Problem Of Chronic Kidney Disease Research Articles

CARDIOVASCULAR IMPACT OF DISCONTINUATION OF RENIN-ANGIOTENSIN SYSTEM INHIBITORS IN ADVANCED CHRONIC KIDNEY DISEASE

Objective: Hypertension is a major problem in chronic kidney disease (CKD) with a prevalence approaching 100%, contributing to the risk of CKD progression, cardiovascular events and all-cause mortality. Renin-angiotensin system inhibitors (RASi) are the first-line therapy for antihypertensive treatment in patients with CKD, due to its protective effects. However, it is common practice stopping RASi in advanced CKD to attempt to delay kidney replacement therapy (KRT) initiation and/or to prevent drug-related acute kidney injury. Design and method: From the CKD-Rein prospective cohort, which included 3033 outpatients from nephrology clinics in France, we selected participants with an estimated glomerular filtration rate (eGFR) <30 mL/min/1.73m2 and who were treated with RASi for at least 3 months. We used the G-formula to deal with time-fixed (age, sex, diabetes, heart failure, lung diseases) and time-varying confounding (eGFR, systolic blood pressure, serum sodium and potassium, diuretic prescription) to compare two treatment strategies: to discontinue or to continue RASi. The outcome, MACE, was the composite of cardiovascular death, myocardial infarction, stroke or hospitalization for heart failure. Competing risks were initiation of KRT and non-cardiovascular death. Results: From the 1,472 patients included (median age 69 years, median eGFR 25mL/min/1.73m2, 34% women), 27% discontinued RASi over a median follow-up of 35 [17-51] months. The crude rate of RASi discontinuation was higher in the presence of cardiovascular comorbidities and more severe CKD. The number of reported serious adverse reactions over the follow-up (such as acute kidney injury or hyperkalemia) was low, but higher in the discontinuation than in the continuation group (47 versus 23 per 1,000 person-years). After taking the afore-mentioned potential confounders into account, the 36-month risk of MACE was twice as high in the discontinuation group as that in the continuation group (RR 2.13, 95%CI 1.60-2.85). Conclusions: RASi discontinuation was significantly associated with MACE risk, the leading cause of morbidity and mortality in advanced CKD. Our results, along with other published data, suggest that the risk-benefit balance favors continued use of RASi in this population.

Molecular Phenotyping and Mechanisms of Myocardial Fibrosis in Advanced Chronic Kidney Disease.

Myocardial fibrosis is a major life-limiting problem in chronic kidney disease (CKD). Despite this, the molecular phenotype and metabolism of collagen fibrillogenesis in fibrotic hearts of patients with advanced CKD have been largely unstudied. We analyzed explanted human left ventricular (LV) heart tissues in a 3-arm cross-sectional cohort study of deceased donor patients on hemodialysis (HD, n=18), hypertension with preserved renal function (HTN, n=8), and healthy controls (CON, n=17), ex vivo. RNA-seq and protein analysis was performed on human donor hearts and cardiac fibroblasts treated with mineral stressors (high phosphate and high calcium). Further mechanistic studies were performed using primary cardiac fibroblasts, in vitro treated with mineral stressors, pro-inflammatory and pro-fibrotic cytokines. Of the 43 donor participants, there was no difference in age (P>0.2), sex (P>0.8), or body mass index (P>0.1) between the groups. Hearts from the HD group had extensive fibrosis (P<0.01). All LV tissues expressed only the trimeric form of collagen type I. HD hearts expressed increased collagen type I (P<0.03), elevated collagen type I:III ratio (P<0.05), and decreased MMP1 (P<0.05) and MMP2 (P<0.05). RNA-seq revealed no significant differential gene expression of extracellular matrix proteins of interest in HD hearts, but there was significant upregulation of LH2, periostin, α-SMA, and TGF-β1 gene expression in mineral stressor-treated cardiac fibroblasts. Both mineral stressors (P<0.009) and cytokines (P<0.03) increased collagen type I:III ratio. Mineral stressors induced trimeric collagen type I, but cytokine treatment induced only dimeric collagen type I in cardiac fibroblasts. Mineral stressors downregulated fibronectin (P<0.03) and MMP2 zymogen (P<0.01) but did not significantly affect expression of periostin, MMP1, or cross-linking enzymes. TGF-β upregulated fibronectin (P<0.01) and periostin (P<0.02) only. Myocardial fibrosis in advanced CKD hearts is characterized by increased trimeric collagen type I and dysregulated collagen metabolism, and is differentially regulated by components of uremia.

The Role of miRNA in Renal Fibrosis Leading to Chronic Kidney Disease.

Chronic kidney disease (CKD) is an important health concern that is expected to be the fifth most widespread cause of death worldwide by 2040. The presence of chronic inflammation, oxidative stress, ischemia, etc., stimulates the development and progression of CKD. Tubulointerstitial fibrosis is a common pathomechanism of renal dysfunction, irrespective of the primary origin of renal injury. With time, fibrosis leads to end-stage renal disease (ESRD). Many studies have demonstrated that microRNAs (miRNAs, miRs) are involved in the onset and development of fibrosis and CKD. miRNAs are vital regulators of some pathophysiological processes; therefore, their utility as therapeutic agents in various diseases has been suggested. Several miRNAs were demonstrated to participate in the development and progression of kidney disease. Since renal fibrosis is an important problem in chronic kidney disease, many scientists have focused on the determination of miRNAs associated with kidney fibrosis. In this review, we present the role of several miRNAs in renal fibrosis and the potential pathways involved. However, as well as those mentioned above, other miRs have also been suggested to play a role in this process in CKD. The reports concerning the impact of some miRNAs on fibrosis are conflicting, probably because the expression and regulation of miRNAs occur in a tissue- and even cell-dependent manner. Moreover, different assessment modes and populations have been used. There is a need for large studies and clinical trials to confirm the role of miRs in a clinical setting. miRNAs have great potential; thus, their analysis may improve diagnostic and therapeutic strategies.

Dietary protein and muscle wasting in chronic kidney disease: new insights.

Muscle wasting is an important health problem in chronic kidney disease (CKD) patients. Protein restriction in the diet can be one of the main causes of muscle wasting in this population. In this review, we aimed to investigate the relationship between dietary protein intake and muscle wasting in CKD patients according to recent literature. The one of the main mechanisms responsible for the muscle wasting is the disturbances in skeletal muscle protein turnover. Muscle wasting primarily occurs when the rates of muscle protein breakdown exceed the muscle protein synthesis. Dietary protein intake represents an important role by causing a potent anabolic stimulus resulting a positive muscle protein balance. Compared to studies made in healthy populations, there are very limited studies in the literature about the relationship between dietary protein intake and muscle wasting in the CKD population. Majority of the studies showed that a more liberal protein intake is beneficial for muscle wasting in especially advanced CKD and hemodialysis population. Although evaluating muscle wasting in CKD patients, the amount of protein in the diet of patients should also be reviewed. Although excessive protein intake has some negative consequences on this patient group, a more liberated dietary protein intake should be taken into account in this patient group with muscle wasting and especially in dialysis patients.

IMPROVING THE PERFORMANCE OF SUPPORT VECTOR MACHINE WITH FORWARD SELECTION FOR PREDICTION OF CHRONIC KIDNEY DISEASE

Chronic kidney disease is a disorder that affects the kidneys and arises due to various factors. Chronic kidney disease, usually develops slowly and is chronic. For prevention and control, proper treatment is needed, so that detection of this disease can play a very important role. This study aims to determine the level of accuracy in predicting chronic kidney disease through SVM based on forward selection and to determine the performance of Feature Selection which is applied to the SVM method in solving problems in chronic kidney disease. This research was conducted an experiment on the SVM method using various kinds of kernels and it was seen that SVM with the dot kernel was 98.50% with AUC 1,000 which was superior to the polynominal kernel and RBF. However, when the experiment was carried out again by applying FS to SVM, it was found that SVM+FS with the RBF kernel outperformed the other kernels by 99.75% with AUC 1,000. So it can be concluded that the Forward Selection of SVM has succeeded in improving its performance, especially in this case, namely the prediction of chronic kidney disease

Management of Growth in Pediatric Chronic Renal Failure: A Narrative Review

Background: Growth impairment is a common problem in Chronic Kidney Disease (CKD) children. Approximately 40% of children with CKD have a reduced final height. Growth impairment affects school attendance, duration of hospitalization, adult height, and even risk of death. Objectives: Various studies have shown that patients with moderate to severe growth failure have higher mortality rates (three folds) than those with normal growth. This narrative review aimed to define the management of growth in pediatric chronic renal failure. Methods: This study was conducted through a literature search with the keywords of chronic renal failure, kidney transplant, Glomerular Filtration Rate (GFR) combined with growth, short stature, and growth hormone using PubMed, Scopus, Web of Sciences, Cochrane, and Embase databases. Results: Growth impairment in children with CKD occurs due to diverse etiologies, such as uremia, anemia, metabolic acidosis, etc. It becomes more prominent in GFR&lt;75 ml/min/1.73 m2. Growth hormone (GH) therapy seems to be a safe and effective therapeutic modality consequent to the correction of associated metabolic disturbances. Conclusions: This study indicated that pretransplant GH therapy in children with CKD and its temporary discontinuation at kidney transplantation up to one year after transplantation leads to improved growth velocity. Therefore, it seems that considering GH therapy in children with CKD is mandatory.

Correlation between blood urea nitrogen level and cochlear outer hair cell function in non-dialysis chronic kidney disease patients.

Background: Hearing loss due to impaired cochlear function, which results from increased blood urea nitrogen (BUN) level, is one of the important clinical problems in chronic kidney disease (CKD) patients with uremia. This study aims to determine correlation between blood urea nitrogen (BUN) levels and cochlear outer hair cell (OHC) dysfunction in non-dialysis stage 3-5 CKD patients so that the BUN levels may also be used to determine the presence of cochlear OHC dysfunction.Design and methods: An observational analytic study with a cross sectional design and consecutive sampling. This study was conducted from November 2019 to February 2020 at the Department of Internal Medicine, Soetomo Hospital, Surabaya, Indonesia, and Otorhinolaryngology-Head and Neck Surgery Department, Soetomo Hospital, Surabaya, Indonesia. Non-dialysis CKD patients who met the inclusion and exclusion criteria were subjected to a Distortion Product Otoacoustic Emissions (DPOAE) test to assess cochlear OHC function at the Otorhinolaryngology- Head and Neck Surgery, Soetomo Hospital, Surabaya.Results: Female patients were in larger number than male patients in a ratio of 1 : 2. Most of the patients were between 51-60 years of age. DPOAE distribution was refer in 25 patients (83.3%) and pass in 5 patients (16.7%). The highest pass was at 2000 Hz in 24 patients (80.0%), while the refer results were mostly at 12,000 Hz in 29 patients (96.7%). The highest average signal to noise ratio (SNR) was at 2000 Hz and 4000 Hz (12.77 dB and 11.13 dB), while the lowest at 11,000 Hz and 12,000 Hz (1.60 dB and 1.03 dB). Pearson’s correlation test on DPOAE results did not show a significant correlation (p>0.05) between BUN levels and impaired cochlear OHC function.Conclusions: There was no correlation between increased blood urea nitrogen levels and cochlear outer hair cell function disorders in non-dialysis patients with CKD stage 3-5. Significance for public health One of the most commonly found disabilities in the world is hearing loss, which has a prevalence of 5% of the world population or affecting 466 million people. One that contributes to the prevalence of hearing loss is Chronic Kidney Disease (CKD). Its contribution to hearing loss prevalence may reach 45% to 80%. This is because CKD itself may cause malfunctions of some organs, including auditory organs. Therefore, early detection of hearing loss among patients with CKD is necessary by determining correlation of a kidney disease marker, the blood urea nitrogen (BUN), and cochlear Outer Hair Cell (OHC) dysfunction. The otoacoustic emission examination (OAE) should be used to detect cochlear dysfunction as it has 95% sensitivity and 90% specificity. It was expected that by the finding of correlation between BUN levels and cochlear OHC dysfunction in CKD patients, possible hearing loss of these patients can be anticipated early.

Effect of fat on chronic kidney disease (CKD) patients; a retrospective cohort study

Rationale: Dyslipidemia is one of the main problems in chronic kidney disease (CKD) and risk factor for cardio vascular disease (CVD).Proper management will slow kidney failure and CVD. regularly monitor the patient’s fat profile. Much concern was given to the quality and purity of coconut oil and use of physically refined coconut oil.

The assessment of cognitive impairment in maintenance hemodialysis patients and the relationship between cognitive impairment and depressive symptoms.

Cognitive impairment and depression are common mental health problems in chronic kidney disease (CKD) patients with maintenance hemodialysis (MHD). Previous studies have proven that cognitive impairment and depression were risk factors for poor prognosis in MHD patients. However, the related factors of cognitive function and the association between cognitive impairment and depression in MHD patients are still unclear. The purpose of this study is to explore the related factors affecting the cognitive function of MHD patients and evaluate the relationship between cognitive function and depression in MHD patients. This single-center, cross-sectional study enrolled 160 MHD patients. Cognitive function and depressive symptoms were measured using Montreal Cognitive Assessment (MoCA) and Patient Health Questionnaire-9 (PHQ-9), respectively. Cognitive impairment was detected in 58.1% of 160 MHD patients. Multivariate linear regression analysis showed that age, level of education and homocysteine (HCY) were independent influencing factors of MoCA scores and the scores of attention and abstract thinking were independently correlated with PHQ-9 score after adjusting for confounding factors CONCLUSIONS: These findings indicated that age, level of education and HCY were independently associated with cognitive function, and attention and abstract thinking could independently affect depressive symptoms in MHD patients.

Cytokines and progressive chronic kidney disease in children

The problem of chronickidney disease is one of the urgent problems in nephrology. There is data on the multifaceted participation of cytokines in the development and prognosis of pathological conditions. The recent studies are focusedon the mechanismsoflocal inflammation with the analysis of interleukins level in the urine. Cytokines are mediators between nonspecific defense reactions and specificimmunity. Being synthesized in the focus of inflammation, cytokines influence almost all cells involvedin inflammation. In case of local defense failure, cytokines enterthe circulation and act at the systemic level, developing an acutephaseresponse in the body. The review presents data on the cytokine status in chronic kidney disease in children and its rolein the progression oft he disease. The authors emphasize the scientific and practical significance of studies of the cytokine status in chronic kidney diseases.

Elderly with chronic kidney disease in outpatient treatment: risk factors and prevention pathways

Introduction. At present, doctors in all disciplines are facing an increasing problem of chronic kidney disease (CKD) management. It is particulary relevant for screening and treatment of aged patients, because they suffer from CKD most frequently. This is due both to physiological age characteristics and kidney disease risk factors of these patient’s category.Aim. To provide an analysis of the main causes and risk factors of CKD in elderly patients.Materials and methods. Analysis of outpatient charts of patients aged 55–90 with multiple chronic diseases observed in the local health service in Moscow, which is the base of the Department of Outpatient Therapy, RNRMU.Results. We analyzed the most significant risk factors of CKD and their frequency, the indications of this syndrome in the formulation of diagnosis, the prescription of drugs, providing nephroprotective strategy.Conclusion. CKD is one of the most frequent pathologies in the elderly. An analysis of the outpatient charts showed that the main causes of CKD among patients in this age group were not kidney diseases but comorbide pathology, primarily arterial hypertension. These patients also had high frequency of diabetes mellitus, hyperlipidemia, obesity. Not all patients have been identified with CKD in the structure of diagnosis, which could influence the correct tactics for treating related diseases. Nephroprotective therapy was also not fully available to patients. Current recommendations can be used by primary health-care doctors in practice.54

Socio-economic status and chronic kidney disease problems among the fisher community in Uvari coastal panchayat of Tirunelveli district

Socio-economic status and chronic kidney disease problems among the fisher community in Uvari coastal panchayat of Tirunelveli district

Customized versus conventional video counseling for peritoneal dialysis decision-making in patients with stage 5 chronic kidney disease under a PD-first policy: a randomized controlled study.

BackgroundIndecision regarding the start of peritoneal dialysis (PD) is a challenging problem in chronic kidney disease (CKD) stage 5 patients who receive conventional video counseling. This study aimed to evaluate the effect of video counseling customized to the local context versus conventional video counseling on PD decision-making in CKD stage 5 patients under PD-first policy.MethodsWe enrolled 120 patients with stage 5 CKD in Thailand who initiate PD between May 2016 to January 2017 in a randomized, open-label, controlled study. Patients were randomized to either a customized or conventional video counseling group. The primary outcome was PD acceptance rate with complete PD catheter insertion on schedule. The secondary outcomes were change in patient knowledge and confidence in PD and reasons for indecision PD.ResultsWe analyzed 120 patients (customized, n = 60 vs. conventional, n = 60). The two groups were similar for age (55 vs. 56 years), blood urea nitrogen (89 vs. 86 mg/dL), creatinine (10.37 vs. 11.29 mg/dL), and eGFR (4.7 vs. 5.6 mL/min/1.73 m2). The PD acceptance rate along with PD catheter insertion on schedule in the customized video counseling group was not significantly different from that in the conventional video counseling group (66.6% vs. 63.3%, relative risk 0.97, 95% confidence interval 0.73 to 1.29; P = 0.86). Patient knowledge of and confidence in PD increased after counseling, but the difference was not significant.ConclusionAmong stage 5 CKD patients, counseling content customized to a local context did not differ in a rate of acceptance for beginning PD with PD catheter insertion on schedule compared with conventional video counseling.

P0889TO WHAT EXTENT CAN WE ACHIEVE MINERAL BONE METABOLISM TREATMENT TARGETS AS SUGGESTED BY UPDATED 2017 KDIGO GUIDELINES IN PATIENTS WITH PREDIALYSIS CHRONIC KIDNEY DISEASE

Abstract Background and Aims The mineral bone disorder is an essential problem in chronic kidney disease (CKD). It is an independent modifiable risk factor for renal damage progression and CKD related mortality. Therefore, it is important to treat chronic kidney disease mineral bone disorder (CKD-MBD) according to international guidelines. Data on the management of mineral bone disorders in predialysis patients is scarce. We aimed to investigate the proportion of CKD-MBD patients reaching targets suggested by the updated 2017 KDIGO guidelines. Method We performed a multicenter cross-sectional study. We recruited consecutive adult (&amp;gt;18 years of age) CKD 3-5 patients who were on regular nephrology outpatient clinic follow up. Patients who have GFR loss over 30% in the last six months, patients with malignancy, and decreased life expectancy due to severe comorbid disease and patients on renal replacement therapy were excluded. Data were collected in two-time points: one during the recruitment (second data point) and one, three to six months prior to the current visit (first data point). Persistent laboratory abnormalities were defined by out of normal range values in both time points. Therapeutic inertia was calculated for hyperphosphatemia. It was defined as a lack of using phosphate binders despite hyperphosphatemia. Results We examined a total of 213 patients for 3 different nephrology outpatient clinics. Of these patients, 49.5 % were male, with a mean age of 64,9 ± 12,0 years. 51.7 % of the patients were diabetic, 78 % were hypertensive, and 20.1 % had a history of coronary artery disease. Laboratory values related to MBD are shown in Table 1. KDIGO guideline targets were not reached in 14.8%, 18.4%, 59.0%, 71.0% patients regarding Ca, P, PTH, and vitamin D in the first visit. The targets were not reached in 15.0%, 19,2%, 61,2%, 81% patients regarding Ca, P, PTH, and vitamin D in the second visit. Persistence of out of target values were observed in 5.8%, 9.9%, 49.2% and 65.4% of the patients for Ca,P, PTH and Vitamin D respectively. The prevalence of therapeutic inertia for hyperphosphatemia was 34,4 % in the second visit Conclusion Regarding KDIGO guidelines, MBD is not optimally managed in predialysis CKD patients. Clinicians should have an active attitude regarding the correction of MBD even at the earlier stages of CKD.

Sarcopenia is an actual problem in chronic kidney disease of the 5d stage

BACKGROUND. The lack of data on the epidemiology of presarcopenia/sarcopenia leads to an underestimation of the role of this condition in the structure of morbidity and mortality of haemodialysis patients in theRussian Federation. THE AIM: to study the epidemiological aspects of presarcopenia /sarcopenia in patients with chronic kidney disease stage 5d. PATIENTS AND METHODS. This study comprised 317 patients receiving programmed bicarbonate haemodialysis for 8.2 ± 5.1 years, among them 171 women and 146 men, the average age was 57.1 ± 11.3 years. The assessment of the presence of sarcopenia was performed using the method recommended by the European Working Group on Sarcopenia in Older People. RESULTS. The prevalence of presarcopenia was 0.7 % and sarcopenia 29.6 %. The incidence of skeletal muscle mass deficiency according to muscle mass index (IMM) was 30.3 %, 48.7 % showed a decrease in muscle strength according to dynamometry, and low performance of skeletal muscles according to 6 minute walk test was determined in 42.8 %. Sarcopenia patients were significantly characterized by lower body mass index, as well as higher body fat mass values. The duration of haemodialysis (χ2 = 22.376, p = 0.0001) and the patient's age (χ2 = 10.545 p = 0.014) were an independent risk factors for the development of sarcopenia. CONCLUSION. Sarcopenia is recorded more frequently in hemodialysis patients than presarcopenia. Its prevalence increases among patients of older age groups and with a hemodialysis duration of more than 5 years. The age and experience of dialysis make their independent contribution to the development of this syndrome.

Factors associated with erythropoiesis-stimulating agent hyporesponsiveness anemia in chronic kidney disease patients.

Anemia is one of the most common problems in chronic kidney disease (CKD). Despite comprehensive investigations in several cases, definite causes of anemia frequently remain unknown. Our study aimed to analyze the factors that possibly affect anemia in CKD patients who were referred for hematology consultation. A total of 87 patients were retrospectively included in the cohort. Forty-four cases were excluded, including 30 cases with unavailable intact parathyroid hormone (iPTH) data, 11 cases with bone marrow diseases (8 Pure red cell aplasia, 3 Myelodysplastic syndrome) and 3 cases with thalassemia. In total, 43 patients were analyzed. Patients with high iPTH had a significantly lower Hemoglobin (Hb) level and required a higher dose of erythropoiesis stimulating agents (ESAs) compared with the normal iPTH group (Hb 8.29 vs 9.24 mg/dL, P=0.032 and ESAs dose of 16,352.94 vs. 12,444.44 U/week, P=0.024). Univariate, followed by stepwise multivariate analysis was performed and determined that serum phosphate (PO4) was significantly associated with lower Hb level (P=0.01 and P=0.013, respectively). In addition, Hb level was inversely correlated with iPTH and serum phosphate (PO4) level (r=-0.54, P<0.001 and r=-0.47, P=0.005; respectively). Mineral disequilibrium is an important factor associated with anemia in ESA hyporesponsive CKD. Also, hyperphosphatemia and secondary hyperparathyroidism are significantly correlated with low Hb. As a result, we strongly suggest correction of mineral disequilibrium factors prior to performing bone marrow study.

Impact of Inflammation on Ferritin, Hepcidin and the Management of Iron Deficiency Anemia in Chronic Kidney Disease.

Iron deficiency anemia (IDA) is a major problem in chronic kidney disease (CKD), causing increased mortality. Ferritin stores iron, representing iron status. Hepcidin binds to ferroportin, thereby inhibiting iron absorption/efflux. Inflammation in CKD increases ferritin and hepcidin independent of iron status, which reduce iron availability. While intravenous iron therapy (IIT) is superior to oral iron therapy (OIT) in CKD patients with inflammation, OIT is as effective as IIT in those without. Inflammation reduces predictive values of ferritin and hepcidin for iron status and responsiveness to iron therapy. Upper limit of ferritin to predict iron overload is higher in CKD patients with inflammation than in those without. However, magnetic resonance imaging studies show lower cutoff levels of serum ferritin to predict iron overload in dialysis patients with apparent inflammation than upper limit of ferritin proposed by international guidelines. Compared to CKD patients with inflammation, optimal ferritin levels for IDA are lower in those without, requiring reduced iron dose and leading to decreased mortality. The management of IDA should differ between CKD patients with and without inflammation and include minimization of inflammation. Further studies are needed to determine the impact of inflammation on ferritin, hepcidin and therapeutic strategy for IDA in CKD.

Dental and periodontal disease in hemodialysis patients is associated with inflammation; a study from North India

Introduction: Poor oral health and periodontitis is an important problem in chronic kidney disease (CKD) patients on hemodialysis (HD) awaiting kidney transplantation. This could contribute to increased morbidity and mortality as a result of infections and consequences of inflammation. Objectives: To study the oral health status and assess its impact in inducing inflammation in CKD patients on HD. Patients and Methods: Fifty CKD patients on HD (group I) were compared with 50 healthy controls (group-II) in a prospective cohort study. Oral health assessment was done with the WHO oral health assessment form with a mouth mirror and a community periodontal index (CPI) probe by a trained dentist. The demographic clinical data of oral health and periodontitis was collected in dialysis patients and healthy controls. CRP levels were assayed as markers of inflammation. Results: Data shows that patients on dialysis have evidence of increased inflammation as indicated by raised CRP values. Our study shows the poor oral and mouth hygiene and periodontitis and inflammation was much more in dialysis patients as compared to control group (P<0.05). Amongst dialysis patients with higher inflammation (CRP values), there was poorer oral health and more periodontitis (P<0.05). This indicates that higher inflammation could result from poor dental hygiene and periodontitis. Conclusion: Poor oral and mouth hygiene was associated with inflammation as indicated by high CRP values in CKD patients on dialysis with poor dental hygiene. Periodontitis was significantly associated with development of inflammation.

Chronic kidney disease as a multidisciplinary problem of contemporary medicine.

A review deals with the problem of chronic kidney disease (CKD) from the position of a physician and cardiologist. The epidemiology of the disease was discussed both abroad and in Russia, including the most up-to-date data. In Russia CKD markers were detected in 49.4% of hypertensives. Authors describe risk factors and mechanisms of CKD at the most important pathogenetic conditions: hypertension, diabetes and obesity. The current classification and methods for calculating the glomerular filtration rate are given. The review disclose a paradigm of the renal continuum and its relation to cardiovascular diseases. It is well known fact that the final causes of the death of patients with CKD, as a rule, are cardiovascular complications. Based on the literature data, the necessity and expediency of screening for renal dysfunction is justified. In the example of use of an angiotensin receptor blocker II - irbesartan nephroprotective demonstrated possibilities of intervention in patients with renal dysfunction of varying severity.

Analysis of pharmacists’ recommendations to address drug-related problems in chronic kidney disease patients as a basis to develop therapeutic drug monitoring form in an Indonesian hospital

This study aimed to develop therapeutic drug monitoring (TDM) form based on analysis of pharmacists’ recommendation to address drug-related problems (DRPs) in chronic kidney disease (CKD) patients in a private hospital. The profile of DRPs and pharmacists’ recommendations, and clinical significance assessment of pharmacists’ recommendations before and after development of TDM form were compared. Focus group discussions (FGD) was undertaken to evaluate the TDM form. There was similar pattern of DRPs identified using either pre-developed or post-developed TDM form with dose selection being the most frequent DRP. No considerable difference regarding physician acceptance rate to pharmacists’ active recommendations before and after form development (70.6% and 65.4%, respectively). The commonest recommendations in both phases were dose change, drug discontinuation and drug change. There was no statistical difference regarding the clinical significance of recommendations between both phases but higher level of clinical significant recommendations was documented after form development. Major issues of pre-developed form identified during FGD including unclear instruction of documentation, inadequacy to justify the reasons for recommendations and non-integration within medical record. Development of TDM form unchanged the profile of DRPs and pharmacists’ recommendations, yet the developed form might generate more responses from other health professions and clinically significant recommendations.