Kidney Disease Outcomes Quality Initiative Research Articles

Cardiovascular mortality in peritoneal dialysis: the impact of mineral disorders.

Introduction:Mineral and bone disorders (MBD) are associated with higher mortality in dialysis patients. The main guidelines related to the subject, Kidney Disease Outcomes Quality Initiative (KDOQI) and Kidney Disease: Improving Global Outcomes (KDIGO), were elaborated based on published information from hemodialysis participants. The aim of our study was to evaluate the impact of calcium (Ca), phosphorus (P), and parathyroid hormone (PTH) (according to guideline ranges from KDOQI and KDIGO) on the cardiovascular mortality of peritoneal dialysis (PD) patients.Methods:We used the BRAZPDII database, an observational multi-centric prospective study, which assessed participants on PD between December 2004 and January 2011. Amongst 9,905 participants included in this database, we analyzed 4424 participants who were on PD for at least 6 months. The appropriate confounding variables were entered into the model. Serum levels of Ca, P, and PTH were the variables of interest for the purposes of the current study.Results:We found a significant association between high P serum levels, categorized by KDOQI and KDIGO (P above 5.5 mg/dL), and cardiovascular survival (p < 0.01). Likewise, a compelling association was found between lower levels of PTH, categorized by guidelines (KDOQI and KDIGO - PTH less than 150 pg/mL, p < 0.01), and cardiovascular survival.Conclusion:In conclusion, levels of P above and PTH below the values proposed by KDOQI and KDIGO were associated with cardiovascular mortality in PD patients.

Study of clinical profile and factors associated with chronic kidney disease at tertiary health care center

Background: Chronic kidney disease (CKD) is a common public health problem with a rising prevalence in developing countries. The progressive nature of CKD and the ensuing ESRD is putting a substantial burden on global health resources since all modalities of treatment are expensive. Present study was aimed to study clinical profile and factors associated with CKD at tertiary health care center. Material and Methods: Present study was single-center, prospective, observational study, conducted in patients age &gt; 18 years, of either gender, diagnosed case of chronic kidney disease CKD was defined by criteria set by National Kidney Foundation. Kidney Disease Outcome Quality Initiative for diagnosing CKD. Results: During study period 155 patients were considered for present study. Male patients (69.68%) outnumbered female (30.32%) and male to female ratio was 2.3:1. Mean age of study patients was 48.1 ± 10.93 years. Majority of patients were from 40-59 years (43.23 %) age group involved was, followed by ≥60 years (37.42 %) age group. Presenting complaints noted were dyspnea (70.97 %), oliguria (66.45 %), GI symptoms (64.52 %), volume overload (59.35 %), neuromuscular (38.06 %) and pruritus (2.58 %). Other factors were smoking (27.10 %), alcohol (14.84 %), Tobacco chewing (10.32 %), NSAID use (6.45 %) and use of herbominerals (2.58 %). Major pre-existing co-morbidities were hypertension (52.26 %), anemia (42.58 %), diabetes (30.97 %), hyperlipidemic disease (21.94 %) and coronary artery disease (9.68 %). 20 % patients had no major medical co-morbidity present. Etiology for CKD noted in present study were hypertensive nephropathy (45.16 %), chronic glomerulonephritis (CGN) (32.90 %), diabetic nephropathy (14.84 %), obstructive uropathy (2.58 %), unknown (1.94 %), tubulo-interstitial disease (1.29 %) and ADPKD (1.29 %), Renal function has been noted in present study was 00 %, 36.77 %, 32.90 %, 18.71 % and 11.61 % patients of stage 1,2,3,4 and 5 respectively, according to the Kidney Disease Outcomes Quality Initiative guidelines. Conclusion: Chronic kidney disease is a serious condition, requiring proper medical attention. Periodic screening is must in patients with one or more co-morbid conditions (e.g. hypertension, diabetes mellitus, etc. ) so as to prevent CKD.

Community-based screening to determine the prevalence, health and nutritional status of patients with CKD in rural and peri-urban Bangladesh.

Background:Studies have labelled chronic kidney disease (CKD) among the adult population in urban Bangladesh. To address knowledge gaps on CKD, we aimed to generate data on prevalence, health and nutrition of CKD individuals living in rural and peri-urban Bangladesh.Methods:Participants were recruited from the Mirzapur Demographic Surveillance System by age-stratified random sampling. We screened participants by measuring serum creatinine and urine albumin to creatinine ratio, and collected socio-demographic, lifestyles and health information (phase I). After 3 months (phase II), we repeated the urine and blood tests as per the Kidney Disease Outcomes Quality Initiative guidelines. The glomerular filtration rate was calculated using the CKD Epidemiology Collaboration equation.Results:Among 928 participants, 872 completed the study. In phase I, probable CKD cases were 281 (32.2%); in phase II, confirmed cases were 192 (22.0%) (stage 1, 4.0%; stage 2, 11.8%; stage 3, 5.5%; stage 4, 0.6%; stage 5, 0.1%). In multivariable analysis, associated factors for prevalent CKD included aged ⩾60 years [adjusted odds ratio (aOR) 5.02; 95% confidence interval (CI) 1.85–13.65], hypertension (aOR 3.08; 95% CI 2.07–4.59), diabetes (aOR 2.52; 95% CI 1.60–3.96), presence of red blood cell in urine (aOR 3.20; 95% CI 1.71–5.98) and anemia (aOR 2.50; 95% CI 1.63–3.84).Conclusions:This is the first ever research on CKD prevalence in rural and peri-urban Bangladesh and recorded about 22%, which is higher than urban settings. Monitoring systems are needed to evaluate the overall burden and to mitigate risk factors with an emphasis on the rural and peri-urban population.

The optimal range of serum intact parathyroid hormone for a lower risk of mortality in the incident hemodialysis patients

The serum intact parathyroid hormone (iPTH) is associated with the prognosis of hemodialysis (HD) patients, however, its optimal range for reducing mortality remains inconsistent. We designed a prospective cohort study of 346 incident HD patients to assess the association between different serum iPTH level and mortality. According to the Kidney Disease Outcomes Quality Initiative (K/DOQI) international guidelines (2003), we divided patients into three groups (iPTH < 150 pg/mL, 150–300 pg/mL and >300 pg/mL). During the median follow-up of 58 months, 157 patients (45.38%) died. Multivariate Cox regression analysis showed that iPTH < 150 pg/mL and >300 pg/mL were associated with all-cause and cardiovascular mortality. Then, we performed a sensitivity analysis of patients divided into 6 serum PTH levels groups according to the folds of the K/DOQI target range. Multivariate Cox regression analysis showed that patients with serum iPTH ≥750 pg/mL, 600–749 pg/mL, 450–599 pg/mL had significantly higher risk of all-cause and cardiovascular mortality compared with those with serum iPTH in the range of 150–299 pg/mL. The association between serum iPTH and mortality shows a U-shaped curve. The optimal serum iPTH level which confers the lowest risk of all-cause and cardiovascular mortality could range from 150 pg/mL to 450 pg/mL in this group of incident HD patients.

Reduction of Tunnelled Haemodialysis Catheters Related Infections by Intervention and Training: A 12 and 18-month Audit

Introduction: Catheter-Related Blood Stream Infections (CRBSI) are an important complication of both non tunnelled and tunnelled haemodialysis catheters, but are often poorly reported for tunnelled haemodialysis-catheters. Aim: To assess the rate, aetiology, and outcomes of CRBSI in patients using a tunnelled catheter at 12-month and 18-month audits at the newly-opened haemodialysis unit having care bundle as a part of routine catheter care. Materials and Methods: A retrospective cross-sectional study involving two audits of CRBSI risk (12-month and 18-month audit) was conducted by the dialysis unit doctors and nursing staff at Medanta Super-Specialty Private Hospital, Indore, Madhya Pradesh, India. Centres for Disease Control (CDC) and prevention core intervention/care bundle for Blood Stream Infections (BSI) reduction were incorporated as a part of routine catheter care. The 12-month (May 2018 to April 2019) and 18-month (May 2018 to November 2019) internal clinical audit were evaluated to assess the impact of care bundle on incidence of CRBSIs. Kidney-Disease- Outcome Quality-Initiative (KDOQI)-2006-criteria was used to define CRBSI. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 19.0 software (IBM Corporation, New York, United States). Descriptive and dispersion statistical analysis was done for studied variables. Results: Total patients in 12-months audit with tunnelled haemodialysis catheter were 14 (7 male and 7 female) with median age 64 years and in 18-months audit patient with tunnelled haemodialysis catheter were 18 (11 male and 7 female) with median age 67.5 years. CRBSI incidence was 2.58 per 1000 catheter days at the end of 12-month, with 132 (71.25-202.25) days of median catheter use. Over the 18-month, the incidence of CRBSI dropped to 1.99 per 1000 catheter days. Median period of catheter use increased to 149.5 (83.5-294.5) days. The primary organisms isolated were predominantly gram negative bacterias. Conclusion: Tunnelled catheters may be a reasonable alternative vascular access for haemodialysis in patients with arteriovenous fistula failure as implementation and maintenance of multidisciplinary care bundle reduces CRBSI rate in such patients.

KDOQI US Commentary on the 2020 ISPD Practice Recommendations for Prescribing High-Quality Goal-Directed Peritoneal Dialysis

The recently published 2020 International Society for Peritoneal Dialysis (ISPD) practice recommendations regarding prescription of high-quality goal-directed peritoneal dialysis differ fundamentally from previous guidelines that focused on "adequacy" of dialysis. The new ISPD publication emphasizes the need for a person-centered approach with shared decision making between the individual performing peritoneal dialysis and the clinical care team while taking a broader view of the various issues faced by that individual. Cognizant of the lack of strong evidence for the recommendations made, they are labeled as "practice points" rather than being graded numerically. This commentary presents the views of a work group convened by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) to assess these recommendations and assist clinical providers in the United States in interpreting and implementing them. This will require changes to the current clinical paradigm, including greater resource allocation to allow for enhanced services that provide a more holistic and person-centered assessment of the quality of dialysis delivered.

Serum Creatinine can be Reduced by Applying Homeopathic Medicines according to the Symptom Similarity: Case Study Analysis of Chronic Kidney Disease (CKD)

Background: Over the past few decades, chronic kidney disease (CKD) with high serum creatinine has turned into an intensive clinical and epidemiological research in Bangladesh as well as globally. Even though the transparency provided by the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines, there appears to be within the CKD with high serum creatinine research literature significant dissimilarity on how to define CKD and assess kidney function. In this situation homeopathic symptomatic treatment can play a vital role in CKD with high creatinine. Methods: The cases of four patients with CKD and high creatinine from our observations are discussed, those whom were benefited by homeopathic treatment. The more common remedies administered in the treatment of CKD with high creatinine include: Lycopodium clavatum, Apis mellifica, Apocynum cannabinum, Aurum muriticum, Cuprum metalicum Cantharis, Sarsaparilla, Glonoine, Serum anguillae, Berbaris vulgaris,… etc. The patho-physiologies, diagnosis, review of CKD and serum creatinine are discussed. These case study analyses of CKD emphasize that a consideration of CKD symptoms with high serum creatinine, in addition to more constitutional symptoms, is important when homeopathically analyzing these cases.&#x0D; Results: The positive effects of different homeopathic medicines were clearly reducing serum creatinine during the treatment of CKD patients without hemodialysis with cost effectiveness and most harmless way.&#x0D; Conclusions: These case study analyses found that early proper diagnosis, most appropriate selection of homeopathic remedies and follow-up is important to cure the CKD with high serum creatinine and possible resulting renal failure can be dreadful.

Ready to Change: Attitudes of an Elderly CKD Stage 3-5 Population towards Testing Protein-Free Food.

The recent Kidney Disease Outcomes Quality Initiative (K-DOQI) guidelines suggest an early start of protein restriction, raising issues on willingness to change dietary habits. The aim of this exploratory real-life study was to report on a test of dietary products (protein-free, not previously available in France) in a large, mainly elderly, chronic kidney disease (CKD) population (220 patients, median age: 77.5 years, Charlson comorbidity index (CCI): seven, malnutrition inflammation score (MIS): five, estimated glomerular filtration rate (eGFR): 26 mL/min), also as a means to tailor further implementation strategies. Forty-nine patients (22.28%) were considered to be poor candidates for the trial (metabolically unstable or with psychological, psychiatric or logistic barriers); of the remaining 171, 80.70% agreed to participate. Patients to whom the diet was not proposed had lower eGFR and higher comorbidity (eGFR 21 vs. 27 p = 0.021; MIS six vs. four p: <0.001). Patients who refused were 10 years older than those who accepted (83 vs. 73 years p < 0.001), with a higher CCI (eight vs. seven p = 0.008) and MIS (five vs. four p = 0.01). In the logistic regression, only age was significantly associated with refusal to participate (Odds ratio (OR): 5.408; 95% CI: 1.894 to 15.447). No difference was found according to low/intermediate/high frequency of weekly use of protein-free food. Our study suggests that most of the patients are ready to test new diet approaches. Only old age correlated with refusal, but frequency of implementation depended on individual preferences, underlying the importance of tailored approaches to improve adherence.

Medical Nutritional Therapy for Patients with Chronic Kidney Disease not on Dialysis: The Low Protein Diet as a Medication.

The 2020 Kidney Disease Outcome Quality Initiative (KDOQI) Clinical Practice Guideline for Nutrition in chronic kidney disease (CKD) recommends protein restriction to patients affected by CKD in stages 3 to 5 (not on dialysis), provided that they are metabolically stable, with the goal to delay kidney failure (graded as evidence level 1A) and improve quality of life (graded as evidence level 2C). Despite these strong statements, low protein diets (LPDs) are not prescribed by many nephrologists worldwide. In this review, we challenge the view of protein restriction as an “option” in the management of patients with CKD, and defend it as a core element of care. We argue that LPDs need to be tailored and patient-centered to ensure adherence, efficacy, and safety. Nephrologists, aligned with renal dietitians, may approach the implementation of LPDs similarly to a drug prescription, considering its indications, contra-indications, mechanism of action, dosages, unwanted side effects, and special warnings. Following this framework, we discuss herein the benefits and potential harms of LPDs as a cornerstone in CKD management.

Use of Multiple Urinary Biomarkers for Early Detection of Chronic Kidney Disease in Sickle Cell Anemia Patients

BACKGROUND : More than 60% of sickle cell anemia (SCA) adults develop chronic kidney disease (CKD). Identification of early stages of CKD in SCA patients at high risk of complications could lead to personalized treatment and better prognosis. Recently we identified several urinary biomarkers that can differentiate CKD stage 1 in SCA patients. These biomarkers reflect pathophysiology of SCA, including iron homeostasis (ceruloplasmin, transferrin, hemoglobin, and ferritin); inflammation (orosomucoid); and glomerular hyperfiltration (hepatocyte growth factor like). HYPOTHESIS: We hypothesized that combination of novel urinary biomarkers might improve the accuracy of early detection of CKD. METHODS : We evaluated spot urine samples of 54 patients with SCA in a steady state from the University of Illinois at Chicago. Patients were classified by the stage of chronic kidney disease (CKD) based on the National Kidney Foundation, Kidney Disease Outcomes Quality Initiatives guidelines. Three groups of CKD stages were compared: Stage 0 (without CKD, n=23), stage 1 (early stage of CKD, n=19), and stages 2 to 5 (moderate to severe CKD, n=12). Urine levels of ceruloplasmin (CP), transferrin (TrF), hemoglobin (Hgb), ferritin (FrT), orosomucoid (ORM), and hepatocyte growth factor like (HGFL) were measured by ELISA and normalized to urinary creatinine (CRE) concentrations. Differences in sensitivity and specificity of biomarker combinations were compared using the McNemar's Test against the simple model, which uses urine Hgb only, and the complete model, with all the biomarkers together. A test for the equality of the Area Under the Curve (AUC) compared to the simple and complete models was done using the algorithm suggested by DeLong, DeLong, and Clarke-Pearson (1988). RESULTS: We tested the ability of each biomarker to distinguish SCA patients without CKD and with CKD stage 1. Receiver operating characteristic (ROC) curves were constructed to determine appropriate cutoffs for each biomarker. Cutoffs that provided the highest Youden Indexes were used. Three biomarkers (Hgb, CP, and ORM) had a sensitivity of 100%; however, specificity was lower than 80% (range: 65.2%-72.7%). Other biomarkers (Frt, Trf, and HGFL) had sensitivities lower than 80%, suggesting that individually these biomarkers are not accurate for early detection of CKD. We compared different combinations to the single biomarker model (Hgb only or model 0) and a complete combination of six biomarkers (model 1) (Table 1). The complete combination significantly improved specificity (from 69.6 to 82.6%) and increased AUC (from 0.86 to 0.96) compared to the single biomarker model. All combinations significantly increased the specificity (from 69.6% to 78.3-82.7%) compared to the single biomarker model. Combinations of four to five biomarkers (models 1-6) significantly increased specificity and AUC values than model 0. Combination of Hgb + CP+ ORM + Frt produced similar specificity and AUC values compared to complete model. CONCLUSION: These results demonstrate that the use of multiple biomarkers can improve the accuracy in the detection of kidney pathology in SCD patients, which has essential value for clinicians and researchers of clinical trials to target high-risk individuals for early treatment and preventive care. LIMITATION: Small cohort of patients from one center. Disclosures Saraf: Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees, Other: Advisory Boards, Speakers Bureau; Novartis, Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees; Pfizer, Global Blood Therapeutics, Novartis: Research Funding. Gordeuk:Imara: Research Funding; Novartis: Consultancy; Ironwood: Research Funding; CSL Behring: Consultancy, Research Funding; Global Blood Therapeutics: Consultancy, Research Funding.

Early screening of chronic kidney disease patients among the asymptomatic adult population in Bangladesh

Introduction: Early identification of chronic kidney disease (CKD) provides valuable opportunities for effective interventions that reduce the risk of outcomes, particularly renal failure. Objectives: This study aimed to screen the Bangladeshi asymptomatic adult population for CKD to identify potential risk factors for its development. Patients and Methods: The screening program was carried out among the 400 subjects in the Thakurgaon district of Bangladesh to identify people with the risk of CKD. All the subjects were asymptomatic and previously been never diagnosed with kidney diseases. Demographic data were collected by a structured questionnaire. Urinary protein was tested by dipstick method, and serum creatinine was measured by an auto-analyzer. Estimated glomerular filtration rate (eGFR) was calculated by using standard formula. CKD was diagnosed and classified according to the National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines. Results: A total of 18.2% respondents were found to have likely CKD to whom 82% were in stage 1 and 18% were in stage 2. The majority of the likely CKD respondents (30.1%) were in age &gt;60 years. The prevalence of proteinuria was significantly (P=0.0001) higher among previously documented CKD patients compared to the control group. Logistic analysis revealed that after adjustments, CKD showed a significant association with diabetes mellitus (ORs: 7.46, P=0.00), smoking (ORs: 2.36, P=0.02), obesity (ORs: 3.98, P=0.00) and hypertension (ORs: 1.16, P=0.66) compared to control. Conclusion: A substantial number of adults were found to be unaware of the existence of CKD hence, large-scale prevention programs should be undertaken to reduce the classical risk factors of these disorders.

Features of the Functional State of the L-arginine / NO-synthase / Arginase System and Oxidative Processes in Patients with end-stage Renal Disease due to Chronic Glomerulonephritis Before and After a Hemodialysis Session

Features of the Functional State of the L-arginine / NO-synthase / Arginase System and Oxidative Processes in Patients with end-stage Renal Disease due to Chronic Glomerulonephritis Before and After a Hemodialysis Session

ASIAN PACIFIC SOCIETY OF NEPHROLOGY CLINICAL PRACTICE GUIDELINE ON DIABETIC KIDNEY DISEASE.

ASIAN PACIFIC SOCIETY OF NEPHROLOGY CLINICAL PRACTICE GUIDELINE ON DIABETIC KIDNEY DISEASE.

Evolution of Treatment for Anemia in Chronic Kidney Disease

Evolution of Treatment for Anemia in Chronic Kidney Disease

A Dietary Assessment Of Mid-Spectrum Chronic Kidney Disease

BACKGROUND: Diets of adult individuals with mid-spectrum Chronic Kidney Disease (CKD) remain understudied. The 2015-2020 Dietary Guidelines for Americans food patterns based on the Recommended Dietary Allowances (RDA) in concert with the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) guidelines are advised to individuals with CKD. Estimated glomerular filtration rate (eGFR) remains the best method for tracking CKD progression, yet relationships between self-reported dietary intake and eGFR are understudied. PURPOSE: To assess the self-reported dietary pattern in patients with stage 3 or 4 CKD in contrast to the RDA and NKF KDOQI dietary guidelines and to identify predictors of eGFR. METHODS: Twenty participants with stage 3 or 4 CKD [n = 6 male (M); n = 14 female (F)]; age 62.0 ± 9.9 years; weight 80.9 ± 16.2 kg; body fat 37.3 ± 8.5% of weight; eGFR 51.5 ± 6.82 mL/min/1.73m2) completed self-reported dietary assessments for an average of 5 days. Diet was assessed using the ESHA Food Processor Software, Version 11.1. Micro- and macronutrient analyses for males and females were compared to the RDA and NKF KDOQI guidelines to identify malnutrition, and stepwise multiple linear regression models were used to identify predictors of eGFR, p-values were considered significant at the α = 0.05 level. RESULTS: On average, all subjects met the RDA and NKF KDOQI guidelines for caloric intake. Average consumption of saturated fat (F = 24.3 ± 10.8g, M = 34.1 ± 6.0g), sodium (F = 3780 ± 2510mg, M = 4210 ± 386mg) and protein (F = 65.0 ± 23.5g, M = 107.3 ± 27.3g) was high while the average consumption of fiber (F = 13.6 ± 4.1g, M = 14.8 ± 7.3g), calcium (F = 573 ± 325mg, M = 720 ± 224mg), potassium (F = 240 ± 1800mg, M = 940 ± 492mg) and phosphorous (F = 628 ± 1320mg, M = 425 ± 314mg) was low. Significant predictors of eGFR were age (β = -0.29, p = 0.023), calcium (β = 0.02, p < 0.001), body fat percentage (BF%) (β = -1.47, p = 0.001), protein intake (β = -1.20, p < 0.001), weight (β = 0.42, p = 0.033), and daily caloric intake (β = -0.36, p = 0.045). CONCLUSION: When compared to the RDA and NKF KDOQI guidelines, CKD patients had poor nutritional quality. Increased protein intake and BF% were the strongest predictors of reduced eGFR. Future interventions in CKD patients should improve diet quality to concomitantly improve body composition and eGFR.

Burden and Risk Factors of Chronic Kidney Disease in Children with Sickle Cell Anaemia Aged 5 – 16 Years at the University Teaching Hospital, Lusaka - Zambia

Background: Improved medical care has led to the improved life expectancy of sickle cell anaemia (SCA) patients hence complications associated with SCA such as chronic kidney disease (CKD) are being seen more frequently. Globally, nephropathy of varying severity occurs in 5 to 18 % of the SCA population across all age groups with a third of the adults proceeding to develop CKD while over 30 % of paediatric SCA patients have CKD in Africa. The mortality rate in SCA patients CKD is high. This study sought to determine the prevalence and risk factors of CKD in SCA, information that was not available in Zambia prior to this study. This information will guide in targeting and timing of screening for CKD in SCA in children in our population. Objectives: To determine the prevalence of haematuria, proteinuria, abnormal estimated glomerular filtration rate (eGFR), CKD, and risk factors of CKD among the steady-state SCA patients aged 5 to 16 years at the University Teaching Hospital (UTH), Lusaka. Methodology: This was a prospective cross-sectional study of 197 children aged 5 to 16 years with SCA at the UTH - Lusaka conducted from August 2014 to July 2015. Demographic and clinical data were collected using a structured questionnaire. Urine and blood samples were used to determine the urine albumin creatinine ratio (ACR) and full blood count /blood biochemistry respectively. CKD was defined and determined using the Kidney Disease Outcome Quality Initiative 2012 guidelines employing urine ACR, dipstick urinalysis and eGFR. In this study, spot urine ACR and dipstick urinalysis were done and repeated three months later if initial tests were abnormal. Data was analysed using SPSS version 21. Chi-square and t-test were used to compare proportions between groups. Relation between study variables and CKD were examined using logistic regression. Results: The mean age of the participants was 9.6 years (SD ±3.6). Male to female ratio was 1:1. The median age at diagnosis of SCA was 22 months (IQR = 44). The prevalence of haematuria, proteinuria and CKD among the study participants was 14.2%, 36% and 36 % respectively. Low haemoglobin and elevated mean corpuscular volume (MCV) were associated with CKD-AOR 0.62, 95% CI; 0.46-0.84 and 1.04, 95% CI; 1.01 – 1.08 respectively. Recurrent admissions (due to VOCs, severe anaemia and febrile illness) were also risk factors associated with CKD- AOR 0.52, 95% CI; 0.27-0.98. CKD was not associated with age at enrolment, sex, age at diagnosis of SCA, recurrent Vaso-occlusive crisis (VOCs) or abnormal liver function tests. Conclusion: The prevalence of CKD among the SCA patients at UTH- Lusaka is high (36%) with lower Haemoglobin, elevated MCV and recurrent admissions being risk factors for developing CKD. SCA patients should be screened for CKD routinely at least once a year. Interventions such as the early introduction of hydroxyurea, proactive blood transfusions and ACE inhibitors can reduce the risk of CKD and its progression to end-stage renal disease.

A Novel Technique to Increase the Maturation Rate of Arteriovenous Fistulae

Given the superior patency of arteriovenous (AV) fistulae and the decreased risk of infection compared with AV grafts, the Kidney Disease Outcomes Quality Initiative guidelines recommend the Fistula First approach. Unfortunately, approximately 18% to 53% of all AV fistulae fail to mature. Our objective is to describe a single-center experience with a novel technique using bovine pericardial patch angioplasty to increase the rate of AV fistula maturation.

Prospects for improved glomerular filtration rate estimation based on creatinine-results from a transnational multicentre study.

BackgroundThe Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation is routinely used to assess renal function but exhibits varying accuracy depending on patient characteristics and clinical presentation. The overall aim of the present study was to assess if and to what extent glomerular filtration rate (GFR) estimation based on creatinine can be improved.MethodsIn a cross-sectional analysis covering the years 2003–17, CKD-EPI was validated against measured GFR (mGFR; using various tracer methods) in patients with high likelihood of chronic kidney disease (CKD; five CKD cohorts, n = 8365) and in patients with low likelihood of CKD (six community cohorts, n = 6759). Comparisons were made with the Lund–Malmö revised equation (LMR) and the Full Age Spectrum equation.Results7In patients aged 18–39 years old, CKD-EPI overestimated GFR with 5.0–16 mL/min/1.73 m2 in median in both cohort types at mGFR levels <120 mL/min/1.73 m2. LMR had greater accuracy than CKD-EPI in the CKD cohorts (P30, the percentage of estimated GFR within 30% of mGFR, 83.5% versus 76.6%). CKD-EPI was generally the most accurate equation in the community cohorts, but all three equations reached P30 above the Kidney Disease Outcomes Quality Initiative benchmark of 90%.ConclusionsNone of the evaluated equations made optimal use of available data. Prospects for improved GFR estimation procedures based on creatinine exist, particularly in young adults and in settings where patients with suspected or manifest CKD are investigated.

Role of magnesium in the risk of intradialytic hypotension among maintenance hemodialysis patients.

Intradialytic hypotension (IDH) is a common complication in end-stage renal disease patients on hemodialysis (HD). It has been documented that several factors contribute to IDH. However, the relationship between serum electrolytes and the occurrence of IDH remains unclear. Our study aims to investigate the role of serum magnesium (Mg) for the risk of IDH in maintenance HD patients. The retrospective study included adults starting HD before January 2009 in the blood purification center, Zhongshan Hospital, Fudan University, and treated thrice weekly with standard bicarbonate dialysate by low-flux HD. Patients' characteristics including age and sex, laboratory test results were collected. IDH was defined according to kidney disease outcomes quality initiative (K/DOQI) guidelines as a decrease in systolic blood pressure (SBP) by ≥20 mmHg or a decrease in mean arterial pressure (MAP) by ≥10 mmHg associated with clinical symptoms during HD. Multivariate logistic regression was employed to explore independent risk factors for IDH. Among 423 patients recruited, 175 patients (41.4%) suffered from IDH. Compared with those with non-IDH, patients with IDH presented higher predialysis serum Mg levels. Univariate correlation analysis showed that predialysis serum Mg level was negatively correlated with SBP at 3 hours, 4 hours after dialysis (3 hours SBP r = -0.134 P = 0.006, 4 hours SBP r = -0.142 P = 0.003) and was positively correlated with the differences of blood pressure (BP) (SBP and MAP) (△SBP r = 0.195 P < 0.001, △MAP r = 0.155, P = 0.001). After adjustment for predialysis blood urea nitrogen, platelet distribution width, cardiac troponin T, fasting blood glucose, β2-microglobulin, and predialysis MAP, multivariate logistic regression analysis demonstrated that predialysis serum Mg level was one of the independent risk factors for IDH (odds ratio [95% confidence interval-CI]: 7.154 (1.568-32.637); P = 0.011). In addition, Mg levels of 1.15 mmol/L or higher were associated with a high incidence of IDH. Our findings suggested that higher predialysis serum Mg level was one of the independent risk factors for IDH among maintenance hemodialysis (MHD patients).

Single-stage basilic vein transposition-An effective and viable autogenous access for dialysis.

The National Kidney Foundation's/Kidney Disease Outcomes Quality Initiative recommends autogenous arteriovenous fistulas as the preferred method for long-term hemodialysis access. Basilic vein transposition is not only an alternative in patients with failed arteriovenous access but also can be the first option for arteriovenous access in patients with inadequate cephalic vein. Several studies have shown better patency rates, cost-effectiveness, and fewer complications of autogenous access over prosthetic arteriovenous grafts. To analyze patency, complication rates, and outcomes of single-stage basilic vein transposition. A single-center retrospective non-randomized study conducted at Ramaiah Medical College and Hospitals, Bangalore from July 2015 to June 2018. A total of 94 consented patients who underwent single-stage basilic vein transposition were included in the study. All the surgeries were done in a single stage under regional anesthesia. All the complications and patency rates were calculated at the end of one year. Statistical analysis was performed using the Chi-square test, and patency rates were assessed using the Kaplan-Meir survival curve. A total of 94 single-stage basilic vein transposition was performed. Fifty-four patients had a previous failed autogenous access and 40 had either absent or thrombosed cephalic vein. The mean age was 56.6 years with 59.57% males. The mean basilic vein and brachial artery diameter was 3.6 and 3.8 mm, respectively. The primary patency rate at one year was 84%. Edema and thrombosis were the most common complication in our study. Single-stage basilic vein transposition is a feasible surgical option in end-stage renal disease patients and provides durable autogenous access with very reasonable outcomes in terms of complication rates and patency rates.