its deficiency has been found to be associated with cardiovascular death in patients with end-stage renal failure disease. We investigated the association between plasma fetuin-A and clinical outcome after ST-elevation acute myocardial infarction (STEMI). We measured fetuin-A in 284 consecutive patients with STEMI and correlated these data with the occurrence of death at 6 months (n = 25). We also measured fetuin-A in a control group and chose the 95th percentile as the cutoff to define abnormality. Patient mean (SD) age was 60 (14) years, and creatinine clearance was 83 (31) mL/min; 82% were men. Mean (SD) plasma fetuin-A concentrations at admission [188 (69) mg/L, P = 0.01] and at day 3 [163 (57) mg/L, P <0.0001] were lower in patients than in controls [219 (39) mg/L; 95th percentile 140 mg/L]. Fetuin-A <140 mg/L was observed in 20% of patients at admission vs 40% at day 3 (P <0.001). Fetuin-A concentrations did not correlate with peak cardiac troponin values but did correlate inversely with C-reactive protein (CRP) and NT-pro-brain natriuretic peptide (NT-proBNP). Fetuin-A <140 mg/L at admission (OR = 3.3, P = 0.03) and at day 3 (OR = 6.3, P = 0.002) was an independent correlate of death at 6 months, irrespective of NT-proBNP, CRP, or Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) risk score. Conversely, fetuin-A > or = 140 mg/L was associated with an excellent survival rate [negative predictive value (NPV) = 97% overall], even in high-risk populations with CADILLAC risk score > or = 6 (NPV = 90% in patients). Fetuin-A is an important predictor of death at 6 months in STEMI patients independent of NT-proBNP, CRP, and CADILLAC risk score.