MyMedR

Displaying publications 1 - 20 of 87 in total

Abstract:

Sort:

Fulltext Health related quality of life of dialysis patients in Malaysia: Haemodialysis versus continuous ambulatory peritoneal dialysis

Surendra NK, Abdul Manaf MR, Hooi LS, Bavanandan S, Mohamad Nor FS, Shah Firdaus Khan S, et al.

BMC Nephrol, 2019 04 30;20(1):151.
PMID: 31039745 DOI: 10.1186/s12882-019-1326-x

BACKGROUND: Health related quality of life (HRQOL) is an important predictor of clinical outcomes for End Stage Renal Disease (ESRD) patients and to establish quality adjusted life years (QALYs) for economic evaluation studies. This study aims to measure the health utilities and to identify socio-demographic and clinical factors associated with HRQOL for haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) in Malaysia.
METHODS: A total of 141 patients (77 HD and 64 CAPD) from 1 federal and four state hospitals participated in this cross-sectional study. Patients were randomly selected from the National Renal Registry (NRR) using a stratified random sampling. The EQ-5D-3 L questionnaire was used to measure HRQOL. Variables investigated include dialysis modalities, sociodemographic characteristics, co-morbidities and biochemical markers. Utilities are measured on an ordinal scale of 0-1, where 1 indicates full health and 0 indicates death.
RESULTS: The mean utility scores were 0.854 ± 0.181 and 0.905 ± 0.124 (p > 0.05) and the mean Visual Analogue Scale (VAS) scores were 76.2 ± 12.90 and 77.1 ± 10.26 (p > 0.05) for HD and CAPD patients respectively. There was a significant difference in problems reported between HD (35.1%) and CAPD (15.6%) on usual activities dimension (p = 0.009). The proportion of patients having problems in the pain/discomfort domain in both modalities was high (34.0%). Haemoglobin (

Matched MeSH terms: Kidney Failure, Chronic/therapy*
Fulltext Traditional and complementary medicine use among chronic haemodialysis patients: a nationwide cross-sectional study

Zakaria NF, Mohd Noor MT, Abdullah R

BMC Complement Med Ther, 2021 Mar 16;21(1):94.
PMID: 33726722 DOI: 10.1186/s12906-021-03268-4

BACKGROUND: In the era of digital and improved conventional medicine, many continue to use traditional and complementary medicine (TCM). The prevalence of its usage is not well reported, especially in patients with end-stage kidney disease (ESKD) receiving haemodialysis, thus its benefits and adverse effects are not widely known. This study determines the prevalence, types, perceptions and factors associated with TCM use by chronic haemodialysis patients in Malaysia.
METHODS: This is a multi-centre cross-sectional study involving patients undergoing haemodialysis treatment in Malaysia. A validated face-to-face questionnaire-based interview was conducted. Sociodemographic and clinical profiles of the patients, factors associated with TCM use, perceptions, sources of information, and disclosures to treating doctors were obtained. Data were analysed using SPSS software.
RESULTS: A total of n = 329 participants were recruited. The mean age of the participants was 54.9 ± 12.5 years. The majority were Malays (72%) and females (54.7%). A total of 64.7% (n = 213) reported TCM use; n = 132 used TCM before the initiation of dialysis, while n = 81 used TCM after initiation. In the post-hoc analysis, patients who had never used TCM had a higher mean age (56.7 ± 12.3 years) than the patients who used TCM (51.1 ± 13.1) (p = 0.015) and were likely to have received primary education (p = 0.011). Unemployment was more likely to be associated with non-TCM use; with odds ratio 1.85 (95% CI: 1.15, 2.98). Biologically based therapy was found to be the most popular (97.2%) type of TCM, including herbal medicine (67.6%) and supplements (58.0%). Most respondents did not disclose their TCM use to their doctors (72.3%), and 41.8% had the perception that they felt better.
CONCLUSIONS: TCM is widely used among chronic haemodialysis patients in Malaysia, mainly herbal medicine and supplements. Non-disclosure to healthcare professionals and a poor monitoring and regulation of its use in ESKD patients could be detrimental. Awareness needs to be raised among healthcare professionals and the general population.
TRIAL REGISTRATION: The Ethics Committee for Research, University Putra Malaysia (13th March 2019). Reference: UPM/TNCPI/RMC/1.4.18.2 ( JKEUPM ).

Matched MeSH terms: Kidney Failure, Chronic/therapy*
Risk of Peritoneal Dialysis-Related Peritonitis in a Multi-Racial Asian Population

Ong LM, Ch'ng CC, Wee HC, Supramaniam P, Zainal H, Goh BL, et al.

Perit Dial Int, 2016 05 04;37(1):35-43.
PMID: 27147287 DOI: 10.3747/pdi.2015.00141

♦ BACKGROUND: Peritonitis is one of the most common complications of peritoneal dialysis (PD). Understanding the risk factors of peritonitis in a multi-racial Asian population may help to improve outcomes on PD. ♦ METHODS: We conducted a prospective observational study to identify risk factors for PD-related peritonitis over a 1-year period in 15 adult PD centers. All peritonitis episodes were independently adjudicated. ♦ RESULTS: A total of 1,603 participants with a mean age of 51.6 years comprising 52.7% females, 62.6% ethnic Malays, 27.0% Chinese, and 8.1% Indians were recruited. The overall peritonitis rate was 1 episode per 44.0 patient-months with 354 episodes recorded in 282 (17.6%) patients over 15,588 patient-months. Significant risk factors of peritonitis were severe obesity (incidence-rate ratio [IRR] 3.32, 95% confidence interval [CI]: 1.30, 8.45), hypoalbuminemia (IRR 1.61, 95% CI: 1.06, 2.46), Staphylococcus aureus nasal carriage (IRR 2.26, 95% CI: 1.46, 3.50), and use of Fresenius system (Fresenius Medical Care North America, Waltham, MA, USA) (IRR 2.49, 95% CI: 1.27, 4.89). The risk of peritonitis was lower in those on automated PD compared with standard PD (IRR 0.43, 95% CI: 0.25, 0.74), and in centers with a patient-staff ratio of 15 to 29.9 (IRR 0.67, 95% CI: 0.49, 0.90) and ≥ 30 (IRR 0.52, 95% CI: 0.34, 0.80). Prevalent patients and exit-site care with topical antibiotics were also protective against peritonitis. Peritonitis rates varied between racial groups. The IRRs of overall peritonitis and gram-positive peritonitis in Chinese versus other racial groups were 0.65 (95% CI: 0.46, 0.90) and 0.47 (95% CI: 0.24, 0.91), respectively. ♦ CONCLUSIONS: Multiple patient, center, and PD-system factors influence the risk of peritonitis. In the Asian population, there are racial differences in the risk of peritonitis.

Matched MeSH terms: Kidney Failure, Chronic/therapy*
Fulltext Factors affecting quality of life in patients on haemodialysis: a cross-sectional study from Palestine

Zyoud SH, Daraghmeh DN, Mezyed DO, Khdeir RL, Sawafta MN, Ayaseh NA, et al.

BMC Nephrol, 2016 04 27;17(1):44.
PMID: 27117687 DOI: 10.1186/s12882-016-0257-z

BACKGROUND: Haemodialysis (HD) is a life-sustaining treatment for patients with end-stage renal disease (ESRD). HD can bring about significant impairment in health-related quality of life (HRQOL) and outcomes. Therefore, we sought to describe the patterns of HRQOL and determine the independent factors associated with poor HRQOL in Palestinian patients on HD.
METHODS: A multicenter cross-sectional study was performed from June 2014 to January 2015 using the EuroQOL-5 Dimensions instrument (EQ-5D-5L) for the assessment of HRQOL. ESRD patients undergoing HD in all dialysis centres in the West Bank of Palestine were approached and recruited for this study. Multiple linear regression was carried out to identify factors that were significantly associated with HRQOL.
RESULTS: Two hundred and sixty-seven patients were participated in the current study giving response rate of 96 %. Overall, 139 (52.1 %) were male, and the mean ± standard deviation age was 53.3 ± 16.2 years. The reported HRQOL as measured by mean EQ-5D-5L index value and Euro QOL visual analogue scale (EQ-VAS) score was 0.37 ± 0.44 and 59.38 ± 45.39, respectively. There was a moderate positive correlation between the EQ-VAS and the EQ-5D-5L index value (r = 0.42, p chronic co-morbid diseases and the total number of chronic medications. However, a significant positive association was found between HRQOL with male gender, university education level and patients who live in village.
CONCLUSION: Our results provided insight into a number of associations between patient variables and their HRQOL. Healthcare providers should be aware of low HRQOL among patients with no formal education, female gender, patient's residents of refugee camps, multiple co-morbid diseases, multiple chronic medications, and elderly patients to improve their quality of life.

Matched MeSH terms: Kidney Failure, Chronic/therapy*
Fulltext Use of complementary and alternative medicines in haemodialysis patients: a cross-sectional study from Palestine

Zyoud SH, Al-Jabi SW, Sweileh WM, Tabeeb GH, Ayaseh NA, Sawafta MN, et al.

BMC Complement Altern Med, 2016 Jul 11;16:204.
PMID: 27400742 DOI: 10.1186/s12906-016-1196-8

Complementary and alternative medicine (CAM), and herbal therapies, are accepted worldwide, and have been important from medical, sociological and economic perspectives, among haemodialysis (HD) patients. The primary aim of this study was to evaluate the use of CAM among patients with end-stage renal disease (ESRD) who are undergoing HD.

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 Evaluation of Modified Laboratory Processes for Isolation of Bacteria and Fungi in Continuous Ambulatory Peritoneal Dialysis Patients with Peritonitis

Ahmadi S, Amin-Nordin S, Neela VK, Hamat RA, Goh BL, Nor LA, et al.

Perit Dial Int, 2015 Dec;35(7):767-9.
PMID: 26703853 DOI: 10.3747/pdi.2013.00154
Matched MeSH terms: Kidney Failure, Chronic/therapy*
Fulltext Factors associated with quality of life among hemodialysis patients in Malaysia

Md Yusop NB, Yoke Mun C, Shariff ZM, Beng Huat C

PLoS One, 2013;8(12):e84152.
PMID: 24358336 DOI: 10.1371/journal.pone.0084152

Although hemodialysis treatment has greatly increased the life expectancy of end stage renal disease patients, low quality of life among hemodialysis patients is frequently reported. This cross-sectional study aimed to determine the relationship between medical history, hemodialysis treatment and nutritional status with the mental and physical components of quality of life in hemodialysis patients. Respondents (n=90) were recruited from Hospital Kuala Lumpur and dialysis centres of the National Kidney Foundation of Malaysia. Data obtained included socio-demography, medical history, hemodialysis treatment and nutritional status. Mental and physical quality of life were measured using the Mental Composite Summary (MCS) and Physical Composite Summary (PCS) of the Short-Form Health Survey 36-items, a generic core of the Kidney Disease Quality of Life Short Form. Two summary measures and total SF-36 was scored as 0-100, with a higher score indicating better quality of life. Approximately 26 (30%) of respondents achieved the body mass index (24 kg/m(2)) and more than 80% (n=77) achieved serum albumin level (>35.0 mg/dL) recommended for hemodialysis patients. The majority of respondents did not meet the energy (n=72, 80%) and protein (n=68,75%) recommendations. The total score of SF-36 was 54.1 ± 19.2, while the score for the mental and physical components were 45.0 ± 8.6 and 39.6 ± 8.6, respectively. Factors associated with a higher MCS score were absence of diabetes mellitus (p=0.000) and lower serum calcium (p=0.004), while higher blood flow (p=0.000), higher serum creatinine (p=0.000) and lower protein intake (p=0.006) were associated with a higher PCS score. To improve the overall quality of life of hemodialysis patients, a multidisciplinary intervention that includes medical, dietetic and psychosocial strategies that address factors associated with mental and physical quality of life are warranted to reduce further health complications and to improve quality of life.

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
Peritoneal dialysis in Asia

Cheng IK

Perit Dial Int, 1996;16 Suppl 1:S381-5.
PMID: 8728228

The socioeconomic status of Asian countries is diverse, and government reimbursement policies for treatment of patients suffering from end-stage renal disease (ESRD) vary greatly from one country to another. Both of these factors have a major impact not only on the choice of treatment for ESRD but also on the utilization of peritoneal dialysis (PD) in this region. Based on the data collected from 11 representative Asian countries, several observations can be made. First, the treatment rates for ESRD in these countries correlated closely with their gross domestic product (GDP) per capita income. Second, the PD utilization rate appeared to have a biphasic relationship with the GDP per capita income and treatment rate, in that countries with the highest and the lowest treatment rates tended to have lower PD utilization rates, whereas countries with modest treatment rates tended to have higher PD utilization rates. The reason for low PD utilization in countries with the highest treatment rates differs from that in countries with low treatment rates. In the former, because of full government reimbursement, there is little physician incentive to introduce PD as an alternative form of ESRD treatment to in-center hemodialysis (HD), whereas in the latter, the complete lack of government reimbursement prevents the introduction of PD as a form of treatment. This pattern is likely to change in the future because, of the 11 countries surveyed, all except Thailand have recorded a growth rate which is higher for PD than HD over the last three years. The rate of utilization of different PD systems varies greatly among different Asian countries. Automated PD has yet to gain popularity in Asia. Conventional straight-line systems remain the dominant PD systems in use in Hong Kong, Korea, Thailand, and the Philippines, while in Malaysia and Singapore UV germicidal connection devices are most popular. However, in all these countries there has been a progressive shift over the last three years from the straight-line systems with or without germicidal connection devices to the disconnect systems. In China and India, where PD has been introduced only recently, the disconnect systems are used almost exclusively. The disconnect systems are also the most popular systems in use in Japan and Taiwan. As data concerning the cost-effectiveness of different PD systems becomes available, it is likely that trend towards a more liberal use of disconnect systems will continue in the future. The usage of low calcium peritoneal dialysate and the average number of daily CAPD exchanges also vary among the Asian countries. Low calcium peritoneal dialysate has been introduced only in Japan, Hong Kong, and Singapore, with the highest utilization rate (90%) recorded in Singapore. The Philippines had the lowest average number of daily peritoneal exchanges (6L) among the countries surveyed, followed by Hong Kong (6.4L), China and Indonesia (7L), and the rest (8L). The use of a lower number of exchanges was introduced in some countries, initially, mainly as a cost-saving measure based on the assumption that Asians are of small body build. The justification for the continued use of a lower number of exchanges among Asian patients is debatable, but is supported by the acceptable, long-term clinical outcome of patients given this form of dialysis prescription. It is suggested that long-term prospective studies on dialysis adequacy and clinical outcome should be done in different ethnic groups in Asia to see if the similar guidelines with regard to dialysis adequacy can be applied uniformly to Orientals and Caucasians.

Matched MeSH terms: Kidney Failure, Chronic/therapy
Fulltext Risk factors associated with nosocomial infections among end stage renal disease patients undergoing hemodialysis: A systematic review

Abbasi SH, Aftab RA, Chua SS

PLoS One, 2020;15(6):e0234376.
PMID: 32569265 DOI: 10.1371/journal.pone.0234376

BACKGROUND: Profound healthcare challenges confront societies with an increase in prevalence of end-stage renal disease (ESRD), which is one of the leading causes of morbidity and mortality worldwide. Due to several facility and patient related factors, ESRD is significantly associated with increased morbidity and mortality attributed to infections.
AIMS AND OBJECTIVE: The aim of this study was to assess systematically the characteristics of patients and risk factors associated with nosocomial infections among ESRD patients undergoing hemodialysis.
METHODS: A systematic literature search was performed to identify eligible studies published during the period from inception to December 2018 pertaining to risk factors associated with nosocomial infections among hemodialysis patients. The relevant studies were generated through a computerized search on five databases (PubMed, EBSCOhost, Google Scholar, ScienceDirect and Scopus) using the Mesh Words: nosocomial infections, hospital acquired infections, healthcare associated infections, end stage renal disease, end stage renal failure, hemodialysis, and risk factors. The complete protocol has been registered under PROSPERO (CRD42019124099).
RESULTS: Initially, 1411 articles were retrieved. Out of these, 24 were duplicates and hence were removed. Out of 1387 remaining articles, 1337 were removed based on irrelevant titles and/or abstracts. Subsequently, the full texts of 50 articles were reviewed and 41 studies were excluded at this stage due to lack of relevant information. Finally, nine articles were selected for this review. Longer hospital stay, longer duration on hemodialysis, multiple catheter sites, longer catheterization, age group, lower white blood cell count, history of blood transfusion, and diabetes were identified as the major risk factors for nosocomial infections among hemodialysis patients.
CONCLUSION: The results of this review indicate an information gap and potential benefits of additional preventive measures to further reduce the risk of infections in hemodialysis population. Moreover, several patient-related and facility-related risk factors were consistently observed in the studies included in this review, which require optimal control measures.

Matched MeSH terms: Kidney Failure, Chronic/therapy*
Perception of quality of life amongst end stage renal failure patients undergoing haemodialysis

Ho SE, Ho CC, Norshazwani N, Teoh KH, Ismail MS, Jaafar MZ, et al.

Clin Ter, 2013;164(6):499-505.
PMID: 24424213 DOI: 10.7417/CT.2013.1627

AIMS: The objective of the study was to examine the quality of life amongst the end stage renal disease (ESRD) haemodialysis patients in Malaysia.
MATERIALS AND METHODS: A cross sectional descriptive study was conducted on 72 ESRD patients at a Dialysis Centre in Malaysia. The modified KDQOL-SF™ subscales, kidney disease-targeted scale and 36 item health survey scale questionnaires were used.
RESULTS: The overall health rating was 66.73 ± 11.670 indicating good quality of life. There was no significant difference between quality of life for the different domains according to gender (p >0.05). However, there were significant differences between quality of life in the domain of burden of kidney disease. Physical functioning deteriorated significantly with age (p=0.012) while social functioning was lowest in the 50-65 years age group (p=0.037). Those who had no morbidities had significantly better scores on the effects of kidney (p=0.036), burden of kidney disease (p=0.011) and physical functioning (p=0.025).
CONCLUSIONS: Patients undergoing haemodialysis have been found to have good quality of life despite having ESRD. It is therefore of paramount importance to constantly monitor the standard of care for these patients to enable them to live their life to the fullest.

Matched MeSH terms: Kidney Failure, Chronic/therapy*
An unusual rash and end-stage renal failure

Tan HJ, Eadington D

Hosp Med, 2001 Mar;62(3):176-7.
PMID: 11291470
Matched MeSH terms: Kidney Failure, Chronic/therapy
Fulltext The Omega-3 fatty acids (Fish Oils) and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED) study: the updated final trial protocol and rationale of post-initiation trial modifications

Viecelli AK, Pascoe E, Polkinghorne KR, Hawley C, Paul-Brent PA, Badve SV, et al.

BMC Nephrol, 2015;16:89.
PMID: 26116581 DOI: 10.1186/s12882-015-0089-2

The FAVOURED study is an international multicentre, double-blind, placebo-controlled trial which commenced recruitment in 2008 and examines whether omega-3 polyunsaturated fatty acids (omega-3 PUFAs) either alone or in combination with aspirin will effectively reduce primary access failure of de novo arteriovenous fistulae (AVF) in patients with stage 4 and 5 chronic kidney disease. Publication of new evidence derived from additional studies of clopidogrel and a high screen failure rate due to prevalent aspirin usage prompted an updated trial design.

Matched MeSH terms: Kidney Failure, Chronic/therapy*
Protein-energy wasting and nutritional supplementation in patients with end-stage renal disease on hemodialysis

Sabatino A, Regolisti G, Karupaiah T, Sahathevan S, Sadu Singh BK, Khor BH, et al.

Clin Nutr, 2017 06;36(3):663-671.
PMID: 27371993 DOI: 10.1016/j.clnu.2016.06.007

BACKGROUND & AIMS: Protein-Energy Wasting (PEW) is the depletion of protein/energy stores observed in the most advanced stages of Chronic Kidney Disease (CKD). PEW is highly prevalent among patients on chronic dialysis, and is associated with adverse clinical outcomes, high morbidity/mortality rates and increased healthcare costs. This narrative review was aimed at exploring the pathophysiology of PEW in end-stage renal disease (ESRD) on hemodialysis. The main aspects of nutritional status evaluation, intervention and monitoring in this clinical setting were described, as well as the current approaches for the prevention and treatment of ESRD-related PEW.
METHODS: An exhaustive literature search was performed, in order to identify the relevant studies describing the epidemiology, pathogenesis, nutritional intervention and outcome of PEW in ESRD on hemodialysis.
RESULTS AND CONCLUSION: The pathogenesis of PEW is multifactorial. Loss of appetite, reduced intake of nutrients and altered lean body mass anabolism/catabolism play a key role. Nutritional approach to PEW should be based on a careful and periodic assessment of nutritional status and on timely dietary counseling. When protein and energy intakes are reduced, nutritional supplementation by means of specific oral formulations administered during the hemodialysis session may be the first-step intervention, and represents a valid nutritional approach to PEW prevention and treatment since it is easy, effective and safe. Omega-3 fatty acids and fibers, now included in commercially available preparations for renal patients, could lend relevant added value to macronutrient supplementation. When oral supplementation fails, intradialytic parenteral nutrition can be implemented in selected patients.

Matched MeSH terms: Kidney Failure, Chronic/therapy*
Fulltext Multilevel analysis of hemodialysis-associated infection among end-stage renal disease patients: results of a retrospective cohort study utilizing the insurance claim data of Fukuoka Prefecture, Japan

Jamal A, Babazono A, Li Y, Yoshida S, Fujita T

Medicine (Baltimore), 2020 May;99(18):e19871.
PMID: 32358355 DOI: 10.1097/MD.0000000000019871

The presence of comorbid conditions along with heterogeneity in terms of healthcare practices and service delivery could have a significant impact on the patient's outcomes. With a strong interest in social epidemiology to examine the impact of health services and variations on health outcomes, the current study was conducted to analyse the incidence of hemodialysis-associated infection (HAI) as well as its associated factors, and to quantify the extent to which the contextual effects of the care facility and regional variations influence the risk of HAI.A total of 6111 patients with end-stage renal disease who received hemodialysis treatment between 1 October 2015 and 31 March 2016 were identified from the insurance claim database as a population-based, close-cohort retrospective study. Patients were followed for one year from April 1, 2016 to March 31, 2017. A total of 200 HAI cases were observed during the follow-up and 12 patients died within 90 days of the onset of HAI. Increased risks for HAI were associated with moderate (HR 1.73, 95% confidence interval [CI] 1.00-2.98) and severe (HR 1.87, 95% CI 1.11-3.14) comorbid conditions as well as malignancy (HR 1.36, 95% CI 1.00-1.85). Increased risk was also seen among patients who received hemodialysis treatment from clinics (HR 2.49, 95% CI 1.1-5.33). However, these statistics were no longer significant when variations at the level of care facilities were statistically controlled. In univariate analyses, no statistically significant association was observed between 90-day mortality and baseline patients, and the characteristics of the care facility.The results of the multivariate, multilevel analyses indicated that HAI variations were only significant at the care facility level (σ 2.07, 95% CI 1.3-3.2) and were largely explained by the heterogeneity between care facilities. The results of this study highlight the need to look beyond the influence of patient-level characteristics when developing policies that aim at improving the quality of hemodialysis healthcare and service delivery in Japan.

Matched MeSH terms: Kidney Failure, Chronic/therapy*
Fulltext Current clinical practice in adapted automated peritoneal dialysis (aAPD)-A prospective, non-interventional study

Vera M, Cheak BB, Chmelíčková H, Bavanandan S, Goh BL, Abdul Halim AG, et al.

PLoS One, 2021;16(12):e0258440.
PMID: 34882678 DOI: 10.1371/journal.pone.0258440

Adapted automated peritoneal dialysis (aAPD), comprising a sequence of dwells with different durations and fill volumes, has been shown to enhance both ultrafiltration and solute clearance compared to standard peritoneal dialysis with constant time and volume dwells. The aim of this non-interventional study was to describe the different prescription patterns used in aAPD in clinical practice and to observe outcomes characterizing volume status, dialysis efficiency, and residual renal function over 1 year. Prevalent and incident, adult aAPD patients were recruited during routine clinic visits, and aAPD prescription, volume status, residual renal function and laboratory data were documented at baseline and every quarter thereafter for 1 year. Treatments were prescribed according to the nephrologist's medical judgement in accordance with each center's clinical routine. Of 180 recruited patients, 160 were analyzed. 27 different aAPD prescription patterns were identified. 79 patients (49.4%) received 2 small, short dwells followed by 3 long, large dwells. During follow-up, volume status changed only marginally, with visit mean values ranging between 1.59 (95% confidence interval: 1.19; 1.99) and 1.97 (1.33; 2.61) L. Urine output and creatinine clearance decreased significantly, accompanied by reductions in ultrafiltration and Kt/V. 25 patients (15.6%) received a renal transplant and 15 (9.4%) were changed to hemodialysis. Options for individualization offered by aAPD are actually used in practice for optimized treatment. Changes observed in renal function and dialysis efficiency measures reflect the natural course of chronic kidney disease. No safety events were observed during the study period.

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 A retrospective review of diabetic nephropathy patients during referral to the sub-urban nephrology clinic

Menon R, Mohd Noor FS, Draman CR, Seman MR, Ghani AS

Saudi J Kidney Dis Transpl, 2012 Sep;23(5):1109-14.
PMID: 22982937 DOI: 10.4103/1319-2442.100972

Diabetic nephropathy (DN) has become the most common cause of end-stage renal failure. Early referral and specific nephrology treatment could delay the disease progression and should reduce the treatment cost, mortality and morbidity rate in these patients. This is a single-center, retrospective review of all DN patients referred to the nephrology clinic in Hospital Sultan Ahmad Shah, Temerloh, from 2000 to 2009, to study and define the clinical characteristics of DN patients at the time of the referral to the nephrology clinic. A total of 75 patient case records were reviewed. Forty-three (57.3%) of them were males, with a median age of 64.3 ± 8.5 years at the time of referral. Only 14.7% of them had blood pressure lower than 125/75 mmHg. Co-morbid and disease-related complications were also commonly diagnosed and 28.4% (n = 21) had ischemic heart disease, 23% (n = 17) had diabetic retinopathy and 20.3% (n = 15) had diabetic neuropathy. The mean serum creatinine at the time of referral was 339.8 ± 2.3 μmol/L, gylcated hemoglobin A 1c (HbA1C) was 8.1 ± 2.0 %, serum fasting glucose was 9.6 ± 4.7 mmol/L, serum cholesterol was 5.4 ± 1.2 mmol/L and hemoglobin level was 10.6 ± 2.9 g/dL. Although female patients were less frequently seen in the early stages of chronic kidney disease (CKD), they comprised at least 72.7% of CKD stage 5 (male:female; 6:16, P <0.05). Twenty-nine percent (n=22) of them were referred at CKD stage 5, 48% (n=36) were at CKD stage 4, 17.3% (n=13) were at CKD stage 3, 4% (n=3) were at CKD stage 2 and 1.3% (n=1) was at CKD stage 1. Advanced CKD patients were frequently prescribed with more antihypertensives. CKD stage 5 patients were prescribed with two-and-half types of antihypertensive as compared to two types of anti-hypertensive in CKD stage 2 and stage 3. Furthermore, ACE-inhibitors (ACE-I) were less frequently prescribed to them. Only 22.7% (n=5) of CKD stage 5 patients received ACE-I and 30% (n=11) in CKD stage 4 patients as compared to 53.4% (n=7) in CKD patients stage 3. This review shows that DN patients were referred late to the nephrologists and the overall disease management was suboptimal. Antihypertensive requirement was also increased and ACEIs were less frequently prescribed in the advanced diabetic nephropathy patients.
Study site: Nephrology Clinic, Hospital Sultan Ahmad Shah, Temerloh, Pahang, Malaysia

Matched MeSH terms: Kidney Failure, Chronic/therapy
Fulltext Rapid decline of renal function in patients with type 2 diabetes with heavy proteinuria: a report of three cases

Lim CTS, Nordin NZ, Fadhlina NZ, Anim MS, Kalaiselvam T, Haikal WZ, et al.

BMC Nephrol, 2019 01 16;20(1):22.
PMID: 30651084 DOI: 10.1186/s12882-019-1203-7

BACKGROUND: Although there is a large volume of literature regarding the definition and epidemiology of. Type 2 diabetes nephropathy (T2DN). There has been a paucity of data focused on the rate of transition of T2 DN. Based on our personal observation a certain percentage of our incident end stage renal disease (ESRD) patients from T2DN experienced a rapid decline of renal function. Their rapid decline nature of glomerular filtration rate (GFR) of 46 to 60 mL/min per 1.73m2 per year have far exceeded the KDIGO definitions of acute kidney injury (abrupt decrease in kidney function occurring over 7 days or less), acute kidney disease (acute or subacute damage and/or loss of kidney function for a duration of between 7 and 90 days after exposure to an acute kidney injury initiating event (Chawla et al Nat Rev Nephrol 241-57 2017) or even rapid decliner (eGFR declines > 5 mL/min per 1.73m2 per year) (Chawla et al Nat Rev Nephrol 241-57 2017; Andrassy Kidney Int 622-623 2013).
CASE PRESENTATION: We describe here three cases of type 2 diabetic patients that have rapid renal deterioration with rate of decline 46 - 60 mL/min per 1.73m2 per year. All the patients are heavily nephrotic. All of the renal biopsies done showed the classical diabetic changes, hypertensive changes, diffuse tubulointerstitial damage, and interstitial nephritis. All of the patients admitted to taking various form of traditional medications in hope of curing their renal disease.
CONCLUSION: We wish to highlight that type 2 diabetics with massive nephrotic range proteinuria have enhanced risk of rapid renal function deterioration. The patients should be educated about the risks of rapid renal function deterioration when there is presence of heavy proteinuria. High grade proteinuria is likely to inflict the diffuse tubulointerstitial inflammation. The interstitial nephritis could be further worsened by traditional supplements consumption. Timely health education and advice must be undertaken to retard this unwanted rapid renal disease progression.

Matched MeSH terms: Kidney Failure, Chronic/therapy

Filters

Please provide feedback to Administrator (afdal@afpm.org.my)

External Links