<i>Brucella</i> Peritonitis in a Patient on Peritoneal Dialysis

Brucellosis is endemic in Saudi Arabia. Brucella peritonitis is an uncommon clinical condition. We herewith report a 67-year-old man with chronic renal failure on continuous ambulatory peritoneal dialysis (CAPD) for four months, who developed chronic brucella peritonitis. Peritoneal fluid grew brucella species with positive brucella serology

Incidence and factors associated with uncontrolled hypertension at 12 months after kidney transplantation in Saudi Arabia

Introduction: Uncontrolled hypertension after kidney transplantation (KTx) is very common and is associated with significant morbidity. However, studies that assess its incidence and risk factors are limited and outdated in the Middle East. Methods: This is a single-center retrospective study of KTx recipients (KTRs) in our center between January 2017 and May 2020 with a 12-month follow-up period. The target of hypertension treatment during the time of this study was <140/90 mmHg, according to the published guidelines. We divided patients according to their blood pressure (BP) control at one year into two groups: controlled blood pressure (cBP) (<140/90) and uncontrolled blood pressure (uBP) ( ≥ 140/90). We studied the association between cBP and patients' demographics, baseline cardiovascular risk factors, and changes in their metabolic and cardiovascular profile during the first 12 months after KTx. Results: A total of 254 KTRs were included. 79.2% developed post-KTx hypertension, 74% were ≥ 30 years, 58% were men, and 80% were living-donor KTRs. The renal replacement modality among our patients/sample before KT was hemodialysis in 78.4%, peritoneal dialysis in 11.5%, and 10.1% underwent pre-emptive transplantation. At one year, 76 (29.9%) KTRs did not attain the target BP goal. Systolic BP decreased from baseline to 12 months by 13±24 mmHg in the cBP group and increased by 8.7±21 mmHg in the uBP group (p<0.001). Additionally, diastolic BP decreased by 8.5±16.9 mmHg in the cBP group and increased by 2.3±18.8 mmHg in the uBP group (p<0.001). Factors associated with uBP included age (47 vs 41 years, p=0.008) and diabetes mellitus (p=0.012). Contrarily, gender, dialysis vintage, preemptive transplantation, type of dialysis (hemodialysis vs peritoneal dialysis), type of transplant (living donor kidney transplant vs deceased donor kidney transplant), and smoking were not different among the two groups. There were no significant differences between the two groups in regard to creatinine change from baseline, rate of rejection, weight change, A1C change, new onset diabetes post-transplant, LDL change, PTH change from baseline, and persistent hyperthyroidism. However, higher BMI at 12 months was associated with a higher incidence of uBP (27.2±5.9 vs 29.2±5.4, p=0.013). Using multivariate analysis, we found that serum creatinine at 12 months was the only predictor of uBP (OR=1.005 (1-1.011), p=0.036). Conclusion: At one-year post renal transplantation, about one-third of KTRs had uBP despite multiple antihypertensive medications. SBP and DBP significantly trended upwards after transplantation in uBP patients, whereas SBP and DBP significantly trended downwards after transplantation in cBP patients. Further controlled, prospective studies in the Saudi population are needed to confirm these findings

Epidemiology of chronic kidney disease in the Kingdom of Saudi Arabia (SEEK-Saudi investigators) - A pilot study

There are no available data about the prevalence of chronic kidney disease (CKD) and its risk factors in the general population of the kingdom of Saudi Arabia. To estimate the prevalence of CKD and its associated risk factors in the Saudi population, we conducted a pilot community-based screening program in commercial centers in Riyadh, Saudi Arabia. Candidates were interviewed and blood and urine samples were collected. Participants were categorized to their CKD stage according to their estimated Modification of Diet in Renal Disease (MDRD3)-based, the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and the presence of albuminuria. The sample comprised 491 (49.9&#x0025; were males) adult Saudi nationals. The mean age was 37.4 &#177; 11.3 years. The over-all prevalence of CKD was 5.7&#x0025; and 5.3&#x0025; using the MDRD-3 and CKD-EPI glomerular filtration equations, respectively. Gender, age, smoking status, body mass index, hypertension and diabetes mel-litus were not significant predictors of CKD in our cohort. However, CKD was significantly higher in the older age groups, higher serum glucose, waist/hip ratio and blood pressure. Only 7.1&#x0025; of the CKD patients were aware of their CKD status, while 32.1&#x0025; were told that they had protein or blood in their urine and 10.7&#x0025; had known kidney stones in the past. We conclude that prevalence of CKD in the young Saudi population is around 5.7&#x0025;. Our pilot study demonstrated the feasibility of screening for CKD. Screening of high-risk individuals is likely to be the most cost-effective strategy to detect CKD patients

Nutritional status and outcomes in hemodialysis patients from the Gulf Cooperation Council countries enrolled in the dialysis outcome and practice patterns study phase 5 (2012-2015)

Nutrition is an important factor in maintaining good health of hemodialysis (HD) patients, affecting their morbidity and mortality. The Dialysis Outcomes and Practice Patterns Study (DOPPS) is an international observational study assessing differences in dialysis practices and outcomes across >20 countries. Here, we present the results for the Gulf Cooperation Council (GCC) countries regarding nutrition data and its relationship with outcomes as a part of the DOPPS Phase 5 study (2012-2015). Data were from Phase 5 of the DOPPS. Main analyses were based on 927 adult chronic HD patients enrolled at the start of the GCC-DOPPS Phase 5 study from each of the 40 randomly selected GCC HD facilities from Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. Within each participating facility, 20-30 patients were randomly selected, depending on facility size. Analysis showed minor differences across GCC countries in age, albumin levels, nutrition supplement use, and being bothered by the lack of appetite. Elderly (>60 years old) and diabetic HD patients displayed poorer nutritional parameters than young and nondiabetic patients. A low albumin level (<3.2 g/dL) was associated with the highest risk of mortality with a hazard ratio (HR) of 2.47 (P <0.0001) followed by diabetes with HR 1.57 (P <0.04) and older age [HR= 1.27/10 years older (P <0.01)]. Quality of life measures physical component summary and mental component summary correlated negatively with albumin <3.2 g/dL (−2.18 and −5.5, respectively, P <0.05 for each), and with serum creatinine level <7.5 mg/dL (−2.29 and −2.1 respectively, P <0.05 for each. We are presenting the first study of the nutrition status and outcomes for HD patients in the GCC countries in DOPPS. Our results were mostly comparable to findings in previous trials in other countries. Although the data are observational, our study provides good insight into aspects of nutrition in the GCC countries and can be compared to the rest of the world to better understand trends and practice differences