Survival rate in acute kidney injury superimposed COVID-19 patients: a systematic review and meta-analysis

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155406/1/Yessayan_Survival_Rate.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155406/4/COVID YESSAYAN DeepBluepermissions_agreement-CCBYandCCBY-NC_ORCID.docxDescription of Yessayan_Survival_Rate.pdf : ArticleDescription of COVID YESSAYAN DeepBluepermissions_agreement-CCBYandCCBY-NC_ORCID.docx : Deep Blue Sharing Agreemen

Chronic Kidney Disease and Cognitive Impairment.

Chronic kidney disease (CKD) is associated with a high risk of cognitive impairment (CI). Both vascular and metabolic factors are implicated in the causation of CI in CKD. The traditional risk factors for CI are more prevalent in CKD and interact reciprocally. CI in CKD is associated with reduced functional capacity, poor quality of life and mortality. Cognition declines significantly after initiation of haemodialysis (HD). Repeated cerebral insults related to intra-dialytic haemodynamic instability may be responsible for the rapid, step-wise decline in cognition observed in HD patients. Cognitive interventions used in the general population have not been adequately tested in CKD. Exercise interventions are likely to be beneficial based on biological plausibility and pilot trial data. Cooled HD may be beneficial in HD patients but needs substantive trial data to support it. Cognition testing should be routinely offered to CKD patients. There is a need for further research into the underlying causes of CI in CKD with a view to developing therapeutic interventions

Effect of Long-Term, Low-Dose Aspirin Therapy on Renal Graft Function

Objectives: Despite improvements in immunosuppressive protocols for renal transplant, long-term success of renal transplant is still limited by the occurrence of interstitial fibrosis and tubular atrophy. Some studies have shown that aspirin decreases the severity of kidney ischemia-reperfusion injury and the development of tubular atrophy in animal models. This study aimed to assess the effects of aspirin therapy started at the time of transplant on long-term graft function. Materials and Methods: We compared renal graft function of 82 patients on low-dose aspirin 75 mg once daily who underwent renal transplant between 1 January 2000 and 31 December 2010 from a single center with 65 patients not taking aspirin. For each patient, the following measurements were collected: age, sex, creatinine level, type of donor, cold ischemia time, occurrence of acute allograft rejections, number of HLA mismatches, first transplant, intake of statins, number of antihypertensive medications, and number of days posttransplant. Patients were excluded from the study who were on aspirin before transplant or who had coronary artery disease. Results: Multilevel modelling was used to compare renal allograft function, as measured by serum creatinine levels, between patients taking and not taking aspirin after kidney transplant. Aspirin was not significantly associated with creatinine levels (P = .59) after adjusting for other relevant variables. Conclusions: Low-dose aspirin started at the time of transplant has a negligible effect on renal allograft function over the 15-year study period posttransplant

Uncertainties in BP management in dialysis patients.

Hypertension in dialysis patients is extremely common. In this article, we review the current evidence for blood pressure (BP) goals in hemodialysis patients, and consider the effectiveness of interventions by which BP may be lowered, including manipulation of dietary and dialysate sodium; optimization of extracellular water; prolongation of dialysis time; and antihypertensive medication. Although two meta-analyses suggest lowering BP using antihypertensive drugs might be beneficial in reducing cardiovascular events and mortality, there are insufficient rigorously designed trials in hypertensive hemodialysis populations to determine preferred antihypertensive drug classes. We suggest aiming for predialysis systolic BP between 130 and 159 mm Hg, while at the same time acknowledge the significant limitations of the data upon which it is based. We conclude by summarizing current knowledge as regards management of hypertension in the peritoneal dialysis population and make recommendations for future research in this field