Cardiac Magnetic Resonance Imaging of the Myocardium in Chronic Kidney Disease

Early stages of chronic kidney disease (CKD) are often underdiagnosed, while their deleterious effects on the cardiovascular (CV) system are already at work. Thus, the assessment of early CV damage is of crucial importance in preventing major CV events. Myocardial fibrosis is one of the major consequences of progressive CKD, as it may lead to reentry arrhythmias and long-term myocardial dysfunction predisposing to sudden death and/or congestive heart failure. Subclinical myocardial fibrosis, with a potential key role in the development of uraemic cardiac disease, can be measured and characterised by appropriate cardiac magnetic resonance (CMR) techniques. Fibrosis detection was initially based on the contrast agent gadolinium, due to the superiority in sensitivity and accuracy of contrast-based methods in fibrosis assessment relative to native techniques. However, the severe consequences of gadolinium administration in uraemia (nephrogenic systemic fibrosis) have forced practitioners to re-evaluate the methodology. In the present overview, we review the possible contrast-based and contrast agent-free CMR techniques, including native T1 relaxation time, extracellular volume and global longitudinal strain measurement. The review also summarises their potential clinical relevance in CKD patients based on recently published studies

Effects of Statins on Renal Outcome in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis

Background: HMG CoA reductase inhibitors (statins) are known to prevent cardiovascular disease and improve lipid profiles. However, the effects of statins on renal outcomes, including decline in estimated glomerular filtration rate (eGFR) and proteinuria in patients with chronic kidney disease (CKD), are controversial. This meta-analysis evaluated the impact of statins on renal outcomes in patients with CKD. Materials and Methods: We comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane Databases. The inclusion criteria were published RCT and cohort studies comparing statin therapy to placebo or active controls in patients with CKD (eGFR <60 ml/min/1.73 m²) not requiring dialysis. The primary outcome was the differences in the change of eGFR. We also examined change of protein concentration in urine as a secondary outcome. A meta-analysis comparing statin and its control groups and a subgroup analysis examining intensity of statin were performed. Results: From 142 full-text articles, 10 studies were included in the meta-analysis. Overall, there was a significant difference in rate of eGFR change per year favoring statin group (mean difference (MD) = 0.10 ml/min/1.73 m², 95% CI: 0.09 to 0.12). In our subgroup analysis, those who received high-intensity statins had a significant difference in eGFR with a MD of 3.35 (95% CI: 0.91 to 5.79) ml/min/1.73 m² compared to control. No significant change in eGFR was found with moderate- and low-intensity statin therapy. Compared with the control group, the statin group did not have a difference in reduction of proteinuria with MD in change of proteinuria of 0.19 gm/day (95% CI: -0.02 to 0.40). Conclusion: Overall, there was a difference in change of eGFR between the statin and control group. High-intensity statins were found to improve a decline in eGFR in population with CKD not requiring dialysis compared with control, but moderate- and low-intensity statins were not. Statins were not found to decrease proteinuria in patients with CKD

Validation of Blood Gas Analysis in Arteriovenous Fistula for Hemodialysis

Introduction: Arterial blood gas analysis is a minimally invasive technique used in our daily practice but is not a complication free technique. The aim of this study was to validate results from blood gas analysis obtained from the arteriovenous fistula (AVF)/graft as a surrogate marker of the arterial blood gas analysis. Methods: A prospective observational study was made in 45 patients. We performed arterial and AVF/graft blood gas analysis and results were compared by a paired sample t Student test. Results: Most of our subjects was male (68.9%) and the mean age was 67 years (±14). Hemodialysis vintage was 63 months (±66), and vascular access age was 62 months (±56). The more prevalent vascular access was left radiocephalic AVF (n = 16; 35.6%) and the main puncture artery was right radial artery (n = 27; 60.0%). There were no statistically significant differences between the samples collected. Conclusions: Our results suggest a possible alternative of arterial blood gas analysis in AVF/graft for hemodialysis patients. This could result in making an uncomfortable procedure almost painless and reducing complications. Future research should take place to include anatomical characteristics of the AVF or the circulation of recirculation.info:eu-repo/semantics/publishedVersio

Nutrition and dietary intake and their association with mortality and hospitalization in adults with chronic kidney disease treated with hemodialysis

Adults receiving hemodialysis still experience high mortality rates. Several interventions that address the typical cardiovascular risk factors which are almost universally present in people with ESKD have been introduced. These interventions unfortunately do not significantly improve health outcomes in such populations. Nutrition and dietary patterns are potential factors influencing health in other health settings but poorly explored in the setting of ESKD. The aim of this body of work was to evaluate the association between exposure to different nutrients and dietary patterns and the risk of mortality (all-cause and cause-specific) and hospital admissions (any, and cause-specific) in adults with chronic kidney disease and specifically those with or end stage kidney disease receiving hemodialysis for renal replacement therapy. This project focused on understanding the impact of diet and nutrient intake, on CKD and ESKD through a comprehensive and systematic series of literature reviews and the design and conduct of the first large scale multinational primary cohort study to explore the association between nutrition (dietary intake) and clinical adverse events in the setting of hemodialysis

A thematic synthesis of the experiences of adults living with hemodialysis

Background and objectives In-center dialysis patients spend significant amounts of time on the dialysis unit; additionally managing ESKD affects many aspects of life outside the dialysis unit. To improve the care provided to patients requiring hemodialysis their experiences and beliefs regarding treatment must be understood. This systematic review aimed to synthesise the experiences of patients receiving in-center hemodialysis. Design, setting, participants, and measurements Embase, MEDLINE, CINAHL and PsychINFO, Google scholar and reference lists were searched for primary qualitative studies exploring the experiences of adult patients receiving treatment with in-center hemodialysis. A thematic synthesis was conducted. Results 17 studies involving 576 patients were included in the synthesis. 4 analytical themes were developed. The first theme “a new dialysis dependent self” describes the changes in identity and perceptions of self that could result from dialysis dependence. The second theme, “a restricted life”, describes the physical and emotional constraints patients described as a consequence of their dependence. Some patients reported strategies that allowed them to regain a sense of optimism and influence over the future and these contributed to the third theme, “regaining control”. The first three themes describe a potential for change through acceptance, adaption and re-gaining a sense of control. The final theme, “relationships with health professionals” describes the importance of these relationships for in-center patients and their influence on perceptions of power and support. These relationships are seen to influence the other three themes through information sharing, continuity and personalized support. Conclusions This synthesis has resulted in a framework that can be utilized to consider interventions to improve patients’ experiences of in-center hemodialysis care. Focusing on interventions that are incorporated into the established relationships patients have with their health care professionals may enable patients’ to progress towards a sense of control and improve satisfaction with care

Gambaran Evaluasi Discharge Planning Pada Pasien Hemodialisa

 Fluid management adherence is a majority problem for hemodialysis patients. Nurse discharge planning is expected to solve this problem. This study aims to describe the evaluation of discharge planning in hemodialysis patients at Panembahan Senopati Hospital, Yogyakarta. This research is a quantitative descriptive study. The population in this study was 261 people. The purposive sampling was used in the 38 chronic renal failure patients who underwent hemodialysis at Panembahan Senopati Hospital, Bantul. The univariate analysis was performed to obtain the frequency distribution on gender, age, marital status, education, employment status, and length of time undergoing hemodialysis. Participants were completed with evaluation sheets and structured interviews. The characteristics of the respondents were male and female (50% each), aged 26-35 years old (36.8%), (79%) did not work, underwent hemodialysis 1-3 years (57.8 %), and half of the respondents (47.1%) had senior high school education. The implementation of nurse discharge planning included the good category of medication (10.5%), treatment (39.5%), health promotion (26.3%), and diet (47.4%). But the finding that discharge education was performed either the patient asks or if there are abnormal clinical/laboratory results only. It concluded that the implementation of discharge planning is deficient. Additional participation and performing further research related to hemodialysis patients confidence and adherence in supporting discharge planning was strongly recommended. 

The concentrations of methaemoglobin, carboxyhaemoglobin and some haematological parameters in tobacco snuff addicts in Igbo of Nigeria

Methaemoglobin, carboxyhaemoglobin concentrations and some haematological parameters were studied in fifty tobacco snuff addicts (40 males and 10 females) in some villages of Anambra State, Nigeria. The aim was to investigate possible adverse effects of tobacco snuff in addicts in Igbos of Anambra State. Fifty apparently healthy persons (25 males and 25 females) who do not inhale snuff were used as controls. The age range of tests and control subjects was 25-65 years. The results showed no statistically significant difference when the tests group was compared with the control group. A comparison of the results on the basis of sex, age and period of exposure, showed no significant differences. Blood picture in test and control groups was normocytic and normochromic. The resultssuggest that tobacco snuff may not have any adverse effect on haemoglobin metabolism and erythropoiesis

Early follow-up results of arteriovenous fistulae created for hemodialysis

Hikmet Iyem&Ccedil;anakkale 18 Mart, &Uuml;niversitesi Tip Fak&uuml;ltesi, TurkeyBackground: The aim of this study was to evaluate the site, early results, and postoperative complications of arteriovenous fistula (AVF) creation procedures for hemodialysis in our clinic.Methods: The hospital records of 384 patients who underwent 411 AVF creation procedures for hemodialysis by the same team at our clinic between February 2008 and January 2010 were included for retrospective analysis. All procedures were performed under local anesthesia with lidocaine. Vasospasm was treated by mechanical dilatation with a probe and topical papaverine.Results: Of our 384 patients, 58.5% were male and 41.5% were female. Mean age was 46 (range 12&ndash;72) years. Of the 411 AVF procedures performed, 106 (25.8%) were created at the anatomical snuffbox, 264 (64.3%) were Brescia&ndash;Cimino procedures, and 41 (9.9%) were antecubital, brachiocephalic, or brachiobasilic procedures. Twenty-three patients (5.98%) were subjected to more than one surgical intervention due to early thrombosis or failure of AVF. Early patency was found in 94.0% of the AVF created. Twenty-three patients underwent more than one surgical intervention due to early AVF thrombosis or failure. Early AVF failure occurred more often in females (60.8%) than in males (39.2%). Complications were observed in a total of 11.4% patients.Conclusion: Mechanical dilatation of the artery and vein, before starting the anastomosis, as well as the use of vasodilatory agents, could decrease early thrombosis of the fistula, and this method has very high early patency.Keywords: end-stage renal failure, arteriovenous fistula, early patency, complication

The therapeutic implications of oxidative stress in patients receiving haemodialysis

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