Prevalence Of Renal Failure Research Articles

Abstract 216: Neuroimaging Profile and Outcomes in Vitamin K Antagonist and Direct Oral Anticoagulant Related Non-traumatic Intracerebral Hemorrhage

Background & Purpose: The safety and efficacy of direct oral anticoagulants (DOAC) for the prevention of thromboembolism in patients with non-valvular atrial fibrillation (NVAF) have been compared to vitamin-k antagonists (VKA) in randomized-controlled clinical trials. There are limited data regarding neuroimaging profile and outcomes in intracerebral hemorrhage (ICH) occurring during DOAC treatment. We sought to compare neuroimaging findings and outcomes in VKA- and DOAC-related ICH. Methods: We prospectively evaluated consecutive NVAF patients with non-traumatic, anticoagulant-related ICH that were admitted during a 1-year period in 9 stroke centers. Baseline hematoma volume was calculated by ABC/2 formula. Baseline stroke severity and 3-month functional outcome (FO) were assessed using NIHSS- and mRS-scores. The ICH severity was determined using ICH-score (severe ICH: ICH-score of 3-5). Results: We evaluated 91 patients with ICH due to DOAC (n=30) or VKA (n=61). The two groups did not differ in demographic, vascular risk factors, HAS-BLED & CHA2DS2-VASc scores, antithrombotic medications with the exception of higher renal failure prevalence in VKA (28% vs. 4%). DOAC group had significantly (p<0.05) lower median baseline NIHSS-score (5 vs. 12 points) and median baseline ICH volume (11 vs. 25 cm 3 ). The rates of severe ICH (13% vs. 34%), perihematomal edema (44% vs.74%), midline shift (20% vs. 49%), 3-month disability (mRS-score: 3-6; 37% vs. 64%) and 3-month mortality (10% vs. 35%) were significantly (p>0.05) higher in VKA group. DOAC-related ICH was independently (p<0.05) associated with lower likelihood of severe ICH (OR=0.14;95%CI:0.03-0.75), perihematomal edema (OR=0.27;95%CI:0.09-0.81) and adverse 3-month FO (common OR= 0.27;95%CI:0.11-0.68) In multivariable logistic regression analyses adjusting for potential confounders. DOAC-related ICH was independently (p=0.028) related to reduced log-trasformed baseline ICH volume in multiple linear regression analyses adjsuting for demographics, risk factors, HAS-BLED & CHA2DS2-VASc scores, ICH location and concomittant medications. Conclusion: DOAC-related ICHs appear to have more favorable neuroimaging profile and functional outcome compared to VKA-related ICHs.

Does consumption of an aqueous extract of Hibscus sabdariffa affect renal function in subjects with mild to moderate hypertension?

Hibiscus sabdariffa (HS) has been traditionally used as a herbal medicine in Nigeria mainly because of its antihypertensive action. In view of the recent increase in the prevalence of renal failure, we have investigated the effect of HS consumption on renal function in Nigerians with mild to moderate hypertension. A total of 78 newly diagnosed but untreated subjects with mild to moderate hypertension attending the medical outpatients unit of Enugu State University Teaching Hospital (Enugu, Nigeria) were recruited for the study. These subjects were randomly divided into three equally sized groups that received HS or lisinopril (treatment groups) or placebo (control group), once daily for 4weeks. Indices of renal function (urine volume and creatinine clearance) were measured at baseline and weekly throughout the study period. HS and lisinopril significantly increased (P<0.001) urine volume compared to placebo, and HS significantly (P<0.001) increased urine volume more than lisinopril. HS significantly increased (P<0.001) creatinine clearance compared to placebo whereas lisinopril did not. These results indicate that HS consumption improved indices of renal function in our study population of Nigerians with mild to moderate hypertension.

Kidney Failure Screening In The General Population Of Rural Africa

Kidney failure is a silently progressive disease too often unknown to the patients. The objective of the study was to assess the impact of kidney disease in Conakry so as to develop strategies for early detection and prevention. This was a descriptive type prospective study done during a period of six months, from 31 January to 31 July 2012, carried out in two areas: in health facilities where the populations have higher risks of developing kidney disease (diabetes, uropathies, infectious diseases and HIV, hypertension and cardiovascular disease) and in apparently healthy populations. We included into the study: black subjects hospitalized in different targeted wards and fully active apparently healthy subjects of the general population. Renal function was assessed with the simplified MDRD formula. Data collection included clinical parameters: blood pressure, weight, height and blood laboratory parameters (creatinine, glucose) and urine (urine dipstick, 24h quantitative proteinuria). One hundred and ninety-nine patients were selected for the study, 117 men and 82 women aging from 20 to 90 years. The prevalence of renal failure was 59% in the population at risk with 53.3% of men and 16% in apparently healthy population with 60% of men with a statistically significant difference: p = 0.00000001. Proteinuria was observed in 86 patients in the population at risk against 19 in the healthy population.

Kidney failure screening in the general population of rural Africa

Kidney failure is a silently progressive disease too often unknown to the patients. The objective of this study was to assess the impact of kidney disease in Conakry so as to develop strategies for early detection and prevention. This was a descriptive-type prospective study carried out over six months, from January 31 to July 31, 2012. The study was carried out in two areas: In health facilities where the population were at a higher risk of developing kidney disease (diabetes, uropathies, infectious diseases and HIV, hypertension and cardiovascular disease), and in an apparently healthy population. In the study we included black subjects hospitalised in different targeted wards, as well as fully active apparently healthy subjects of the general population. Renal function was assessed with the simplified MDRD formula. Data collection included clinical parameters: Blood pressure, weight, height and blood laboratory parameters (creatinine, glucose) and urine (urine dipstick, 24h quantitative proteinuria). One hundred and ninety-nine patients were selected for the study: 117 men and 82 women ageing from 20 to 90 years. The prevalence of renal failure was 59% in the population at risk, with 53.3% of men and 16% in apparently healthy population with 60% of men with a statistically significant difference: p = 0.00000001. Proteinuria was observed in 86 patients in the population at risk against 19 in the healthy population.

Acute renalfailure in the newborns hospitalized at the Intensive Care Unit, University clinical centre Tuzla

Introduction: Reasons for acute renal failure in hospitalized infants were sepsis, hypovolemia, asphyxia, respiratory distress syndrome, surgical interventions and congenital heart defects. The aim of this study was to determine the frequency and main etiologies, and early outcome of neonatal acute renal failure. Materials and Methods: At Intensive Care Unit, Clinical Center Tuzla, from 15. 01. 2013 to 15. 01. 2015 in 21 newborn was diagnosed renal failure, based on the amount of excreted urine and serum creatinine. Results: The prevalence of renal failure was 6.84%, with a higher incidence of female. 33.3% of infants were term neonates. Oliguria was diagnosed in 71.4% of newborns. Sepsis was the most common predisposing factor for the development of renal failure, associated with high mortality. Other causes of renal failure were perinatal hypoxia, RDS, surgical interventions and congenital heart defects. There was a positive correlation between the gestational age of the newborn and serum creatinine. Discussion: Early prevention of risk factors with rapid diagnosis and effective treatment, can affect further outcome of acute renal failure in infants.

Effect of Age on Native Kidney Function after Adult Intestinal Transplants on Long-Term Follow-up

BackgroundKidney function usually deteriorates after intestinal transplant, with prevalence of renal failure almost 20% after 5 years. We report our results on adults from single institution over >10 years. MethodsForty-six patients were transplanted with 22 survivors; we divided them in 2 groups: Group 1, recipients with creatinine >1.2 mg/dL (normal, 0.50–1.2) and Group 2, normal creatinine. Group 1 included 12 patients (9 males) with a mean age of 42.8 years; all lived at home, with normal creatinine at transplant (apart from 1 patient with a creatinine of 1.6 mg/dL), and were mainly transplanted for short bowel syndrome. One underwent retransplantation. Immunosuppression was based on alemtuzumab (8 recipients) plus tacrolimus (FK). Group 2 included 10 patients (6 males) with a mean age of 34.7 years; all lived at home, had normal creatinine at transplantation, and were mainly transplanted for short bowel syndrome. Immunosuppression was mainly based on alemtuzumab (8 recipients) plus FK. ResultsThere were no relevant differences between the 2 groups regarding number of recipients, sex, baseline creatinine at transplant, reason for transplantation, retransplantation, immunosuppression, antifungal or antiviral therapy, hospitalization, total parenteral nutrition (or fluids), or stoma. The only relevant difference was age (P = .04); patients with deteriorated kidney function or altered creatinine were found to be older.

Renal failure prevalence in poisoned patients.

Background:Renal failure is an important adverse effect of drug poisoning. Determining the prevalence and etiology of this serious side effect could help us find appropriate strategies for the prevention of renal failure in most affected patients.Objectives:The present study is aimed to identify drugs that induce renal failure and also to find the prevalence of renal failure in patients referred to emergency departments with the chief complaint of drug poisoning, in order to plan better therapeutic strategies to minimize the mortality associated with drug poisoning induced renal failure.Patients and Methods:This cross-sectional study surveyed 1500 poisoned patients referred to the Emergency Department of Baharloo Hospital in Tehran during 2010. Demographic data including age and gender as well as clinical data including type of medication, duration of hospital stay, and presence of renal failure were recorded. Mann-Whitney U test and chi-squared statistics were used to analyze the results.Results:A total number of 435 patients were poisoned with several drugs, 118 patients were intoxicated with sedative-hypnotic drugs, 279 patients were exposed to opium, and 478 patients were administered to other drugs. The method of intoxication included oral 84.3%, injective 9%, inhalation 4.3% and finally a combination of methods 2.3%. Laboratory results revealed that 134 cases had renal failure and 242 had rhabdomyolysis. The incidence of rhabdomyolysis and renal failure increased significantly with age, and also with time of admission to the hospital. Renal failure was reported in 25.1% of patients exposed to opium, vs. 18.2% of patients poisoned with aluminum phosphide, 16.7% of those with organophosphate, 8% with multiple drugs, 6.7% with alcohol, heavy metals and acids, and 1.7% with sedative hypnotics.Conclusions:Based on the findings of this study, there is a high probability of renal failure for patients poisoned with drugs such as opium, aluminum phosphide, and multiple drugs as well as the patients with delayed admission to the hospital, and it is necessary to seek appropriate treatment to prevent this significant side effect.

Salinity of Drinking Water and its Association with Renal Failure in Gaza Strip, Palestine

Gaza aquifer is the only natural water source for domestic, agricultural, and industrial purposes in Gaza Strip with a population of about 1.7 million. Current rates of the aquifer abstraction are unsustainable and deterioration of groundwater quality is documented in many parts of the Gaza Strip. The overall aim of this study was to determine salinity of drinking water and its association with renal failure in the southern part in Gaza Strip. Another aim was to explore the relationship between renal failure and socio-economic demographic variables. Descriptive, analytic design was used with survey samples from renal failure patients. A face to face questionnaire for renal failure patients was developed. The sample size for patients was 194subjects, with response rate of 70%. This rate was proportional with respect to its size. Reliability was approved by Cronbach alpha test, and validity was approved by content and face validity method. Analysis of the four quantitative extracted domains that reflected subjectsperception for drinking water salinity level in their localities. All water chemical tests of thesouthern municipal domestic wells have been reviewed since 1987. The tests were fluoride, chloride, nitrate, TDS, and sodium levels in all groundwater wells, which reveal a general trend of increasing from north to south in the southern part. The results show that only 8% of the municipal wells meet the WHO drinking standards in chloride level. Chloride, nitrate, TDS, fluoride and sodium concentration exceed 2-9 times the WHO standards in 92% of the southern wells. The study findings show that there was no association between renal failure prevalence and chloride level, sodium level, TDS level and nitrate level and showed only association with fluoride level, with which there was strong and positive association. There is an urgent need to modify the mixing process according to fluoride level, and initiate public information and awareness programs.

Are there sex-based differences in serum troponin I after cardiac surgery?

To determine whether there are sex-based differences in serum troponin I (TnI) after cardiac surgery with cardiopulmonary bypass. Prospective, observational, cohort study. Tertiary cardiac surgery intensive care unit (ICU) at a university hospital. None. Serum TnI was measured in samples obtained at ICU admission and 6, 12, 24, and 48 hours later. A total of 761 consecutive patients were studied (444 men and 317 women). The characteristics and results of the different sex subgroups were as follows:A) Coronary bypass: 165 men and 38 women. Age, Parsonnet score, Acute Physiology and Chronic Health Evaluation III score, prevalence of renal failure, intra-aortic balloon use, and the lengths of cardiopulmonary bypass, mechanical ventilation, and ICU stay were similar in the two groups. Body mass index, red-cell transfusion needs, and use of noradrenaline were significantly higher in women, whereas dobutamine requirements were higher in men. Mortality: 3 men (1.6%) vs. 0 women (p = not significant).The TnI peak was slightly, but significantly, higher in men (6.2 +/- 4.9 vs. 4.5 +/- 2.6 microg/L. p < 0.05).B) Valve surgery: 279 men and 279 women. Some significant differences were found: Women were older than men and had higher Parsonnet score and transfusion needs. The other recorded variables were similar. Mitral prosthesis: 62 men and 125 women (p < 0.05). Mitral valvuloplasty: 24 men, 7 women (p < 0.05). Aortic prosthesis: 162 men, 103 women (p < 0.05). Mitral and aortic prosthesis: 31 men and 44 women (p < 0.05). TnI peaks were similar for both sexes in each valve subgroup. Mortality: 3 men (1%) vs. 11 women (3.4%) (p < 0.05).The TnI peak did not reach any significant differences between sexes (men 7.9 +/- 6.0 vs. 8.5 +/- 6.5 microg/L in women. p = not significant). No clinically relevant sex-based differences were found in the TnI peaks after cardiac surgery.

Prevalence of renal failure and use of antithrombotic prophylaxis among medical inpatients at increased risk of venous thromboembolic events

Background Evidence-based guidelines recommend the use of antithrombotic prophylaxis in medical patients at risk of venous thromboembolism (VTE). Low molecular weight heparins (LMWHs) are usually preferred to unfractionated heparin. However, when prophylactic doses of LMWH are administered, patients with renal failure (RF) are exposed to the risk of excessive accumulation, and thus to an increased risk of bleeding. We aimed to assess the prevalence of RF among medical inpatients at increased risk of VTE and the use and dosage of antithrombotic prophylaxis in these patients. Methods In a cross sectional study carried out at three different hospitals, information on all medical inpatients was collected. Patients were defined at increased risk of VTE according to the American College of Chest Physicians guidelines. Data on the proportion of patients with renal RF, on the use and dosage of antithrombotic prophylaxis, and on the presence of contraindications to antithrombotic therapy were ascertained. Results 439 hospital charts were examined; 158 patients (36.0%) were defined at increased risk of VTE and had no contraindications to antithrombotic treatment. Thromboprophylaxis was prescribed to 61.4% of these patients. Eighty (50.7%) of them also had moderate or severe RF. There was no difference in the rate of prescription nor in the doses of antithrombotic prophylaxis between patients with and without RF ( p = 0.81 and p = 0.94, respectively). Conclusions RF is frequently present in medical patients at risk of VTE. A considerable proportion of these patients may not receive the optimal type or dose of antithrombotic prophylaxis.

Management of urolithiasis with chronic renal failure

Epidemiological trends of urolithiasis and the prevalence of renal failure in patients with stones have changed. This is the era of minimally invasive therapy for stone disease. We review the impact of minimally invasive therapy on the management of urolithiasis in patients with renal failure and its outcome. The prevalence of urolithiasis has reached its peak and plateaued in Europe and North America while it is still rising in the underdeveloped countries. The prevalence of renal failure in patients with chronic renal failure has reduced by half over the last decade. Minimally invasive therapy like percutaneous nephrolithotripsy has fared better than open stone surgery in all respects. Patients with kidney stones do not have normal renal function. Recently, cystine stones, and stones in patients with renal tubular acidosis and bowel disease were shown to affect renal function significantly. Management of stones in chronic renal failure is challenging. Efforts should be made to minimize renal injury. Once a 'stone-free' kidney is achieved, steps should be taken to conserve renal function and address the issue of recurrence.

Renal failure and bacterial infections in patients with cirrhosis: Epidemiology and clinical features

The aim of the study was to investigate the prevalence and clinical course of renal failure that was induced by the various types of bacterial infections in patients with cirrhosis and ascites. Three hundred and nine patients, who were consecutively admitted to the 3 major hospitals of Padova, Italy, during the first 6 months of 2005, were studied prospectively. Of these, 233 patients (75.4%) had evidence of ascites. In 104 patients with cirrhosis and ascites (44.6%) a bacterial infection was diagnosed. A bacterial infection-induced renal failure was observed in 35 of 104 patients (33.6%). The prevalence of renal failure was higher in biliary or gastrointestinal tract infections and in spontaneous bacterial peritonitis (SBP) and in than in other types of infections. In addition, the progressive form of renal failure was only precipitated by biliary or gastrointestinal tract infections, SBP, and urinary tract infections (UTI). In a multivariate analysis only MELD score (P = 0.001), the peak count of neutrophil leukocyte in blood (P = 0.04), and the lack of resolution of infection (P = 0.03) had an independent predictive value on the occurrence of renal failure. The results of the study show that the development of bacterial-induced renal failure in patients with cirrhosis and ascites is related to the MELD score, and to both the severity and the lack of resolution of the infection. A progressive form of renal failure occurs only as a consequence of biliary or gastrointestinal tract infections, SBP, and UTI.

Prevalence of renal failure in hypertensive patients in a hypertension unit

Prevalence of renal failure in hypertensive patients in a hypertension unit

Renal failure in the recipients of nonrenal solid organ transplants.

The increased success and availability of transplantation of solid organs other than kidneys has resulted in a large number of patients at risk for the usual medical complications of long-term immunosuppressive therapy. Acute and chronic renal failure play a critical role in the success of these

Surgical revascularization after acute myocardial infarction: Does timing make a difference?

At present no consensus exists regarding the timing of surgical revascularization after acute myocardial infarction. Patients admitted with acute myocardial infarction between January 1990 and April 1993 underwent early cardiac catheterization if they had postinfarction ischemia or positive results on a low-level exercise stress test. If indications for surgical intervention were found at the time of catheterization, patients were operated on within 1 or 2 days or were discharged and returned for the operation within 2 to 3 weeks. During this period, we performed 2175 isolated coronary artery bypass graft procedures; 23 patients were operated on within 24 hours of acute myocardial infarction with an operative mortality of 4.4%, 30 patients underwent surgery between 24 and 72 hours after infarction with no deaths, 193 patients were operated on between 3 and 7 days after infarction with an operative mortality of 2.1%, 284 patients underwent revascularization between 1 week and 1 month after infarction with an operative mortality of 1.4%, and the 1645 patients without a recent infarction had a mortality rate of 1.9%. Multivariate statistical analysis was performed to evaluate mortality with these independent variables: reoperative surgery, sex, age, diabetes, timing of infarction, location of infarction, and type (transmural versus subendocardial). Myocardial infarction at any time interval less than 1 month before the operation was not associated with mortality when adjusted by these other risk factors. In addition, no differences were noted in length of stay, stroke rate, or prevalence of renal failure or pulmonary insufficiency. We conclude that nonemergency surgical revascularization can be done safely at any time interval after acute myocardial infarction, certainly after 72 hours, with no increase in operative mortality and acceptable morbidity.

Renal involvement in type II diabetes

The incidence and prevalence of renal failure from type II diabetes have been seriously underestimated in the past. Currently, the incidence of uremia in patients with type II diabetes has increased continuously in Europe and the United States, mainly because of better patient survival (ie, they now live until nephropathy develops) and possibly because of a rising prevalence of type II diabetes in the general population (ie, more patients are at risk of developing nephropathy). Generally, renal hemodynamics and glomerular lesions are similar in type I and type II diabetes, but glomerular histology is more diverse in type II diabetes. Given the high prevalence of diabetes and renal failure from various causes in the elderly, coexistence of the two (even in the absence of glomerulosclerosis) occurs in approximately 20% of uremic type II diabetic patients. The development of nephropathy is controlled by strong genetic determinants, but these have not been further characterized.

Hereditary nephritis in the bull terrier: evidence for inheritance by an autosomal dominant gene.

A high prevalence of renal failure has been reported in bull terriers in Australia. The pattern of inheritance was analysed in a family of 33 bull terriers in which 10 dogs had renal disease manifested by proteinuria, ultrastructural abnormalities in the glomerular basement membrane, renal failure, or 'end stage' kidneys. The presence of at least one affected parent for each affected offspring, the approximately equal male/female ratio and the apparent absence of 'generation-skipping', strongly supported an autosomal dominant mode of inheritance, assuming a fully penetrant single major gene locus. Further evidence was not compatible with either an autosomal recessive or X-linked inheritance pattern. This contrasts with the X-linked inheritance shown in Alport's-type human hereditary nephritis and hereditary glomerulopathy in the samoyeds. Hereditary nephritis in the bull terrier should be a useful model for non-Alport's-type human hereditary nephritis, which is also reported to have an autosomal dominant inheritance pattern.

Clinical Manifestations of Systemic Lupus Erythematosus

The identification of differences in the clinical manifestations of systemic lupus erythematosus (SLE) due to racial and socioeconomic factors has been hampered in previous studies by limitations in the numbers of black patients examined. We sought to define racial differences in the cumulative clinical manifestations of SLE in a large, racially balanced cohort (184 black patients and 174 white patients). Differences in the cumulative disease manifestations of SLE between black and white patients were evaluated by multivariate regression techniques, controlling for socioeconomic status and the potential confounding factors of age, gender, duration of follow-up, and treatments. Race was found to be an important factor influencing the prevalence of 9 of 24 clinical features of SLE. As a group, blacks more commonly manifested anti-Sm and anti-RNP antibodies, discoid skin lesions, and proteinuria, and less commonly manifested photosensitivity, than whites. Among specific age, gender, and socioeconomic subgroups, blacks were more likely than whites to have had psychosis, serositis, and urinary cellular casts, and less likely to have had sicca syndrome. Racial differences in the prevalence of renal failure were due to socioeconomic effects. These results suggest that race is under-recognized as a factor influencing the clinical heterogeneity of SLE.

Genetic Polymorphism of C3 and Bf in IgA Nephropathy

C3 and Bf alleles were examined in the general population, in 67 patients with biopsy-confirmed mesangial IgA nephropathy and 81 patients with other types of glomerulonephritis, from the Heidelberg and Leiden renal programmes respectively. In both populations, a significant excess of homozygous phenotype C3FF (3.4% in controls; 10.4% in IgA nephropathy) and a deficit of C3FS heterozygous phenotype (35.8% in controls; 19.4% in IgA nephropathy) were observed in patients with IgA nephropathy, but not in other types of glomerulonephritis. No difference of C3 gene frequencies was found. C3FF was associated with an adverse clinical outcome (a higher prevalence of renal failure and hypertension). A significant excess of Bf-F gene frequency was noted (0.20 in controls; 0.33 in IgA nephropathy). In addition, an excess of phenotype BfFF was found (none in controls; 10.4% in IgA nephropathy). BfFF homozygotes also carried a higher risk of an adverse outcome (renal failure and hypertension). The data suggest a role for genetically coded (presumably) immunological factors in the genesis and course of IgA nephropathy.