Stage Renal Failure Research Articles

Differences in Serum Creatinine Levels in Controlled and Uncontrolled Type 2 Diabetes Mellitus Patients

Diabetes Mellitus is in the top 10 causes of death in the world. Indonesia ranks 5th out of 10 countries in the number of diabetes mellitus sufferers in adults aged 20-79 years. Type 2 Diabetes Mellitus is the most common type of Diabetes Mellitus. Examination of the HbA1c value is the gold standard examination for Type 2 Diabetes Mellitus. In PERKENI 2021, the risk of suffering from Type 2 Diabetes Mellitus increases with increasing age and it is recommended to screen for Type 2 Diabetes Mellitus at the age of > 40 years. The second most common complication of Diabetes Mellitus in Indonesia is nephropathy. Diabetic nephropathy is the main cause of end-stage renal failure which is the 5th stage of chronic renal failure. Examination of creatinine in the blood is an important parameter to determine kidney function. The aim of this study was to determine the average difference between serum creatinine levels in controlled and uncontrolled type 2 diabetes mellitus. This research was an analytical observational study with a cross-sectional design using secondary data from Type 2 Diabetes Mellitus sufferers without Chronic Kidney Failure from medical records at Hospital X in Jakarta in January-December 2023. The research data consisted of 368 respondents. The result was p-value = 0.688. The conclusion of this study is that there is no difference in mean between serum creatinine levels in controlled and uncontrolled Type 2 Diabetes Mellitus sufferers. Furthermore, research can be carried out using respondents with a duration of Diabetes Mellitus ≥ 10 year.

"A call to action: amplifying the role of men in bridging the gender gap in live kidney donations"- A Letter to the Editor.

Dear Editor, We are writing this letter to expound upon an underreported and rarely talked about issue referencing the gender bias invloving the live kidney donations. That being said, the purpose of this letter is purely to underscore the fact that women are less likely to receive a living donor transplant as compared to men. However, they are more likely to serve as living donors for kidney transplantation. [1] Multiple contributory factors including societal stigmas and cultural biases can be attributed to this approach. The evidence of this sex disparity is much more prominent in south Asian countries where men have a 10 times more likely chance to receive a kidney transplant than women. [2] Apart from the male dominance influenced by the socioeconomic reason, this gender imbalance is difficult to quantify. Many women feel obliged to accept the traditional role to care for sick family members. They are less able to refuse the appeal for help within the family compared to men. This is especially true for mothers and spouses. [3] When it comes to men, documented instance in literature show that men in situations where they needed to donate silently disappear from the scene and only show up once the transplantation is over, leaving the women to step forward in this situation. This, cowardice of men is cemented by a recent story of a 36-year-old man with end- stage renal failure. Although one of his healthy brothers was a perfect match, the burden of the transplant still befelled on their old mother. [4] Kidney donation is an act of altruism and devotion. As evidenced by the statistics, the local literature also have frequently portray that women are the frontrunners in this race, while the men are falling far behind. Here the authors need to make it very clear that our purpose is not to say that all men would react this way, but it is to highlight the huge contrast between men and women stepping up as donors for their families. The primary objective of this letter is to accentuate the importance of enhanced access to care for women requiring transplantation while fostering within the male population a deeper understanding of the myths surrounding organ donation and the vital importance of supporting the women in their lives during such critical moments.

Intact Parathyroid Hormone (iPTH) Assay: An Early Approach for Bone Health Assessment in Chronic Renal Failure.

Chronic kidney disease (CKD) is a global public health burden with significantly increasing mortality. Chronic kidney disease leads to various complications, including anemia, cardiovascular complications, salt and water retention, metabolic acidosis, electrolyte disorders, and chronic kidney disease-mineral and bone disorder (CKD-MBD), amongst which CKD-MBD is a particularly important complication that develops early. In the present study, various biochemical analytes were assessed for their significance in monitoring the CKD-MBD in different stages of CKD. Only biochemistry markers were assessed in the present study, as X-rays and other radiological markers give positive results in the very late stages of CKD. The level of intact parathyroid hormone (iPTH) was raised or highly normal from the very early stages of chronic renal failure (CRF), and the differences in progressive stages were highly significant p<0.05. The correlation of iPTH with different biochemistry test parameters of CRF, such as creatinine, estimated glomerular filtration rate (eGFR), vitamin D, calcium, and inorganic phosphate, was also checked to determine its efficacy in the detection of CKD-MBD and, consequently, in preventing the complication of CKD. Parathyroid hormone (PTH) showed a significant positive correlation with creatinine in Stages 4 and 5 (p<0.05 in both stages). It was also observed that with the increase in the PTH level, there was a decrease in the estimated glomerular filtration rate in both Stage 4 and 5 patients. The level of iPTH was significantly increased from Stage 2 onwards; hence, it can be used as a diagnostic marker of CKD-MBD from the initial stages. Subsequent to diagnosis, the progression of CKD-MBD can be prevented by choosing the appropriate intervention from the wide array of treatment options available.

A randomized controlled clinical trial on multimodal prehabilitation in colorectal cancer patients to improve functional capacity: preliminary results

IntroductionMajor colorectal surgery is associated with 20 to 40% reduction in physiological and functional capacity and higher level of fatigue 6 to 8 weeks after surgery. The primary aim of this study was to analyse the effects of a multimodal prehabilitation program in colorectal cancer patients to improve functional capacity. The secondary outcome was to evaluate postoperative complications and length of postoperative hospital stay as well as to determine the costs of implementation and indirect costs.MethodsA single centre, single-blind, randomized controlled trial was conducted. Patients of age > 18 years undergoing elective colorectal resection for colonic cancer were eligible. Exclusion criteria were metastatic disease, severe walking impairments, renal failure stage > 2, ASA score > 3, preoperative chemo-radiation therapy. Patients have been randomized either to prehabilitation intervention groups, receiving 4-week trimodal prehabilitation (physical exercise and nutritional and psychological support) or to control receiving no prehabilitation. Both groups followed enhanced recovery programs and received rehabilitation accordingly. The primary outcome for functional capacity was measured by the 6-Minute Walking Test (6MWT) 4 and 8 weeks after surgery; to evaluate post-operative complications the Clavien-Dindo classification was used.ResultsAn interim analysis of 71 patients undergoing colorectal surgery was performed, with 35 assigned to interventional arm and 36 to control arm. Baseline characteristics were comparable in both groups. The prehabilitation group showed a significant increase in mean 6MWT distance pre-operatively compared to the control group, with an increase of 96 m (523 ± 24.6 vs. 427 ± 25.3, p = 0.01). At 4 and 8 weeks, the prehabilitation group maintained significant improvements, with an increase of 103 m (514 ± 89 vs. 411 ± 115, p = 0.003) and 90 m (531 ± 82 vs. 441 ± 107, p = 0.008), respectively. There were no statistical significant differences in post-operative complications and hospital length of stay between the two groups.ConclusionsThe preliminary results of this study indicate that it is feasible to implement a prehabilitation protocol lasting approximately 4 weeks. This protocol appears to yield a significant improvement in the physical performance of patients with colon cancer undergoing elective colorectal resection at 4 and 8 weeks after surgery.Graphical abstract

The Role of Biochemistry in Understanding Kidney Stone Formation andUrinary Health

Renal illness caused by stones is the term for a solid substance concretion that usually develops inside the kidneys. A rising urological condition influences the well-being of people and affects about 12% of the world's population. An increased chance of ending stage of renal failure and they are closely related. There are several types of kidney stones. The CaC2O4 kidney calculi are the most common type. It appears at Randall plaque's renal papillary surfaces. (1) Several physicochemical mechanisms, such as supersaturating, urinary stone nucleation, growth, aggregation, and retention components found in tubular cells, which aid in the complex process of formation of stones. An inequity between the elements that promote or inhibit the crystallization of urine influences these phases. Moreover, Scientists have noticed that renal injury of cells promotes particle retention reticular body. (2)

Population Pharmacokinetic of Vancomycin Administered by Continuous Infusion in Critically Ill Patients

Introduction: Administration of vancomycin dose by continuous infusion (CI) according to population pharmacokinetic (Pop Pk) models is highly recommended in critically ill patients who exhibit pathophysiological changes. Objective: The objective of this study was to develop and validate a Pop Pk model of vancomycin administered by CI in critically ill patients with normal and impaired renal functions. Methods: The Pop Pk study was performed using a nonparametric approach (Pmetrics*). The influence of covariates (gender, age, weight, height, and creatinine clearance [Cr-Cl]) was tested on the model’s Pk parameters. The performance of the final model was assessed using an external dataset. Results: A one-compartment model (volume of distribution [Vd], elimination from compartment [Ke]) was found to show a good prediction performance. The influence of covariates has shown that age and Cr-Cl affected significantly Vd and Ke, respectively. The distribution of simulated vancomycin clearance (CLv) according to different renal function levels showed a negative correlation between CLv and the severity of the renal impairment. The internal validation of the final model showed that the plot of individual-predicted concentration versus observed concentration resulted in r2 = 0.86 in the final model. The external validation of the final model showed an acceptable predictive performance. Conclusion: We developed a Pop Pk model for vancomycin administered by CI in critically ill patients. A significant impact of Cr-Cl and different stages of renal failure on CLv has been demonstrated. The establishment of an individualized proposal dose based on this model may be helpful to achieve the target range which is critical in optimizing the efficacy and safety of this antibiotic.

#2983 Correlation of microRNA expression with IgA nephropathy progression: preliminary results

Abstract Background and Aims IgA nephropathy (IgAN) is the most common cause of glomerulonephritis worldwide. IgAN is diagnosed based on the result of histopathological examination. The risk factors for disease progression primarily include the level of impairment of renal function at the time of diagnosis (GFR &amp;lt; 60 ml/min/1.73 m2), the presence of hypertension, daily administration of more than 1.0 g, and the occurrence of hematuria. MicroRNAs (miRNAs) are important regulators of gene expression. Their role has a significant impact on the proper functioning of the body, and disorders related to their expression can lead to the development of many pathological processes in the body. The study aimed to assess the dependence of microRNA expression on the stage of the disease in patients with IgA nephropathy. Method A study was conducted involving patients newly diagnosed with IgA nephropathy based on histopathological examination results. The expression of microRNA molecules (miR-146a, miR-155, miR-200b, miR-429) was determined in urine sediment and blood. The analysis focused on examining the relationship between microRNA expression and the stage of disease progression (proteinuria, renal parameters). Blood and urine tests were performed before the start of immunosuppressive treatment with glucocorticosteroids according to the Pozzi regimen. Results Twenty-seven patients were included in the study group- 14 women (51.9%) and 13 men (48.1%). Nephrotic-range proteinuria (&amp;gt;3000 mg/24 h) was observed in 5 patients (18.5%), while subnephrotic proteinuria was present in 22 patients (77.8%). Reserved kidney function (eGFR &amp;gt; 90) was found in 17 patients (63%). The exact distribution of results according to the stage of renal failure is given in the Table 1. Statistically significant positive correlation was found between serum creatinine concentration and miR-200b expression in urine (R = 0,398, p = 0,049). Initially, no statistically significant correlation was found between the expression of selected miRNA molecules and the degree of 24-hour proteinuria. Conclusion MiRNA molecules may be promising, non-invasive biomarkers widely used in clinical practice. Determining the viability of clinical use of microRNA molecules will require a panel of miRNAs or miRNAs used in combination with other biomarkers and clinical outcomes to improve diagnostic utility.

#1581 Anoctamin 3 inhibits gluconeogenesis and contributes to renal interstitial fibrosis through EZH2

Abstract Background and Aims Renal fibrosis is the common pathological pathway of various chronic kidney diseases progressing to the end stage of renal failure. Anoctamin 3 (ANO3) has been identified as a K-channel regulator and been extensively studied in the field of neurobiology. The role of ANO3 in kidney diseases is currently unknown. Method Mouse models of renal fibrosis were established by unilateral ureteral obstruction (UUO) operation or aristolochic acid I (AAI) injection. Human proximal tubular cell line (HK2) was used as an in vitro model. ANO3 was deleted in vitro by siRNA. Western blotting analysis was performed. Glucogenic metabolites were measured. Results We found that ANO3 is upregulated in mouse kidneys with unilateral ureteral obstruction (UUO) or aristolochic acid nephropathy (AAN), and tightly correlated with the progression of renal fibrosis and negatively correlated with expression of several rate-limiting enzymes of renal gluconeogenesis. Knockdown of ANO3 with siRNA increased the concentration of glucose and reduced the concentration of lactate in the supernatant of TGF-β stimulated renal proximal tubular (HK2) cells. In parallel, transfection of ANO3 siRNA significantly reduced the expression of epithelial-to-mesenchymal transition (EMT) and fibrotic markers in TGF-β stimulated HK2 cells. We further showed that ANO3 expression is positively correlated with the expression of a methyltransferase enhancer of zeste homologue 2 (EZH2) in UUO and AAN mouse kidneys by time. Transfection of ANO3 siRNA significantly reduced the expression of EZH2 in TGF-β stimulated HK2 cells. Overexpression of EZH2 by adenovirus reversed the pro-gluconeogenic and anti-fibrotic effect of ANO3 siRNA in TGF-β stimulated HK2 cells by measuring the concentration of glucose and lactate in supernatant and analyzing the expression of EMT or fibrotic markers. Conclusion In conclusion, ANO3 inhibits renal gluconeogenesis through EZH2 and contributes to renal fibrosis. ANO3 could be promising therapeutic target to inhibit renal fibrosis in chronic kidney disease patients.

A Historical Perspective on Uremia and Uremic Toxins.

Uremia, also known as uremic syndrome, refers to the clinical symptoms in the final stage of renal failure. The definition of the term has changed over time due to an improved comprehension of the kidney's function and the advancement of dialysis technology. Here, we aim to present an overview of the various concepts that have developed regarding uremia throughout the years. We provide a comprehensive review of the historical progression starting from the early days of Kolff and his predecessors, continuing with the initial research conducted by Niwa et al., and culminating in the remote sensing hypothesis of Nigam. Additionally, we explore the subsequent investigation into the function of these toxins as signaling molecules in various somatic cells.

Estimate the Correlation Between Some Antioxidant Biomarkers and Pseudo Peroxidase Activity of Hemoglobin in Patients With Chronic Kidney Disease

Background: Hemoglobin, being a hemoprotein, may operate as a peroxidase due to the hemolysis process and the release of heme into the bloodstream. Objective: Evaluation of the oxidative biomarkers and peroxidase activity of hemoglobin in patients with the final stage of renal failure. Materials and Methods: The study encompassed a total of 200 blood samples, with 140 samples collected from patients diagnosed with Chronic Kidney Disease (CKD) and 60 samples obtained from individuals who were considered healthy control subjects. Results: Levels of various serum parameters, including total protein, urea, creatinine, albumin, free amino, disulfide, ischemia-modified albumin (IMA), peroxidase activity, and specific activity, exhibited a significant increase in patients with Chronic Kidney Disease (CKD) when compared to the control group consisting of healthy individuals. Conversely, CKD patients demonstrated a notable decrease in levels of glomerular filtration rate (GFR), hemoglobin, native thiols, and total thiols compared to the control group. Conclusion: Oxidative biomarkers may present useful information about oxidative stress and help to diagnose CKD patients in their advanced stages of the disease.

Еволюція поглядів на функціональну анатомію міхурово-сечовідного сегмента та етіопатогенетичні особливості міхурово-сечовідного рефлюксу в дітей

Bladder-ureteral reflux is a pathological condition in which there is a periodic and/or permanent retrograde flow of urine from the bladder into the urinary tract due to a malfunction of the anti-reflux mechanism of the vesicoureteral segment. The aim - to study etio-pathological mechanisms of vesicoureteral reflux in children to improve diagnostic and therapeutic tactics. Every year in Ukraine, 3,600-3,700 children with congenital defects of the urinary tract are diagnosed, with 1/3 of the defects occurring in their upper parts. According to statistics, there are 40-50 cases of congenital diseases of the urinary system per 1000 newborns. There are reports that the frequency of vesicoureteral reflux in the general pediatric population exceeds 2%. According to modern data, vesicoureteral reflux accounts for 0.1% to 1.0% of all pathology in the general pediatric population, accounting for 10% of all diseases of the urinary system in hospitalized children. Bladder-ureter is the initial link in the chain of pathological reflux in the urinary tract. The leading importance of the mechanism of the vesicoureteral reflux belongs to the study functional anatomy of the urinary tract as a whole. Bladder-ureteral reflux is most often detected during urination against the background of increased intravesical pressure, but it can occur during any of the stages of the urination cycle. Nephrosclerosis with vesicoureteral reflux is formed in 30-60% of cases, which leads to the development of the terminal stage of chronic renal failure in 25-60% of patients due to a decrease in the functional renal reserve, as an indicator of the compensatory capabilities of the kidneys. Conclusions. Review of literature dataregarding the structure and functional anatomy of the vesicoureteral segment convincingly testifies to the complexity and multi-level organization of its antireflux mechanism. Therefore, any further research in this direction will undoubtedly contribute to a deeper understanding of the normal functioning of this complex anatomical part of the human urinary system, which will allow the development and implementation of the latest physiological treatment methods in the practice of pediatric surgeons. No conflict of interests was declared by the authors.

The initial experience of robot-assisted nephron-sparing surgery in patients with renal cell cancer

Purpose of the study: analysis of our experience in performing robotic-assisted nephron-sparing surgeries using the da robotic system. Material and Methods. The retrospective study included the first 37 consecutive patients who underwent robot-assisted partial nephrectomy from May 2020 to december 2022. Results. To assess the surgical outcomes in patients undergoing partial nephrectomy, three parameters associated with trifecta achievement were analyzed. The trifecta was assessed according to the standard criteria, whereas the quadfecta, which in addition to the trifecta included preservation of &gt;90 % of the glomerular filtration rate (calculated according to Cockroft–Gault) in the postoperative period (3–7 days), did not assess the stage of chronic renal failure one year after surgery, thus probably demonstrating the high percentage of its achievement (54.1 %). A positive surgical margin was observed in 1 (2.7 %) patients. Warm ischemia time of more than 25 minutes was used in 8 patients (21.6 %). Complications in the postoperative period (Clavien–dindo II and higher) were observed in 1 (2.7 %) patient. Trifecta and quadfecta rates were 78.4 % and 54.1 %, respectively. To analyze the surgeons’ experience, 37 renal cell cancer patients were divided into two subgroups with first 20 and subsequent robotic partial nephrectomies. There were no differences in gender, age and calculated RENAL value between 2 subgroups. depending on the surgeons’ experience, statistically significant differences in the duration of surgery (p=0.035) and blood loss during surgery (p=0.007) were found. Conclusion. Considering the extensive experience of surgeons in the field of laparoscopic surgery for tumors of the renal parenchyma, the outcomes of robotic partial nephrectomies performed in 37 patients seem to be satisfactory and successful. The accumulated experience of surgeons after 20 robotic-assisted nephron-sparing surgeries makes it possible to significantly reduce surgery time and blood loss. The technique of robotic-assisted partial nephrectomy requires further improvements.

Association between Albumin Alterations and Renal Function in Patients with Type 2 Diabetes Mellitus.

Diabetic kidney disease (DKD) is a major cause of morbidity and mortality in individuals with type 2 diabetes mellitus (T2DM). The aim of this study was to investigate whether albumin structural alterations correlate with DKD severity and evaluate whether native and reduced albumin concentrations could complement the diagnosis of DKD. To this end, one hundred and seventeen T2DM patients without (n = 42) and with (n = 75) DKD (DKD I-III upon KDIGO classification) were evaluated; the total albumin concentration (tHA) was quantified by a bromocresol green assay, while structural alterations were profiled via liquid chromatography-high-resolution mass spectrometry (LC-HRMS). The concentrations of native albumin (eHA, effective albumin) and reduced albumin (rHA) were subsequently assessed. The HRMS analyses revealed a reduced relative amount of native albumin in DKD patients along with an increased abundance of altered forms, especially those bearing oxidative modifications. Accordingly, both eHA and rHA values varied during the stages of progressive renal failure, and these alterations were dose-dependently correlated with renal dysfunction. A ROC curve analysis revealed a significantly greater sensitivity and specificity of eHA and rHA than of tHA for diagnosing DKD. Importantly, according to the multivariate logistic regression analysis, the eHA was identified as an independent predictor of DKD.

Adaptation of the Serious Illness Conversation Guide to Singapore's Multicultural Setting for Patients With Heart Failure, Renal Failure, or Cancer.

The Serious Illness Conversation Guide (SICG) was developed by Ariadne Labs in the United States. However, there is a scarcity of literature on the cross-cultural adaptations of the SICG in Asian settings. We aimed to adapt the SICG for English-speaking patients with serious illnesses in Singapore. We purposively recruited 28 patients with advanced stages of heart failure, renal failure, or cancer from a tertiary hospital. A designated research team member conducted semistructured interviews to obtain participants' feedback on the SICG. The interviews were transcribed by the designated study team member. Participants' response to each item on the SICG was coded quantitatively into categories to denote participant acceptance, partial acceptance, or nonacceptance. Transcripts were further analyzed using content analysis to understand participants' rationale regarding feedback of the specific SICG item. Modifications to the SICG were iteratively made over time to obtain its current version. Participants indicated a preference for direct language with shorter sentences and inclusive pronouns. It was considered important that clinicians keep the conversation hopeful, individualize the conversation content according to the patient's journey, and use prompts where necessary to support the patient's elaboration. This study outlined a patient-centric approach to localizing the SICG in the English language to a new cultural context, marking the first such effort in an Asian setting. Further study is under way to evaluate the SICG in more disease populations and non-English languages used in Singapore.

Диетотерапия для собак и кошек при нефрологических патологиях

The article presents the pathophysiological mechanisms of the development of chronic renal failure in dogs and cats, discusses the causes, symptoms and stages of chronic renal failure, and also focuses on the importance of diet therapy in the treatment of nephrological pathologies. The work analyzes the features of the composition of dietary feeds for animals with acute and chronic renal failure, emphasizing the key factors that must be taken into account when selecting a diet. The article provides practical recommendations for dietary therapy for dogs and cats with nephrological pathologies, aimed at improving the quality of life of animals.

Impact of mildly reduced kidney function on 5-year mortality in patients with STEMI treated with primary PCI

Abstract PURPOSE Previous research associated renal failure (RF), as documented by estimated glomerular filtration rate (eGFR) &amp;lt;60 ml/min/1.73m2, with increased mortality risk following acute myocardial infarction. Our aim was to assess the impact of baseline mild RF (eGFR 60-89 ml/min/1.73m2) on mortality during 5-year follow-up after ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). Methods The study included 8378 STEMI patients undergoing primary PCI in the period from 2009 until 2019 for whom baseline eGFR data were available, according to the Modification of Diet in Renal Disease (MDRD) study equation. Cox regression models were created to assess the effect of different stages of renal failure on 30-day and 5-year mortality. Follow-up data were available for 8202 patients at 30 days and 5650 patients at 5 years. Results Renal function was impaired in 49% of patients (eGFR &amp;lt;30 ml/min/1.73m2 in 2.5%, eGFR 30-59 ml/min/1.73m2 in 16.2% and eGFR 60-89 ml/min/1.73m2 in 30%). Patients with eGFR &amp;lt;90 ml/min/1.73m2 had higher mortality rates at 30 days (10.0% vs. 1.7%, p&amp;lt;0.001) and at 5 years (44.1% vs 13.5%, p&amp;lt;0.001). Mortality increase was synchronous with the degree of renal failure at both 30 days and 5 years (Figure, panel A and B, respectively). At 30-days, patients with mild RF had higher adjusted mortality compared to patients with eGFR&amp;gt;90 ml/min/1.73m2 (HR 1.6, CI95% 1.1-2.4, p 0.027). At 5 years, eGFR 60-89 ml/min/1.73m2 was also associated with the higher adjusted mortality (HR 1.4, CI95% 1.2-1.6, p&amp;lt;0,001). As expected, severe (eGFR &amp;lt;30 ml/min/1.73m2) and moderate (eGFR 30-59 ml/min/1.73m2) renal failure was associated with a higher risk of mortality (30 days: HR 4.4 and 2.6 respectively; 5 years: HR 3.7 and 2.2 respectively). Conclusions The risk of short- and long-term mortality after STEMI increases proportionally with the degree of baseline renal failure. Compared with patients with a normal renal function, even mild renal failure (eGFR 60-89 ml/min/1.73m2) is associated with higher mortality at both 30 days and 5 years.

Effectiveness of a Combined Exercise Program in Improving Balance, Quality of Life, and Satisfaction With Life of Patients With Hemodialysis

Background and Aims The quality of life of hemodialysis patients who are in the final stages of renal failure is affected by various factors. Balance, as an important factor in physical ability, plays an important role in the physical and daily activities of people, including hemodialysis patients. Exercise and physical activity in these patients can reduce the symptoms of uremic syndrome, increase hemodialysis quality, and reduce mortality in these patients. This study aims to investigate the improvement of balance, quality of life, and satisfaction with life of hemodialysis patients after 8 weeks of combined exercises. Methods In this study, 24 patients with hemodialysis aged 40-60 years in Urmia, Iran participated voluntarily and were randomly divided into two groups of control (n=12) and exercise (n=12). Their quality of life (by 26-item World Health Organization quality of life questionnaire in four areas of physical health, psychological health, social relationships, and environmental health), satisfaction with life (by the satisfaction with life scale), static and dynamic balance (using the Prokin 212N device) were measured before and after 8 weeks of resistance-aerobic exercises in both groups. The control group had their normal daily activities during this period without any intervention. Results The combined exercise program significantly improved the static balance (P=0.001), dynamic balance (P=0.001), and quality of life (P=0.001 for physical, psychological, and environmental health; P=0.010 for social relationships) in the exercise group compared to the control group. In addition, a significant effect was found on the satisfaction with life in the exercise group (P=0.001). Conclusion The combined exercise program is effective in improving balance, satisfaction with life, and quality of life of hemodialysis patients. It is recommended to use these exercises to improve the balance, quality of life, and satisfaction with life of these patients.

Predictive Model for Reintervention in Total Ankle Arthroplasty

Category: Ankle Arthritis Introduction/Purpose: Osteoarthritis (OA) of the tibiotalar joint is associated with a high degree of morbidity, being comparable with final stages of renal and heart failure. The incidence of OA of the tibiotalar joint is as high as 47.7 per 100,000 habitants, of whom most of them will need a surgical intervention to improve their quality of life. Up to date evidence supports the use of the total ankle arthroplasty for its management. A great effort has been made to elucidate the factors associated with failure of the total ankle prothesis, until now no attempt has been made to look for factors associated with the need of surgical reintervention, beyond revision of the prothesis. Methods: Prospective cohort study in patients with tibiotalar OA operated between 2015 and 2022, with a minimum follow-up of 12 months, excluding revision prothesis and lost to follow-up. Reintervention was considered as any complication, related to the prothesis, that needed a surgical intervention that was not planned. We performed a multivariate logistic regression model with 13 variables (diabetes, hypertension, tabaquism, age, etiology, hind foot alignment, subtalar OA, talonavicular OA, calcaneocuboid OA, pes planus, cavo varus, previous subtalar arthrodesis and surgical time). Confounding effect was assessed with the change of the odds ratio of the principal independent variable, by adding or subtracting potentially confounder variables into the model. The variables that were statistically non-significant and those variables that do not cause confusion effect, were discarded. Goodness of fit was evaluated using the Hosmer-Lemeshow test and the discrimination of the model with the ROC curve. The Kaplan-Meier curve was used for survival analysis. Results: 105 total ankle arthoplasties were included, the statistically significant variables were: take-down etiology OR = 171.73 (CI: 6.87 - 4294.95, p &lt; 0.01), post-traumatic etiology OR = 14.56 (CI: 1.98 - 107.04, p &lt; 0.01) and surgical time OR = 0.96 (CI: 0.92 - 0.99, p = 0.04), while age OR = 1.02 (CI: 0.96 - 1.09, p = 0.57) and cavo varus OR = 4.75 (CI: 0.71 - 31.93, p = 0.11), wereincluded in the model because of its confounding effect. Goodness of fit demonstrates that the data fit the model adequately (p = 0.84). The ROC curve demonstrates 89.03% discriminatory power. The survival rate at 8 years was 80.39%, median of survival rate was not determined, because longer follow-up was needed. Conclusion: The take-down and post-traumatic etiology can be considered as important risk factors for requiring a surgical reintervention. Patients with a take-down etiology that have a cavo varus deformity and higher age, have a higher risk to require a surgical reintervention. Longer surgical time can be considered as a protective factor for needing a surgical reintervention. At 8 years 20.61% of patients will need a surgical reintervention, related to their Total Ankle Arthroplasty.

Clinical Significance of Serum Creatinine, Urea Nitrogen and Uric Acid Levels in Patients with Chronic Renal Failure

Chronic renal failure (CRF) is a clinical syndrome characterized by chronic progressive renal parenchymal damage caused by various reasons, resulting in obvious atrophy of the kidney and inability to maintain basic functions. Metabolite retention, imbalance of water, electrolyte and acid-base balance, and systemic involvement of various systems are the main manifestations in clinic. Due to its complicated metabolic disorder, once it develops to the stage of renal failure or even the end stage of uremia, it is often more difficult to treat other renal diseases. Therefore, early detection, early diagnosis and early treatment of chronic renal failure are of great significance to improve the therapeutic effect of patients. In this project, 150 subjects were divided into chronic renal failure group (75 cases) and healthy group (75 cases). By analyzing the data of renal function indexes (blood creatinine, urea nitrogen, uric acid) of patients with chronic renal failure and healthy control group, the clinical significance of blood creatinine, urea nitrogen and uric acid level detection for chronic renal failure was discussed, and the importance of blood creatinine, urea nitrogen and uric acid monitoring for chronic renal failure was explained, providing scientific basis for timely prevention or delay of chronic renal failure. Biochemical tests were carried out on 150 serum samples from the combined healthy group of chronic renal failure. the values of uric acid, urea nitrogen and serum creatinine detected by the two groups were counted and treated with statistical methods. the results showed that the values of urea nitrogen, uric acid and serum creatinine in the chronic renal failure group were significantly higher than those in the healthy group, and the same indexes in the two groups were compared, P&lt;0.05. statistics showed that the difference of the same data between the two groups was significant. Serum uric acid, urea nitrogen and creatinine are easy to detect and the test results are relatively accurate. The results can be used for auxiliary diagnosis of patients with chronic renal failure and have clinical significance for diagnosis of patients with chronic renal failure.

ОСТРЫЙ ГНОЙНЫЙ ДВУСТОРОННИЙ ПИЕЛОНЕФРИТ: ДИАГНОСТИКА И ЛЕЧЕНИЕ

Background. Acute purulent bilateral pyelonephritis is the most severe form of acute pyelonephritis. The disease is often accompanied with oligo- or anuria and is complicated by urosepsis. Purpose of the study. To analyze information content of diagnostic methods and immediate results of treatment of patients with acute bilateral pyelonephritis in the phase of purulent inflammation. Material and methods. 44 patients with acute bilateral pyelonephritis were observed. The purulent process in both kidneys was diagnosed by ultrasound and contrast-enhanced computed tomography (CT). Urosepsis was laboratory confirmed in 34 patients. All patients were operated on both sides. Organ-preserving surgeries were performed in 43 cases, and both kidneys were removed in one patient. Histological examination of fragments of the kidney parenchyma confirmed the purulent process in 41 patients. After surgery all patients received targeted antibacterial and detoxification therapy. Results. After operations 5 patients died due to the progression of multiple organ failure. After surgery two patients required hemodialysis due to the development of anuria. 37 patients were discharged from the clinic in a satisfactory condition. 1 year after the operation 19 were diagnosed with chronic renal failure stage III. Conclusions. 1. CT with contrast enhancement is the best method for detecting foci of purulent destruction in the renal parenchyma. 2. Acute purulent bilateral pyelonephritis in 77.3% is complicated by urosepsis which requires intensive complex treatment: surgical debridement of purulent foci in both kidneys followed by long-term targeted antibacterial and detoxication therapy. 3. The prognosis for acute purulent bilateral pyelonephritis is always uncertain for life and poor for recovery.