Life In Chronic Kidney Disease Patients Research Articles

Chronic kidney disease and sports participation by children and adolescents.

Individuals suffering from chronic kidney disease (CKD) deal with major morbidity and mortality including poor exercise tolerance. A variety of factors including anemia, poor muscle mass, cardiovascular changes and limited physical activity contribute to exercise intolerance. Studies suggest that early initiation of aerobic and resistance training improves the muscle function, ability to tolerate exercise and quality of life in CKD patients. A thorough medical examination and exercise testing are recommended before initiating an exercise regimen in individuals with CKD. Though current recommendations suggest a qualified approval to contact sports in patients with solitary kidney, a proper risk assessment and counselling must be provided detailing all the risks involved. Special care must be taken to avoid infection or damage to the peritoneal dialysis catheter and hemodialysis vascular access sites. Collision sports should be avoided in individuals with kidney transplant, ectopic kidney or with other urological abnormalities (severe hydronephrosis or ureteropelvic junction obstruction) with high risk of injury.

Epoetin beta pegol prevents endothelial dysfunction as evaluated by flow-mediated dilation in chronic kidney disease rats

Chronic kidney disease (CKD) patients have a poor prognosis due to cardiovascular disease. Anemia and endothelial dysfunction are important risk factors for cardiovascular events in CKD patients, and treatment with erythropoiesis-stimulating agent (ESA) has been reported to improve the quality of life in CKD patients. In this study, we evaluated the effect of anemia correcting dose of epoetin beta pegol (continuous erythropoietin receptor activator; C.E.R.A.) on endothelial function in 5/6 nephrectomized rats (Nx rats). C.E.R.A. was subcutaneously administered once a fortnight, 5 times in total, from 1 week after nephrectomy. Twenty-four hours after last administration, endothelial function was evaluated by measuring flow-mediated dilation (FMD) in the femoral arteries of anesthetized Nx rats by ultrasound system. Femoral arteries were harvested for western blot analysis. C.E.R.A. significantly increased FMD of Nx rats. Endothelium-independent vasodilation induced by nitroglycerin injection was not influenced by C.E.R.A treatment. Nox4 expression and nitrotyrosine accumulation were significantly decreased, and phosphorylation of eNOS was significantly enhanced in the femoral arteries of C.E.R.A.-treated rats. C.E.R.A. normalized hemoglobin levels but did not affect body weight, systolic blood pressure, heart rate, urinary protein excretion and plasma creatinine. These results indicate that C.E.R.A. prevented endothelial dysfunction in Nx rats, possibly through reduction of local oxidative stress and enhancement of eNOS phosphorylation in the arteries. This study provides the first evidence that C.E.R.A. prevented endothelial dysfunction in CKD model rats under conditions of amelioration of anemia.

Depression and quality of life in patients with chronic kidney disease on haemodialysis in Central Province in Saudi Arabia

Introduction: Chronic kidney disease (CKD) implies long-standing, and usually progressive, impairment in renal function. Owing to the chronic nature of the illness, the majority of CKD patients may trigger physiological, psychological and social stressors at any point during the disease which interferes with their normal lifestyle and quality of life. Objectives: To investigate the prevalence of depression among CKD patients on dialysis in the central region of the Kingdom of Saudi Arabia (KSA) and to evaluate their lifestyle, social relationship and quality of life. Materials and methods: An observational cross-sectional hospital-based study. Data were collected from 159 CKD patients of either sex from haemodialysis units at King Abdulaziz Medical City of National Guard, Riyadh, King Saud Medical City, Riyadh and King Khalid General Hospital, Al Majma’ ah, KSA. A self-administered questionnaire containing demographic questions (Beck Depression Inventory) for measuring the severity of depression, and the HHHHHMM Scale and a modified form of WHOQOL (World Health Organization Quality of Life) questionnaire to evaluate the quality of life of CKD patients. Data were entered and analysed using IBM SPSS Statistics version 20 (IBM Corporation, Armonk, NY, USA). Results: The prevalence of depression among CKD patients was 57%. The majority of patients [112 (70.4%)] had depression at the beginning of the condition after being diagnosed with CKD, and the majority of the patients [127 (79.9%)] were leading a normal social life despite the disease. A significant association was observed between depression scale and depression at the beginning of the condition (P =0.043), showing that patients had mild mood disturbance (n =48, 30.2%), borderline clinical depression (n =28, 17.6%), moderate depression (n =38, 23.9%) or severe depression (n =23, 14.5%). A significant association was observed between depression scale and the QOL scale (P <0.001), showing that those within an acceptable quality of life had borderline depression (n =22, 78.5%), and those with an unacceptable quality of life, the majority, had severe depression (n =16, 69.5%). Conclusions: A high proportion of CKD patients on dialysis experienced depression, which eventually resulting in an impaired quality of life.

Measuring quality of life in anaemia management

Anaemia often develops in the early stages of chronic kidney disease (CKD) and gradually gets worse as renal function declines. Left untreated, anaemia can become the cause of poor quality of life in CKD patients. Karen Jenkins looks at the link between anaemia and quality of life in CKD patients, how quality of life may be measured and how anaemia in CKD patients may be best managed.

Health-related Quality of Life in CKD Patients

Very few large-scale studies have investigated the determinants of health-related quality of life (HRQOL) in chronic kidney disease (CKD) patients not on dialysis or the evolution of HRQOL over time. A prospective evaluation was undertaken of HRQOL in a cohort of 1186 CKD patients cared for in nephrology clinics in North America. Baseline and follow-up HRQOL were evaluated using the validated Kidney Disease Quality Of Life instrument. Baseline measures of HRQOL were reduced in CKD patients in proportion to the severity grade of CKD. Physical functioning score declined progressively with more advanced stages of CKD and so did the score for role-physical. Female gender and the presence of diabetes and a history of cardiovascular co-morbidities were also associated with reduced HRQOL (physical composite score: male: 41.0 +/- 10.2; female: 37.7 +/- 10.8; P < 0.0001; diabetic: 37.3 +/- 10.6; nondiabetic: 41.6 +/- 10.2; P < 0.0001; history of congestive heart failure, yes: 35.4 +/- 9.7; no: 40.3 +/- 10.6; P < 0.0001; history of myocardial infarction, yes: 36.1 +/- 10.0; no: 40.2 +/- 10.6; P < 0.0001). Anemia and beta blocker usage were also associated with lower HRQOL scores. HRQOL measures declined over time in this population. The main correlates of change over time were age, albumin level and co-existent co-morbidities. These observations highlight the profound impact CKD has on HRQOL and suggest potential areas that can be targeted for therapeutic intervention.

Diagnosis and Treatment of Anemia of Chronic Kidney Disease in the Primary Care Setting: A Primer for Nurse Practitioners

Anemia of chronic kidney disease (CKD) is associated with increased cardiovascular morbidity, health care costs, and mortality. Both early CKD and its attendant anemia may be asymptomatic and thus often go undetected. Appropriate anemia treatment may improve cardiovascular prognosis, physical activity, and quality of life in CKD patients not requiring dialysis. Primary care nurse practitioners are ideally positioned to detect and treat CKD-related anemia. This review discusses the pathophysiology, consequences, and primary detection and management of anemia of CKD.

Anemia of chronic disease: Past, present, and future: Management of comorbidities in kidney disease in the 21st century: Anemia and bone disease

ANEMIA AND CHRONIC KIDNEY DISEASE Anemia is common among patients with chronic kidney disease (CKD) and is a powerful risk factor for cardiovascular disease [1–9]. The risk for developing anemia is several times higher in those with CKD as compared to the general United States population [9], and recent evidence indicates that anemia develops earlier in CKD than previously thought, especially in diabetic nephropathy [5]. The cause of anemia in CKD is multifactorial, including erythropoietin deficiency, decreased responsiveness to erythropoietin, shortened red blood cell survival, iron deficiency, and chronic inflammation [10]. Observational studies indicate that anemia in CKD is associated with increased risk for coronary artery disease [11], hospitalization for cardiac disease [12], death from congestive heart failure (CHF) [2], and all-cause mortality [1, 12, 13]. Anemia is a modifiable risk factor in patients with CKD; however, several studies indicate that treatment of anemia in the predialysis and dialysis populations is suboptimal [6, 7, 14, 15]. Cardiac disease at onset of dialysis is common, including concentric and eccentric left ventricular hypertrophy (LVH) in 75%, coronary artery disease in 15%, overt systolic dysfunction in 15%, and dysrhythmia in 7% [3]. Erythropoietin deficiency plays a major role in anemia and treatment with exogenous erythropoietin can completely correct anemia in many with CKD. Treatment of anemia has been associated with improvement in quality of life in CKD patients before and after initiation of dialysis [16]. In addition, treatment of anemia improves hemoglobin level and quality of life and has been shown to reduce progression of LVH. However, clinical erythropoietin treatment to normalize hemoglobin in patients on dialysis has not demonstrated reduction in mortality or morbidity [17, 18]. Thus, treatment with erythropoietin to improve anemia has not been shown to definitively reduce cardiovascular mortality or improve cardiac function in those with preexisting cardiac disease. Little is known about the effects