Treatment Of Chronic Kidney Failure Research Articles

Focus on Mitochondrial Respiratory Chain: Potential Therapeutic Target for Chronic Renal Failure.

The function of the respiratory chain is closely associated with kidney function, and the dysfunction of the respiratory chain is a primary pathophysiological change in chronic kidney failure. The incidence of chronic kidney failure caused by defects in respiratory-chain-related genes has frequently been overlooked. Correcting abnormal metabolic reprogramming, rescuing the "toxic respiratory chain", and targeting the clearance of mitochondrial reactive oxygen species are potential therapies for treating chronic kidney failure. These treatments have shown promising results in slowing fibrosis and inflammation progression and improving kidney function in various animal models of chronic kidney failure and patients with chronic kidney disease (CKD). The mitochondrial respiratory chain is a key target worthy of attention in the treatment of chronic kidney failure. This review integrated research related to the mitochondrial respiratory chain and chronic kidney failure, primarily elucidating the pathological status of the mitochondrial respiratory chain in chronic kidney failure and potential therapeutic drugs. It provided new ideas for the treatment of kidney failure and promoted the development of drugs targeting the mitochondrial respiratory chain.

Quality of Life of Family Caregivers of Patients Undergoing Dialysis: A Literature Review.

Dialysis is a long-term treatment for chronic kidney failure. Family caregivers play a significant role in the care of patients undergoing dialysis. The quality of life (QoL) of family caregivers is related to the quality of care provided to patients undergoing dialysis. This recent literature review aimed to synthesize the QoL experienced by caregivers of family members undergoing dialysis. This literature review employed four online databases, including SCOPUS, PubMed, ScienceDirect, and Web of Science. The extracted articles were further screened on the basis of the PRISMA guidelines. In this review, articles were selected on the basis of the following eligibility criteria: double-blind peer-reviewed articles, articles written in English language and published between 1 January 2013 and January 2023. This review used thematic synthesis. Four analytical themes emerged, including physical capacity, social relations, psychological state, and environment. All of these themes correspond to the dimensions of QoL. The QoL of family caregivers of patients undergoing dialysis must be considered. A good QoL of these caregivers will improve the balance of life and further increase the ability and quality of care they provide for family members undergoing dialysis.

The Effects of Prescription for Restoring Kidney Function on Chronic Kidney Failure (Renal Deficiency with Blood Stasis and Turbidity) and Its Impact on Renal Function

Objective: To analyze the clinical effects of Prescription for restoring kidney function in the treatment of chronic kidney failure with renal deficiency, blood stasis, and turbidity, and its influence on renal function recovery. Methods: A comparative treatment study was conducted on 72 patients with chronic kidney failure due to renal deficiency with blood stasis and turbidity, seen at the Yongchuan District Chinese Medicine Hospital in Chongqing (study period: February 2023 to October 2023). The patients were randomly divided into two groups: the control group (36 cases) received standard treatment, and the study group (36 cases) received combined treatment with Prescription for restoring kidney function. Statistical analysis was performed on changes in traditional Chinese medicine symptom scores, renal function indicators, and treatment effectiveness between the two groups before and after treatment. Results: (1) After treatment, the study group exhibited significantly lower scores for symptoms such as lumbar and knee soreness, shortness of breath, poor appetite, nausea, vomiting, and limb heaviness, as well as lower levels of blood Scr, BUN, and UA compared to the control group. The differences were statistically significant (P<0.05). (2) Compared to the control group, the study group showed an increased clinical treatment effectiveness rate (94.44%), with a statistically significant difference (P<0.05). Conclusion: Prescription for restoring kidney function provides precise clinical effectiveness in the treatment of chronic kidney failure with renal deficiency, blood stasis, and turbidity. It not only addresses symptom presentations according to traditional Chinese medicine but also corrects the metabolic function of the kidneys, optimizing clinical treatment outcomes.

A case study on management of resistant hypertension and reduction of serum creatinine in a Chronic Kidney Disease patient through Vajedi Basti

Kidney diseases are prevalent due to changing life style, improper eating habits, hypertension and uncontrolled diabetes. According to modern science, the treatment for chronic kidney failure is haemodialysis or kidney transplant, both are quite expensive. Ayurveda plays an important role for finding effective and safe medicines to prevent kidney failure. A 38-year-old male patient diagnosed with Chronic Kidney Disease (CKD) and uncontrolled Hypertension (HTN) on three anti-hypertensive agents attended the OPD of Sane Guruji Arogya Kendra, Malwadi, Hadapsar Pune. The patient was initially kept on oral ayurvedic treatment for ten days. Then he was subjected to Basti Karma along with Sthanik Snehana-Swedana. After this therapy which continued for 21 days, it was found that the baseline blood pressure (180/110 mmHg) came down to 140/90 mmHg in the third week and serum creatin level ratio also reduced gradually. This therapy was provided along with allopathic medication as prescribed and patient was advised to continue allopathic medicine and to monitor BP regularly. After another 180 days monitoring, the patient had normal blood pressure along with a reduction in serum creatinine levels. From the results, it is concluded that this procedure is useful in resistant hypertension (RH), reducing the creatine level and in stabilizing and maintaining the blood pressure in a long run. Further study is recommended.

Effect of Group Acceptance and Commitment Therapy on Body Image and Self-compassion of Women Undergoing Dialysis: A Randomized Clinical Trial

Objectives Dialysis for the treatment of chronic kidney failure has negative effects on the quality of life, daily activities, lifestyle, and physical, mental, and social health. The present study aims to assess the effect of group acceptance and commitment therapy (ACT) on the body image and self-compassion of women undergoing dialysis. Methods This is a quasi-experimental study (randomized clinical trial) with a pre-test/post-test/follow-up design. The study population consisted of all women receiving dialysis who were referred to the Dialysis Patients Support Association in Khorasan Razavi, Iran, in 2021-2022. Of these, 30 were selected by a convenience sampling method and were randomly assigned to two groups of intervention and control. The intervention group received group ACT at 10 sessions each for 120 minutes, while the control group received no intervention. Both groups completed the Body Image Concern Inventory and the Self-Compassion Scale in the pre-test, post-test, and two-month follow-up phases. The data were analyzed using the repeated measures analysis of variance in SPSS software, version 25. Results The intervention group showed a significant improvement in body image (F=39.271, P=0.001) and self-compassion (F=7.342, P=0.001) in the post-test phase compared to the control group, which remained stable in the two-month follow-up. Conclusion The group ACT can be a suitable method to increase body image satisfaction and self-compassion in women undergoing dialysis.

Kajian Interaksi Obat Pasien Gagal Ginjal Kronis Di Instalasi Rawat Inap Rumah Sakit Samarinda Medika Citra

Patients with chronic kidney failure generally have comorbidities that cause the treatment of chronic kidney failure to be complex so that the number of drugs received by patients increases. The number of drugs consumed by the patient will increase the potential for drug interactions. The purpose of this study was to determine the characteristics, treatment patterns and potential drug interactions of patients with chronic kidney failure at Samarinda Medika Citra Hospital. The research method used is a non-experimental (observational) descriptive study with a retrospective approach. Data collection was carried out based on the medical record sheet of Chronic Kidney Failure patients in the inpatient room at Samarinda Medika Citra Hospital and obtained 59 patients. The results of the study of characteristic data based on age with the highest percentage in the elderly as much as 52.54%, based on gender, the highest percentage of sex was in the male sex, namely 50.85% and female as much as 49.15%. The most common comorbidities was anemia 50.84%. The most use of drug class is combination of 4 therapies with Antihypertensive + Supplement, Vitamin, Mineral + Antiulcer + Antiemetic group as much as 79.66%. The most common potential drug interactions found was the interaction of ranitidine with calos as much as 35.59% with minor severity.

MO955RENAL TRANSPLANTATION IN PATIENTS WITH LOW URINARY TRACT ABNORMALITIES

Abstract Background and Aims Kidney transplantation is the only curative treatment for chronic kidney failure that allows to restaure a normal quality of life for patients. In case of abnormalities of the lower urinary tract, there is a risk of recurrence of renal failure due to urodynamic disturbances. The objective of our study is to analyze the profile of transplanted patients with urodynamic abnormalities and to study their impact on the graft. Method Our study was conducted within our Nephrology Department, including renal transplant patients during the period from 2007 to 2020 and who underwent a pre-transplant urodynamic evaluation. Patients with vesical or sphincteral abnormalities were selected, their demographic characteristics, graft survival and infectious complications compared to patients without vesico-sphincteral abnormalities were studied. Results Of 209 kidney transplant patients during the period 2007-2020, 54 had undergone a pre-transplant urodynamic assay, which resulted in 32 patients having an abnormality: 12 cases of vesical hypertonia or hypotonia, 12 cases of sphincteral hypertonia and 9 patients had vesico-sphincteral dyssynergy. In this group with vesical abnormalities, the average age was 24 years, with extremes of 7 and 49 years, 19 were male versus 13 females. Initial nephropathy was tubulointerstitial in 75% of cases with reflux nephropathy in 17 patients. Comparing this group (G1) to the group of patients with no vesico-sphincteral abnormalities (G2), there was more graft reflux 34.4% in G1 compared to 18.2% in G2 (p= 0.16), more urological complications (p=0.2), more urinary tract infections, 0.55 episodes per patient per year in G1 versus 0.98 in G2 (p=0.21). For the graft function, there was no statistically significant difference between the 5-year creatinine post-transplant averages. Conclusion Vesico-sphincteral abnormalities are frequently found in young patients with pre-transplant NIC, they are not responsible for more post-transplant complications or significant graft failure

Evaluation of Fatigue, Sleep Quality and Activities of Daily Living in Patients with Chronic Renal Failure

Introduction: Patients receiving hemodialysis treatment for chronic renal failure (CRF) develop various symptoms and experience lifestyle changes. CRF is a progressive disease characterized by irreversible loss of nephrons. Objective: The aim of the study was to evaluate fatigue, sleep quality and activities of daily living in patients with chronic renal failure. Method: This was a descriptive cross-sectional study. Sixty-seven CRF patients aged over 18 years who admitted to a private dialysis center for hemodialysis treatment were included. Sociodemographic information was recorded and the 'Visual Analog Scale for Fatigue' was used to evaluate fatigue, the 'Pittsburgh Sleep Quality Index' for assessment of sleep quality and the 'Katz Activities of Daily Living Scale' for evaluation of activities of daily living for all patients. All evaluations were conducted by the same investigator before hemodialysis session. Fatigue level assessment was repeated after hemodialysis session. The data obtained were analyzed using the SPSS 24.0 software package. Results: Thirty (44.8%) females and 37 (55.2%) males were enrolled in the study. The mean age of the study population was 55.8 ± 15.75 years. 74.6% of the patients had poor sleep quality. The mean fatigue score of the patients was 4.82 ± 2.02 before hemodialysis and 8.79±1.67 after hemodialysis, as assessed by VAS-F. All participants were independent in activities of daily living. The average of Katz ADL Scale was 16.80 ± 1.76. Discussion and Conclusion: In line with former studies, fatigue was the most common symptom in the study patients undergoing hemodialysis treatment for chronic kidney failure. Additionally, poor sleep quality and reduced performance in the activities of daily living in the study participants are noteworthy. Hemodialysis causes a number of symptoms that patients have to cope with in their daily lives. It is important to guide patients about individualized rehabilitation programs in the treatment of chronic renal failure.

Renal Fibrosis, Immune Cell Infiltration and Changes of TRPC Channel Expression after Unilateral Ureteral Obstruction in Trpc6-/- Mice

The transient receptor potential cation channel subfamily C member 6 (TRPC6) is a Ca2+-permeable nonselective cation channel and has received recent attention because of its capability to promote chronic kidney disease (CKD). The aims of this study were (i) to examine whether deletion of TRPC6 impacts on renal fibrosis and inflammatory cell infiltration in an early CKD model of unilateral ureter obstruction (UUO) in mice; and (ii) whether TRPC6-deficiency as well as UUO affect the regulation of TRPC expression in murine kidneys. Wild-type (WT), Trpc6-knockout (Trpc6-/-) and New Zealand obese (NZO) mice underwent sham operation or unilateral ureteral obstruction (UUO). The kidneys were harvested 7 days after surgery. We examined renal fibrosis and inflammatory cell infiltration by histological and immunohistochemical staining. The mRNA expression of TRPC members and markers of fibrosis and inflammation in kidney were assessed by using real-time quantitative reverse transcription PCR. Histological and immunohistochemical analyses revealed less inflammatory cell infiltration (F4/80 and CD3) in UUO kidneys of Trpc6-/- mice compared to UUO kidneys of WT mice as well as less fibrosis. Genomic deletion of TRPC6 also affected the expression of pro-fibrotic genes in UUO Trpc6-/- kidneys compared to UUO WT kidneys while the expression of pro-inflammatory genes did not differ. UUO caused marked up-regulation of Trpc6 and down-regulation of Trpc1 mRNA in kidneys of WT and NZO mice. Trpc3 mRNA expression was significantly elevated in kidneys of Trpc6-/- mice underwent UUO while the levels did not change in kidneys of neither WT nor in NZO mice underwent UUO. TRPC6 contributes to renal fibrosis and immune cell infiltration in the UUO mouse model. Therefore, inhibition of TRPC6 emerges as a promising novel therapeutic strategy for treatment of chronic kidney failure in chronic obstructive nephropathy. However, confounding genomic and non-genomic effects of other TRPC channels should be taken into consideration to fully comprehend the renoprotective potential of targeting TRPC6 therapeutically under chronic kidney damaging conditions.

Exploring Barriers and Potential Solutions in Home Dialysis: An NKF-KDOQI Conference Outcomes Report

Home dialysis therapy, including home hemodialysis and peritoneal dialysis, is underused as a modality for the treatment of chronic kidney failure. The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative sponsored a home dialysis conference in late 2017 that was designed to identify the barriers to starting and maintaining patients on home dialysis therapy. Clinical, operational, policy, and societal barriers were identified that need to be overcome to ensure that dialysis patients have the freedom to choose their treatment modality. Education of patients and patient partners, as well as health care providers, about home dialysis therapy, if offered at all, is often provided in a cursory manner. Lack of exposure to home dialysis therapies perpetuates a lack of familiarity and thus a hesitancy to refer patients to home dialysis therapies. Patient and care partner support, both psychosocial and financial, is also critical to minimize the risk for burnout leading to dropout from a home dialysis modality. Thus, the facilitation of home dialysis therapy will require a systematic change in chronic kidney disease education and the approach to dialysis therapy initiation, the creation of additional incentives for performing home dialysis, and breakthroughs to simplify the performance of home dialysis modalities. The home dialysis work group plans to develop strategies to overcome these barriers to home dialysis therapy, which will be presented at a follow-up home dialysis conference.

Avaliação psicológica de candidatos a transplante renal intervivos

A insuficiência renal crônica é uma das principais doenças crônico-degenerativas da atualidade.Seu tratamento é constituído por importantes demandas, pois envolve perdas na autonomia,alterações psicossociais e grande impacto emocional. O transplante renal intervivos representa uma alternativa importante ao tratamento convencional da insuficiência renal crônica. Entretanto esse contexto é caracterizado por dúvidas, dificuldades e expectativas,tanto para candidatos a receptor quanto candidatos a doador. Torna-se necessário, então, que a avaliação psicológica de pacientes em preparação para transplante renal seja baseada no modelo biopsicossocial de atenção à saúde. Este trabalho propõe um protocolo de acompanhamento e avaliação psicológica para candidatos a transplante renal intervivos, baseado na literatura referida e no atendimento ambulatorial prestado no Serviço de Transplantes em um hospital universitário. São discutidos aspectos importantes a respeito da atuação do psicólogo neste contexto, bem como elementos primordiais que devem ser acessados na avaliação, a fim de promover a preparação adequada dos candidatos ao transplante renal e garantir a autonomia do doador sobre sua escolha. Elementos de ordem biológica, fatores afetivos e emocionais e aspectos de ordem social são destacados como essenciais em uma avaliação psicológica, pois têm influência direta na decisão e preparação para um transplante renal. Ao término deste trabalho, é proposto um roteiro para avaliação psicológica.

Osthole protects against inflammation in a rat model of chronic kidney failure via suppression of nuclear factor-κB, transforming growth factor-β1 and activation of phosphoinositide 3-kinase/protein kinase B/nuclear factor (erythroid-derived 2)-like 2 signaling.

Multiple pharmacological applications of osthole have been previously recognized, including antioxidant, anti-inflammatory, anti‑platelet and estrogenic effects, and resistance to pain. The present study investigated the protective effects of osthole against inflammation in a rat model of chronic kidney failure (CRF) and the underlying mechanisms. Osthole treatment with significantly reversed CRF‑induced changes in serum creatinine, calcium, phosphorus and blood urea nitrogen levels in CRF rats. Male Sprague‑Dawley rats (age, 8weeks) received 200mg/kg 2% adenine suspension to induce CRF in the model group. In the osthole‑treated group, rats received 200mg/kg 2% adenine suspension+osthole (40mg/kg, intravenously). The results revealed that treatment with osthole significantly inhibited CRF‑induced tumor necrosis factor‑α, interleukin (IL)‑8 and IL‑6 expression, and suppressed nuclear factor‑κB (NF‑κB) protein expression in CRF rats. Osthole treatment significantly attenuated the protein expression of transforming growth factor‑β1 (TGF‑β1), reduced monocyte chemoattractant protein‑1 activity and increased the phosphoinositide 3‑kinase (PI3K)/protein kinaseB (Akt) ratio in CRF rats. These results suggested that osthole protects against inflammation in a rat model of CRF via suppression of NF‑κB and TGF‑β1, and activation of PI3K/Akt/nuclear factor (erythroid‑derived 2)‑like 2 signaling. Therefore, osthole may represent a potential therapeutic agent for the treatment of CRF.

Pediatric kidney transplantation: a historical review.

Successful renal transplantation is the optimal treatment for chronic kidney failure, but this was not always so for children. Beginning with the first kidney transplants in the 1950s, children experienced poorer patient and graft survival rates than adult patients. But over the last 6 decades, an improved understanding of the immune system which has steered pediatric multi-center clinical/pharmacokinetic and mechanistic studies that have sculpted our immunosuppression with markedly better patient and graft survivals. In addition, uniquely pediatric issues related to growth, development, neurocognitive maturation, increased complications from primary viral infections, and comorbid congenital/inherited disorders, are now diagnosed and effectively managed in these children. Refined pretransplant preparation (vaccinations for preventable diseases, attention to cognitive delays, effective dialysis and nutrition) improved donor selection, and more potent immunosuppression have all contributed to enhanced outcomes. Similarly, improvements in pediatric surgical techniques, postoperative care and better antiviral prophylaxis have all shortened hospitalizations and reduced morbidity. Today pediatric kidney transplant outcomes are markedly improved and younger children today experience better long-term graft survival than adults! While difficult problems remain, we have made tremendous progress and anticipate even more advances in the future of pediatric kidney transplantation.

An alternative approach to estimate age-related mortality of kidney transplant recipients compared to the general population: results in favor of old-to-old transplantations

Compared to dialysis, kidney transplantation appears to be the best treatment for chronic kidney failure, even for older aged patients. Nevertheless, the individual benefit of transplanting elderly patients has to be balanced against the corresponding increase in the number of patients awaiting grafts. We analyzed the excess mortality related to kidney transplant recipients by taking into account the expected mortality of the general population (additive regression model for relative survival). We applied this method to a cohort of patients who received a first deceased-donor kidney transplant between 1998 and 2009 in France (DIVAT, n = 3641). Overall 10-year mortality was 13%. As expected, recipient age was the main risk factor associated with overall mortality. In contrast, recipient age was no longer significantly associated with the excess of mortality related to kidney transplant status by subtracting the expected mortality of the general population. Delayed graft function (DGF), pretransplantation immunization, and past history of diabetes appeared as the main risk factors of this higher mortality rate. Our results constitute a strong argument in favor of kidney transplantation, regardless of the patient's age. Preventing DGF may be more effective for decreasing the risk of death specifically attributable to the disease.

Dialysis at a Crossroads

The ability to offer repetitive hemodialysis for treatment of chronic kidney failure has now reached its half-century anniversary. Although millions of patients have benefited from this life-extending procedure, current results in the United States have now stagnated with only small annual improvements in survival and continued high hospitalization rates. Recognition that this stagnation may be, at least in part, the result of inadequacies of current and prior paths utilized in dialysis treatment has led to the concept that dialysis therapy is at a crossroads and that new paths need to be articulated, explored, and applied. This article proposes some of these new paths and their rationale. Two elements of the new paths are emphasized: avoidance of indwelling catheters for vascular access and meticulous attention to control of extracellular volume and mitigation of left ventricular hypertrophy and fibrosis. It is postulated that progress in these two areas, along with continued attention to other elements embodied in the new and old paths, will unlock the stagnation in outcomes of dialysis therapy of end-stage kidney failure and allow it to realize its full potential of prolonging life and alleviating disability.

Posttransplant Lymphoproliferative Disorder Following Kidney Transplant

Posttransplant Lymphoproliferative Disorder Following Kidney Transplant

Developing Decision Support for Dialysis Treatment of Chronic Kidney Failure

The complexity, variability, quantitative nature, and data density of treatment for chronic kidney failure make dialysis information systems excellent candidates for computerized decision support. We describe the development of an intelligent system building on existing knowledge and susceptible to reconfiguration on the basis of knowledge acquired during the use of the system. Various decision support techniques were used to design and develop the decision support modules. This paper briefly reviews the literature on clinical decision support, discusses some of the problems faced by practitioners in managing chronic kidney failure (end-stage renal disease) patients, and sets forth the decision support techniques used in developing a dialysis decision support system.

The Renal Treatment Satisfaction Questionnaire (RTSQ): A measure of satisfaction with treatment for chronic kidney failure

Quality and effectiveness of care can be enhanced through the use of condition-specific measures of satisfaction with treatment. The aim of the present study was to design and develop a measure of satisfaction with treatment for patients with chronic kidney failure (CKF) for use in routine clinical care and clinical trials. The Renal Treatment Satisfaction Questionnaire (RTSQ) was designed to be suitable for people using any of the various treatment modalities for CKF. Items measure satisfaction with aspects of treatment, including convenience, flexibility, freedom, and satisfaction to continue with present form of treatment. A 12-item RTSQ was investigated at a UK hospital-based renal unit, using data from 140 outpatients undergoing renal replacement therapy (hemodialysis, n = 35; continuous ambulatory peritoneal dialysis, n = 57; transplantation, n = 46). An 11-item scale was developed from the original 12-item version, with a single factor accounting for 59% of the variance and item loadings greater than 0.58. Scale reliability was excellent (alpha = 0.93) in the full sample and proved robust to analysis in separate treatment subgroups. As expected, RTSQ scores differed significantly ( P < 0.0001) between the transplantation and other treatment groups. Those who had received a transplant expressed greater overall satisfaction, with specific advantages of transplantation shown by all individual items, including convenience, time, lifestyle, freedom, and satisfaction to continue current treatment. The RTSQ provides a brief reliable measure of satisfaction with treatment for patients with CKF that is suitable for use in routine clinical care and clinical trials.

Dobesilate Calcium in the treatment of chronic kidney failure

慢性肾功能不全(CRI),终末期肾衰时的透析治疗常给患者及社会带来沉重的经济负担 .羟苯磺酸钙是一种微血管保护剂,具有降低血小板粘附和血粘度,改善微循环障碍[1] 等作用,主要用于糖尿病微血管病变[2] .我们应用羟苯磺酸钙治疗CRI患者,旨在观察其对肾功能的影响,为临床CRI患者延长非透析治疗时间,延缓透析寻求治疗途径。

Trying to have it both ways[review of "Beginnings Count: The Technological Imperative in American Health Care" (Rothman, D.) [Book review

This book examines the state of health care in the United States, focusing on health insurance and medical services. How can the United States spend so heavily on health care yet provide so poorly for so many people? The author describes some of the complex interactions between technology and health care that have helped bring this deplorable situation about. This is a book about three medical technologies (the iron lung, dialysis for treatment of chronic kidney failure, andthe ventilator) and three policies (Blue Cross, Medicare, and the failed Clinton health care initiative), artfully arranged as case studies.