METHODS: This cross-sectional study involved 340 caregivers of chronic kidney patients undergoing hemodialysis. The setting was in Terengganu, Malaysia. The caregivers completed the measures of caregiving burden, quality of life, social support, and symptoms of anxiety and depression.

RESULTS: About 28.8% and 52.4% of caregivers showed clinically moderate levels of anxiety and depressive symptoms, respectively. Furthermore, 35.9% and 3.8% of them showed clinically high levels of anxiety and depressive symptoms, respectively. Analyses showed that general quality of life was a significant predictor of both anxiety and depressive symptoms. Burden and psychological domains of quality of life significantly predicted anxiety. In addition, a lack of social support was a determinant of depressive symptoms. Evidence suggested that social support moderated the burden-anxiety relationship. Specifically, caregivers with low levels of social support showed more elevated levels of anxiety symptoms when their burden was higher.

Aims and Objective: To identify an ideal systolic blood pressure range based on optimal survival among ESRD patients on dialysis.

Method: A systematic search for clinical trials assessing the impact of different systolic blood pressure range on mortality among ESRD patients on hemodialysis was conducted through PubMed, EBSCOhost, Science Direct, Google Scholar, and Scopus. All randomized control trials (RCTs) involving ESRD patients on hemodialysis with primary or secondary outcome of assessing the impact different systolic blood pressure range (140 mm Hg) on all-cause mortality were included. The quality of reporting of the included studies was evaluated using the Jadad scale. Two researchers independently conducted eligibility assessment. Discrepancies were resolved by discussion and consultation with a third researcher when needed. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated.

Results: A total of 1,787 research articles were identified during the initial search, after which six RCTs met our inclusion criteria. According to the Jadad scale, all six RCTs scored 3 points each for quality of reporting. Four RCTs employed pharmacological intervention while two RCTs assessed non-pharmacological intervention. Of the six RCTs, two studies were able to achieve a systolic blood pressure of <140 mm Hg at the end of trial with a RR for reduction in mortality of 0.56 (95% CI, 0.3-1.07; P = 0.08). Four RCTs were able to achieve a systolic blood pressure of >140 mm Hg at the end of trial, with the RR for reduction of mortality of 0.72 (95% CI, 0.54-0.96; P = 0.003). Overall, pooled estimates of the six RCTs suggested the reduction in systolic blood pressure statistically reduce all cause of mortality (RR, 0.69%; 95% CI, 0.53-0.90; P = 0.006) among ESRD patients on hemodialysis.

Conclusion: Though not statically significant, the current study identifies <140 mm Hg as a promising blood pressure range for optimum survival among ESRD patients on hemodialysis. However, further studies are required to establish an ideal blood pressure range among hemodialysis patients.

MATERIALS AND METHODS: We report 20 consecutive patients with end-stage renal failure (ESRF) who had central vein occlusion and were not amenable to endovascular intervention. They underwent extra-anatomical vein to vein surgical bypass. The axillary and iliac or femoral veins were approached via infraclavicular and extraperitoneal groin incisions respectively. In all the patients, an externally supported 6 or 8 mm polytetrafluoroethylene (PTFE) graft was used as a conduit and was tunnelled extra-anatomical. All patients had double antiplatelet (Aspirin and Clopidogrel) therapy post-operatively.

RESULTS: Substantial improvement in the facial, neck and upper limb swelling was noticed following this diversion surgery. The vein to vein bypass was patent at 12 months in 10 out of 20 patients. Graft infection occurred in two (10%) cases. Re-thrombectomy or assisted patency procedure (stent/plasty) was done in four (20%) cases. The patients with preoperative fistula flow rate of more than 1500 ml/min and post-operative graft flow rate of more than a 1000 ml/min were patent at 12 months (P=0.025 and p=0.034 respectively).

OBJECTIVE: To evaluate the efficacy and adverse effects of methylprednisolone in patients with IgA nephropathy at high risk of kidney function decline.

DESIGN, SETTING, AND PARTICIPANTS: An international, multicenter, double-blind, randomized clinical trial that enrolled 503 participants with IgA nephropathy, proteinuria greater than or equal to 1 g per day, and estimated glomerular filtration rate (eGFR) of 20 to 120 mL/min/1.73 m2 after at least 3 months of optimized background care from 67 centers in Australia, Canada, China, India, and Malaysia between May 2012 and November 2019, with follow-up until June 2021.

INTERVENTIONS: Participants were randomized in a 1:1 ratio to receive oral methylprednisolone (initially 0.6-0.8 mg/kg/d, maximum 48 mg/d, weaning by 8 mg/d/mo; n = 136) or placebo (n = 126). After 262 participants were randomized, an excess of serious infections was identified, leading to dose reduction (0.4 mg/kg/d, maximum 32 mg/d, weaning by 4 mg/d/mo) and addition of antibiotic prophylaxis for pneumocystis pneumonia for subsequent participants (121 in the oral methylprednisolone group and 120 in the placebo group).

MAIN OUTCOMES AND MEASURES: The primary end point was a composite of 40% decline in eGFR, kidney failure (dialysis, transplant), or death due to kidney disease. There were 11 secondary outcomes, including kidney failure.

METHODS: The source questionnaire in English was translated into Bahasa Melayu. Linguistic validation guidelines by the MAPI Research Institute were followed. The already validated Bahasa Melayu PedsQL 4.0 Generic Core Scales was used for comparison. Sociodemographic data were collected during the interview. Statistical analyses were performed using SPSS version 25.0.

RESULTS: Sixty-nine children aged 8 to 18 with CKD stages 4 and 5, with or without dialysis, and their caregivers were recruited. Mean age was 12.62 ± 2.77 (SD). Evaluation of the PedsQL 3.0 ESRD Module Bahasa Melayu version demonstrated good internal consistency (Cronbach alpha 0.82). There was good agreement between child self-report and parent proxy report in all domains; average intraclass correlation coefficients (ICC) were 0.78, 95% CI (0.71, 0.84). Scores obtained from Generic 4.0 scales correlated with the disease-specific ESRD 3.0 scale, Spearman's rho = 0.32, p = 0.007. The Kruskal-Wallis H test indicated that there were no significant differences between stages of CKD and their respective mean HRQoL score, χ2(2) = 2.88, p = 0.236.

PURPOSE: We set out to describe the reproductive health issues in women being treated with either hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD).

PATIENTS AND METHODS: All adult female patients on chronic dialysis in Hospital Seremban from January 1991 to December 2001 were included in our study. Patients (or their spouses or children) were interviewed regarding the menstrual status of the patient, gynecologic screening tests administered to the patient, and the patient's use of hormone replacement therapy (HRT).

RESULTS: We recruited 137 women into the study. Of those women, 52.6% were on HD; the rest were on CAPD. Mean age at diagnosis of ESRD was 46.5 +/- 14.1 years (range: 14 - 82 years), and mean duration on dialysis was 33.3 months (range: 2 months - 18 years). Responses about menstrual status were obtained for 118 patients. Of those 118 patients, 55 (46.6%) were postmenopausal at dialysis initiation. Average age at menopause had been 48.5 +/- 4.9 years. Another 19 patients (16.1%) had still been menstruating at dialysis initiation, but subsequently entered menopause. Their average age at menopause had been 45.1 +/- 10.3 years. The remaining 44 patients (37.3%) were still menstruating at an average age of 35.7 years (range: 15 - 49 years). Only 3 of 73 responders were on HRT; 63% had undergone a Pap smear; and 54% had had a breast examination.