Form Of Renal Replacement Therapy Research Articles

Renal replacement therapy in critical ill patients

Acute kidney injury (AKI), especially when caused or accompanied by sepsis, is associated with prolonged hospitalization, progression of chronic kidney disease (CKD), financial burden on the health care system, and increases mortality in various entities. Extended renal replacement therapy (CRRT) is the predominant form of renal replacement therapy (RRT) in intensive care units (ICU) by providing hemodynamic stability in critically ill patients, more precise control of fluid balance, correction of acid-base imbalances, electrolyte disorders and achieving a stable level of osmolarity correction, including in multimorbid patients. This article examines the various aspects of CRRT in critically ill patients with severe AKI with high comorbidity, as well as in patients with sepsis and multiple organ failure. An analytical evaluation of the choice of CRRT over intermittent/intermittent hemodialysis (IHD) in selected clinical settings is being conducted. Filter/dialyzer life is assessed, including assessment of filtration fraction, use of anticoagulation options including regional citrate anticoagulation (RCA), dose of CRRT prescribed and delivered, vascular access management, general criteria, timing of initiation and cessation of CRRT, and initiation of renal replacement therapy for nonrenal indications. with AKI and/or sepsis.

Knowledge, attitude, practice, needs, and implementation status of intensive care unit staff toward continuous renal replacement therapy: a survey of 66 hospitals in central and South China

BackgroundContinuous renal replacement therapy (CRRT) is a commonly utilized form of renal replacement therapy (RRT) in the intensive care unit (ICU). A specialized CRRT team (SCT, composed of physicians and nurses) engage playing pivotal roles in administering CRRT, but there is paucity of evidence-based research on joint training and management strategies. This study armed to evaluate the knowledge, attitude, and practice (KAP) of ICU staff toward CRRT, and to identify education pathways, needs, and the current status of CRRT implementation.MethodsThis study was performed from February 6 to March 20, 2023. A self-made structured questionnaire was used for data collection. Descriptive statistics, T-tests, Analysis of variance (ANOVA), multiple linear regression, and Pearson correlation coefficient tests (α = 0.05) were employed.ResultsA total of 405 ICU staff from 66 hospitals in Central and South China participated in this study, yielding 395 valid questionnaires. The mean knowledge score was 51.46 ± 5.96 (61.8% scored highly). The mean attitude score was 58.71 ± 2.19 (73.9% scored highly). The mean practice score was 18.15 ± 0.98 (85.1% scored highly). Multiple linear regression analysis indicated that gender, age, years of CRRT practice, ICU category, and CRRT specialist panel membership independently affected the knowledge score; Educational level, years of CRRT practice, and CRRT specialist panel membership independently affected the attitude score; Education level and teaching hospital employment independently affected the practice score. The most effective method for ICU staff to undergo training and daily work experience is within the department.ConclusionICU staff exhibit good knowledge, a positive attitude and appropriately practiced CRRT. Extended CRRT practice time in CRRT, further training in a general ICU or teaching hospital, joining a CRRT specialist panel, and upgraded education can improve CRRT professional level. Considering the convenience of training programs will enhance ICU staff participation. Training should focus on basic CRRT principles, liquid management, and alarm handling.

Evaluation of hepatosteatosis and gallstone disease in patients with chronic kidney disease.

The prevalence rates of hepatosteatosis and gallstones are increasing owing to the multifactorial causes of chronic kidney disease, and the prevalence may change with the availability of different forms of renal replacement therapy. We aimed to determine the incidence or prevalence rates of hepatosteatosis, cholelithiasis, and acute cholecystitis in patients with chronic kidney disease and compare them between renal replacement therapy modalities. A total of 270 patients (90 with chronic kidney disease stages III-V, 90 undergoing peritoneal dialysis, and 90 undergoing hemodialysis) were included and categorized into the pre-dialysis, hemodialysis, and peritoneal dialysis groups. The patients were questioned about previous gallbladder surgeries and chronic diseases. The results of abdominal ultrasonography, tomography, and magnetic resonance imaging were retrospectively evaluated with respect to the findings on the hepatobiliary system. Hepatosteatosis and cholelithiasis were diagnosed by expert radiologists on the basis of abdominal ultrasonography, tomography, and magnetic resonance imaging findings. The prevalence rates of hepatosteatosis, cholelithiasis, and other liver findings were compared between the groups. Hepatosteatosis and cholelithiasis were detected in 16.7% and 21.5% of the 270 cases, respectively. Hepatosteatosis was present in 17.8%, 25.6%, and 6.7% of patients in the pre-dialysis, hemodialysis, and peritoneal dialysis groups, respectively. The prevalence of hepatosteatosis was significantly higher in patients undergoing hemodialysis than in patients undergoing peritoneal dialysis (p = 0.002). However, no statistically significant difference was found between the peritoneal dialysis and pre-dialysis groups or between the hemodialysis and pre-dialysis groups (p >0.05). The prevalence rates of cholelithiasis were 15.6%, 28.9%, and 20.0%, in the pre-dialysis, hemodialysis, and peritoneal dialysis groups, respectively, and there were no statistically significant differences among the groups. The incidence of acute cholecystitis was significantly higher in the hemodialysis group than in the pre-dialysis group (p = 0.006). Our study showed that the hepatobiliary system is frequently affected in chronic kidney disease and that the findings may differ depending on the renal replacement therapy modality.

Early experience with endovascular arteriovenous fistula creation

Background: Patients opting for haemodialysis as a form of renal replacement therapy require prompt and reliable vascular access. The gold standard for delivering high-quality and safe haemodialysis is through the creation of an arteriovenous fistula (AVF), typically formed at the wrist or elbow. This intervention promotes increased blood flow through superficial veins, fortifying them for repeated needle insertion during haemodialysis treatment. The emergence of percutaneous endovascular arteriovenous fistula (pAVF) introduces a non-surgical alternative for AVF creation. This method eliminates the need for incisions, reducing the likelihood of surgical scarring and changes in vein appearance. Advantages of pAVF encompass the potential for accelerated convalescence, enhanced comfort for the patient, and a diminished adverse effect on body image perception. These non-surgical options may motivate patients to undergo the procedure promptly, enhancing the timeliness of vascular access for haemodialysis and positively impacting overall health outcomes. These relatively new interventions are evolving, enabling the refinement of more efficient and safer techniques. Dialysis nurses play a crucial role in overall success, necessitating further training and development of their skills and knowledge for needling these new fistulas. With an increasing number of successful cases and more readily available information, these non-surgical techniques are gaining popularity among patients, particularly those conscious about their body image. Aim: The goal is to outline an early experience with a comprehensive approach to planning a percutaneous endovascular arteriovenous fistula service at King's College Hospital. Method: This article describes the referral process, screening, clinical assessments, procedural elements and cannulation. Insights are drawn from a single-centre experience in the UK with the WavelinQ System (BD). Emphasis will be placed on key staffing needs, particularly related to patient selection and dialysis nurse training. Conclusion: By addressing these essential considerations, a pAVF service can be successfully implemented.

Predictors of graft function and survival in second kidney transplantation: A single center experience.

The increasing kidney retransplantation rate has created a parallel field of research, including the risk factors and outcomes of this advanced form of renal replacement therapy. The presentation of experiences from different kidney transplantation centers may help enrich the literature on kidney retransplantation, as a specific topic in the field of kidney transplantation. To identify the risk factors affecting primary graft function and graft survival rates after second kidney transplantation (SKT). The records of SKT cases performed between January 1977 and December 2014 at a European tertiary-level kidney transplantation center were retrospectively reviewed and analyzed. Beside the descriptive characteristics, the survivals of patients and both the first and second grafts were described using Kaplan-Meier curves. In addition, Kaplan-Meier analyses were also used to estimate the survival probabilities at 1, 3, 5, and 10 post-operative years, as well as at the longest follow-up duration available. Moreover, bivariate associations between various predictors and the categorical outcomes were assessed, using the suitable biostatistical tests, according to the predictor type. Out of 1861 cases of kidney transplantation, only 48 cases with SKT were eligible for studying, including 33 men and 15 women with a mean age of 42.1 ± 13 years. The primary non-function (PNF) graft occurred in five patients (10.4%). In bivariate analyses, a high body mass index (P = 0.009) and first graft loss due to acute rejection (P = 0.025) were the only significant predictors of PNF graft. The second graft survival was reduced by delayed graft function in the first (P = 0.008) and second (P < 0.001) grafts. However, the effect of acute rejection within the first year after the first transplant did not reach the threshold of significance (P = 0.053). The mean follow-up period was 59.8 ± 48.6 mo. Censored graft/patient survival rates at 1, 3, 5 and 10 years were 90.5%/97.9%, 79.9%/95.6%, 73.7%/91.9%, and 51.6%/83.0%, respectively. Non-immediate recovery modes of the first and second graft functions were significantly associated with unfavorable second graft survival rates. Patient and graft survival rates of SKT were similar to those of the first kidney transplantation.

Abstract 12228: Prognostic Role of Renal Replacement Therapy Among Hospitalized Patients With Heart Failure in the Brazilian National Public Health System

Introduction: Data on survival and prognostic factors of patients hospitalized with HF in Brazil are scarce. Aims: To determine the in-hospital all-cause mortality rate, in-hospital renal replacement therapy (RRT) rate, and its association with in-hospital mortality in a population of patients admitted with HF to hospitals from the Brazilian National Public Health System (SUS). Methods: We included adult patients with a documented diagnosis of HF (ICD-10 I50.X) admitted to any public hospital in the SUS Hospital Information System (SIHSUS) registry from April 2017 to August 2021. RRT included intermittent hemodialysis, continuous hemodialysis, and peritoneal dialysis. Descriptive statistics and univariate and multivariate Cox regression were employed. Results: Of the 910,128 HF hospitalizations identified, 106,383 (11.7%) resulted in in-hospital death (Table 1). RRT (required by 8,179 non-survivors [7.7%] and 11,496 survivors [1.4%, p &lt; 0.001]) was associated with a 56% increase in the risk of death (HR 1.56, 95% CI 1.52 - 1.59) (Fig 1). All forms of RRT were independently associated with in-hospital mortality (Fig 2). Female sex (HR 1.04, 95% CI 1.03-1.06) and COVID-19 (HR 1.41, 95% CI 1.14-1.81) were identified as risk factors for in-hospital mortality, while heart transplantation improved survival (HR 0.37, 95% CI 0.29-0.47). Hospitalizations requiring RRT and hospitalizations resulting in death were both longer and costlier (Fig 3, 4). Conclusion: In this nationwide registry of patients admitted with HF to Brazilian public hospitals, we found an alarming mortality rate double the estimates reported in European and North American countries. RRT was strongly associated with a prolonged hospital stay, higher cost-of-hospitalization, and in-hospital death. Our findings highlight the significance of optimizing medical therapy for patients admitted with HF to prevent the deterioration of their renal function and the need for RRT.

Prognostic role of renal replacement therapy among hospitalized patients with heart failure in the Brazilian national public health system.

Data on patients hospitalized with acute heart failure in Brazil scarce. We performed a cross-sectional, retrospective, records-based study using data retrieved from a large public database of heart failure admissions to any hospital from the Brazilian National Public Health System (SUS) (SUS Hospital Information System [SIHSUS] registry) to determine the in-hospital all-cause mortality rate, in-hospital renal replacement therapy rate and its association with outcome. In total, 910,128 hospitalizations due to heart failure were identified in the SIHSUS registry between April 2017 and August 2021, of which 106,383 (11.7%) resulted in in-hospital death. Renal replacement therapy (required by 8,179 non-survivors [7.7%] and 11,496 survivors [1.4%, p < 0.001]) was associated with a 56% increase in the risk of death in the univariate regression model (HR 1.56, 95% CI 1.52 -1.59), a more than threefold increase of the duration of hospitalization, and a 45% or greater increase of cost per day. All forms of renal replacement therapy remained independently associated with in-hospital mortality in multivariable analysis (intermittent hemodialysis: HR 1.64, 95% CI 1.60 -1.69; continuous hemodialysis: HR 1.52, 95% CI 1.42 -1.63; peritoneal dialysis: HR 1.47, 95% CI 1.20 -1.88). The in-hospital mortality rate of 11.7% observed among patients with acute heart failure admitted to Brazilian public hospitals was alarmingly high, exceeding that of patients admitted to North American and European institutions. This is the first report to quantify the rate of renal replacement therapy in patients hospitalized with acute heart failure in Brazil.

The experiences of patients with peritoneal dialysis: A systematic review of qualitative evidence protocol.

The incidence of end-stage renal disease (ESRD) is on the rise, it has been a major public health problem and places a significant burden on healthcare systems. Peritoneal dialysis (PD) is an increasingly popular form of renal replacement therapy. Patients undergoing dialysis treatment undergo specific pathophysiological and psychological changes. The aim of this systematic review is to investigate the experiences of ESRD patients receiving PD in order to gain deeper insights into their attitudes and beliefs towards this treatment. This will help researchers and health professionals to target interventions to improve the quality of life of PD patients. Protocol for a qualitative systematic review. This systematic review protocol will follow the Joanna Briggs Institute (JBI) meta-analysis methodology. We will conduct a comprehensive search, including English and Chinese databases. It will include all published qualitative studies of patients' experiences with PD. Both English and Chinese literature will be covered. Two reviewers will independently participate in the literature selection, document selection, and data extraction process. Synthesis will be carried out through in-depth reading of the original text and subsequent creation of similar categories. Experiencing is a complex dimension that includes physical, psychological and social aspects. This review will enable nurses to gain a deeper understanding of the feelings and beliefs of patients with PD. Our findings will provide healthcare professionals and policy makers with evidence to provide better care for patients with PD.

Water quality and adverse health effects on the hemodialysis patients: An overview.

Hemodialysis is considered a treatment of choice for patients with renal failure worldwide, allowing the replacement of some kidney functions by diffusion and ultrafiltration processes. Over 4 million people require some form of renal replacement therapy, with hemodialysis being the most common. During the procedure, contaminants in the water and the resulting dialysate may pass into the patient's blood and lead to toxicity. Thus, the quality of the associated dialysis solutions is a critical issue. Accordingly, the discussion of the importance of a dialysis water delivery system controlled by current standards and recommendations, with efficient monitoring methods, disinfection systems, and chemical and microbiological analysis, is crucial for improving the health outcomes of these patients. The importance of treatment, monitoring, and regulation is emphasized by presenting several case studies concerning the contamination of hemodialysis water and the adverse effects on the respective patients.

#3182 IT FOLLOWS: THE EFFECTS OF COVID ON THE INCIDENCE OF OPTIMAL RENAL REPLACEMENT THERAPY YEARS AFTER ITS ONSET

Abstract Background and Aims Patients with advanced chronic kidney disease and those on dialysis have had increased morbidity and mortality in relation to COVID infection. However, patients who did not contract the infection also suffered its effects; since the lack of face-to-face consultations and the impossibility of going to the Emergency Department during the pandemic had negative results on the care of these patients’ kidney condition. Method We present a single-center retrospective observational study of a cohort of 423 patients that were discharged from the ACKD clinic from the start of 2018 to the end of 2022 to initiate renal replacement therapy. We recorded whether the initiation had been optimal or not, defining non-optimal renal replacement therapy as patients who had: • Initiated RRT due to an acute decompensation of their underlying disease that required hospitalization. • Initiated hemodialysis through a central venous catheter instead of an arteriovenous fistula, because the access was not mature yet or otherwise unavailable. • Had to change their preferred form of renal replacement therapy because of rapid decompensation. • Chose conservative management, but died without benefiting from home medical and nursing care. We also collected their age, cardiovascular risk factors (hypertension, diabetes mellitus, dyslipidemia, obesity and smoking), initial preferred therapy, actual RRT, reason of non-optimal therapy and whether there had been an intercurrent COVID infection at the time of initiation. Results We analyzed 423 patients that had chosen a preferred RRT (16,8% chose conservative therapy and were treated by home care services, 34% initiated hemodialysis through an AVF, 27,4% initiated dialysis through a permanent central venous catheter, 5,2% through a temporal CVC, 13,5% initiated peritoneal dialysis, 1,7% died before initiating their preferred technique and 1,4% underwent a preemptive kidney transplant). The patients that initiated hemodialysis before the pandemic started had a significantly lower risk (p 0,001) of starting RRT in a non-optimal manner (HR 0,514 [95% CI] 0,341-0,775) compared to those after the pandemic. Of the cardiovascular risk factors, only diabetes mellitus was significantly associated with non-optimal RRT (p 0,005). Patients without diabetes had significantly less risk of substandard RRT initiation (HR 0,561 [95% CI] 0,373-0,845). Patients with COVID at the time of starting renal replacement therapy had a significantly higher risk of beginning it in a non-optimal way (p 0,013). Age had no statistically significant relation to optimal RRT. The most frequent reason for non-optimal RRT was an acute decompensation that required hospitalization, which accounted for 62% of the patients. 9,6% had a catheter inserted even though they were arteriovenous fistula carriers, and 9% had to change techniques. As for the rest, they chose conservative management but died without home care or two or more reasons were named. Conclusion The incidence of COVID has decreased since the early years of the pandemic, and the effects of the virus are less lethal thanks to vaccines. However, the harmful effects of the pandemic on the care of renal patients and the evolution of their disease are still present, as it is shown by the result of our study. We should be especially mindful of patients with diabetic disease and undergoing a covid infection, because these factors may precipitate non-optimal renal replacement therapy initiation.

Intradialytic Hypotension During Heamodyalysis

OBJECTIVES Haemodialysis (HD) is a form of renal replacement therapy commonly prescribed for chronic kidney disease (CKD) patients. However, it is not without deleterious haemodynamic responses which may occur either during or immediately after the termination of the procedure. These may include hypotension or hypertension. The objective of this study was to determine the frequency of intradialytic blood pressure changes in chronic kidney disease patients on maintenance hemodialysis.METHODOLOGY Patients with chronic kidney disease on maintenance hemodialysis were enrolled. Predialysis and immediate post dialysis blood pressure was recorded. Increase in postdialysis blood pressure by &gt;20mmHg was called intradialytic hypertension and decrease by &gt;20mmHg was called intradialytic hypotension.RESULTSA total of 203 patients on maintenance hemodialysis were enrolled. Age of the patients ranged from 18 to 50 years. Mean age of the patients was 39.80 ± 5.245 years. Male to female ratio was 1.8:1. Intradialytic hypotension was observed in 36 patients (17.7%) while intradialytic hypertension was observed in 22 patients (10.8%).CONCLUSIONIntradialysis blood pressure fluctuations such as hypotension and hypertension are common complications during hemodialysis. Intradialytic hypotension is more frequent.

Process control: simply a matter of efficiency or of survival and costs? A single-centre quality improvement project in living donor renal transplant

BackgroundRising incidence and prevalence of end-stage renal disease is a worldwide concern for sustainability of healthcare systems and societies. Living donor renal transplant [LDRT] provides highest health achievements and cost containment than any alternative form of renal replacement therapy. Nonetheless, about 25% of potential LDRTs are missed for causes directly related with inadequate timing in donor assessment. Our quality improvement (QI) project implement process control tools and strategy aiming at reducing total evaluation time for donor candidates and minimizing dialysis exposure for intended recipients, which are the two main determinants of clinical outcomes and costs.MethodsThe study includes patients who underwent donor nephrectomy between January 1, 2017 and December 31, 2021. Six Sigma DMAIC approach was adopted to assess Base Case performance (Jan2017-Jun2019) and to design and implement our QI project. Study of current state analysis focused on distribution of time intervals within the assessment process, analysis of roles and impacts of involved healthcare providers and identification of targets of improvement. Improved Scenario (Jul2019-Dec2021) was assessed in terms of total lead time reduction, total pre-transplantation dialysis exposure and costs reduction, and increase in pre-emptive transplantations. The study was reported following SQUIRE 2.0 Guidelines for QI projects.ResultsStudy population includes 63 patients, 37 in Base Case and 26 in Improved Scenario. Total lead time reduced from a median of 293 to 166 days and this in turn reduced pre-transplantation dialysis exposure and costs by 45%. Rate of potential pre-emptive donors’ loss changes from 44% to 27%.ConclusionsLean methodology is an effective tool to improve quality and efficiency of healthcare processes, in the interest of patients, healthcare professionals and payers.

Prevalence of Dental Caries in Patients on Renal Replacement Therapy—A Systematic Review

Patients under renal replacement therapy (RRT) often show oral problems, including dry mouth, periodontal and dental diseases. This systematic review aimed to evaluate the caries burden in patients on RRT. Therefore, a systematic literature search based on the databases PubMed, Web of Science and Scopus was performed by two independent individuals in August 2022. Search terms were: "caries" AND "dialysis", "caries" AND "renal replacement therapy", "caries" AND "kidney". The systematic process was complemented by manual search. Studies on adult patients (age ≥ 18 years), treated by any form of RRT and explicitly reporting caries prevalence or incidence were checked for their eligibility and subsequently analyzed qualitatively. For all included studies, a quality appraisal was applied. From the systematic search, 653 studies were identified, of which 33 clinical investigations were included in the qualitative analysis. The majority (31 studies) of all included patients underwent hemodialysis (HD), with a sample size between 28 and 512 participants. Eleven studies investigated a healthy control group. Oral examinations were heterogeneous across studies; the caries burden was primarily assessed by decayed-(D-T), missing- and filled-teeth index (DMF-T). The number of decayed teeth ranged between 0.7 and 3.87 across studies. Only six out of these 11 studies found significant differences in caries prevalence/incidence between RRT and controls, whereby only four studies confirmed worse caries burden in RRT individuals. No information was provided on caries stadium (initial caries, advanced caries, invasive treatment need), caries activity or location (e.g., root caries) across studies. Most of the included studies were assessed to be of moderate quality. In conclusion, patients on RRT suffer from a high prevalence of dental caries. Alongside a need for further research in the field, improved, multidisciplinary, patient-centered dental care concepts are required to support dental and overall oral health in individuals on RRT.

Indoxyl Sulphate Retention Is Associated with Microvascular Endothelial Dysfunction after Kidney Transplantation.

Kidney transplantation (KTx) is the preferred form of renal replacement therapy in chronic kidney disease (CKD) patients, owing to increased quality of life and reduced mortality when compared to chronic dialysis. Risk of cardiovascular disease is reduced after KTx; however, it is still a leading cause of death in this patient population. Thus, we aimed to investigate whether functional properties of the vasculature differed two years post-KTx (postKTx) compared to baseline (time of KTx). Using the EndoPAT device in 27 CKD patients undergoing living-donor KTx, we found that vessel stiffness significantly improved while endothelial function worsened postKTx vs. baseline. Furthermore, baseline serum indoxyl sulphate (IS), but not p-cresyl sulphate, was independently negatively associated with reactive hyperemia index, a marker of endothelial function, and independently positively associated with P-selectin postKTx. Finally, to better understand the functional effects of IS in vessels, we incubated human resistance arteries with IS overnight and performed wire myography experiments ex vivo. IS-incubated arteries showed reduced bradykinin-mediated endothelium-dependent relaxation compared to controls via reduced nitric oxide (NO) contribution. Endothelium-independent relaxation in response to NO donor sodium nitroprusside was similar between IS and control groups. Together, our data suggest that IS promotes worsened endothelial dysfunction postKTx, which may contribute to the sustained CVD risk.

Outcome of Renal Transplantation at Ahmed Gasim Cardiac and Renal Transplant Centre in Sudan-2014

Background: Although not life-saving procedures like liver or heart transplantation, renal transplantation is the preferred treatment for many patients with end-stage renal disease because it improves patients’ quality of life, while other forms of renal replacement therapy (RRT) such as haemodialysis (HDX) shown to regain only 10% of the patient’s renal function [1]. Transplantation releases patients from the dietary and fluid restrictions and the physical constraints imposed by other forms of (RRT), patients become able to return to their normal activities. Patient’s 5-year survival is higher post transplant. Patients and methods: This is Descriptive, retro-prospective, cross sectional analytic and multicentre study done in Ahmed Gasim Cardiac and Renal Transplant Centre including 105 patients. After meeting the Inclusion Criteria and exclusion Criteria, then cases were selected and written in constructed questionnaire. The aim of the study was to evaluate the outcome of renal transplantation in Sudan. Results: 105 cases were used with male predominate and ratio male to female ratio 3:1, the main age of presentation between 31 - 45 years, most of the patients discharge uneventful with good outcome. During one-year follow-up following renal transplantation. Patient survival 95.2 % graft survival 82.4%. Overall morbidity shows 70.5%. Conclusion: this study showed that the one-year patient survival of 95.2%. Actuarial one-year graft survival of 92.4%. Renal transplantation complications can be reduced by meticulous preoperative workup including good cardiovascular assessment, tissue mismatch and BMI good postoperative follow up for early detection of graft rejection and long-term complications and finally patient education.

The role of urological pathology in the development of terminal renal failure

Background. Chronic kidney disease (CKD) is one of the most serious and pressing health problems worldwide today. The end stage of CKD leads to disability and dramatically reduces the quality of life, which is caused by the need for continuous renal replacement therapy. The causes of CKD are various and are often caused by urological pathology.&#x0D; Materials and methods. Five hundred eighty seven case histories of patients with CKD on renal replacement therapy in the Krasnoyarsk Territory for 2022 were analyzed. Most of them were patients with chronic glomerulonephritis (38%) and urological diseases (29%). Other reasons that led to hemodialysis are diabetic nephropathy (12%), hypertensive nephropathy (8%), mixed nephropathy (5%). Systemic diseases with kidney damage, oncological diseases, rejection of a kidney transplant, genetic diseases 2% each.&#x0D; Results. Оne hundred and seventy patients with urological diseases are on program hemodialysis. The mean age of this group of patients was 56.2 years. The incidence of CKD varies slightly between men (48%) and women (52%). The structure of the incidence of urological pathology is as follows: all patients somehow had signs of chronic pyelonephritis. Of 170 people, only 15% had primary chronic pyelonephritis as the main cause of end-stage CKD. The remaining 81% of patients showed signs of secondary pyelonephritis. Patients with polycystic kidney disease accounted for 44%, patients with urolithiasis 13%, patients with anomalies in the development of the kidneys and urinary tract 7%, vesicoureteral reflux, with prostate adenoma 5% patients with signs of a neurogenic bladder 3% and 3% patients with ureteral structure. Patients with oncological pathology accounted for 4%.&#x0D; Conclusion. Over the past decade, the structure of diseases of patients on hemodialysis has changed. Due to the more accessible diagnostic service in the region, the proportion of urological pathologies in patients is increasing. At the same time, the timely use of reconstructive, minimally invasive, nephron-sparing operations can reduce the risks of progression of CKD. However, the number of end-stage patients is steadily increasing, requiring continued development of the hemodialysis service and other forms of renal replacement therapy.

Antibiotic availability for outpatient treatment of acute peritonitis in chronic peritoneal dialysis patients: A case series

BackgroundPeritoneal dialysis (PD) is a commonly used form of renal replacement therapy for patients that have reached end-stage renal disease. Acute bacterial peritonitis (ABP) in chronic PD patients results in pain, increased costs, injury to the peritoneal membrane, and PD modality failure. Optimal antibiotic treatment of acute bacterial peritonitis (ABP) in chronic PD patients should be intraperitoneal, outpatient-based, appropriate, prompt, and uninterrupted. We investigated the frequency of and predisposition to suboptimal antibiotic courses for ABP in our chronic PD patients. MethodsTwenty-four charts of patients with ABP were reviewed, to test the null hypothesis that all ABP patients received antibiotics optimally. ResultsAfter 12 patient exclusions (hospitalization), 9 suboptimal antibiotic events were detected in 6 of the remaining 12 patients, disproving the null hypothesis (p < 0.02). Most suboptimal antibiotics courses (7 of 9) resulted from delays and/or gaps in therapy or antibiotics prescribed outside of community standard. Suboptimal antibiotic events occurred on nights and weekends rather than during the workweek (p < 0.02) and in the emergency room rather than the PD clinic (p < 0.02). ConclusionsSuboptimal ABP antibiotic therapy occurs commonly and is influenced by time and location of presentation and lack of knowledge by patients and physicians. Prevention of suboptimal antibiotic courses in the treatment of ABP in chronic PD patients includes education of patients and providers and allowing emergency rooms and PD clinics to dispense antibiotics for home use.

Complications Associated with Continuous RRT.

Continuous renal replacement therapy (CRRT) is a form of renal replacement therapy that is used in modern intensive care units (ICUs) to help manage acute kidney injury (AKI), end stage kidney disease (ESKD), poisonings, and some electrolyte disorders. CRRT has transformed the care of patients in the ICU over the past several decades. In this setting, it is important to recognize CRRT-associated complications but also up-to-date management of these complications. Some of these complications are minor, but others may be more significant and even life-threatening. Some CRRT complications may be related to dialysis factors and others to specific patient factors. Our overarching goal in this article is to review and discuss the most significant CRRT-related complications at the different stage of management of CRRT. With the advent of newer solutions, there have been newer complications as well.

Quality of Life Assessment in Patients of Stage V Chronic Kidney Disease

Introduction: Despite ongoing advances in the treatment of chronic kidney disease (CKD), the mortality rate, and level of health-related quality of life (HRQOL) for the CKD population remain significantly higher than for the general population. The importance of measuring end-stage renal failure (ESRF) patients' quality of life in relation to healthcare lies in not only providing absolute survival but also the quality of that survival. Due to cost constraints, the profile of chronic kidney disease patients and their treatment in Bangladesh is almost identical to that of India, with patients frequently requesting a reduction in the frequency of dialysis sessions, the use of less expensive dialyzers, dialyzer reuse, and the absence of erythropoietin therapy. Hence, augmenting the QOL may perhaps be a challenge and an observable fact of specific interest for renal healthcare teams. This study is intended to assess KDQOL among patients receiving hemodialysis for 8 hours, and 12 hours per week, patients receiving CAPD, and patients of CKD stage V who decline any form of renal replacement therapy, and remained on conservative treatment. The aim of the study was to assess the quality of life among patients of CKD Stage V. Methods: This cross-sectional study was carried out at the Department of Nephrology, Dhaka Medical College Hospital and BIRDEM general hospital. The patients who received consultation at the Outdoor Department of selected hospital from November 2010 to October 2011. The study assess the of Quality of Life, and Cost Effectiveness on different modalities of treatment among the patients of chronic kidney disease stage V, and also to find out the best modality of dialysis. A total number of 134 consecutive patients were enrolled in this study, out of which 42 patients who were advised to commence renal replacement therapy, and after counseling opted to remain in conservative treatment were considered as GROUP I, 39 patients who received hemodialysis 8 hours per week were considered as GROUP II, 30 patients who received hemodialysis 12 hours per week in one or more centers were considered as GROUP III, and 23 patients who received Continuous Peritoneal Dialysis at least 3 exchanges per day were considered as GROUP IV. Result: Mean age was almost similar in all four groups, and most of the patients were 5th decade, and above. Male was predominant in all four groups, and the male-female ratio was almost 2:1 in the whole study patients. Diabetic nephropathy and glomerulonephritis were more common etiology of CKD in all four groups. Monthly expenditure was significantly (p&lt;0.05) higher in group IV, followed by group III, group II, and group I in all three follow-ups, however, monthly expenditure was almost similar between group III, and group IV (p&gt;0.05) but the mean monthly expenditure was higher in group IV patients. Mean serum Creatinine was lowest in group IV followed by group III, group II, and group I in descending order. Serum albumin was low in all the groups but almost parallel in all follow-ups in group II, groups I, and group IV, whereas the lowest was in group II followed by group I and group IV, but declined in group III during the 2nd, and 3rd follow-up from 1st follow-up. Hemoglobin level consistently remained within the target range in group IV in all follow-ups but below the target range in group I followed by group II, and group III in ascending order. The physical component score increased significantly in Group III, and Group IV at consecutive follow-ups, however, it was higher in Group IV. Similarly, the mental component score was recorded highest in Group IV, followed by group III, group II, and group I. Regarding mortality, it was observed that more than half of the patients were expired in group I, one-third in group II, and 16.7% in group III, and only 8.7% in group IV during final follow-up. Conclusion: Patients receiving continuous ambulatory peritoneal dialysis achieved the best clinical parameters in terms of control of blood pressure, and volume overload. On the other hand, parameters were a lot away from the desired target in patients receiving hemodialysis for 8 hours per week, and they did not have significantly better parameters in comparison to those who were only on conservative treatment. The scenario of serum albumin, and serum creatinine, though complicated by the existence of malnutrition, were in best approximation to the desired level in these patients. According to the age-sex-matched risk categorization of the patients, it was found that the majority of patients on conservative treatment were in more than the average risk category.

EVALUATION OF RESULTS OF LAPAROSCOPIC DONOR NEPHRECTOMY

Context: Chronic kidney disease is a major cause of mortality and morbidity in the world today. Diseases like diabetes mellitus, hypertension and glomerulonephritis more commonly lead to CKD, which in later stages (stage V CKD) may require renal replacement therapy through hemodialysis, peritoneal dialysis or renal transplant. Renal transplantation offers best form of renal replacement therapy. It can be performed by open or laparoscopic methods. Laparoscopic donor nephrectomy is associated with decrease post operative pain, lesser duration of hospitalization, etc. for donors, thus, leading to more number of people opting for kidney donation and augmenting the donor pool. To assess the impact of laparoscopic donor nephrectomy on graft func Aims: tion in recipient of kidney transplantation and to evaluate the advantages of laparoscopic surgery on donor. Settings and Design: A prospective observational study conducted at a tertiary care hospital of New Delhi. A total of 33 transpla Methods and Material: nt pairs were studied. Results of laparoscopic donor nephrectomies were assessed by graft function and donor well being. We studied operative time, warm ischemia time, length of hospitalization, post operative pain and return to work in donors and graft function along with time taken by serum creatinine to normalize in recipients. Statistical analysis used: Data entry was done on Microsoft Excel and was analysed over SPSS version 21.0. A short Results: duration of hospitalisation, low analgesics requirement, lesser post-operative pain, early oral intake, small scar, less chances of wound infection and better cosmesis were seen with laparoscopic donor nephrectomy. We observed that mean duration of donor nephrectomy was 365±73.09 mins with blood loss of 150ml and rst warm ischemia time of 6±0.92mins. Two patients had delayed graft function (DGF). Trend in serum urea and creatinine normalization and post-transplant urine outputs were similar to open donor nephrectomy group. Laparoscopic Conclusions: donor nephrectomy as a minimally invasive procedure is safe and effective. It leads to short hospitalisation, less post-operative pain, better cosmesis etc. for donor without affecting immediate or late graft function in recipient.