Hyponatremia in hospitalized patients with chronic kidney disease; aetiology, treatment, and outcome, in a tertiary care hospital, Dubai, UAE

Background: Hyponatremia is common among hospitalized patients. Unfortunately, articles describing the management of profound hyponatremia (serum sodium <125 mEq/l) in the background of kidney disease are scarce. This review focuses on the incidence, prevalence, patient characteristics, and clinical features among hospitalized chronic kidney disease (CKD) patients with particular attention to CKD stage 3 to 5.Methods: 71 adult patients with CKD stage 3 to 5 and had presented with profound hyponatremia (serum sodium <125 mEq/l) were included. Patient demographic data, laboratory parameters and treatment received were recorded. The primary endpoint was the development of central nervous syste (CNS) manifestations, while the secondary outcomes included early mortality (death within 30 days).Results: 97 episodes of hyponatremia were recorded in 71 patients. 35 patients (49%) were UAE national and 53.5% patients were females. 52% were in CKD stage-5 refusing dialysis. Diabetic nephropathy was the underlying cause in 66%. The initial Sodium level upon admission ranged from 107-125 mEq/l, with a mean±standard deviation (SD) value of 117.7±4.54 mEq/l. The correction of hyponatremia had ranged between 24 hours in 60% of the patients to 96 hours. Diuretics were used in conjunction with the saline in 85%. Hospital stay ranged between 2-58 days (average 11.7 days). No CNS symptoms were recorded in any of the treated patients. Three patients had died (within 30 days) of sepsis of different sources.Conclusions: Management of hyponatremia in CKD patients remains challenging and should be directed to the underlying cause. Yet, complex patients with advanced CKD particularly in concurrence with heart failure might represent a medical dilemma. Administering hypertonic saline in different mixed concentrations depending on the volume status of the patients appear to be safe, efficient, and suitable for high-risk CKD patients while monitoring Sodium level carefully

Post-Transplant Diabetes Mellitus in Renal Transplant Recipients, Single-Centre Data: Incidence, Risk Factors, and Effect on Graft Function and Mortality

Background: De novo post-transplant diabetes mellitus (PTDM) is a frequent complication among renal transplant recipients; it confers a high risk for graft failure and patient mortality. This single-centre study aimed to determine the incidence and risk factors of PTDM and its effects on graft outcome and mortality. Methods: In a single-centre longitudinal cohort analysis of 383 non-diabetic renal transplant follow-up recipients, outcomes were analysed through a detailed chart review. We hypothesized that different donor and recipient characters such as age, gender, and HLA mismatch would affect PTDM development in renal transplant recipients. PTDM is defined on basis of fasting plasma sugar (≥7 mmol/L or ≥126 mg/dL), random plasma sugar (≥11.1 mmol/L or ≥200 mg/dL), and glycated haemoglobin (HBA1C: &gt;6.5% or 48 mmol/mol). We assessed PTDM incidence, risk factors, and its effect on patient mortality and graft outcome using Cox regression. Results: The mean age at the time of transplantation was 35.70 (±14.27) years, and 50.91% were male. PTDM incidence in the study period was 23.30%. Independent risk factors include older age at the time of transplantation, cyclosporine immunosuppression, cytomegalovirus, and hepatitis C virus infection. PTDM is not associated with graft dysfunction, whereas it significantly carries high mortality. Conclusion: PTDM is common among renal transplant recipients. Older age at the time of transplantation, cyclosporine immunosuppression, cytomegalovirus, and hepatitis C virus are risk factors. PTDM carries high mortality but is not associated with graft failure

Renal allograft survival: Incidence and risk factors associated with graft dysfunction

Background: Renal transplantation is considered the best available therapy for patients suffering from end-stage kidney disease. Improvement in allograft outcome, patient survival, and quality of life are the most important indicators of the effectiveness of renal transplantation. Short-term allograft survival has improved significantly, however, long-term allograft survival and associated risk factors need to be studied. Objectives: This single-center study aims to determine the incidence of long-term graft dysfunction (GD) and the associated risk factors among renal transplant recipients in Dubai Hospital, Dubai, United Arab Emirates. Materials and Methods: A single-center longitudinal cohort analysis of 506 renal transplant follow-up recipients' allograft functions was analyzed through a detailed chart review. We hypothesized that different recipients' characteristics such as age (present and age at the time of transplantation), gender, history of acute rejection, posttransplant viral infections (hepatitis B virus, hepatitis C virus [HCV], Cytomegalovirus, BK virus), and comorbid would affect allograft function in renal transplant recipients. Allograft dysfunction is defined as a 15%–20% increase in creatinine from baseline. We assessed the incidence of allograft dysfunction and associated risk factors. Results: The median age of transplant recipients and the age at the time of transplantation were 55 ± 21 and 39 ± 14.93 years, respectively. About 61.85% (n = 313) of the transplant population were males. The incidence of allograft dysfunction in the study period was 57.15%. In our study population, 1-, 5-, and 10-year graft survival rate was 98.62%, 82.35%, and 54.90%, respectively. Independent risk factors include age, male gender, history of acute rejection, HCV infection, and diabetes mellitus (DM). Posttransplant DM (PTDM) is not associated with GD. Conclusion: Allograft dysfunction is quite common among renal transplant recipients. Independent risk factors in our analysis include age, male gender, history of acute rejection, HCV infection, and DM. PTDM is not associated with GD