Prevalence of sleep apnoea in patients with chronic kidney disease (CKD) receiving renal replacement therapy by haemodialysis

Background. Sleep disorders in kidney disease patients occur more frequently than in the general population. Chronic renal disease patients are commonly diagnosed with sleep apnoea syndrome. It occurs in the obstructive, central and mixed form and is of multicausal nature. The aim of the present paper was to assess the frequency of individual types of sleep-related breathing disorders in chronically haemodialysed patients using polysomnography. Material and methods. The study involved stage 5 CKD patients receiving continuous renal replacement therapy by haemodialysis. Results. The obtained results suggest that weight gain between consecutive haemodialysis sessions correlates with more frequent occurrences of disordered breathing events (apnoeas and hypopnoeas) in patients on the night preceding haemodialysis session. Conclusions. Positive linear correlations are observed of systolic and diastolic BP measured before PSG performed on the day before a haemodialysis session with the number of snoring episodes, which might suggest that breathing disorders affect the complex pathogenesis of hypertension in haemodialysed patients

Peritoneal dialysis performed on a subject with a rare congenital disorder — Cornelia de Lange syndrome. Case report

Zespół Cornelii de Lange (CdLs) jest rzadką wadą uwarunkowaną genetycznie. W jej przebiegu może wystąpić uszkodzenie nerek i rozwój przewlekłej choroby nerek (PChN) z koniecznością leczenia nerkozastępczego. U 18-letniego chorego z zespołem CdLs z powodu nieodwracalnego uszkodzenia nerek rozpoczęto leczenie ciągłą ambulatoryjną dializą otrzewnową (CADO) prowadzoną w formie dializy asystowanej. Bezpośrednią opiekę nad przebiegiem dializoterapii domowej sprawowała matka pacjenta. W pracy przedstawiono przebieg okresu dializ otrzewnowych i trudności w ich prowadzeniu. U chorego niewspółpracującego, z rzadką wadą genetyczną możliwe jest prowadzenie dializoterapii, choć stwarza ono wiele problemów i stanowi bardzo duże obciążenie zarówno dla bezpośredniego opiekuna chorego, jak i zespołu pielęgniarsko- lekarskiego.Cornelia de Lange syndrome (CdLS) is a rare congenital disorder. In its course, renal damage and chronic kidney disease (CKD) might occur, resulting in the need for renal replacement therapy. Assisted continuous ambulatory peritoneal dialysis (CAPD) was initiated in an 18-year-old male with CdLS and irreversible renal damage. Home dialysis was supervised by the patient’s mother. The course of and difficulties in peritoneal dialysis in this case have been presented in this report. In case of a non-compliant patient with a rare genetic disorder it is possible to administer renal replacement therapy, although it carries numerous difficulties and imposes a burden on the carer and the nurse-physician team

Częstość występowania bezdechu sennego u pacjentów z przewlekłą chorobą nerek (PChN) leczonych nerkozastępczo hemodializami

Wstęp: Zaburzenia snu występują częściej u pacjentów z chorobami nerek niż w ogólnej populacji. Zespół bezdechu sennego jest częściej diagnozowany u pacjentów z przewlekłą chorobą nerek (PChN). Przybiera on formę obturacyjną, ośrodkową lub mieszaną i ma złożoną etiologię. Celem niniejszej pracy była ocena częstości występowania poszczególnych typów zaburzeń oddychania w trakcie snu przy użyciu polisomnografii u pacjentów długotrwale hemodializowanych. Materiały i metody: Badaniem objęto pacjentów w V stopniu PChN długotrwale leczonych nerkozastępczo metodą hemodializ. Wyniki: Uzyskane wyniki sugerują, że wzrost wagi pacjentów pomiędzy kolejnymi hemodializami koreluje z większą częstością występowania incydentów zaburzeń oddychania w czasie snu (bezdech lub spłycenie oddechu) u pacjentów poddawanych hemodializom. Wnioski: W oparciu o wyniki uzyskane na podstawie przedstawionego badania można wnioskować, że przyrost masy ciała pomiędzy zabiegami hemodializy wiąże się z większą liczbą obserwowanych nieprawidłowych zjawisk oddechowych (bezdechow i spłyceń oddechów) u pacjentów w trakcie nocy poprzedzającej zabieg HD. Ponadto obserwuje się dodatnie korelacje liniowe pomiędzy wartościami RR skurczowego i rozkurczowego zmierzonymi przed badaniem PSG wykonanym w dniu poprzedzającym kolejną hemodializę a liczbą epizodów chrapania, co może sugerować wpływ zaburzeń oddechowych na złożoną patogenezę nadciśnienia tętniczego u chorych hemodializowanych

Preventive program of early detection of chronic kidney disease. Action “Warning Kidney”- Bydgoszcz 2010.

Chronic kidney disease (CKD) is a significant health problem in Poland and all over the world. It is estimated that in Poland CKD affects more than 4 million people (it is about 10-13% of the Polish population). Early detection of CKD is of great importance because of the possibility of an effective therapy to protect kidney function especially in patients with high risk of developing CKD. The aim of the study was to analyze the results of the program for early detection of kidney disease conducted in Bydgoszcz in 2010. 347 subjects took part in preventive action of early detection of kidney disease. They underwent free laboratory tests:urinalysis, serum creatinine level, eGFR calculation. Moreover, in each patient’s blood pressure was measured. Besides laboratory tests results, all patients were given comprehensive information concerning further nephrological management. 347 people were evaluated in this local Preventive Program of Early CKD detection. There were two fold more women than men. The largest group among the respondents were people aged between 50 and 70 years of age, in stage 2 (63.1%, GFR> 60 ml/min) and 3-stage kidney disease (31.4%, eGFR 60 ml/min) i w stadium 3 PChN (31.4%, eGFR <60 ml / min)

Associations between depressive symptoms and disease progression in older patients with chronic kidney disease: results of the EQUAL study

Background Depressive symptoms are associated with adverse clinical outcomes in patients with end-stage kidney disease; however, few small studies have examined this association in patients with earlier phases of chronic kidney disease (CKD). We studied associations between baseline depressive symptoms and clinical outcomes in older patients with advanced CKD and examined whether these associations differed depending on sex. Methods CKD patients (&gt;= 65 years; estimated glomerular filtration rate &lt;= 20 mL/min/1.73 m(2)) were included from a European multicentre prospective cohort between 2012 and 2019. Depressive symptoms were measured by the five-item Mental Health Inventory (cut-off &lt;= 70; 0-100 scale). Cox proportional hazard analysis was used to study associations between depressive symptoms and time to dialysis initiation, all-cause mortality and these outcomes combined. A joint model was used to study the association between depressive symptoms and kidney function over time. Analyses were adjusted for potential baseline confounders. Results Overall kidney function decline in 1326 patients was -0.12 mL/min/1.73 m(2)/month. A total of 515 patients showed depressive symptoms. No significant association was found between depressive symptoms and kidney function over time (P = 0.08). Unlike women, men with depressive symptoms had an increased mortality rate compared with those without symptoms [adjusted hazard ratio 1.41 (95% confidence interval 1.03-1.93)]. Depressive symptoms were not significantly associated with a higher hazard of dialysis initiation, or with the combined outcome (i.e. dialysis initiation and all-cause mortality). Conclusions There was no significant association between depressive symptoms at baseline and decline in kidney function over time in older patients with advanced CKD. Depressive symptoms at baseline were associated with a higher mortality rate in men

Kidney Failure Prediction Models: A Comprehensive External Validation Study in Patients with Advanced CKD

Background: Various prediction models have been developed to predict the risk of kidney failure in patients with CKD. However, guideline-recommended models have yet to be compared head to head, their validation in patients with advanced CKD is lacking, and most do not account for competing risks.Methods: To externally validate 11 existing models of kidney failure, taking the competing risk of death into account, we included patients with advanced CKD from two large cohorts: the European Quality Study (EQUAL), an ongoing European prospective, multicenter cohort study of older patients with advanced CKD, and the Swedish Renal Registry (SRR), an ongoing registry of nephrology-referred patients with CKD in Sweden. The outcome of the models was kidney failure (defined as RRT-treated ESKD). We assessed model performance with discrimination and calibration.Results: The study included 1580 patients from EQUAL and 13,489 patients from SRR. The average c statistic over the 11 validated models was 0.74 in EQUAL and 0.80 in SRR, compared with 0.89 in previous validations. Most models with longer prediction horizons overestimated the risk of kidney failure considerably. The 5-year Kidney Failure Risk Equation (KFRE) overpredicted risk by 10%-18%. The four- and eight-variable 2-year KFRE and the 4-year Grams model showed excellent calibration and good discrimination in both cohorts.Conclusions: Some existing models can accurately predict kidney failure in patients with advanced CKD. KFRE performed well for a shorter time frame (2 years), despite not accounting for competing events. Models predicting over a longer time frame (5 years) overestimated risk because of the competing risk of death. The Grams model, which accounts for the latter, is suitable for longer-term predictions (4 years)

The association between TMAO, CMPF and clinical outcomes in advanced CKD; results from the EQUAL study

Background Trimethylamine N-oxide (TMAO), a metabolite from red meat and fish consumption, plays a role in promoting cardiovascular events. However, data regarding TMAO and its impact on clinical outcomes are inconclusive, possibly due to its undetermined dietary source. Objectives We hypothesized that circulating TMAO derived from fish intake might cause less harm compared with red meat sources by examining the concomitant level of 3-carboxy-4-methyl-5-propyl-2-furanpropionate (CMPF), a known biomarker of fish intake, and investigated the association between TMAO, CMPF, and outcomes. Methods Patients were recruited from the European QUALity (EQUAL) Study on treatment in advanced chronic kidney disease among individuals aged &gt;= 65 y whose estimated glomerular filtration rate (eGFR) had dropped for the first time to &lt;= 20 mL/min per 1.73 m(2) during the last 6 mo. The association between TMAO, CMPF, and outcomes including all-cause mortality and kidney replacement therapy (KRT) was assessed among 737 patients. Patients were further stratified by median cutoffs of TMAO and CMPF, suggesting high/low red meat and fish intake. Results During a median of 39 mo of follow-up, 232 patients died. Higher TMAO was independently associated with an increased risk of all-cause mortality (multivariable HR: 1.46; 95% CI: 1.17, 1.83). Higher CMPF was associated with a reduced risk of both all-cause mortality (HR: 0.79; 95% CI: 0.71, 0.89) and KRT (HR: 0.80; 95% CI: 0.71, 0.90), independently of TMAO and other clinically relevant confounders. In comparison to patients with low TMAO and CMPF, patients with low TMAO and high CMPF had reduced risk of all-cause mortality (adjusted HR: 0.49; 95% CI: 0.31, 0.73), whereas those with high TMAO and high CMPF showed no association across adjusted models. Conclusions High CMPF conferred an independent role in health benefits and might even counteract the unfavorable association between TMAO and outcomes. Whether higher circulating CMPF concentrations are due to fish consumption, and/or if CMPF is a protective factor, remains to be verified

Symptom Burden before and after Dialysis Initiation in Older Patients

For older patients with kidney failure, lowering symptom burden may be more important than prolonging life. Dialysis initiation may affect individual kidney failure-related symptoms differently, but the change in symptoms before and after start of dialysis has not been studied. Therefore, we investigated the course of total and individual symptom number and burden before and after starting dialysis in older patients