scholarly journals Chronic Kidney Disease: Implications for Progression Using Telehealth Monitoring

2018 ◽  
Vol 2 (4) ◽  
Author(s):  
Abeera Mansur
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Medical Condition ◽  
Vital Signs ◽  
Public Health Problem ◽  
Management Approach ◽  
Study Group ◽  
Multiple Parameters ◽  
Ckd Stage ◽  
Common Medical Condition

Background: Chronic Kidney Disease (CKD) is a complex and common medical condition requiring a multidisciplinary management approach, including control of multiple parameters to delay progression of the disease. Telehealth has been used for monitoring chronic conditions and can be used for managing chronic kidney disease. Materials and Methods: Patients (N = 34) with CKD Stage II-V were studied for four months. Vital signs, weight, intake and output, blood glucose level, oxygen saturation, and edema were checked twice weekly by trained nurses, transmitted via WhatsApp, and incorporated into the electronic medical records of the patients. Monthly serum creatinine, hemoglobin, and electrolytes were obtained and reviewed by a nephrologist. Necessary intervention was conveyed to the patients. Results: Patient satisfaction rate with telehealth management was high. Measured parameters were maintained in the recommended range in a higher percentage of the study group compared to the controls. Glomerular filtration rate was maintained in a significantly more patient in the study group (p<0.001). Conclusions: Telehealth monitoring of patients with CKD (tele-nephrology) is a viable and effective option for management of this increasingly prevalent disease. Chronic kidney disease (CKD) is a worldwide public health problem with increasing severity in renal dysfunction extending to dialysis.

scholarly journals Comparative study of serum electrolytes Na+, K+, Ca++ in patients of chronic kidney disease in relation to its severity

2020 ◽  
Vol 8 (5) ◽  
pp. 1766
Author(s):  
Bibhu P. Behera
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
General Medicine ◽  
Public Health Problem ◽  
Study Group ◽  
Serum Electrolytes ◽  
Chi Square ◽  
College Hospital ◽  
Atypical Manifestations ◽  
Average Serum

Background: Chronic kidney disease (CKD) is a worldwide public health problem. Globally, CKD is the 12th cause of death and the 17th cause of disability, respectively. Yearly incidence of ESRD in India is approximately 150-200 pmp.Methods: The observational study was conducted in Department of General Medicine, Pandit Raghunath Murmu Medical College Hospital, Baripada between May 2018 and January 2019. 244 patients of Chronic Kidney Disease above 15 years of age satisfying the inclusion and exclusion criteria were included in the study.Results: Study group constitutes 64.34% (157) of male and 35.66% (87) of female patients with M:F of 1.8:1. The average age of the patients in the study was 55.91±12.49 yrs. 42.21% (103) of the patients were between 46 and 60 years of age. Maximum number of cases (190 cases) (77.87%) are in stage 4 and 5 with e-GFR <30 ml/ min. The average serum electrolytes in this study group for serum sodium, potassium, calcium are 137.31±10.05 mEq/L, 4.12±1.48 mEq/L and 1.10±0.19 mmol/L respectively. When association of hypokalemia with risk factor (known and unknown) is compared, chi-square value found to be 13.664 (p=0.0002) which is statistically extremely significant.Conclusions: Authors found significant number of cases, more commonly younger patients, presented with atypical manifestations having no specific etiology; the cause may be defect in rennin-angiotensin system or, may be genetic or, may be environmental.

scholarly journals Breath Ammonia Is a Useful Biomarker Predicting Kidney Function in Chronic Kidney Disease Patients

Biomedicines ◽  
2020 ◽  
Vol 8 (11) ◽  
pp. 468
Author(s):  
Ming-Jen Chan ◽  
Yi-Jung Li ◽  
Chao-Ching Wu ◽  
Yu-Chen Lee ◽  
Hsiao-Wen Zan ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Characteristic Curve ◽  
Laboratory Data ◽  
Public Health Problem ◽  
Exhaled Breath ◽  
Ckd Stage ◽  
Significant Difference ◽  
Stage 1

Chronic kidney disease (CKD) is a public health problem and its prevalence has increased worldwide; patients are commonly unaware of the condition. The present study aimed to investigate whether exhaled breath ammonia via vertical-channel organic semiconductor (V-OSC) sensor measurement could be used for rapid CKD screening. We enrolled 121 CKD stage 1–5 patients, including 19 stage 1 patients, 26 stage 2 patients, 38 stage 3 patients, 21 stage 4 patients, and 17 stage 5 patients, from July 2019 to January 2020. Demographic and laboratory data were recorded. The exhaled ammonia was collected and rapidly measured by the V-OSC sensor to correlate with kidney function. Results showed no significant difference in age, sex, body weight, hemoglobin, albumin level, and comorbidities in different CKD stage patients. Correlation analysis demonstrated a good correlation between breath ammonia and blood urea nitrogen levels, serum creatinine levels, and estimated glomerular filtration rate (eGFR). Breath ammonia concentration was significantly elevated with increased CKD stage compared with the previous stage (CKD stage 1/2/3/4/5: 636 ± 94; 1020 ± 120; 1943 ± 326; 4421 ± 1042; 12781 ± 1807 ppb, p < 0.05). The receiver operating characteristic curve analysis showed an area under the curve (AUC) of 0.835 (p < 0.0001) for distinguishing CKD stage 1 from other CKD stages at 974 ppb (sensitivity, 69%; specificity, 95%). The AUC was 0.831 (p < 0.0001) for distinguishing between patients with/without eGFR < 60 mL/min/1.73 m2 (cutoff 1187 ppb: sensitivity, 71%; specificity, 78%). At 886 ppb, the sensitivity increased to 80% but the specificity decreased to 69%. This value is suitable for kidney function screening. Breath ammonia detection with V-OSC is a real time, inexpensive, and easy to administer measurement device for screening CKD with reliable diagnostic accuracy.

scholarly journals Clinical and Nutritional Follow-up of Cats with Chronic Kidney Disease Fed with a Renal Prescription Diet

2021 ◽  
Vol 49 ◽  
Author(s):  
Gabriela Da Cruz Schaefer ◽  
Silvana Bellini Vidor ◽  
Juliana Toloi Jeremias ◽  
Cristiana Fonseca Ferreira Pontieri ◽  
Marcio Antonio Brunetto ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Nutritional Assessment ◽  
Complete Blood Count ◽  
Body Condition Score ◽  
Management Approach ◽  
Ckd Stage

Background: The use of prescription diets for cats with chronic kidney disease (CKD) is one of the main management approach of this disease in cats, and is considered a renoprotective strategy that may promote increased survival and/or improve quality of life, according to the stage of CKD. Besides that, nutritional assessment is important to monitor the maintenance of quality of life of the patients and their response to disease, especially those with chronic conditions. The aim of this study was to follow the clinical and nutritional status of cats with chronic kidney disease (CKD) IRIS stages II, III and IV fed with a renal prescription diet, followed for 12 months. Materials, Methods & Results: Patients were fed exclusively with a dry renal prescription diet and medications for the management of CKD were prescribed when needed. Exclusion criteria were cats that already received a renal prescription diet or medications for the treatment of CKD. Cats were evaluated every 2 months, considering body weight (BW), body condition score (BCS), muscle mass score (MMS), clinical and laboratory parameters. In all assessments, a complete blood count and biochemistry were performed by conventional methods with the patient fasted for 12 h. In addition, urinalysis, urinary protein:creatinine ratio (UPC) and urine culture were performed from a urine sample collected by cystocentesis. The quantitative variables were tested for their stability on consecutive assessments using the non-parametric Friedman test, and did not present significant variation during follow-up, except for systolic blood pressure (SBP). Eight cats with a diagnosis of CKD were included in the study and 6 of them remained in the same CKD stage during follow-up. On cat died due to an unrelated CKD cause. Regarding nutritional assessment, 5 of 7 cats maintained BW during the 12 months. Of these, 4 also maintained MMS and BCS. Three of 7 cats presented a decrease in MMS, 2 of which presented also a decreased BW and one maintained BW.Discussion: IRIS staging results combined with Friedman’s analysis demonstrated that the diet and the clinical management were effective in the non-progression of CKD in this study. As renal injury is not expected to be reversed in CKD, the maintenance of cats in the same IRIS stages and the minimum variation of the parameters is considered a positive result in this study. Hypertensive cats started on antihypertensive therapy during the study, achieving adequate control of SBP in most cases, what can justify the variation of this clinical parameter over the 12 months. Hyperphosphatemia was a frequent alteration, included stage II cats, and presented a positive response to nutritional and medical therapy. Despite CKD staging progression was not observed in most cats using serum creatinine as a single parameter, some cats presented BW and MMS reduction, which may have influenced this result. Weight loss and muscle wasting may have occurred by several reasons, including periods of hyporexia, presence of concomitant diseases, aging process or reduced protein content on renal prescription diets. This study enhances the importance of the association of clinical and nutritional management in the maintenance of cats with CKD. We suggest that other studies are done during longer periods of time and with a larger sample to support the results found. We also suggest new studies to evaluate the protein requirements for cats with CKD.

scholarly journals Study of hematological profile in patients with chronic kidney disease

2019 ◽  
Vol 7 (1) ◽  
pp. 11
Author(s):  
Gautam Panduranga ◽  
Ugendhar Perla
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Iron Deficiency ◽  
Transferrin Saturation ◽  
Public Health Problem ◽  
In Vitro Tests ◽  
Moderate Degree ◽  
Important Public Health Problem ◽  
Cross Sectional ◽  
Ckd Stage

Background: Chronic Kidney Disease (CKD) with its high prevalence, morbidity and mortality, has become an important public health problem. The incidence and prevalence of CKD is increasing worldwide, including India. CKD is associated with a variety of hematological abnormalities, include anaemia, infections and bleeding diathesis. Anaemia is the most consistent hematological abnormality and is associated with poor quality of life and poor cardiovascular outcomes.Methods: A hospital based cross-sectional observational study was done to detect the prevalence of haematological abnormalities, correlation of anaemia with CKD stage and evaluation of iron deficiency. Newly diagnosed CKD (stages 3 to 5) patients were included in this study. Presence of anaemia (Hb%, haematocrit, MCV, peripheral smear), iron deficiency (TSAT, serum ferritin), thrombocytopenia, leucocyte count and coagulation abnormalities (PT, APTT) in different stages of CKD were studied.Results: All the subjects in study group had anaemia which was normocytic and normochromic and of moderate degree in most patients. The severity of anaemia progressed with stage of the disease. Iron deficiency was significantly prevalent (52% in the study population, with transferrin saturation (TSAT) <20%). WBC count was not significantly altered. There was mild thrombocytopenia in a few patients. Bleeding time or other in vitro tests of platelet function were not measured. The coagulation parameters, PT and APTT, were not significantly altered.Conclusions: All CKD patients should be screened for iron deficiency anaemia for its early treatment and to decrease morbidity.

scholarly journals P0683PATTERNS OF HYPERKALAEMIA RECURRENCE AMONG CHRONIC KIDNEY DISEASE PATIENTS IN UK CLINICAL PRACTICE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Michael Hurst ◽  
Louise Hoskin ◽  
Karolina Badora ◽  
Eskinder Tafesse ◽  
Daniel Sugrue ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Clinical Practice ◽  
Kidney Disease ◽  
Serum Potassium ◽  
Recurrent Events ◽  
Medical Condition ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Increased Risk ◽  
Ckd Stage

Abstract Background and Aims Patients with chronic kidney disease (CKD) are at increased risk of hyperkalaemia, HK (high serum potassium concentration) due to impaired renal function. This medical condition is potentially life threatening if untreated or poorly managed. This study describes the characteristics of CKD patients in the UK who experience HK and assessed the frequency of recurrent HK and time between first (index) and subsequent events. Method A retrospective cohort study was conducted using linked Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) data from 01 January 2008 to 30 June 2018, with a five-year lookback period (2003-2007). Patients were included if they were diagnosed with CKD stage 3+ (READ code or eGFR &lt;60 mL/min/1.73m2 without prior dialysis) during the study or lookback periods and aged &gt;18 years at diagnosis (index). Patient demographics, clinical history and baseline medication use were described. HK was defined as serum K+ ≥5.0 mmol/L. HK events occurring during the study period, but after diagnosis of CKD, were assessed. Recurrent HK was defined as any event subsequent to the first event. Time to recurrence was calculated using Kaplan-Meier. Results In total, 297,702 CKD patients (mean age 74.7 years [standard deviation: 11.3], male [41.4%]) met eligibility criteria. At time of CKD diagnosis, 30.6% of the population had resistant hypertension. Other prominent comorbidities included diabetes (22.24%), CKD (7.9%) and cancer (7.8%). Approximately half of patients were in receipt of diuretics at baseline (49.2%), while 32.5% and 32.0% were in receipt of beta blockers and calcium channel blockers, respectively. During follow up, 67.0% of patients received a renin-angiotensin aldosterone system inhibitor (RAASi). 147,215 patients (49.5%) experienced at least one HK event, of which 53,695 (36.5%) had only one HK event, 93,250 (63.5%) had two or more HK events and 29,413 (20.0%) had six or more events. HK event incidence was predictive of subsequent events, with the probability of experiencing a HK event increasing from 49.5% to 63.5%, 70.7%, 74.1%, 76.5% and 78.6% for patients experiencing 2-6 events, respectively. There was an inverse relationship between the number of recurrent events and time to next event, with less time between the next event for those experiencing multiple events (Figure 1). Conclusion This study shows that approximately half of CKD patients experienced a HK event. Furthermore, patients who experienced a HK event were at increased risk of subsequent events. Frequent monitoring of serum potassium may help reduce the burden of HK in patients with CKD.

scholarly journals Where are we now? Emerging opportunities and challenges in the management of secondary hyperparathyroidism in patients with non-dialysis chronic kidney disease

2021 ◽  
Author(s):  
Markus Ketteler ◽  
Patrice Ambühl
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Secondary Hyperparathyroidism ◽  
Extended Release ◽  
Therapeutic Agents ◽  
Management Approach ◽  
Optimal Management ◽  
Release Formulation ◽  
Extended Release Formulation ◽  
Ckd Stage

Abstract Rising levels of parathyroid hormone (PTH) are common in patients with chronic kidney disease (CKD) not on dialysis and are associated with an elevated risk of morbidity (including progression to dialysis) and mortality. However, there are several challenges for the clinical management of secondary hyperparathyroidism (SHPT) in this population. While no recognised target level for PTH currently exists, it is accepted that patients with non-dialysis CKD should receive early and regular monitoring of PTH from CKD stage G3a. However, studies indicate that adherence to monitoring recommendations in non-dialysis CKD may be suboptimal. SHPT is linked to vitamin D [25(OH)D] insufficiency in non-dialysis CKD, and correction of low 25(OH)D levels is a recognised management approach. A second challenge is that target 25(OH)D levels are unclear in this population, with recent evidence suggesting that the level of 25(OH)D above which suppression of PTH progressively diminishes may be considerably higher than that recommended for the general population. Few therapeutic agents are licensed for use in non-dialysis CKD patients with SHPT and optimal management remains controversial. Novel approaches include the development of calcifediol in an extended-release formulation, which has been shown to increase 25(OH)D gradually and provide a physiologically-regulated increase in 1,25(OH)2D that can reliably lower PTH in CKD stage G3–G4 without clinically meaningful increases in serum calcium and phosphate levels. Additional studies would be beneficial to assess the comparative effects of available treatments, and to more clearly elucidate the overall benefits of lowering PTH in non-dialysis CKD, particularly in terms of hard clinical outcomes. Graphic abstract

Biochemical and Paraclinical Evaluation of Organ Damage in Arterial Hypertension with Associated Chronic Kidney Disease

2020 ◽  
Vol 71 (6) ◽  
pp. 194-204
Author(s):  
Teim Baaj ◽  
Ahmed Abu-Awwad ◽  
Mircea Botoca ◽  
Octavian Marius Cretu ◽  
Elena Ardeleanu ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Ventricular Hypertrophy ◽  
Ankle Brachial Index ◽  
Intima Media Thickness ◽  
Organ Damage ◽  
Left Ventricular ◽  
Study Group ◽  
Group A

Organ damages, which contribute to the overall cardiovascular risk of hypertensive patients, should be early detected, prevented and treated. The study evaluated organ damage in a hypertensive study group with chronic kidney disease (CKD), compared with a study group of hypertension without CKD. Albuminuria was present in 41.2% and reduced estimated glomerular filtration rate [60 ml/min/m2 was present in 72.5% of hypertensive with CKD. The comparison of organ damage revealed in the CKD group a statistical significant higher prevalence of organ damage as follows: intima-media thickness ]0.9 mm in 39.9% vs 10.5%, carotid plaques in 28.2% vs 12.6%, left ventricular hypertrophy in 39.9% vs 31%, ankle brachial index in 6.2% vs 3.5%. Early detection and treatment of additional cardiovascular risk factors as dyslipidaemia and hyperglycaemia, that have significant role in the pathogenesis of organ damage, contribute to the better prevention of cardiovascular and renal complications in hypertension with CKD.

P0203EARLY DETECTION OF BREAST ARTERIAL CALCIFICATION IN DIFFERENT STAGES OF CHRONIC KIDNEY DISEASE PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Basma Sultan ◽  
Hamdy Omar ◽  
Housseini Ahmed ◽  
Mahmoud Elprince ◽  
Osama Anter adly ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Lipid Profile ◽  
Statistical Significance ◽  
University Hospital ◽  
Arterial Calcification ◽  
Control Group ◽  
Inpatient Ward ◽  
Stage 4 ◽  
Ckd Stage

Abstract Background and Aims Vascular calcification (VC) plays a major role in cardiovascular disease (CVD), which is one of the main causes of mortality in patients with chronic kidney disease (CKD). The study aims at early detection of breast arterial calcification (BAC) in different stages of CKD (stage 2, 3& 4) patients as an indicator of systemic VC. Method A case control study was conducted targeting CKD women, aged 18- 60 years old. The sample was divided into 3 groups; A,B,C (representing stage 2, 3 & 4 of CKD) from women who attended nephrology and Internal medicine clinics and admitted in inpatient ward in Suez Canal University Hospital. A 4th group (D) was formed as a control group and included women with normal kidney functions (each group (A, B, C, D) include 22 women). The selected participants were subjected to history taking, mammogram to detect BAC and biochemical assessment of lipid profile, Serum creatinine (Cr), Mg, P, Ca, PTH and FGF23. Results Our study detected presence of BAC in about 81.8% of hypertensive stage 4 CKD patients compared with 50% in stage 3 CKD, also in the majority of stage 4 CKD patients who had abnormal lipid profile parameters and electrolyte disturbance. Most of the variables had statistical significance regarding the presence of BAC. Conclusion Although it is difficult to determine the definite stage at which the risk of VC begins but in our study, it began late in stage 2 CKD, gradually increased prevalence through stage 3 and became significantly higher in stage 4. These results suggest that preventive strategies may need to begin as early as stage 2 CKD.

scholarly journals Heart Rate Variability and Long Chain n-3 Polyunsaturated Fatty Acids in Chronic Kidney Disease Patients on Haemodialysis: A Cross-Sectional Pilot Study

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2453
Author(s):  
Ana M Pinto ◽  
Helen L MacLaughlin ◽  
Wendy L Hall
Keyword(s):  
Chronic Kidney Disease ◽  
Fatty Acids ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Kidney Disease ◽  
Polyunsaturated Fatty Acids ◽  
Cardiac Death ◽  
Cross Sectional ◽  
Ckd Stage ◽  
Long Chain

Low heart rate variability (HRV) is independently associated with increased risk of sudden cardiac death (SCD) and all cardiac death in haemodialysis patients. Long chain n-3 polyunsaturated fatty acids (LC n-3 PUFA) may exert anti-arrhythmic effects. This study aimed to investigate relationships between dialysis, sleep and 24 h HRV and LC n-3 PUFA status in patients who have recently commenced haemodialysis. A cross-sectional study was conducted in adults aged 40–80 with chronic kidney disease (CKD) stage 5 (n = 45, mean age 58, SD 9, 20 females and 25 males, 39% with type 2 diabetes). Pre-dialysis blood samples were taken to measure erythrocyte and plasma fatty acid composition (wt % fatty acids). Mean erythrocyte omega-3 index was not associated with HRV following adjustment for age, BMI and use of β-blocker medication. Higher ratios of erythrocyte eicosapentaenoic acid (EPA) to docosahexaenoic acid (DHA) were associated with lower 24 h vagally-mediated beat-to-beat HRV parameters. Higher plasma EPA and docosapentaenoic acid (DPAn-3) were also associated with lower sleep-time and 24 h beat-to-beat variability. In contrast, higher plasma EPA was significantly related to higher overall and longer phase components of 24 h HRV. Further investigation is required to investigate whether patients commencing haemodialysis may have compromised conversion of EPA to DHA, which may impair vagally-mediated regulation of cardiac autonomic function, increasing risk of SCD.

scholarly journals Chronic kidney disease progression among patients with type 2 diabetes identified in US administrative claims: a population cohort study

2020 ◽  
Author(s):  
Csaba P Kovesdy ◽  
Danielle Isaman ◽  
Natalia Petruski-Ivleva ◽  
Linda Fried ◽  
Michael Blankenburg ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Disease Progression ◽  
Administrative Claims ◽  
Short Period ◽  
Ckd Stage

Abstract Background Chronic kidney disease (CKD), one of the most common complications of type 2 diabetes (T2D), is associated with poor health outcomes and high healthcare expenditures. As the CKD population increases, a better understanding of the prevalence and progression of CKD is critical. However, few contemporary studies have explored the progression of CKD relative to its onset in T2D patients using established markers derived from real-world care settings. Methods This retrospective, population-based cohort study assessed CKD progression among adults with T2D and with newly recognized CKD identified from US administrative claims data between 1 January 2008 and 30 September 2018. Included were patients with T2D and laboratory evidence of CKD as indicated by the established estimated glomerular filtration rate (eGFR) and urine albumin:creatinine ratio (UACR) criteria. Disease progression was described as transitions across the eGFR- and UACR-based stages. Results A total of 65 731 and 23 035 patients with T2D contributed to the analysis of eGFR- and UACR-based CKD stage progression, respectively. CKD worsening was observed in approximately 10–17% of patients over a median follow-up of 2 years. Approximately one-third of patients experienced an increase in eGFR values or a decrease in UACR values during follow-up. Conclusions A relatively high proportion of patients were observed with disease progression over a short period of time, highlighting the need for better identification of patients at risk of rapidly progressive CKD. Future studies are needed to determine the clinical characteristics of these patients to inform earlier diagnostic and therapeutic interventions aimed at slowing disease progression.

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