MyMedR

Blood Pressure and Mortality in Hemodialysis Patients: A Systematic Review of an Ongoing Debate

Khan YH, Sarriff A, Adnan AS, Khan AH, Mallhi TH

Ther Apher Dial, 2016 Oct;20(5):453-461.

PMID: 27151394 DOI: 10.1111/1744-9987.12406

Hypertension is prevalent in 75-80% of hemodialysis patients and remains the most controversial prognostic marker in end stage kidney disease patients. In contrast to the general population where systolic blood pressure of ≤120 mm Hg is considered normal, a debate remains regarding the ideal target blood pressure in hemodialysis patients. Using the PUBMED and EMBASE databases, the research studies that evaluated the relationship between blood pressure measurements and mortality in hemodialysis patients were searched. Thirteen studies were identified from different regions of the world. Five studies reported low predialysis systolic blood pressure as a prognostic marker of mortality. Other studies showed varying results and reported postdialysis systolic blood pressure as well as ambulatory blood pressure as better predictors of mortality and emphasized their optimized control. One study in this review concluded that there is no direct relationship between mortality and blood pressure if the patients are on anti-hypertensive medications. The observed all-cause mortality varied from 12% to 36%, whereas the cardiovascular mortality varied from 16% to 60%. On the basis of studies included in the current review, a low predialysis systolic blood pressure (<120 mm Hg) is shown to be a widely accepted prognostic marker of mortality while ambulatory blood pressure best predicts CV mortality. Therefore, we recommend that apart from routine BP (pre, post and intradialysis) monitoring in centers, assessment of ambulatory BP must be mandatory for all patients to reduce CV mortality in hemodialysis patients.

Matched MeSH terms: Kidney Failure, Chronic/therapy*

Pantoea agglomerans as a rare cause of catheter-related infection in hemodialysis patients

Wong KW

J Vasc Access, 2013 Jul-Sep;14(3):306.

PMID: 23599132 DOI: 10.5301/jva.5000139

Matched MeSH terms: Kidney Failure, Chronic/therapy*

Ultrasound-guided costoclavicular approach infraclavicular brachial plexus block for vascular access surgery

Beh ZY, Hasan MS

J Vasc Access, 2017 Sep 11;18(5):e57-e61.

PMID: 28478621 DOI: 10.5301/jva.5000720

INTRODUCTION: We report the use of a newly described regional technique, ultrasound-guided costoclavicular approach infraclavicular brachial plexus block for surgical anesthesia in two high-risk patients undergoing 2nd stage transposition of basilic vein fistula.

METHODS: Both patients had features of difficult airway, American Society of Anesthesiologists (ASA) physical status class III and central venous occlusive disease. The common approach, i.e., ultrasound-guided supraclavicular brachial plexus block was technically difficult with inherent risk of vascular puncture due to dilated venous collaterals at the supraclavicular area possibly compromising block quality. The risk of general anesthesia (GA) was significant as patients were morbidly obese with possible risk of obstructive sleep apnea postoperatively. As an alternative, we performed the ultrasound-guided costoclavicular approach infraclavicular brachial plexus block with 20 mL local anesthetic (LA) ropivacaine 0.5% delivered at the identified costoclavicular space using in-plane needling technique. Another 10 mL of LA was infiltrated along the subcutaneous fascia of the proximal medial aspect of arm.

RESULTS: Both surgeries of >2 hours' duration were successful, without the need of further local infiltration at surgical site or conversion to GA.

CONCLUSIONS: Ultrasound-guided costoclavicular approach can be an alternative way of providing effective analgesia and safe anesthesia for vascular access surgery of the upper limb.

Matched MeSH terms: Kidney Failure, Chronic/therapy*

The pattern of chronic renal failure in Kelantan, northeastern state of Malaysia

Zainal D, Monniaty M, Nazmi N

Southeast Asian J. Trop. Med. Public Health, 1995 Dec;26(4):781-4.

PMID: 9139394

The pattern and outcome of patients with chronic renal failure (CRF) in Kelantan, the northeastern state of Malaysia was determined. A total of 60 patients with CRF managed at the Hospital Universiti Sains Malaysia between January 1991 and June 1993 were reviewed retrospectively. The prevalence of CRF was 24.8 patients per year. The ratio of male to female patients was 1.5 : 1.0. Their mean age at presentation was 51.4 +/- 13.7 years. The cause of CRF in majority of our patients was unknown. Their mean blood urea and serum creatinine were 38.9 +/- 9.8 mmol/l and 1,154.9 +/- 458.7 mumol/l respectively. Sixty-five percent of our patients were already in end-stage renal failure (ESRF) at the time of presentation and only 53.8% of them could afford a definitive renal replacement therapy. Their mortality rate was 21.7% and majority of the death occurred in patients who were not receiving definitive renal replacement therapy. This debilitating course will continue unless the cost of renal replacement therapy is subsidised or a renal transplantation program is activated. Hence public education to encourage organ donation in this part of Malysia is necessary.

Matched MeSH terms: Kidney Failure, Chronic/therapy*

Fulltext Melioidosis and peritoneal dialysis related peritonitis

Wong KW

Med J Malaysia, 2013 Apr;68(2):179-80.

PMID: 23629573 MyJurnal

We report a case of melioidosis presenting as peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD). A 47-year-old man, a lorry driver, with end-stage renal disease due to diabetes mellitus on CAPD presented in PD-related peritonitis. He was started on intraperitoneal cloxacillin and ceftazidime, and changed to intraperitoneal vancomycin and meropenam after day 5 due to nonresponse. Burkholderia pseudomallei was identified from the dialysate culture. He was treated with intraperitoneal meropenam for two weeks, and IV ceftazidime for 4 weeks. He responded, and the Tenckhoff catheter was not removed. He was discharged well and continued on oral sulfamethoxazole/trimethoprim for six months. This patient had done his PD exchanges in a lorry.

Matched MeSH terms: Kidney Failure, Chronic/therapy

Fulltext In-centre intermittent peritoneal dialysis: a viable interim option to an eventual definitive renal replacement therapy?

Ng EK, Goh BL, Hamdiah P

Med J Malaysia, 2012 Apr;67(2):151-4.

PMID: 22822633 MyJurnal

In-centre intermittent peritoneal dialysis (IPD), a decade-old modality commonly associated with acute (stab) PD, continues to play an undeniably important role of providing "temporary" renal replacement therapy (RRT) in Malaysia. In our center, IPD is commenced after insertion of Tenckhoff catheter by interventional nephrologists as an interim option until a definitive RRT is established. This study aims to describe our experience and evaluate the viability of this modality as a bridging therapy. We retrospectively analyzed 39 IPD patients from January 2007 to December 2009; looking at demographics, cause of end-stage renal disease, duration on the program, length of hospitalization, PD-related infection profile, biochemical parameters and clinical outcomes. We accumulated a total experience of 169 patient-months, the average age of patients was 54.6 +/- 11.6 years, 84.6% of them diabetics. The median duration of a patient in the program was 88 days with accumulated in-hospital stay of 45 days. Eventually 48.7% of the patients secured placement for long-term haemodialysis while 20.5% were converted to CAPD. The mortality rate was 7.7% while the peritonitis rate was at 1 per 18.8 patient months. Our study shows that IPD is a viable interim option with a low infection rate and good clinical outcome.

Matched MeSH terms: Kidney Failure, Chronic/therapy*

Fulltext Patients with end stage renal disease: a registry at Sultanah Aminah Hospital, Johor Bahru, Malaysia

Liu WJ, Hooi LS

Med J Malaysia, 2007 Aug;62(3):197-200.

PMID: 18246906 MyJurnal

The epidemiology of new patients presenting to Sultanah Aminah Hospital Johor Bahru (HSAJB) with end-stage renal disease (ESRD) in 2003 and 2004 was analysed. Patients with ESRD were prospectively registered in the renal replacement therapy (RRT) database in the nephrology unit. The incidence of ESRD and the RRT provision rate in the district of Johor Bahru were calculated according to gender and race. There were 306 new patients in 2003 and 299 in 2004. Diabetic nephropathy contributed 56.8% new patients in 2003 and 57.9% in 2004. The mean age was 50.8 + 15.1 years in 2003 and 51.3 + 14.2 years in 2004. Males accounted for 53.3% in 2003 and 47.8% in 2004. Haemodialysis was the commonest form of RRT (60.5% in 2003, 69.9% in 2004), followed by continuous ambulatory peritoneal dialysis (30.1% in 2003, 19.4% in 2004) and renal transplantation (5.5% in 2003, 2.3% in 2004). Ninety-one percent of patients in 2003 and 90% in 2004 were alive at the end of the year they presented. The incidence of ESRD in the district of Johor Bahru was estimated as 136 per million population (p.m.p.) in 2003 and 151 p.m.p. in 2004. In the two year period the incidence of ESRD was higher among females (154 p.m.p.) than males (134 p.m.p.). Malays (194 p.m.p.) had higher ESRD incidence compared to Chinese (126 p.m.p.) and Indians (134 p.m.p.). RRT provision in Johor Bahru (92.7%) did not differ significantly with gender or race. The increasing number of patients presenting to HSAJB with ESRD especially those with diabetic nephropathy is a major concern. Prevention strategies at the primary care level may curb the burden of this chronic disease.

Matched MeSH terms: Kidney Failure, Chronic/therapy

Fulltext Quality of life of dialysis patients in Malaysia

Liu WJ, Chew TF, Chiu AS, Zaki M

Med J Malaysia, 2006 Dec;61(5):540-6.

PMID: 17623953 MyJurnal

The aims of this retrospective analysis were (i) to examine the trends of quality of life (QoL) scores and (ii) to identify the risk factors for QoL scores among 6908 dialysis patients entering dialysis between 1997 and 2002. The Spitzer QoL Index was the instrument used by the National Renal Registry of Malaysia to assess the QoL amongst dialysis patients. Demographic and biochemical data were analysed to identify risk factors for poor QoL. The median QoL-index score ranged between 9 and 10. Significant risk factors for poor QoL were female gender, age > 40, diabetes, cohort starting dialysis 2001-2002, haemodialysis modality, body mass index < 18.5, albumin < 30g/dL, cholesterol < 3.2 mmol/L, haemoglobin < 10 g/dL, diastolic blood pressure of > 90 mHg, iPTH < 100 pg/ml. The overall QoL of dialysis patients is satisfactory. The negative impact of diabetes and haemodialysis on QoL warrants further evaluation as each factor involves 50% and 90% of our dialysis population.

Matched MeSH terms: Kidney Failure, Chronic/therapy

Fulltext Dialysis in Malaysia

Hooi LS

Med J Malaysia, 2006 Dec;61(5):513-5.

PMID: 17623948

Matched MeSH terms: Kidney Failure, Chronic/therapy*

Fulltext Dialysis for end stage renal disease: a descriptive study in Penang Hospital

Shaza AM, Rozina G, Izham MIM, Azhar SSS

Med J Malaysia, 2005 Aug;60(3):320-7.

PMID: 16379187 MyJurnal

This research was carried out to study the characteristics of ESRD patients and the resources consumed with dialysis treatment as well as to assess the clinical outcomes of ESRD treatment in Penang Hospital. A total of 117 ESRD patients were studied over 30 months. 56.4% of the patients were male and the median age was 40. Diabetic nephropathy was the commonest cause of ESRD (29.9%). Hypertension was the predominant comorbidity (60.6%). A larger proportion started treatment with Continuous Ambulatory Peritoneal Dialysis (59.0%). At the end of the study period, 49.6% of the patients continued their treatment in the same modality and 27.4% died. Average Dialysis Adequacy (Kt/V) achieved was satisfactory, 2.29 in CAPD and 1.50 in Haemodialysis.

Matched MeSH terms: Kidney Failure, Chronic/therapy*

Fulltext Tuberculous orchitis in chronic renal failure

Alper M, Balbay O, Akman Y, Arbak P, Cam K

Med J Malaysia, 2004 Mar;59(1):118-9.

PMID: 15535348

Tuberculosis confined to the testes with no epididymal involvement is uncommon. Chronic renal failure patients requiring hemodialysis have increased risk for developing tuberculosis. We report a 47-year old chronic renal failure man presenting with right testicular tuberculous orchitis. A high index of suspicion is required to recognize the unusual presentation of tuberculosis in this group of patients, and routine screening for tuberculosis may be recommended in patients undergoing hemodialysis.

Matched MeSH terms: Kidney Failure, Chronic/therapy

Treatment of chronic hepatitis C in patients with renal disease

Gane E

Med J Malaysia, 2005 Jul;60 Suppl B:72-6.

PMID: 16108179

Matched MeSH terms: Kidney Failure, Chronic/therapy

Fulltext Pontine myelinolysis following correction of hyponatraemia

Loo CS, Lim TO, Fan KS, Murad Z, Suleiman AB

Med J Malaysia, 1995 Jun;50(2):180-2.

PMID: 7565192

A patient with severe hyponatreamia secondary to chronic renal failure was treated with peritoneal dialysis (PD). On the third day of admission, she developed progressive obtundation. Neurological examination showed bilateral brisk reflexes with intact brain stem reflexes. Magnetic resonance imaging demonstrated patchy demyelination of the pontine area indicating central pontine myelinolysis (CPM). Despite supportive measures, the patient died on the fifteenth day of admission. The rate of correction of hyponatraemia with peritoneal dialysis can be rapid and detrimental to hyponatraemic chronic renal failure patients and careful monitoring of serum sodium level is advocated.

Matched MeSH terms: Kidney Failure, Chronic/therapy

Fulltext Pattern of bone disease in maintenance haemodialysis patients in Malaysia

Segasothy M, Kamal A, Suleiman AB

Med J Malaysia, 1986 Jun;41(2):144-51.

PMID: 3821610

Skeletal radiographs of 122 patients treated by maintenance haemodialysis were reviewed retrospectively for bone disease. Significant radiological bone changes were very low at commencement of dialysis (2- 9%), as well as at six months of dialysis (6.1%). This figure rose to 19.7% when the total period of dialysis was considered. In the latter group, fractures occurred in seven patients (5.7%), erosions in 12 patients (9.8%), vascular calcification in 13 patients (10.7%) and osteosclerosis in eight patients (6.6%). Osteoporosis was noted to be very common (76.2%). Significant bone changes are hence rare in maintenance haemodialysis patients in Malaysia.

Matched MeSH terms: Kidney Failure, Chronic/therapy

Fulltext Dialysis encephalopathy in Kuala Lumpur

Suleiman AB, Rejab SM, Khoo HE

Med J Malaysia, 1986 Mar;41(1):12-8.

PMID: 3796341

The clinical syndrome of dialysis encephalopathy which has been observed all over the world has also been seen here. The clinical syndrome and clinical course are reported; it has been associated with high levels of aluminium in untreated water used for haemodialysis. Since the introduction of water treatment, this disease has not been observed.

Matched MeSH terms: Kidney Failure, Chronic/therapy

Isoniazid-induced encephalopathy in an end-stage renal disease patient - A case report and literature review

Low JM, Wong KW

Med J Malaysia, 2019 12;74(6):553-554.

PMID: 31929489

Patients with end stage renal disease have higher risk of tuberculosis due to lower cell-mediated immunity. Standard regime of anti-tuberculosis contains isoniazid where neurological side effects such as seizure and encephalopathy have been documented. We present a case of isoniazid-induced encephalopathy in a haemodialysis patient. A literature review on isoniazid-induced encephalopathy was done. Recognition of this condition is important as it is reversible with cessation of isoniazid and institution of high dose pyridoxine.

Matched MeSH terms: Kidney Failure, Chronic/therapy

Review of the complications in peritoneal dialysis

Mukherjee AP

Med J Malaya, 1969 Sep;24(1):21-3.

PMID: 4243838

Matched MeSH terms: Kidney Failure, Chronic/therapy*

Gentamicin ototoxicity in continuous ambulatory peritoneal dialysis

Gendeh BS, Said H, Gibb AG, Aziz NS, Kong N, Zahir ZM

J Laryngol Otol, 1993 Aug;107(8):681-5.

PMID: 8409715 DOI: 10.1017/s0022215100124132

A prospective study was undertaken of 10 chronic renal failure patients on Continuous Ambulatory Peritoneal Dialysis (CAPD) complicated by repeated bouts of peritonitis treated with gentamicin. Each 10-day treatment course consisted of a 120 mg loading dose, followed by 16 mg in 21 of peritoneal dialysate, given four times a day. Serum gentamicin analysed by enzyme immunoassay showed a mean level of 5.2 micrograms/ml, (range 3.7 to 6.6 mg/ml) four hours after the loading dose. Similar levels, well within the therapeutic range, were maintained on the 3rd, 5th, 7th and 9th days of intraperitoneal gentamicin therapy, suggesting no accumulation of gentamicin in the serum. Pure tone audiometry, electronystagmography and clinical assessment were performed during each course of treatment. Although no evidence of ototoxicity was found during the first two courses of gentamicin, but disequilibrium and bobbing oscillopsia were present during the third and fourth courses of gentamicin. These findings could be explained by cumulative injury to the vestibular apparatus caused by repeated therapeutic insults.

Matched MeSH terms: Kidney Failure, Chronic/therapy*

Alkaline phosphatase predicts calcium requirements after total parathyroidectomy in patients receiving dialysis

Goh BL, Yudisthra MG, Hisham AN

Br J Surg, 2010 Feb;97(2):185-8.

PMID: 20035536 DOI: 10.1002/bjs.6818

: It can be difficult to achieve a stable serum calcium level after parathyroidectomy for renal hyperparathyroidism. This study examined the impact of a calcium replacement protocol guided by predicted need in reducing hospital stay.

Matched MeSH terms: Kidney Failure, Chronic/therapy

Fulltext The status of intermittent peritoneal dialysis in Hospital University Science Malaysia

Zainal D, Loo CS

Singapore Med J, 1995 Aug;36(4):379-82.

PMID: 8919150

Acute (stab) peritoneal dialysis is commonly practised in Malaysia. This study is designed to improve the management of peritoneal dialysis (PD) in Hospital University Science Malaysia (HUSM). Consecutive peritoneal dialysis (PD) on adult inpatients from May 1992 to September 1992 were reviewed prospectively. There were 40 episodes of peritoneal dialysis on 27 patients during this period given at the rate of 2 PD per week. The mean age of patients were 53 +/- 15 years. Uraemia was the main indication for dialysis, while hyperkalaemia and pulmonary oedema were indications for urgent dialysis. Complications occurred in 14 episodes of dialysis (35%). The most common complication was bleeding in the peritoneal cavity while peritonitis was the second most common complication. Dialysis episodes complicated by peritonitis were done by less experienced performers compared to uncomplicated dialysis episodes. Overall mean time spent on each dialysis and time per cycle were longer than recommended (59 +/- 24 hours and 77 +/- 14 minutes). In conclusion, acute PD performed on patients admitted in Hospital University Malaysia was safe and had complication rates comparable to other established centres. However, improvements are possible through closer supervision of new doctors and tighter nursing precautions.

Matched MeSH terms: Kidney Failure, Chronic/therapy*

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