scholarly journals Risk Factors Associated with Mortality among Chronic Kidney Disease Patients on Regular Hemodialysis Presenting in Emergency Services

2021 ◽  
Vol 2 (1) ◽  
pp. 001-007
Author(s):  
Tirtha Man Shrestha ◽  
Laxman Bhusal ◽  
Ram Prasad Neupane ◽  
Rajan Ghimire ◽  
Pratap Narayan Prasad
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Emergency Room ◽  
Serum Potassium ◽  
Potassium Level ◽  
Emergency Visit ◽  
Survivor Group ◽  
Regular Hemodialysis

Background: With the increasing number of Chronic Kidney Disease (CKD), emergency visit of these patients is also increasing. This study tried to find some of the reasons for which patients with CKD visit the emergency room and the reasons for their mortality. Method: A cross-sectional study was done in the emergency room of Tribhuvan University Teaching Hospital, Kathmandu, Nepal. We conducted this study from 1 May 2018 to 31 October 2018 among the adult CKD patients under regular hemodialysis. We used a convenience sampling method. Three hundred patients were included. We studied the following variables: patient’s age, sex, risk factors, laboratory parameter during the emergency visit (viz. hemoglobin, pH, serum bicarbonate level, and potassium level), emergency hemodialysis, blood transfusion, and clinical outcome during emergency room stay. Result: We enrolled 300 patients in the study. The mean age was 45.04 years in the mortality group and 45.69 years in the survival group 152 (50.7%) of patients had hypertension. Mean hemoglobin was 6.52gm% (SD = 1.93). Mean hemoglobin in survivor and the non-survivor group was 6.59 gm% and 5.58 gm% respectively. Serum creatinine was 1220.87 micromol/l and 1064.01 micromol/l in mortality and survivor group respectively. Likewise, serum potassium was 6.13 mEq/l and 5.74 mEq/l among mortality and survivor groups respectively. Binary logistic regression showed significant association (p <0.05) of anemia, emergency dialysis and presence of sepsis with the mortality. There was significant correlation of presence of comorbidities, anemia, serum creatinine, serum potassium level, and sepsis with mortality. Area under the Receiver Operating Curve to predict mortality among CKD patients was 0.660 for potassium and 0.598 for serum creatinine. Conclusion: Anemia, increased serum creatinine, and hyperkalemia was significantly correlated with mortality in chronic kidney disease and were causes of frequent visits in the emergency room. Therefore, we should address these factors during the management of CKD patients.

scholarly journals METABOLIC SYNDROME - AN EMERGING RISK FACTOR FOR CHRONIC KIDNEY DISEASE

2018 ◽  
Vol 11 (6) ◽  
pp. 212
Author(s):  
Ashwini Shenai ◽  
Savitha G
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
Body Mass Index ◽  
Chronic Kidney Disease ◽  
Risk Factor ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Healthy Individuals ◽  
Serum Urea ◽  
The Mean

Objective: Metabolic syndrome (MetS) is a common health problem worldwide. According to third national health and nutrition examination survey criteria, about 47 million people have MetS. It is defined as having three or more of the following five risk factors including abdominal obesity, increased triglyceride levels, low-density lipoprotein cholesterol level, elevated blood pressure, and elevated fasting glucose levels. These components of MetS are major risk factors for the development of chronic kidney disease (CKD) also. CKD is a major public problem and it is a major risk factor for the development of cardiovascular disease. Hence, the aim of the current study was to evaluate the association between MetS and CKD.Methods: A total of 50 patients reporting to Saveetha Dental College and Hospitals were enrolled into the study which includes 25 patients with MetS and 25 healthy individuals. 5 mL of venous blood was collected and centrifuged. Then, it is analyzed for fasting blood sugar (FBS), serum triglycerides, serum urea, and creatinine using the standard kit method. The data obtained were subjected to statistical analysis using the SPSS software.Results: The mean body mass index, FBS, serum creatinine, and triglyceride levels were higher in MetS patients in comparison to healthy individuals. The mean body mass index (BMI), FBS, serum urea, serum creatinine, and triglyceride levels in the control group and MetS group were 27.75±3.67, 84.8±12.5, 17.52±5.2, 0.91±0.17, and 96.5±60.13 and 35.14±4.25, 108.8±34.69, 21.4±5.9, 1.0±0.14, and 239.76±51.21, respectively. There was a significant difference in the mean BMI, FBS, urea, creatinine, and triglyceride levels of the above group.Conclusion: Serum urea and creatinine levels were significantly higher in MetS individuals. Hence, MetS could be a one of the risk factors for the development of CKD.

Retrospective evaluation of risk factors and treatment outcome predictors in cats presenting to the emergency room for constipation

2019 ◽  
Vol 22 (2) ◽  
pp. 153-160 ◽  
Author(s):  
Sarah E Benjamin ◽  
Kenneth J Drobatz
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Physical Examination ◽  
Emergency Room ◽  
Treatment Protocol ◽  
Urgent Care ◽  
Hospital Data ◽  
Increased Risk ◽  
Clinicopathologic Findings

Objectives Constipation is a common complaint in cats presenting to the emergency room and can become a frustrating recurrent condition. Despite widespread anecdotal reports of risk factors for constipation, at the time of writing there have been no studies supporting these associations or assessing treatment outcomes. The aim of this study was to identify risk factors in the signalment, history, physical examination and clinicopathologic findings of cats presenting to the emergency room for constipation. In addition, we aimed to assess factors contributing to the success or failure of enemas administered to these cats. Methods A medical record search identified 189 cats with a diagnosis of constipation/obstipation that were treated and discharged by the emergency service at an academic veterinary hospital. Data regarding signalment, medical history, physical examination and clinicopathologic findings, as well as treatments performed, were recorded. Ninety-nine cats presenting to the emergency room for other reasons were identified as controls. Statistical analysis was performed to assess risk factors for constipation, as well as success/failure of enema treatments. Results Older, overweight cats and cats with chronic kidney disease or previous episodes of constipation were found to be at increased risk of constipation ( P <0.0001, P = 0.0004, P = 0.0046 and P <0.0001, respectively). Ionized calcium levels were significantly higher in constipated cats, though varied significantly within the cohort ( P = 0.0133). Cats noted to be painful on abdominal palpation were less likely to defecate following an enema. Adjunctive treatments (fluids, laxatives) increased the likelihood of a successful enema but were not statistically significant. Conclusions and relevance Older, overweight cats with a history of constipation or chronic kidney disease are more likely to present for constipation. Further studies are needed to determine the most appropriate treatment protocol in an urgent care setting.

Clinical Presentations of Chronic Kidney Disease Patients on Regular Haemodialysis Attending in Tribhuvan University Teaching Hospital Emergency Services

2019 ◽  
Vol 2 (2) ◽  
pp. 138-143
Author(s):  
Tirtha Man Shrestha ◽  
Pratap Narayan Prasad ◽  
Laxman Bhusal ◽  
Ram Prasad Neupane ◽  
Rajan Ghimire
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Teaching Hospital ◽  
Emergency Services ◽  
University Teaching ◽  
Receiver Operating Curve ◽  
Maintenance Hemodialysis ◽  
Institute Of Medicine ◽  
Emergency Visit

 Background: Chronic kidney disease is increasing day by day and so is condition of renal replacement therapy mainly hemodialysis. Emergency visit of the patients under maintenance hemodialysis is frequent. The objective of the study is to study clinical parameters of these patients so that in future these deranged parameters can be focused during patient management and decrease their emergency visit. Methods: A prospective cross sectional study was conducted in emergency services of Tribhuvan University Teaching Hospital from 1st May 2018 to 31st October 2018 among the adult chronic kidney disease patients under maintenance hemodialysis. Ethical approval was taken from Institutional review board, Institute of Medicine, Tribhuvan University. Non-probability sampling method was used. Total of 300 patients were enrolled in the study. Patients’ age, sex, causes, laboratory parameter during emergency visit, need of emergency hemodialysis, and need of blood transfusion were studied. Results: Out of total 300 patients, mean age was 45.64 years (S.D =17.15). 190 (63.3 %) were male and 110(36.70%) were female. 152(50.70%) of patients had hypertension.Diabetes and Glomerulonephritis both had equal prevalence of 63(21%). Mean hemoglobin was 6.52gm% (S.D = 1.93). Mean pH was 7.17 (S.D =0.154). Mean serum potassium and creatinine level were 5.77 mEq/L (S.D =0.76) and 1076.03 mmol/l (S.D =367.25) respectively. Area under the Receiver Operating Curve was 0.660 for potassium and 0.598 for serum creatinine. Conclusion: Causes of chronic kidney disease, decreased hemoglobin level, increased serum creatinine and potassium level and metabolic acidosis are reasons of frequent emergency room visit among CKD patients. So these conditions need to be addressed to decrease emergency visit of these patients

Prevalence and risk factors of acquired long QT syndrome in hospitalized patients with chronic kidney disease

2018 ◽  
Vol 67 (2) ◽  
pp. 289-294 ◽  
Author(s):  
Peng Liu ◽  
Dan Han ◽  
Xuanzi Sun ◽  
Hui Tan ◽  
Zhigang Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Serum Potassium ◽  
Hospitalized Patients ◽  
Qtc Prolongation ◽  
Long Qt ◽  
Acquired Long Qt Syndrome ◽  
Qt Syndrome

Patients with chronic kidney disease (CKD) have a high risk of fatal arrhythmias. The extended severe corrected QT (QTc) interval is a hallmark of ventricular arrhythmias and sudden cardiac death. The objective of this study was to evaluate the prevalence of acquired long QT syndrome (aLQTS) in hospitalized patients with CKD and search for potential risk factors to improve clinical risk stratification in patients with CKD. Information about patients with CKD was retrospectively collected in our hospital between January 2013 and June 2017. The prevalence of aLQTS in different stages of CKD was evaluated. The common risk factors for QTc prolongation in patients with CKD were compiled, and multivariable logistic regression analysis was used to evaluate how each factor was related to aLQTS in CKD. A total of 804 patients with CKD (299 females, 37.2%) participated in our study. The prevalence of aLQTS among all 804 patients was 56.97%, and the prevalence of QTc prolongation (>500 ms) was 10.07%. Among the elderly, impaired kidney function, hemodialysis, low serum potassium and low left ventricular ejection fraction (LVEF) were associated with QTc prolongation in patients with CKD. The prevalence of aLQTS is much higher and increases with the decline of kidney function in hospitalized patients with CKD, which is related to older age, impaired kidney function, hemodialysis, serum potassium and low LVEF.

scholarly journals Contrast-induced nephropathy in patients with chronic kidney disease and peripheral arterial disease

2015 ◽  
Vol 4 (6) ◽  
pp. 205846011558303 ◽  
Author(s):  
Christian Kroneberger ◽  
Christian N Enzweiler ◽  
Andre Schmidt-Lucke ◽  
Ralph-Ingo Rückert ◽  
Ulf Teichgräber ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Peripheral Arterial Disease ◽  
Serum Creatinine ◽  
Contrast Material ◽  
Arterial Disease ◽  
Contrast Induced Nephropathy ◽  
Related Risk ◽  
Peripheral Arterial

Background The risk for contrast-induced nephropathy (CIN) after intra-arterial application of an iodine-based contrast material is unknown for patients with chronic kidney disease (CKD) and peripheral arterial disease (PAD). Purpose To investigate the incidence of CIN in patients with CKD and PAD. Material and Methods This retrospective study was approved by the local ethics committee. One hundred and twenty patients with 128 procedures (73 with baseline eGFR in the range of 45–60 mL/min/1.73m2, 55 with eGFR < 45 mL/min/1.73m2) were evaluated. All patients received intra-arterially an iodine-based low-osmolar contrast material (CM) after adequate intravenous hydration with isotonic NaCl 0.9% solution. CIN was defined as an increase in serum creatinine of more than 44 μmol/L within 4 days. The influence of patient-related risk factors (age, weight, body mass index, eGFR, serum creatinine, hypertension, diabetes mellitus, coronary heart disease, heart failure) and therapy-related risk factors (amount of CM, nephrotoxic drugs, number of CM applications) on CIN were examined. Results CIN developed in 0% (0/73) of procedures in patients with PAD and an eGFR in the range of 45–60 mL/min/1.73m2 and in 10.9% (6/55) of procedures in patients with an eGFR <45 mL/min/1.73m2. No risk factor significantly influenced the development of CIN, although baseline serum creatinine ( P = 0.06) and baseline eGFR ( P = 0.10) showed a considerable dependency. Conclusion Patients with an eGFR in the range of 45–60 mL/min/1.73m2 and PAD seem not at risk for CIN after intra-arterial CM application and adequate hydration. Whereas, an eGFR < 45 mL/min/1.73m2 correlated with a risk of 10.9% for a CIN.

scholarly journals Risk Factors for Renal Function Impairment in Childen with Meningomyelocele; a Single Center Study

2020 ◽  
pp. 86-89
Author(s):  
Hülya Nalçaçıoğlu ◽  
Demet Tekcan ◽  
Özlem Aydoğ
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Pediatric Nephrology ◽  
Renal Scintigraphy ◽  
Clean Intermittent Catheterization

Introduction: Chronic kidney disease and its complications are among the most frequent cause of morbidity and mortality in patients with meningomyelocele. Objective: In this study, we aimed to determine the risk factors leading to chronic kidney disease progression in these patients. Material and Method: Fifty patients with meningomyelocele were analyzed retrospectively. Age, gender, followup period, serum creatinine, glomerular filtration rate, vesicoureteral reflux (VUR), initial urodynamic findings and initiation time of clean intermittent catheterization (CIC) were noted. The progression of Chronic kidney disease (CKD) was evaluated by DMSA renal scintigraphy, changes in serum creatinine (Screa), and glomerular filtration rate (GFR). Results: 30 of the 50 patients were included in the study. VUR was detected in 63% of the patients, and scar was detected in 83% by renal scintigraphy. The median value of Screa was 0.5 mg/dl in admission, while the median Screa was 1.02 mg/dl (min-max: 0.27-5) at the last visit and the difference was statistically significant (p=0.001). A statistically significant was found between CKD progression and GFR in admission (p=0.001), CIC onset age (p=0.03), degree of VUR (p=0.046), presence of renal scar (p=0.002). It was shown that delay in admission (p=0.011; OR 1.36; CI 1.07-1.73) and low GFR in admission (p=0.036 OR 0.915 CI 0.842-0.994) were the most important risk factors. Conclusion: In our study, it was shown that delay in neurogenic bladder treatment, delay in the initiation of CIC, and low GFR at admission were important risk factors for the progression of CKD in children with meningomyelocele. Therefore, we aimed to emphasize the importance of regular follow-up of these children in Pediatric Nephrology Clinics from the neonatal period.

MO208ASSOCIATION OF SERUM BETA-2 MICROGLOBULIN LEVEL WITH DIFFERENT CARDIAC AND METABOLIC RISK FACTORS IN CKD PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Nazia Arfin Siddiqui ◽  
M Sahadat Hossain ◽  
Babrul Alam ◽  
S R Chaudhury ◽  
Maa Chowdhury ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Uric Acid ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Serum Phosphate ◽  
Metabolic Risk Factors ◽  
Metabolic Risk ◽  
Beta 2 ◽  
Beta 2 Microglobulin

Abstract Background and Aims Serum β M is a middle molecule uremic toxin that accumulates in serum and deposits at various tissues in chronic kidney disease (CKD), especially more in dialysis patients. The βâ M is generally considered as a predictor of cardiovascular morbidity and mortality and this is more investigated in dialysis group. However its relationship with several cardiac and metabolic risk factors in all stages of CKD is still under evaluation. This study was undertaken to evaluate the association of plasma βâ M level in different stages of chronic kidney disease patients with different cardiac, renal and metabolic risk factors that can predict future cardiovascular events Method This cross-sectional study was conducted by selecting consecutive 132 CKD subjects of stages 1-5D including both patients not requiring dialysis and those on maintenance hemodialysis. Their demographic, clinical and laboratory data were recorded in a data sheet. Fasting blood samples in dialysis non requiring subjects and predialysis samples in hemodialysis group (G5D) were taken for testin in laboratory for CBC, serum βâ M, hCRP, iPTH, lipid profile, creatinine, uric acid and serum albumin as cardiac, renal and metabolic risk markers. Urine sample was taken from predialysis patients for chemical test and ACR. The CKD staging were done by MDRD criteria. Additional 25 no CKD subject was taken as healthy referents. Results Primarily Beta-2 microglobulin was higher in CKD patients than in healthy group (13.53 ± 14.74 vs. 1.81 ± 0.47, mg/l; p&lt;.001). The levels were gradually rising with the advancing stages of CKD (G1&2-3.46 ± 2.39, G3-3.66 ± 1.08, G4-6.51 ± 2.20, G5-11.43 ± 2.98 and G5D-41.79 ± 8.58, mg/l). A Beta-2 microglobulin cut-off of &gt;7.7 vs. &lt; 7.7 mg/l showed significantly increased Systolic BP (136 ±22 vs. 123 ± 22, mmHg), diastolic BP (80 ± 12 vs. 75 ± 8.96, mmHg),( p&lt;0.01); CRP (6.83 ± 6.03 vs. 4.39 ± 5.35, mg/l)( p&lt;0.007); serum phosphate (4.84 ± 1.79 vs. 3.85 ±.92,mg/dl)( p&lt;0.001); uric acid (5.89 ± 1.41 vs. 5.01 ± 1.57,mg/dl)( p&lt;0.01); TG (189± 103 vs. 155 ± 88, mg/dl),( p&lt;0.04); and PTH (239.83 ± 186.50 vs. 90.52 ± 81.77, pg/ml), ( p&lt;0.001) indicating higher cardio metabolic risks in higher group. Similarly renal parameters were also more altered in high Beta-2 microalbumin group for serum creatinine (6.89 ± 3.54 vs. 1.58 ± .81, mg/dl) (p&lt;0.001) and ACR (824 ± 917 vs. 320 ± 753, mg/g),( p&lt;0.001). B-2 microglobulin also positively correlated with systolic blood pressure (r=.295, p&lt;.001), serum creatinine (r=.879, p&lt;.001), serum phosphate (r=.175, p =.047), serum iPTH (r=.403, p&lt;.001) , hCRP ( r=.193, p =.050) , Triglycerides (r=.196, p =.023) and urine ACR in CKD patients. Conclusion Beta-2 microglobulin level was significantly higher in CKD with an increasing pattern towards advancing stages. The higher levels positively correlated with cardio renal and metabolic risk factors. Hence measuring Beta-2 microglobulin regularly can help to take preventive measures early to manage patients at risk.

Does dietary potassium intake associate with hyperkalemia in patients with chronic kidney disease?

2020 ◽  
Author(s):  
Christiane I Ramos ◽  
Ailema González-Ortiz ◽  
Angeles Espinosa-Cuevas ◽  
Carla M Avesani ◽  
Juan Jesus Carrero ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Serum Potassium ◽  
Multivariable Analysis ◽  
Food Groups ◽  
Cross Sectional ◽  
Potassium Intake ◽  
Dietary Potassium ◽  
Dialysis Vintage

Abstract Background Dietary potassium restriction is a strategy to control hyperkalemia in chronic kidney disease (CKD). However, hyperkalemia may result from a combination of clinical conditions. This study aimed to investigate whether dietary potassium or the intake of certain food groups associate with serum potassium in the face of other risk factors. Methods We performed a cross-sectional analysis including a nondialysis-dependent CKD (NDD-CKD) cohort and a hemodialysis (HD) cohort. Dietary potassium intake was assessed by 3-day food records. Underreporters with energy intake lower than resting energy expenditure were excluded. Hyperkalemia was defined as serum potassium &gt;5.0 mEq/L. Results The NDD-CKD cohort included 95 patients {median age 67 [interquartile range (IQR) 55–73] years, 32% with diabetes mellitus (DM), median estimated glomerular filtration rate 23 [IQR 18–29] mL/min/1.73 m2} and the HD cohort included 117 patients [median age 39 (IQR 18–67) years, 50% with DM]. In NDD-CKD, patients with hyperkalemia (36.8%) exhibited lower serum bicarbonate and a tendency for higher serum creatinine, a higher proportion of DM and the use of renin–angiotensin–aldosterone system blockers, but lower use of sodium bicarbonate supplements. No association was found between serum and dietary potassium (r = 0.01; P = 0.98) or selected food groups. Conditions associated with hyperkalemia in multivariable analysis were DM {odds ratio [OR] 3.55 [95% confidence interval (CI) 1.07–11.72]} and metabolic acidosis [OR 4.35 (95% CI 1.37–13.78)]. In HD, patients with hyperkalemia (50.5%) exhibited higher serum creatinine and blood urea nitrogen and lower malnutrition inflammation score and a tendency for higher dialysis vintage and body mass index. No association was found between serum and potassium intake (r = −0.06, P = 0.46) or food groups. DM [OR 4.22 (95% CI 1.31–13.6)] and serum creatinine [OR 1.50 (95% CI 1.24–1.81)] were predictors of hyperkalemia in multivariable analyses. Conclusions Dietary potassium was not associated with serum potassium or hyperkalemia in either NDD-CKD or HD patients. Before restricting dietary potassium, the patient’s intake of potassium should be carefully evaluated and other potential clinical factors related to serum potassium balance should be considered in the management of hyperkalemia in CKD.

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