International Journal of Nephrology and Renovascular Disease最新文献

Chronic kidney disease (CKD) is a major public health concern in the Middle East and Africa (MEA) region and a leading cause of death in patients with type 2 diabetes mellitus (T2DM) and hypertension. Early initiation of sodium-glucose cotransporter - 2 inhibitors (SGLT-2i) and proper sequencing with renin-angiotensin-aldosterone system inhibitors (RAASi) in these patients may result in better clinical outcomes due to their cardioprotective properties and complementary mechanisms of action. In this review, we present guideline-based consensus recommendations by experts from the MEA region, as practical algorithms for screening, early detection, nephrology referral, and treatment pathways for CKD management in patients with hypertension and diabetes mellitus. This study will help physicians take timely and appropriate actions to provide better care to patients with CKD or those at high risk of CKD.

Background: Fluid overload is a common complication of the care of End-stage Renal Disease patients that may lead to prolonged hospitalization and mortality. This warrants an effective and systemic approach to early recognition and management to improve patient outcomes.

Aim: This study aims to evaluate the effect of a modified fluid assessment tool to improve accurate clinical assessments, detection, and management of blood pressure control and fluid alteration among hemodialysis patients.

Methods: In this retrospective study, data were collected from forty-three dialysis patients who were seen and followed up from a dialysis unit of an acute care hospital during 8 weeks of standard care. A modified assessment tool was used to systematically highlight the appropriateness of the patient set dry weight using intradialytic weight gain (IWDG) and patient blood pressure. Paired sample t-test and repeated measure ANOVA within-group analysis were applied to compare the mean difference score for IDWG and the mean arterial pressure within the study group, respectively.

Result: A total of 43 patients were enrolled (mean age, 59.07) (ranges 27-88 years) (SD - 14.30); 51.16% female; 79% Emirati Nationals, with Chronic Kidney Disease. A repeated measure ANOVA analysis showed a significant difference in the mean arterial pressure within the study group based on time, over six measurements (p = 0.001). However, the difference between the pre- and post-intra-dialytic weight gain mean scores yields insignificant results (p = 0.346).

Conclusion: The implementation of a modified assessment tool improved blood pressure control, increased staff and physician involvement in assessing patient dry weight facilitated through fluid status evaluation, methodical assessment of dry weight, and precise fluid removal calculation, enhancing overall blood pressure and fluid management in HD patients.

Introduction: Chronic kidney disease is a widespread medical problem that leads to higher morbidity, mortality, and a decrease in the overall well-being of the general population. This is especially expressed in patients with end-stage renal disease (ESRD) undergoing maintenance haemodialysis. Several variables could be used to evaluate those patients' well-being and mortality risk. One of them is the presence of residual urine output.

Materials and methods: The study was conducted on 485 patients treated with maintenance haemodialysis. After enrollment in the study, which consisted of medical history, physical examination, hydration assessment, and blood sampling, each patient was followed up for 24 months. We used residual urine output (RUO) as a measure of residual renal function (RRF). The entire cohort was divided into 4 subgroups based on the daily urinary output (<=100mL per day, >100mL to <=500mL, >500mL to <=1000mL and >1000mL).

Results: The data show that the mortality rate was significantly higher in groups with lower RUO, which was caused mainly by cardiovascular events. Also, patients with higher RUO achieved better sodium, potassium, calcium, and phosphate balance. They were also less prone to overhydration and had a better nutritional status. Preserved RRF also had a positive impact on markers of cardiovascular damage, such as NT-proBNP as well as TnT.

Conclusion: In conclusion, preserving residual urine output in ESRD patients undergoing maintenance haemodialysis is invaluable in reducing their morbidity and mortality rates and enhancing other favourable parameters of those patients.

Beta-blockers include a large spectrum of drugs with various specific characteristics, and a well-known cardioprotective efficacy. They are recommended in heart failure, hypertension and arrhythmia. Their use in chronic hemodialysis patients is still controversial, mainly because of the lack of specific randomized clinical trials. Large observational studies and two important clinical trials have reported almost unanimously their efficacy in chronic hemodialysis patients, which seems to be related to their levels of dialyzability and cardioselectivity. A recent meta-analysis suggested that high dialyzable beta-blockers are correlated to a reduced risk of all-cause mortality and cardiovascular complications compared with low dialyzable beta-blockers. Despite their benefits, beta-blockers may have adverse effects, such as intradialytic hypotension with low dialyzability beta-blockers or the risk of sub-therapeutic plasma concentration of high dialyzable ones during dialysis sessions. Both cases are linked to adverse cardiovascular events. A solution for both high and low dialyzable drugs could be their administration after dialysis sessions. Futhermore, the bulk of existing literature seems to favor cardioselective beta-blockers with moderate-to-high dialyzability as the ideal agents in dialysis patients, but further, larger studies are needed. This review aims to analyze beta-blockers' characteristics, indications and evidence-based role in chronic hemodialysis patients.

Purpose: The study aimed to create a machine learning model (MLM) to predict the stone-free status (SFS) of patients undergoing percutaneous nephrolithotomy (PCNL) and compare its performance to the S.T.O.N.E. and Guy's stone scores.

Patients and methods: This is a retrospective study that included 320 PCNL patients. Pre-operative and post-operative variables were extracted and entered into three MLMs: RFC, SVM, and XGBoost. The methods used to assess the performance of each were mean bootstrap estimate, 10-fold cross-validation, classification report, and AUC. Each model was externally validated and evaluated by mean bootstrap estimate with CI, classification report, and AUC.

Results: Out of the 320 patients who underwent PCNL, the SFS was found to be 69.4%. The RFC mean bootstrap estimate was 0.75 and 95% CI: [0.65-0.85], 10-fold cross-validation of 0.744, an accuracy of 0.74, and AUC of 0.761. The XGBoost results were 0.74 [0.63-0.85], 0.759, 0.72, and 0.769, respectively. The SVM results were 0.70 [0.60-0.79], 0.725, 0.74, and 0.751, respectively. The AUC of Guy's stone score and the S.T.O.N.E. score were 0.666 and 0.71, respectively. The RFC external validation set had a mean bootstrap estimate of 0.87 and 95% CI: [0.81-0.92], an accuracy of 0.70, and an AUC of 0.795, While the XGBoost results were 0.84 [0.78-0.91], 0.74, and 0.84, respectively. The SVM results were 0.86 [0.80-0.91], 0.79, and 0.858, respectively.

Conclusion: MLMs can be used with high accuracy in predicting SFS for patients undergoing PCNL. MLMs we utilized predicted the SFS with AUCs superior to those of GSS and S.T.O.N.E scores.