End-stage Renal Disease Stage Research Articles

KFRE for predicting ESRD risk in CKD 3-4 patients

Objective: The Kidney Failure Risk Equation (KFRE) is a useful tool for predicting chronic kidney disease (CKD) progression to end-stage renalkidney disease (ESRD). It has been validated in various countries populations. This study aimed to evaluate the prognostic significance of the KFRE model in a Turkish CKD cohort. Materials and Methods: In a prior retrospective study at a single center, the 4-variable KFRE model's accuracy in predicting end-stage renal disease (ESRD) progression was assessed. Among 246 stage 3 or 4 CKD individuals, two-year risk predictions categorized participants into low-intermediate (<20%) and high (≥20%) risk groups. Results: The model showed a sensitivity of 48.9% (95% confidence interval [CI] 34.08–63.94) and a specificity of 89.45% (95% CI 84.32–93.35) in predicting kidney failure progression in the Turkish population with stage 3–4 CKD. The area under the receiver operating characteristic curve was 0.69 (95% CI 0.60–0.79, p = 0.0001). Albuminuria, glomerular filtration rate, and renin–aldosterone system blockage were independently associated with kidney failure progression according to the Cox regression analysis. Conclusion: The findings of this study have demonstrated that the Kidney Failure Risk Equation (KFRE) model shows potential utility in predicting the progression of stage 3–4 chronic kidney disease (CKD) toward the critical stage of end-stage renal disease (ESRD) for the Turkish population.

ПЕРСПЕКТИВЫ РЕТРАСНПЛАНТАЦИИ ПОЧКИ. КЛИНИЧЕСКИЙ СЛУЧАЙ

According to a number of large epidemiological studies, about 10% of the world's population suffer from chronic kidney disease (CKD), the most severe stage of which is end-stage chronic renal failure (ESRD). Chronic renal failure is a symptom complex that develops in chronic bilateral kidney diseases due to the gradual irreversible death of nephrons and is characterized by a violation of the homeostatic function of the kidneys. The disease is diagnosed in 10-13% of the adult population, and 20% of them are people over 60 years of age. In Russia, according to international studies, up to 27 million people suffer from chronic kidney disease. The task of conservative therapy is to slow down the progression of chronic renal failure, to eliminate factors that aggravate its course, as well as to correct hormonal and metabolic disorders inherent in uremia - anemia, hyperphosphatemia, hyperlipidemia. The fifth stage of chronic kidney disease, also called the stage of end-stage renal disease, means a decrease in kidney function by more than 80%, which leads to life-threatening disorders of homeostasis and metabolism. The only way to continue life at this stage is lifelong use of renal replacement therapy, which includes three varieties: hemodialysis, peritoneal dialysis and kidney transplantation. The aim of each type of this therapy is to replenish, as far as possible, the lost functions of the patient's kidneys. Recently, the quality and reliability of dialysis machines, water purification systems, vascular access has improved significantly. However, there are complications associated with the procedure. This is also facilitated by an increase in the number of patients with diabetes mellitus, cardiovascular pathology, who are most susceptible to interaction with a dialysis machine. If there is no possibility of a transplant, a long waiting list, or there are contraindications to surgery, dialysis therapy is the treatment of choice. It must be remembered that dialysis is also supportive therapy for transplant rejection.

Functional representation of the network organisation of dialysis activities in France: A novel level for assessing quality of care.

To assess quality of care, groups of care units that cared for the same patients at various stages of end-stage renal disease, might be more appropriate than the centre level. These groups constitute "communities" that need to be delineated to evaluate their practices and outcomes. In this article, we describe the use of an agglomerative (Fast Greedy) and a divisive (Edge Betweenness) method to describe dialysis activities in France. The validation was based on the opinion of the field actors at the regional level of the REIN registry. At the end of 2018, ESRD care in France took place in 1,166 dialysis units. During 2016-2018, 32 965 transfers occurred between dialysis units. With the Edge Betweenness method, the 1,114 French dialysis units in metropolitan France were classified into 156 networks and with the Fast Greedy algorithm, 167 networks. Among the 32 965 transfers, 23 168 (70%) were defined in the same cluster by the Edge Betweenness algorithm and 26 016 (79%) in the same cluster by the Fast Greedy method. According to the Fast Greedy method, during the study period, 95% of patients received treatment in only one network. According to the opinion of the actors in the field, the Fast Greedy algorithm seemed to be the best method in the context of dialysis activity modelling. The Edge Betweenness classification was not retained because it seemed too sensitive to the volume of links between dialysis units.

Emodin-Mediated Treatment of Acute Kidney Injury.

Acute kidney injury (AKI), a common condition associated with a high mortality rate, is characterized by declined glomerular filtration rate, retention of nitrogen products, and disturbances in balance of water, electrolyte, and acid-base. Up to date, there is no effective treatment for AKI. Despite the continuous improvement in blood purification techniques, a considerable proportion of patients with AKI still progress to end-stage renal disease. These patients with advanced stage of end-stage renal disease will require long-term renal replacement therapy, which places a heavy burden on the family and the society. In recent years, the use of traditional Chinese medicine (TCM) in AKI management has been gradually increasing. Clinical evidence has demonstrated that three-month treatment with TCM produced better clinical outcomes in terms of clinical effectiveness rate and improvement in renal function (serum creatinine, neutrophil gelatinase-associated lipocalin, and cystatin C) compared with Western medicine. Rhubarb is a commonly used herb in TCM for the treatment of AKI. The main active component of rhubarb is emodin, which was first recorded in Shennong's Classic of Materia Medica. It has been shown that emodin has a variety of pharmacological activities including antibacterial, anti-inflammatory, antiulcer, and immunosuppressive effects. Emodin has been found to be effective against renal fibrosis and has been widely studied for its effects on kidney diseases such as diabetic nephropathy, renal fibrosis, and AKI. Moreover, promising results have been obtained from these studies. In this study, the results obtained from research on the use of emodin for AKI treatment has been reviewed.

Outcomes of corneal transplantation using donor corneas retrieved from patients with chronic kidney disease

Purpose:To report the outcomes of corneal transplantation utilizing corneas retrieved from donors with chronic kidney disease (CKD).Methods:Outcomes of corneal transplantation (optical PK and EK) performed from Jan 2018 to Dec 2018 utilizing donor corneas retrieved from CKD patients was performed retrospectively.Results:Of the total of 233 donor corneas retrieved from CKD, 135 (57.9%) were utilized for transplantation after the routine screening protocol of the eye bank. Mean age of the donors was 56.2 ± 13.5 years. The mean endothelial cell density on specular microscopy of the donor corneas used for optical PK was 2685.7 ± 377.6 cells/mm2 (range, 2028–3448 cells/mm2) and for EK was 2731.7 ± 189.1 cells/mm2 (range, 2380–3194 cells/mm2). The overall primary graft failure rate was 5.1%. All grafts except 1, cleared in the PK group. In the EK group (6 DMEK and 16 DSAEK), 1 patient had a complete graft detachment and another 1 had a primary graft failure after DMEK.Conclusion:The donor corneas retrieved from chronic kidney disease patients are safe and suitable for optical keratoplasty provided they meet the criteria for transplantation.

Current indications to parathyroidectomy in CKD patients before and after renal transplantation

Secondary hyperparathyroidism (SHP) is one of the most challenging complications in the most advanced stages of end-stage renal disease. In the last decade, newly available medical tools have greatly increased the possibilities for controlling SHP. However, one of these tools, cinacalcet, has not yet been approved for its use in transplanted patients and the evidence for its safety in this clinical setting is still incomplete. For these reasons, many questions still remain open for the clinical nephrologist: when to consider a parathyroidectomy (PTX) in a patient on a waiting list for kidney transplant (KTx); when to recommend PTX after KTx; when could a regression of parathyroid hyperplasia be expected at any time after KTx. In the present paper, we will briefly deal with these questions in the light of an unusual clinical case.

Stage-specific educational interventions for patients with end-stage renal disease: psychological and psychiatric considerations

To optimize the success of educational interventions for adults with end-stage renal disease, we developed a psychosocial framework of illness adjustment. Currently, no stage-specific guidelines are available for understanding the psychosocial concerns of patients with end-stage renal disease nor are there specific models of coping with the disease. The content and implementation of educational programs must correspond to a patient's stage of adjustment to the illness. Psychological or psychiatric concerns may also affect participation in and response to educational interventions. Recommendations for structuring and implementing educational interventions about renal replacement that are specific to the unique psychosocial tasks associated with adjusting to each stage of end-stage renal disease are presented. Increased information about this disease and the treatment options available can be instrumental in improving patients' quality of life.

Stage-Specific Educational Interventions for Patients with End-Stage Renal Disease: Psychological and Psychiatric Considerations

To optimize the success of educational interventions for adults with end-stage renal disease, we developed a psychosocial framework of illness adjustment. Currently, no stage-specific guidelines are available for understanding the psychosocial concerns of patients with end-stage renal disease nor are there specific models of coping with the disease. The content and implementation of educational programs must correspond to a patient's stage of adjustment to the illness. Psychological or psychiatric concerns may also affect participation in and response to educational interventions. Recommendations for structuring and implementing educational interventions about renal replacement that are specific to the unique psychosocial tasks associated with adjusting to each stage of end-stage renal disease are presented. Increased information about this disease and the treatment options available can be instrumental in improving patients' quality of life.

Kidney Transplantation and Enzyme α-Galactosidase A Therapy in Patient With Fabry Disease: A Case Report

Fabry disease, an X-linked recessive glycolipid storage disease, is caused by a deficiency of the lysosomal enzyme α-galactosidase A (α-Gal A), which cleaves a fatty substance called globotriaosylceramide (GL3). The abnormal storage of GL3 in blood vessel walls leads to ischemia and necrosis, particularly in blood vessels of the skin, kidneys, heart, brain, and nervous system. The aim of our study was to present the results of cadaveric kidney transplantation with enzyme α-Gal A therapy in a patient with Fabry disease. The patient was diagnosed with Fabry disease at the age of 33 years, based on enzymatic tests. Renal manifestations occurred a year later as proteinuria. At the age of 35 years, the glomerular filtration rate (GFR) was within the normal range. The patient received supplemental enzyme treatment with α-Gal (1 mg/kg every 2 weeks). At 3 months after starting supplementation, renal function worsened with serum creatinine levels at 1.7 to 1.8 mg/dL. The following months of supplementation (α-Gal 1 mg/kg) concurred with progressive renal dysfunction. After 27 months of supplementation at 37 years, with a creatinine value of 5.5 mg/dL, hemodialysis began and months later the patient received a cadaveric kidney graft. The patient no longer required dialysis. On postoperative day 5 the serum creatinine was 3.9 mg/dL; on day 7, 2.2 mg/dL; on day 14, 1.5 mg/dL. Enzyme supplementation began on posttransplant day 13. Renal graft function has been good during 5 months of observation with creatinine levels at 1.2 to 1.3 mg/dL. The treatment does not interfere with tacrolimus metabolism. Simultaneous chronic enzyme supplementation is the optimal treatment in the fifth stage of end-stage renal disease in Fabry disease.

End-stage disease of native kidneys in a patient with biopsy-proven Arndt-Gottron scleromyxoedema and recurrence in the transplanted kidney

End-stage renal disease-stage 5 chronic kidney disease (CKD)-of the native kidneys, related to biopsy-proven Arndt-Gottron scleromyxoedema, developed in a male patient. From 1998 until 2001, the patient was treated by haemodialysis. In June 2001, cadaveric kidney transplantation was performed. In January 2004, a kidney biopsy was performed because of deteriorating renal function revealing relapse of scleromyxoedema with typical concentric narrowing of the arterioles due to accumulation of mucopolysaccharides with severe glomerular ischaemia. Arndt-Gottron scleromyxoedema is an as yet unsuspected cause of stage 5 CKD of the native kidneys. Moreover, the disease can relapse in the transplanted kidney, again leading to intractable transplant stage 5 CKD.

Calciphylaxis due to poor compliance in a child with end stage renal disease: A case report

Calciphylaxis (calcific uremic arteriolopathy) is a vasculopathy that is often defined in patients due to renal failure, however, some patients with calciphylaxis do not show secondary or tertiary hyperparathyroidism. It results from mural calcification of arteries and arterioles in the deep dermis and subcutaneous adipose tissue, leading to vessel occlusion. The resulting ischemia may be so severe that infarction of the downstream tissue may develop, the most affected sites being the skin and subcutaneous adipose tissue. The regions of the body with thicker subcutaneous adipose tissue such as the breast, abdomen, thighs and buttocks may be more frequently affected. 1 The accepted concept is that reduced glomeruler filtration rate, even in the early stages of end-stage renal disease (ESRD), results in diminished renal phosphorus excretion and an increase in serum phosphorus concentration. The retained inorganic phosphorus combines with plasma calcium and the calcium × phosphate product with CaHPO4 concentration rise. 2 This leads to the stimulation of parathyroid hormone secretion and secondary hyperparathyroidism as well as the resorption of calcium and phosphorus from bone with resulting osteodystrophy and metastatic calcification. Cutaneous metastatic calcification was reported as long ago as 100 years. The lesions are quite characteristic, starting as areas of painful purple discoloration in the extremities that are plaquelike or nodular. They usually progress to necrotizing gangrenous areas and ulcerations. Some reports describe actual gangrene and self-amputation of digits or extremities. 3 In this case report, we present an 8-year-old girl who experienced cutaneous and widespread visceral calcifications due to poor compliance of her parents to the treatment of chronic renal failure. Case report

Adaptation of African-American Cultural and Food Preferences in End-Stage Renal Disease Diets

Emphasis on culturally based and ethnically oriented food selection by nutrition health professionals is needed to effectively plan therapeutic diets. With the influx of numerous ethnic groups into the United States and the merging of cultural practices, it is important for dietitians to become familiar with specific ethnic foods and regional cooking techniques. In this review, the influence of immigration on regional cuisine is documented. Dominant patterns of typical African-American ethnic menus for holidays and special celebrations are revealed. Analysis of common foods in the African-American culture are listed for reference, along with a glossary of ethnic foods. Renal guidelines are presented for various stages of end-stage renal disease. When planning a specific renal diet, African-American ethnic preferences can be incorporated into the meal plan or appropriate substitutions can be recommended. A suggested sample menu for hemodialysis patients that incorporates African-American preferences is included for reference. Health risks also influence current eating trends of the African-American population. Hypertension and obesity are two physiological factors that need to be evaluated and considered when planning renal diets. Literacy skills and appropriate dietary instructional material is discussed. Reference materials developed for nutrition professionals are important and can be used in the planning of renal diets for African-Americans.