End-stage Renal Failure Patients Research Articles

Seroprevalence occurrence of viral hepatitis and HIV among hemodialysis patients

Patients with chronic renal failure (CRF) were on maintenance invasive haemodialysis (HD) procedure. This procedure by itself affects immunity of the patients and they become more susceptible to viral infections. We investigate the occurrence of HBV HCV and HIV infections in patients with hemodialysis. A retrospective study of 430 endstage renal failure patients referred to hemodialysis department at AlKindy Teaching Hospital Baghdad, Iraq from January 2015 to January 2017 was conducted. Patients were investigated for HBsAg using enzymelabeled antigen test (ForesightEIAUSA) HCV Abs (IgG) specific immunoglobulin using a HCV enzymelabeled antigen test (ForesightEIAUSA) and anti HIV Abs (IgG) using enzymelabeled antigen test (ForesightEIAUSA). The frequency of HBV infection in the first year was not significant between males (111%) and females (000%)(P = 0295). About HCV also there are no significant differences between males (1263%) and females (931%)(P = 0347). After one year of follow up the frequencies of HBV and HCV were not significant between two sexes. Additionally none of the patients had an HIV infection. This study brings to light that HBV and HCV have the same frequencies in both genders and lower occurrence with time. Furthermore HIV was not detected in those patients.

Seroprevalence occurrence of viral hepatitis and HIV among hemodialysis patients.

BackgroundPatients with chronic renal failure (CRF) were on maintenance invasive hemodialysis (HD) procedure. This procedure by itself affects immunity of the patients and became more susceptible to viral infections.Aim of the studyto investigate the occurrence of HBV, HCV and HIV infections in patients with hemodialysis.Patients and methodsA retrospective study of 430 end-stage renal failure patients, referred to hemodialysis department at XXXX Teaching Hospital, Baghdad-Iraq from January-2015 to January-2017. Patients were investigated for HBs-Ag using enzyme-labeled antigen test (Foresight-EIA-USA), HCV- Abs (IgG) specific immunoglobulin using an HCV enzyme-labeled antigen test (Foresight-EIA-USA)and anti - HIV Abs (IgG) using enzyme-labeled antigen test (Foresight-EIA-USA).ResultsThe frequency of HBV infection in the first year was not significant between males (1.11%) and females (0.00%) (P = 0.295). About HCV also there are no significant differences between males (12.63%) and females (9.31%) (P = 0.347). After one year of follow up the frequencies of HBV and HCV were not significant between two sexes. Additionally, no any one of the patients had HIV infection.ConclusionsThis study brings a light on that HBV and HCV were having the same frequencies in both genders and lower occurrence with time. Furthermore, HIV was not detected in those patients.

Renal Osteodystrophy in End Stage Renal Failure Patients on Maintenance Haemodialysis Visiting at Tertiary Care Hospital, Karachi

Objective: To determine the frequency of different patterns of renal osteodystrophy in end stage renal failure patients on maintenance haemodialysis visiting at tertiary care Hospital, Karachi. Methodology: A Cross sectional study was conducted at Nephrology Department, Jinnah Postgraduate Medical Center, Karachi from April to October 2009. Fifty-six (56) patients on maintenance hemodialysis were included through non-probability purposive sampling. Various biochemical parameters of renal osteodystrophy were included in the current study. Serum corrected calcium, phosphate, and alkaline phosphatase and iPTH levels. Chi square test was used to determined frequency of renal osteodystrophy in ESRD patients. Results: Mean age was 45.85 ± 13.5 years. 34 (61%) were male and 22 (39%) were female. Renal osteodystrophy was found in 89%. The most common type was secondary hyperparathyroidism (Osteitis Fibrosa Cystica) in 32%. Hypophosphatemia was observed in 62% while hypercalcaemia in only 7%. Osteomalacia was common in adolescent age group (66%), Osteitis Fibrosa Cystica (OFC) in adult group (36%) while mixed variety in elder group (50%). Similarly OFC was the most common pattern in both genders. Conclusion: In the present study it was concluded that the prevalence of renal osteodystrophy was significantly increased. Secondary hyperparathyroidism (Osteitis Fibrosa Cystica) is the most common pattern of ROD followed by mixed osteodystrophy and adynamic bone disease.

Case Report: Two Cases of Mycobacterium Abscessus Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis (CAPD)

CAPD is an important mode of dialysis for end stage renal failure patients. However, CAPD associated peritonitis remains a challenge with increasing number of cases reported leading to significant morbidity and mortality. CAPD peritonitis caused by non tuberculous Mycobacterium(NTM) is often under-recognized and associated with poor outcome. We reported two cases of Mycobacterium abscessus CAPD peritonitis at our centre with different clinical outcomes. The first patient responded well to the antimicrobial therapy while the second patient succumbed to the infection.

Pleural effusion in end stage renal failure patients

Objectives:The aim of this study was to determine the causes of pleural effusion in patients who experienced end-stage renal failure and did not demonstrate any regression of effusion with dialysis treatment.Methods:Patients with pleural effusion that did not regress though they attained dry weight with dialysis and those with 2 years of follow-up were included in the study. The mean age of the patients was 48.16±14.5 years. Thirty-five patients were receiving hemodialysis treatment and 8 (18%) were continuous peritoneal dialysis patients. Ascites Ascites (n=6), pleural effusion (n=13), both ascites and pleural effusion (n=5), and pleural effusion that was bilateral (n=22, 51%), right-sided (n=13, 30%), and left-sided (n=8:18%) were detected. According to Light’s criteria, the pleural effusion was classified as exudate in 40 (93%) cases and transudate in 3 (7%). Microbiological examination did not identify any pathological agent in any case, and cytological examinations did not reveal atypical cells. The causes of pleural effusion were infection (tuberculosis: n=20, 46%), pneumonia (n=3, 7%), empyema (n=1, 2%), malignancy (lung cancer: n=3, 7%; renal carcinoma: (1, 2%), collagen diseases (n=1, 2%), hepatic abscess (n=1, 2%), pulmonary thromboembolism (n=2, 4%), and idiopathic causes (n=11, 25%).Results:The causes of pleural effusion were infection (tuberculosis: n=20, 46%), pneumonia (n=3, 7%), empyema (n=1, 2%), malignancy (lung cancer: n=3, 7%; renal carcinoma: n=1, 2%), collagen disease (n=1, 2%), hepatic abscess (n=1, 2%), pulmonary thromboembolism (n=2, 4%), and idiopathic cases (n=11, 25%).Conclusion:Tuberculosis was the most common cause of pleural effusion that did not regress with dialysis treatment.

The cardiovascular risk factor profiles among end-stage renal failure patients treated with continuous ambulatory peritoneal dialysis and intermittent hemodialysis.

Cardiovascular (CV) event is the most common cause of death in dialysis patients. Both traditional and nontraditional CV risk factors related to malnutrition, inflammation, and anemia are commonly found in this population. This study was conducted to evaluate the burden factors of CV risk factors and its management in our regularly dialyzed patients. It was a single-center, cross-sectional analysis of prevalent intermittent hemodialysis (IHD) and continuous ambulatory peritoneal dialysis (CAPD) patients followed up in our hospital. Both the traditional and non-traditional CV risk factors were recorded and compared between the two groups. Eighty-eight patients were recruited. Forty-five were treated with CAPD and 43 patients were treated with IHD. The mean age was 49.5 ± 15.17 years old and 54.5% were females. Eighty percent were Malay followed by Chinese (14.7%) and Indian (5.7%). Thirty-eight percent were hypertensive and 17% were diabetic. The mean age of CAPD patients was 48.9 ± 16.9 compared to 50 ± 13.5 years old for IHD patients (P > 0.05). The body mass index (BMI) of CAPD patients was 23.9 kg/m2 versus 21.7 kg/m2 of the IHD (P = 0.04). The systolic and diastolic blood pressure of CAPD patients were 158 and 89 mm Hg in comparison to 141 and 72 mm Hg in IHD patients (P <0.001) and their total and low-density lipoprotein cholesterol level were 5.93 mmol/L and 3.84 mmol/L versus 4.79 mmol/L and 2.52 mmol/L, respectively (P≤0.001). The CAPD patients were hyperglycemic more than IHD patients, although it was not statistically significant. All the nontraditional CV risk factors except serum albumin were comparable between the two groups. Serum albumin in CAPD patients was 35.5 g/L compared to 40.8 g/L in the IHD patients (P <0.001). In our prevalent dialysis-dependent patients, both traditional and non-traditional CV risk factors are common. Due to the prolonged and continuous glucose exposure from the peritoneal dialysis fluid, the CAPD patients had highly atherogenic serum, higher BMI, and intensified inflammation which pre-disposed them to higher CV events.

A Study of Hematological Profile in Patients of Chronic Renal Failure Undergoing Hemodialysis at a Tertiary Health Care Institute

The complete blood count, peripheral blood smear, bleeding time, clotting time and renal function tests of 114 patients of chronic renal failure who had required hemodialysis for a period of at least 3 months prior to the commencement of this study were studied. The purpose of this study was to investigate the derangements in the haematological profile of chronic renal patients undergoing hemodialysis and to correlate the same with the duration and severity of the renal failure. The principal finding in the study was a 100% prevalence of anemia among chronic renal failure patients, which was predominantly of the normocytic normochromic type. Red blood cell count was reduced in nearly all (93%) of study patients. There was also a strong negative correlation (r = -0.74) between haemoglobin and duration of hemodialysis. However, a significant proportion of cases showed abnormal cells in the peripheral blood cells such as burr cells, schistocytes and pencil cells, suggesting other contributing factors to the anemia. Female patients also showed a significantly greater prevalence of increased red cell distribution width (>15%) as compared to males (p = 0.001) and a lower prevalence of normocytic normochromic anemia as compared to males (p = 0.009). White blood cell counts, platelet counts, and bleeding and clotting times were largely within normal limits, and none of these variables showed a statistically significant association with the duration of hemodialysis, or serum creatinine, or serum blood urea nitrogen. The inference from the study is that anemia is a major comorbidity in end-stage renal failure patients, with many factors contributing to it, and detailed workup and effective treatment of anemia is necessary in this group of patients.

P6481Incidence and impact of dialysis modality on acute coronary syndrome and death in end stage renal failure patients

P6481Incidence and impact of dialysis modality on acute coronary syndrome and death in end stage renal failure patients

024 STARFRUIT - THE FORBIDDEN FRUIT FOR RENAL FAILURE PATIENT. REMINDER FROM A FATAL CASE OF NEUROTOXICITY

Category: Other Presenter: Dr KWEK FOONG CHEW Keywords: Starfruit toxicity, neurotoxicity, Hemodialysis, CVVHDF, charcoal hemoperfusion, status epilepticus, seizure Starfruit (SF), also known as Carambola, is common in South East Asia, usually consumed raw or taken as a juice. It is known to cause neurotoxicity due to neurotoxin called Caramboxin. This toxin has a glutamatergic ionotropic molecular action, with potent excitatory, convulsant, and neurodegenerative properties. Here we described a case of fatal starfruit intoxication in an end stage renal failure (ESRF) patient. A 67 years old lady with ESRF whom recently commenced on regular haemodialysis (HD). She presented with hiccups, insomnia, lethargy and episodes of blank stares one day after ingesting two SF. She became unconscious and developed generalized tonic-clonic seizures which progressed to status epilepticus. She was put on mechanical ventilation and required multiple anti-epileptics and propofol infusion. She was treated with HD initially and then was put on continuous veno-venous hemodiafiltration (CVVHDF) and charcoal heamoperfusion treatment. However, she did not obtain any significant neurological recovery. Electroencephalography (EEG) showed an encephalopathic picture. Magnetic resonance imaging (MRI) showed bilateral gyriform hyperintense signal changes and multiple microhemorrhages changes. Eventually she succumbed to nosocomial infection. High index of suspicion and active enquiry regarding SF ingestion is required for ESRF patients presenting with hiccups and seizure. Early diagnosis and treatment is important as immediate haemodialysis is potentially beneficial in starfruit neurotoxicity. Poor conscious level and seizures development in SF neurotoxicity are poor prognosis factors. Patients with renal failure should be advised to avoid starfruit ingestion.

A Review of Arteriovenous Fistulae Creation in Octogenarians

To analyze the outcomes of arteriovenous fistulae (AVFs) creation in octogenarians. A retrospective study of 47 AVFs created in patients aged 80years and above from 2008 to 2014. Patient and AVF characteristics and outcomes were evaluated. Predictors of patency were analyzed with multivariate analysis and Kaplan-Meier patency, and survival analysis was performed. Forty-seven of 1,259 AVFs created were for octogenarians (4%). Mean age was 83years old (range: 80-91 years), with 27 male (57%) and 35 with tunneled dialysis catheters in situ (75%). There were a total of 15 (32%) radiocephalic AVFs, 30 (64%) brachial-cephalic AVFs, and 2 (4%) brachial-basilic transposition AVFs. At 12months, assisted primary patency rate was 28% (13 patients) while primary failure rate was 72% (34 patients). Subset analysis showed brachial-cephalic AVFs to have the highest assisted primary patency rate at 33%. Within 24months, tunneled dialysis catheter-related sepsis rate was 31% (11 patients). Multivariate analysis did not reveal any factor to be statistically significant in predicting AVF patency. Kaplan-Meier survival curve showed a 50% survival rate at 63months after AVF creation. In view of high AVF primary failure rate and relatively low tunneled dialysis catheter bacteremia rate, long-term tunneled dialysis catheters as the main form of hemodialysis renal access may be a viable option. However, with 50% of end-stage renal failure patients surviving up to 63months after AVF creation, the risks and benefits of long-term tunneled dialysis catheters must be balanced against those of AVF creation.

Effect of Alprazolam on Redox Status in Renal Transplantation Donors and Recipients.

BACKGROUND Benzodiazepines are the most popular premedication drugs thought to act through the GABA/benzodiazepine receptor complex and alprazolam is one of the most potent benzodiazepines that have a quick onset. While there is a growing body of evidence supporting alprazolam in the amelioration of redox status in animals, no study has been performed concerning its antioxidant activity in humans. The purpose of this investigation was to determine the effect of alprazolam on redox status. MATERIAL AND METHODS This study was a four-group randomized controlled trial. Participants were recruited from Acibadem University Acibadem International Hospital and included a convenience sample of 82 donors and recipients undergoing renal transplantation. Patients were randomly divided into four groups. While donors and recipients in experimental groups (G1 and G3) were administered alprazolam 0.5 mg orally one hour before the operation, those in control groups (G2 and G4) were not. Serum advanced oxidative protein products, total thiol, free hemoglobin, ischemic modified albumin, and sialic acid levels at different time points were measured to evaluate the redox status. RESULTS All oxidative stress parameters were higher in the alprazolam premedication groups (G1, G3) at all time points than in the control groups (G2, G4). Basal values of oxidative parameters (at time point T1) in patients with CKD (G3, G4) were lower than in healthy donors (G1, G2). CONCLUSIONS Alprazolam premedication in donors and end-stage renal failure patients undergoing renal transplantation does not improve redox homeostasis but further experimental studies are needed.

Characteristics, Management, and Outcomes of Surgically Treated Arteriovenous Fistula Aneurysm in Patients on Regular Hemodialysis

To investigate the clinical characteristics, surgical interventions, and outcomes of arteriovenous fistula (AVF) aneurysms, we retrospectively analyzed patients on regular hemodialysis (HD). We conducted a cohort study of all patients with HD access who presented with AVF aneurysms and underwent operative procedures over a 11-year period. Patients' demographics, comorbidities, vascular access characteristics, management of aneurysms, complications, and outcomes were analyzed. Of the 700 end-stage renal failure patients, 530 patients were maintained on HD (130through PermCath and 400 through AV access in terms of AVF and arteriovenous graft). We identified 129 patients who developed AV aneurysms, and 40 of them required surgical interventions (24 men and 16 women) with a mean age of 58±14.6years. The 40 patients who developed AVF aneurysms underwent 43 surgical interventions. The majority of aneurysms were presented with thinning and ulceration (82.5%) of the overlying skin. Thirty-four patients had true aneurysms and 6 had pseudoaneurysms. The aneurysmal AVF comprised 26 brachiocephalic fistulas, 9 radiocephalic fistulas, 3 brachial artery grafts, 1 ulnar-basilic fistula, and 1 Fem-Fem graft at presentation. Patients were treated mainly with ligation (13; 32.5%), excision and repair with graft interposition (15; 37.5%) or vein interposition (11; 27.5%), and end-to-end AVF (1;2.5%). The median follow-up postsurgery duration was 53months (range 1-192) andthemedian duration from fistula creation to the surgical intervention was 52months (range 4-182). On follow-up, 34 patients continued on HD, while 5 underwent renal transplantation and 1 shifted to peritoneal dialysis. The overall all-cause mortality rate was 37.5% and the leadingcauses of mortality were sepsis/pneumonia (60%), myocardial infarction, and heart failure (40%). In HD patients, the rate of AVF aneurysmal formation is high with a significant rate of morbidity and mortality. Therefore, timely and appropriate evaluation and surgical intervention are crucial.

Peritonitis outcomes in patients with HIV and end-stage renal failure on peritoneal dialysis: a prospective cohort study

BackgroundFew studies have investigated the management of human immunodeficiency virus (HIV)-associated end-stage renal failure particularly in low-resource settings with limited access to renal replacement therapy. We aimed to evaluate the effects of HIV infection on continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis outcomes and technique failure in highly active antiretroviral therapy (HAART)-treated HIV-positive CAPD populations.MethodsWe conducted a single-center prospective cohort study of consecutive incident CAPD patients recruited from two hospitals in Durban, South Africa from September 2012-February 2015. Seventy HIV-negative and 70 HIV-positive end-stage renal failure patients were followed monthly for 18 months at a central renal clinic. Primary outcomes of peritonitis and catheter failure were assessed for the first 18 months of CAPD therapy. We assessed risk factors for peritonitis and catheter failure using Cox regression survival analysis.ResultsThe HIV-positive cohort had a significantly increased rate of peritonitis compared to the HIV-negative cohort (1.86 vs. 0.76 episodes/person-years, respectively; hazard ratio [HR], 2.41; 95% confidence interval [CI], 1.69–3.45, P < 0.001). When the baseline CD4 count was below 200 cells/μL, the peritonitis rate rose to 3.69 episodes/person-years (HR 4.54, 95% CI 2.35–8.76, P < 0.001), while a baseline CD4 count above 350 cells/μL was associated with a peritonitis rate of 1.60 episodes/person-years (HR 2.10, CI 1.39–3.15, P = 0.001). HIV was associated with increased hazards of peritonitis relapse (HR, 3.88; CI, 1.37–10.94; P = 0.010). Independent predictors associated with increased peritonitis risk were HIV (HR, 1.84; CI, 1.07–3.16; P = 0.027), diabetes (HR, 2.09; CI, 1.09–4.03; P = 0.027) and a baseline CD4 count < 200 cells/μL (HR, 3.28; CI, 1.42–7.61; P = 0.006). Catheter failure rates were 0.34 (HIV-positive cohort) and 0.24 (HIV-negative cohort) episodes/person-years (HR, 1.42; 95% CI, 0.73–2.73; P = 0.299). Peritonitis (HR, 14.47; CI, 2.79–75.00; P = 0.001), average hemoglobin concentrations (HR, 0.75; CI, 0.59–0.95; P = 0.016), and average serum C-reactive protein levels were independent predictors of catheter failure.ConclusionsHIV infection in end-stage renal disease patients managed by CAPD was associated with increased peritonitis risk; however, HIV infection did not increase the risk for CAPD catheter failure rate at 18 months.

Intravenous catheter complications in hemodialysis

Background: Vascular access, still is a problem for hemodialysis. Venous catheters are commonly used for acute angioaccess during maintenance hemodialysis in acute renal failure and end-stage renal failure patients. However, the catheters are often complicated by mechanical or infectious complications which may result in morbidity and or premature removal of the catheter. Even though, there are various studies on central venous catheters used in hemodialysis in western countries less is documented in India. Aims and Objectives: Complications of intravenous catheter used during hemodialysis in our set up. Materials and Methods: This prospective study was conducted on 110 patients selected by random sampling in dialysis units of a government district hospital from October 2014 to September 2015. Patient age, sex, history, type of kidney disease, and associated conditions were also noted according to the pro forma. Date of intravenous catheter insertion, site of insertion, and insertion complications were noted. All patients were followed up until the day of catheter removal. Date of catheter removal, reason for catheter removal, and duration of catheter days were noted. Data were collected and tabulated. Result: Only 47.8% of patients suspected with infections showed bacterial growth in catheter tip culture. However, blood culture showed bacterial growth only in 19.6% of infection suspected patients. Blood culture reported 55.6% Staphylococcus aureus growth followed by Pseudomonas (22.2%), Escherichia coli, and Acinetobacter (11.15%) growth in samples collected from infection suspected dialysis patients. Conclusion: Fever due to infections is the most common cause for catheter removal.

Shift in paradigm: understanding adjustment of dialysis patients

End stage renal failure (ESRF) and its treatment can lead to adjustment difficulties. However, the extent of these difficulties is not known. Adjustment is a complex and multidimensional construct. In general beliefs about illness and its treatment influence adjustment but the findings are inconsistent. This is probably because adjustment and beliefs have been defined in a variety of ways based on professional or theoretical views. One possible way of establishing a standard approach to defining adjustment and beliefs is to be guided by patients’ own views. Qualitative studies identify ways of evaluation of life and beliefs about ESRF and its treatment that have not been identified by quantitative studies. These findings can be considered as patient-derived targets for psychoeducational programs or clinical practice for ESRF patients. However, qualitative research cannot provide evidence about the frequency of patients’ beliefs and ways of evaluation of life. Therefore, questionnaires have been developed on the basis of qualitative findings. These helped to examine the utility of the findings for clinical practice, and understand the relationship of quality of life with beliefs. More research is needed to investigate how the findings on these questionnaires converge and diverge with those on existing generic and/or ESRF specific quality of life and beliefs measures.

Correlations of serum magnesium with dyslipidemia in patients on maintenance hemodialysis

Correlations of serum magnesium with dyslipidemia in patients on maintenance hemodialysis

Relationship between serum apelin and cardiac parameters in hemodialysis patients

Objectives The aim of this work was to study the apelin level in hemodialysis (HD) patients and assess its association with cardiac parameters among these patients. Background Mortality in end-stage renal disease (ESRD) patients on maintenance HD is higher by several folds compared with that in the general population, and up to 50% of deaths in these patients are caused by cardiovascular diseases. Apelin, which is a recently discovered active peptide, has a broad range of physiological and pathological actions. Patients and methods A total of 80 nondiabetic end-stage renal failure patients on regular HD, in addition to 20 apparently healthy individuals as the control group, were studied. Lipid profile, serum apelin level, and echocardiography were measured in all patients. Results Serum apelin is highly significantly lower in ESRD patients on maintenance HD compared with that in the control group (P ≤ 0.001). Serum apelin was significantly positively correlated with left ventricular end-systolic dimension (r = 0.290, P = 0.038), left ventricular end-diastolic dimension (r = 0.30, P = 0.021), interventricular septum (r = 0.295, P = 0.036), right ventricle (r = 0.271, P = 0.042), left atrium (r = 0.357, P = 0.014), and aorta (r = 0.339, P = 0.023) in ESRD patients. Conclusion The apelin level was highly significantly lower in HD patients and it was significantly positively correlated with echocardiographic parameters. Thus it might be involved in the pathophysiology of cardiovascular disease in ESRD.

PREVALENCE OF CARDIOVASCULAR DISORDERS BEFORE AND AFTER RENAL TRANSPLANTATION

Renal transplantation is the optimal approach to management of patients with terminal end-stage renal failure (ESRF). The leading position in the mortality structure of recipients of kidney transplants belongs to cardiovascular disorders. The review analysis the causes and the role of arterial hypertension, myocardial hypertrophy, congestive heart failure, coronary artery disease, and dyslipidemia at different stages of chronic kidney disease (the initial pre-dialysis stage, the hemodialysis or peritoneal dialysis stage, and the post-transplant stage), as well as the possibilities of management of cardiovascular complications. Despite the fact that a successful transplantation would lead to restoration of the renal function, the prevalence of post-transplant arterial hypertension remains significant and continues to be a major prognostic factor. Arterial hypertension in ESRF patients triggers myocardial and chamber remodeling, mediated by left ventricular hypertrophy. Left ventricular hypertrophy progression due to fibrotic proliferation underlies the systolic and diastolic dysfunction, as well as electrical instability of the myocardium, which leads to such clinical conditions as heart arrhythmias and congestive heart failure. The development of congestive heart failure in transplant recipients has been recognized as an unfavorable prognostic factor. The high prevalence of coronary artery disease among the kidney recipients is related to such risk factors as left ventricular hypertrophy, decreased myocardial contractility, anemia, hypertension, and diabetes mellitus. Screening for coronary artery disease in patients with ESRF awaiting for transplantation, with subsequent preventive revascularization, may reduce perioperative risks of adverse cardiovascular events and improve long-term results of transplantation. Disorders of lipid metabolism related to ESRF are an independent risk factor for coronary atherosclerosis and coronary artery disease. Even after a successful renal transplantation, dyslipidemia remains a significant problem with its specific characteristics. In addition to its effect on cardiovascular morbidity, the lipid disorders can deteriorate renal function. Identification of potentially reversible risk factors for cardiovascular events and their early management are a key strategy that determines the life longevity and quality of life in renal transplant recipients. A thorough screening for risk factors in this patient category is necessary to optimize their management.

Impact of Chronic Kidney Insufficiency on Cardiovascular Outcomes in Patients that Undergo Coronary Revascularization: A Historical Review

Chronic kidney disease (CKD) is associated with poorer short and long-term cardiovascular morbidity and mortality. Even after the commencement of haemodialysis in end stage renal failure patients, mortality exceeds 20% in the first year1. More than 50% of these deaths are contributed by cardiovascular diseases (CVD), of which 20% are caused by acute myocardial infarction2. Consequent to these findings, the degree and impact of coronary revascularization on CKD patients represents a clinical challenge, especially in the setting of advanced stages of CKD.

Computed Tomography Coronary Angiogram to Exclude Significant Coronary Artery Disease in Prospective Renal Transplant Candidates

Background: Patients with end stage renal failure (ESRF) require exclusion of significant coronary artery disease (CAD) before being listed for renal transplant. Functional assessment such as stress echocardiography is usually performed initially but these often have equivocal results in this population. CT coronary angiography (CTCA) may be an appropriate second line test to exclude CAD rather than an invasive coronary angiogram (ICA). Methods: Patients undergoing CTCA (Siemens Definition Flash) following abnormal or equivocal stress echocardiography were evaluated for image quality, diagnostic findings and whether they required ICA before being listed for transplant assessment. The studies were co-reported by a radiologist and cardiologist. Results: Twenty-three ESRF patients aged 49 ± 9.0 years with average BMI 31 ± 6 kg/m2, 56 % Pacific Islander, 30 % Māori. All were on renal replacement therapy, 58 % due to diabetic nephropathy. Image quality was good (38 %) or adequate (54 %) and 4 % of scans were of poor quality. CTCA demonstrated that fourteen (58 %) had non-significant CAD while eight (33 %) had significant CAD; one was non-diagnostic. No non-diabetic patients had significant CAD (p < 0.05). Of the eight patients with significant CAD, four proceeded to ICA (one false positive). Three of the fourteen patients with non-significant CAD proceeded to renal transplant. Conclusion: CTCA excluded significant CAD in approximately half of ESRF patients who had an equivocal stress echocardiogram, allowing them to be listed for renal transplant. CTCA may be particularly useful in the non-diabetic ESRF population.