Renal Failure Replacement Therapy Research Articles

FEATURES OF THE DAILY PROFILE OF ARTERIAL PRESSURE AND THE POSSIBILITY OF DOCLINE DIAGNOSTICS OF ARTERIAL HYPERTENSION IN CHILDREN WITH TYPE 1 DIABETES

Diabetic nephropathy takes a leading place among diseases requiring replacement therapy for renal failure, and is also a leading cause of disability and mortality among patients with type 1 diabetes. The development of arterial hypertension is one of the markers of the formation of diabetic nephropathy. We performed a prospective cohort study. A comprehensive clinical and instrumental examination of 78 children with type 1 diabetes was carried out. The features of changes in the daily profile of blood pressure and microcirculatory disorders in children before the formation of diabetic nephropathy were revealed. A mathematical model is developed for predicting the development of arterial hypertension by determining microcirculation parameters using a laser Doppler flowmeter. Early diagnosis will allow timely prescribing of pathogenetic treatment, improving the prognosis of this category of patients.

TAKING VIRUSES TO HEART: AN INTERESTING CASE OF COXSACKIE MYOCARDITIS

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Diagnosing the cause of heart failure in young, healthy adults can be challenging and often associated with high morbidity. Here, we present a case of heart failure associated with viral myocarditis in a patient with a bicuspid aortic valve. CASE PRESENTATION: A 28-year-old man with no medical history presented with epigastric pain, nausea, vomiting, chest pain, and chills. On initial evaluation, he was afebrile, with a blood pressure of 102/72 mmHg, and a heart rate of 127 bpm. A 2/6 mid-systolic murmur and 2/6 early diastolic murmur were heard without jugular venous distension. Otherwise, his exam was unrevealing. Labs were significant for elevated liver function tests (AST 372 U/L and ALT 422 U/L), elevated creatinine of 1.64 mg/dL (no baseline available), and an elevated white blood cell count of 14.7 K/uL. Abdominal computed topography was unremarkable. A transthoracic echocardiogram showed a dilated left ventricle with moderate to severe global hypokinesis with an ejection fraction of 30%. A large 2.8 cm x 1.0 cm mass on the aortic valve was seen causing aortic stenosis and moderate to severe aortic regurgitation, concerning for endocarditis. The patient was empirically initiated on gentamicin and vancomycin but clinically deteriorated into presumptively septic shock requiring supplemental oxygen, vasopressors, and continuous renal replacement therapy for renal failure. He was taken to the operating room for emergent resection and replacement of the aortic valve. However, intraoperatively the surgeon found and removed a heavily calcified bicuspid aortic valve. His blood cultures and microbiology of his valve revealed no infectious organisms; antibiotics were discontinued. Slowly he improved clinically. Without clear reason for his decompensation, a viral panel was obtained and returned positive for coxsackie B virus. DISCUSSION: In the United States, myocarditis is uncommon, impacting only one percent of the population. The Coxsackie viruses are the most common cause of infectious myocarditis, and predominantly affect men with the average age of onset being 42 years old. The cardiac manifestations of the virus typically occur two weeks after viral infection and are caused by direct cytopathic effects, pathologic immune responses, or autoimmunity triggered by the infection. Therapy with ribavirin has shown to reduce mortality in rodent models if initiated soon after inoculation which limits its applicability in human treatment. In this patient, his viral illness precipitated his acute clinical condition in the setting of a congenital bicuspid aortic valve with calcification, and he was treated with supportive therapy. CONCLUSIONS: This case highlights the importance of evaluating for viral myocarditis in young patients with acute heart failure and nonspecific symptoms and the need to remain vigilant for undiagnosed structural heart defects in otherwise healthy patients. Reference #1: Tam, Patricia E. "Coxsackievirus myocarditis: interplay between virus and host in the pathogenesis of heart disease.” Viral immunology 19.2 (2006): 133-146. Reference #2: O.V. Blagova, O.V. Blagova, A.V. Nedostup, E.A. Kogan, V.P. Sedov, Y.U.V. Frolova, S.L. Dzemeshkevich, A.G. Kupryanova, V.A. Zaidenov, A.E. Donnikov; High prevalence of viral and immune myocarditis in patients with "idiopathic” and genetic dilated cardiomyopathy: biopsy proved diagnosis, European Heart Journal, Volume 34, Issue suppl_1, 1 August 2013, P4238, https://doi.org/10.1093/eurheartj/eht309.P4238 DISCLOSURES: No relevant relationships by Kara Calhoun, source=Web Response No relevant relationships by Jennifer Duke, source=Web Response No relevant relationships by Brandy McKelvy, source=Web Response No relevant relationships by Abin Puravath, source=Web Response

High-Urgency Renal Transplantation for Patients With Vascular Access Failure: A Single-Center Experience

In the face of access failure for renal replacement therapy or severe complications despite or due to dialysis, high-urgency renal transplant (HU-RT) allocation is possible. Vascular access failure patients have multiple comorbidities and a higher risk of cardiovascular and thrombotic events. Thus, it is presumed that graft and patient survivals might be worse for these patients.The aim of this paper was to analyze the characteristics and outcomes of HU-RT patients due to access failure for renal replacement therapy when comparing them to a population of deceased-donor renal transplant (DDRT) patients.We analyzed data from our Renal Transplantation Unit from January 2006 to April 2017. In this period, 374 patients had a renal transplant. Of these, 11 patients received a high-urgency deceased-donor renal transplant (HU-DDRT).Compared with patients who had a DDRT, HU-DDRT patients were predominantly female (54.5% vs 43.5%, P = .007) and younger (41.6 ± 7.9 vs 49.4 ± 11.8, P = .031). HU-DDRT patients were not significantly more sensitized than DDRT (14.1 ± 27.4 vs 13.5 ± 24.1, P = .935), and had a comparable number of HLA mismatches (3.4 ± 1.4 vs 3.6 ± 1.2, P = .343). Despite the higher incidence in hypertensive (90.9 vs 73.5%, P = .196) and diabetic patients (27.3% vs 15.7%, P = .305) in the HU-DDRT group, this difference was not statistically significant. The percentage of retransplantation was similar in both groups (9.1% vs 7.2%, P = .808). Donor sex, age, and baseline serum creatinine were similar between the groups. There was an increased proportion of expanded criteria donors in HU-DDRT (54.5% vs 25.1%, P = .028).There were no differences in cold or warm ischemia time nor in serum creatinine at discharge or during the first 2 years of follow-up. In both groups, a similar proportion of patients experienced acute rejection episodes. Comparable to DDRT patients, HU-DDRT patients had a high proportion of graft survival at the 1-year follow-up (90.9% vs 93.1%, P = .777). At a 2-year follow-up, graft survival was lower in the HU-DDRT group (81.8% vs 91.5%, P = .267).Mean follow-up for both groups was comparable (78.5 ± 46.7 vs 68.4 ± 40.8 months, P = .424). Overall, graft loss occurred in approximately 36.4% of HU-DDRT patients and 20.9% of DDRT patients (P = .219). Both groups had an overall mortality rate of around 9%. The differences were not statistically significant due to the limited number of patients.More comorbidities and reportedly worse cardiovascular prognosis of access failure (AF) patients and use of expanded criteria donors did not negatively reflect in worse short-term outcomes in our cohort, which highlights the importance of HU-RT in prolonging the survival of AF patients.

Multi-factor analysis of failure of renal replacement therapy in acute renal failure developed after cardiac surgery

IntroductionAcute renal failure (ARF) is a rare (2-15%), but severe complication of cardiac surgery with overall mortality reaching 40-80%. In order to save patients’ lives they are treated with renal replacement therapy (RRT). The aim of our study was to assess the impact of different perioperative factors on mortality among patients treated with RRT because of acute renal failure, which occurred as a complication of a heart surgery.Material and methodsRetrospective analysis included 45 patients, operated in the years 2009-2013, who underwent renal replacement therapy in order to treat postoperative ARF. The perioperative factors were analysed in two groups: group 1 – patients who died before discharge; and group 2 – those who survived until hospital discharge.ResultsForty-five of 3509 cardiac surgical patients (1.25%) required RRT after the surgery. A total of 23 (51.11%) died before discharge (group 1). Patients in group 1 were characterised by older age (70.21 vs. 67 years), higher mean EuroSCORE value (9.28 vs. 7.15) (p < 0.05), higher percentage of concomitant surgery (63.63% vs. 28.57%) (p < 0.05) and of admission of catecholamines in the postoperative period (100% vs. 68.42%) (p < 0.005), and higher mean urea blood level prior to RRT initiation (156.65 vs. 102.54 mg/dl) (p < 0.05).ConclusionsThe statistically relevant death predictors proved to be: high EuroSCORE, concomitant surgery, and high urea level at RRT initiation and admission of catecholamines in the postoperative period. After conformation in further studies, those factors may prove useful in stratification of death risk among surgical patients requiring RRT.

Autosomal recessive polycystic kidney disease: radiologic-pathologic correlation.

Autosomal recessive polycystic kidney disease is a heritable but phenotypically variable disorder characterized by varying degrees of nonobstructive renal collecting duct ectasia, hepatic biliary duct ectasia and malformation, and fibrosis of both liver and kidneys. In the kidney, the dilated collecting ducts and interstitial fibrosis, when severe, may significantly impair renal function and result in hypertension and renal failure. Imaging typically shows large but reniform kidneys, diffusely increased renal parenchymal echogenicity at ultrasonography, and a striated nephrogram after contrast material administration. In the liver, periportal fibrosis accompanies the malformed and dilated bile ducts; this may result in portal hypertension. The liver may appear normal or may show intrahepatic biliary dilatation; once portal hypertension develops, splenomegaly and varices are usually evident. The relative degrees of kidney and liver involvement tend to be inverse: Children with severe renal disease usually have milder hepatic disease, and those with severe hepatic disease tend to evidence mild renal impairment. Presently, treatment consists of supportive management and control of hypertension. Replacement therapy for renal failure (dialysis or kidney transplantation) and control of portal hypertension (portal circulatory diversion or liver transplantation) may be necessary.

Geographical variation in the referral of patients with chronic end stage renal failure for renal replacement therapy

The number of dialysis units per million population is low in the UK by comparison with other European countries, and this may affect the referral of patients for renal replacement therapy. We used a Poisson regression model to analyse the spatial distribution of all 539 adult patients resident in south-west Wales (Dyfed and West Glamorgan) who started chronic renal replacement therapy between April 1985 and March 1994. Controlling for patient age, population distribution, socio-economic variables and ethnic group, there was a significant negative relationship between referral rates and distance of residence from the renal unit for patients aged over 60 years, but not for younger patients. The prevalence of renal replacement therapy rose from 128 to 454 per million in Dyfed, and from 188 to 647 per million in West Glamorgan, between 1985 and 1995.

Referral of Elderly Patients with End-stage Renal Failure for Renal Replacement Therapy

An increasing number of patients with end-stage renal failure is being treated in the United Kingdom and in 1987 approximately 50 new patients per million started renal replacement therapy. Nevertheless comparatively fewer patients are treated in this country than in some other European countries and in North America. During the 3 years 1985 to 1988, 95 patients from West Glamorgan started chronic renal replacement therapy (87 patients/million population/year). Of these, 16 were aged 75 years or over on starting treatment. In addition two others attained the age of 75 years during the study period. The proportion of elderly new patients is increasing and in the year 1987 to 1988, 59 per cent were older than 65 years and 32 per cent were older than 75 years. Throughout the United Kingdom many elderly patients are being denied treatment, due partly to under-referral.