Does experience matter? The relationship between nephrologist characteristics and end stage kidney disease patient outcomes

2021 ◽  
Author(s):  
Scott Reule ◽  
Robert Foley ◽  
Daniel Shaughnessy ◽  
Paul Drawz ◽  
Areef Ishani ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Patient Outcomes ◽  
Disease Patient ◽  
End Stage Kidney Disease ◽  
End Stage ◽  
The Relationship

scholarly journals Accelerated extensive mitral valve calcification in a young end-stage kidney disease patient

2020 ◽  
Vol 41 (45) ◽  
pp. 4361-4361
Author(s):  
Saarwaani Vallabhajosyula ◽  
Sameh M Said ◽  
Anna S Kitzmann ◽  
Hector I Michelena
Keyword(s):  
Mitral Valve ◽  
Kidney Disease ◽  
Disease Patient ◽  
End Stage Kidney Disease ◽  
Valve Calcification ◽  
End Stage ◽  
Mitral Valve Calcification

scholarly journals Serum Erythroferrone Levels Associate with Mortality and Cardiovascular Events in Hemodialysis and in CKD Patients: A Two Cohorts Study

2019 ◽  
Vol 8 (4) ◽  
pp. 523 ◽  
Author(s):  
Spoto ◽  
Kakkar ◽  
Lo ◽  
Devalaraja ◽  
Pizzini ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Iron Absorption ◽  
Linear Increase ◽  
Enzyme Linked Immunosorbent Assay ◽  
End Stage Kidney Disease ◽  
End Point ◽  
Traditional Risk Factors ◽  
End Stage ◽  
Stage 1 ◽  
The Relationship

Erythroferrone (ERFE) is a hepcidin inhibitor whose synthesis is stimulated by erythropoietin, which increases iron absorption and mobilization. We studied the association between serum ERFE and mortality and non-fatal cardiovascular (CV) events in a cohort of 1123 hemodialysis patients and in a cohort of 745 stage 1–5 chronic kidney disease (CKD) patients. Erythroferrone was measured by a validated enzyme-linked immunosorbent assay (ELISA). In the hemodialysis cohort, serum ERFE associated directly with erythropoiesis stimulating agents (ESA) dose (p < 0.001) and inversely with serum iron and ferritin (p < 0.001). Erythroferrone associated with the combined outcome in an analysis adjusting for traditional risk factors, factors peculiar to end-stage kidney disease, serum ferritin, inflammation, and nutritional status (HR, hazard ratio, (5 ng/mL increase: 1.04, 95% confidence interval, CI: 1.01–1.08, p = 0.005). Furthermore, treatment with ESA modified the relationship between ERFE and the combined end-point in adjusted analyses (p for the effect modification = 0.018). Similarly, in CKD patients there was a linear increase in the risk for the same outcome in adjusted analyses (HR (2 ng/mL increase): 1.04, 95% CI: 1.0–1.07, p = 0.015). Serum ERFE is associated with mortality and CV events in CKD and in HD patients, and treatment by ESA amplifies the risk for this combined end-point in HD patients.

scholarly journals Biochemical Parameters of Diabetes Ketoacidosis in patients with End-Stage Kidney Disease and Preserved Renal Function

2021 ◽  
Author(s):  
Rodolfo J Galindo ◽  
Francisco J Pasquel ◽  
Priyathama Vellanki ◽  
Cesar Zambrano ◽  
Bonnie Albury ◽  
...  
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Kidney Disease ◽  
Biochemical Parameters ◽  
University Hospitals ◽  
End Stage Kidney Disease ◽  
Emory University ◽  
End Stage ◽  
The Relationship ◽  
Moderate Renal Failure

Abstract Introduction Differences in biochemical parameters of diabetic ketoacidosis in patients with end-stage kidney disease (ESKD) has not been established. Accordingly, we assessed the relationship between degree of metabolic acidosis and ß -hydroxybutyrate in patients ESKD (eGFR &lt;15 mL/min/1.73 m 2), moderate renal failure (eGFR 15-60) or preserved renal function (eGFR &gt;60). Methods This observational study included adults (18-80 years) with DKA, admitted to Emory University Hospitals between 01/01/2006 to 12/31/2016. DKA and renal stages were confirmed on admission laboratory values. Results Admission bicarbonate levels (13.9±5 vs 13.4±5.3 vs 13.8±4.2 mmol/L, p=0.7), and pH levels (7.2±0.3 vs 7.2±0.2 vs 7.2±0.2, p=0.8) were similar among groups. Patients with ESKD had lower mean ß -hydroxybutyrate (4.3±3.3 vs 5.6±2.9 vs 5.9±2.5 mmol/L, p=0.01), but higher admission glucose (852±340.4 vs 714.6±253.3 mg/dL vs 518±185.7 mg/dL, p &lt;0.01), anion gap (23.4±7.6 vs 23±6.9 vs 19.5±4.7 mmol/L, p &lt;0.01), and osmolality (306±20.6 vs 303.5± vs 293.1±3.1mOsm/kg, p&lt;0.01), compared to patients with moderate renal failure and preserved renal function. The sensitivity of ß-hydroxybutyrate &gt;3 mmol/L for diagnosing DKA by bicarbonate level &lt;15 and &lt;18 mmol/L was 86.9% and 72% in ESKD, 89.3% and 83.7% in moderate renal failure and 96.2% and 88.3% in preserved renal function. In patients with ESKD, the corresponding ß-hydroxybutyrate with bicarbonate levels &lt;10, 10-15, &lt;18 mmol/L were 5.5, 3.9, 3.0 mmol/L, respectively. Conclusions Significant metabolic differences were found among DKA patients with different levels of renal function. In patients with ESKD, a ß-hydroxybutyrate level &gt; 3 mmol/L may assist with confirmation of DKA diagnosis.

scholarly journals Importance of AST-120 (Kremezin®) Adherence in a Chronic Kidney Disease Patient with Diabetes

2018 ◽  
Vol 8 (2) ◽  
pp. 107-111 ◽  
Author(s):  
Yasuhiko Tomino ◽  
Atsuko Hisada-Urita ◽  
Takuto Seki ◽  
Tomonari Watanabe ◽  
Reo Kanda ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Kidney Function ◽  
Japanese Society ◽  
Disease Patient ◽  
Insulin Injection ◽  
Adult Case ◽  
End Stage Kidney Disease ◽  
End Stage

We report herein an adult case of chronic kidney disease (CKD) associated with diabetes. The patient had been treated with insulin injection for diabetes 10 years ago. At the time of his first visit to our division for further examinations, we diagnosed him as CKD: cause (C) diabetes; glomerular filtration rate (GFR) (G) G5 (estimated [e] GFR, 10.2 mL/min/1.73 m2; serum creatinine of 4.90 mg/dL); and albuminuria (A) A3 (2.62 g/gCr) by the Japanese Society of Nephrology (JSN) CGA classification. Because he had complained of severe constipation and kidney function, i.e., eGFR was not improved by previous medications, we added on a minimal dosage (2 g/day) of AST-120 (Kremezin®; ordinary dose 6 g/day). After 3 months of AST-120 therapy, eGFR was increased to 17.8 mL/min/1.73 m2 (serum creatinine of 2.90–2.72 mg/dL). Although the patient used some laxative products, he could not continue to take Kremezin and completely stopped 8 months after starting this drug. Kidney function then abruptly declined and progressed to end-stage kidney disease (ESKD). In June 2017, he was introduced to hemodialysis. It appears that the adherence of Kremezin is very important for inhibiting the progression to ESKD for patients with CKD with diabetes.

scholarly journals Therapeutic Challenges to End-Stage Kidney Disease in a Patient with Tetralogy of Fallot

2015 ◽  
Vol 8 ◽  
pp. CCRep.S32121 ◽  
Author(s):  
Ken Ohara ◽  
Tetsu Akimoto ◽  
Takuya Miki ◽  
Naoko Otani ◽  
Taro Sugase ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Tetralogy Of Fallot ◽  
Clinical Course ◽  
Disease Patient ◽  
End Stage Kidney Disease ◽  
Appetite Loss ◽  
Dialysis Treatment ◽  
Complex Processes ◽  
End Stage ◽  
Available Information

In this report, we describe the case of an end-stage kidney disease patient with tetralogy of Fallot (TOF). A 33-year-old female with TOF was admitted to our hospital with complaints of general fatigue and appetite loss probably due to uremic milieu. She was ultimately treated with peritoneal dialysis (PD) with a favorable clinical course. TOF patients with chronic kidney disease are not exceptional, although the currently available information regarding the association between TOF and renal failure severe enough to require dialysis treatment is limited. We also discuss the complex processes of how and why PD was selected as a mode of chronic renal replacement therapy in this case.

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