Increasing access to integrated ESKD care as part of Universal Health Coverage

The global nephrology community recognizes the need for a cohesive strategy to address the growing problem of end-stage kidney disease (ESKD). In March 2018, the International Society of Nephrology hosted a summit on integrated ESKD care, including 92 individuals from around the globe with diverse expertise and professional backgrounds. The attendees were from 41 countries, including 16 participants from 11 low- and lower-middle–income countries. The purpose was to develop a strategic plan to improve worldwide access to integrated ESKD care, by identifying and prioritizing key activities across 8 themes: (i) estimates of ESKD burden and treatment coverage, (ii) advocacy, (iii) education and training/workforce, (iv) financing/funding models, (v) ethics, (vi) dialysis, (vii) transplantation, and (viii) conservative care. Action plans with prioritized lists of goals, activities, and key deliverables, and an overarching performance framework were developed for each theme. Examples of these key deliverables include improved data availability, integration of core registry measures and analysis to inform development of health care policy; a framework for advocacy; improved and continued stakeholder engagement; improved workforce training; equitable, efficient, and cost-effective funding models; greater understanding and greater application of ethical principles in practice and policy; definition and application of standards for safe and sustainable dialysis treatment and a set of measurable quality parameters; and integration of dialysis, transplantation, and comprehensive conservative care as ESKD treatment options within the context of overall health priorities. Intended users of the action plans include clinicians, patients and their families, scientists, industry partners, government decision makers, and advocacy organizations. Implementation of this integrated and comprehensive plan is intended to improve quality and access to care and thereby reduce serious health-related suffering of adults and children affected by ESKD worldwide

Nocturia and its clinical implications in older women

The aim of this study is to demonstrate the relationship between nocturia and geriatric syndromes, and comprehensive geriatric assessment parameters (CGA) in older women. 858 older outpatient women were included in this cross-sectional study. For the nocturia variable, the question, ‘‘Generally, during the past 30 days, how many times did you usually urinate after you have gone to sleep at night until the time you got up in the morning?’’ was used. The relationships between nocturia status and common geriatric syndromes, and CGA parameters were determined. The mean age of patients was 74.1±8.0 years. The prevalence of patients who reported average of 0, ≥1, ≥2, ≥3, and ≥4 nocturnal episodes was 14.7%, 85.3%, 66.3%, 42.13%, and 24.1%, respectively. When all the covariates including age, education, Charlson Comorbidities Index score, glomerular filtration rate, antimuscarinic drugs and alpha-blockers use, diabetes mellitus, chronic obstructive pulmonary disease, and incontinence were adjusted, there were higher rates of insomnia, recurrent falls and higher scores of Timed Up-Go test in older women with ≥2 nocturia episodes (p<0.05). There was a significant correlation between ≥ 3 nocturia episodes and lower Instrumental Activities of Daily Living scores and a significant correlation between ≥ 4 nocturnal episodes and frailty and polypharmacy (p<0.05). Nocturia is quite common and associated with insomnia, frailty, polypharmacy, incontinence, falls, lower gait speed, and functionality in older women.Therefore, nocturia is very important for geriatric practice and ≥2 nocturia episodes can be a marker of poor health status in older women

Trends and Prevalence of Nocturia Among US Adults, 2005-2016

Purpose: Increased nocturia episodes can be a clinical marker of poor health status. The present study aimed to evaluate patterns and temporal trends in nocturia and sociodemographic and lifestyle correlates in the US population. Methods: Participants, aged 20 years or older, were included in this repeated cross-sectional study. The National Health and Nutrition Examination Survey from 2005 to 2016 was used. Participants were asked “During the past 30 days, how many times per night did you most typically get up to urinate, from the time you went to bed at night until the time you got up in the morning?”. Individuals were categorized as either ≥ 1 nocturia episode or ≥ 2 nocturia episodes per night. Results: The estimated prevalence of ≥ 1 nocturia was high among men (20–39 years, 56.8%; 40–59 years, 70.2%; ≥ 60 years, 82.7%) and women (20–39 years, 68.9%; 40–59 years, 74.3%; ≥ 60 years, 84.7%), particularly in Non-Hispanic-blacks. From 2005–2016, the trends in prevalence of ≥ 1 nocturia increased for the age groups 20–39 and 40–59 years among men (p < 0.001 and p = 0.001, respectively) and women 20–39 and 40–59 years (p < 0.001 and p = 0.032, respectively), but a stable trend was observed among men and women who were 60 years and older (p = 0.814, and p = 0.64, respectively). A significant increasing trend of ≥ 2 nocturia episodes was observed among men only aged 40–59 years (p = 0.007). Conclusions: From 2005 through 2016, the secular trend in the frequency of nocturia increased in both men and women in general, which was significant under the age of 60 years, particularly in Non-Hispanic-blacks

Prevalence of erectile dysfunction in patients with chronic kidney disease: a systematic review and meta-analysis

Growing evidence reports that chronic kidney diseases (CKD) might play a role in erectile dysfunction (ED), but limited knowledge is available. Therefore, we performed a systematic review up to 21/08/2019 to investigate the associations between CKD and ED. The main analysis reported the prevalence of ED as absolute estimates (in %) with their 95% confidence intervals (CIs) and across CKD stages (when specified), hemodialysis and transplant, calculating the p for interaction across strata. Among 291 studies, we included 34 articles with 5986 men. We found an overall prevalence of 76% (95%CI: 72–79) with a high degree of heterogeneity (I2 = 84.2%; p < 0.0001). Analyzing the data by CKD stage, we found a significant higher prevalence of ED in CKD (78%; 95%CI: 75–81%; I2 = not possible) compared with hemodialysis stage (prevalence = 77%; 95%CI: 73–80%; I2 = 84.5) or to patients undergoing transplant (prevalence = 64%; 95%CI: 54–74%; I2 = 54%) (p across strata = 0.036). Considering the high prevalence of ED in men with CKD, health care practitioners should focus on issues of sexual health in men with CKD. Given the advancements in dialysis and therapy and the associated advancements in survival and life expectancy, maintaining the patients’ sexual function is important for their well-being and quality of life

A case of fluoxetine-induced syndrome of inappropriate antidiuretic hormone secretion

Background A 58-year-old schizophrenic male who had been drinking at least 4-51 of pure water every day for 30 years was admitted to a hospital with complaints of nausea, fatigue, and irregular, fluctuating fevers (up to 39 degrees C). He had previously been prescribed fluoxetine at a dose of 20 mg/day and had been using the drug for 28 days

Strategic plan for integrated care of patients with kidney failure

There is a huge gap between the number of patients worldwide requiring versus those actually receiving safe, sustainable, and equitable care for kidney failure. To address this, the International Society of Nephrology coordinated the development of a Strategic Plan for Integrated Care of Patients with Kidney Failure. Implementation of the plan will require engagement of the whole kidney community over the next 5�10 years