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Epidemiological Profile of Chronic Kidney Disease at the General Hospital of National Reference of N’Djamena (Chad)  [PDF]
Ibrahim Hamat, Guillaume Mahamat Abderraman, Zeinab Ma?ga Moussa Tondi, Mahamat Youssouf, Mouhammadou Moustapha Cisse, Fotclossou Tara, Elhaj Fary Ka, Abdou Niang, Boucar Diouf
Open Journal of Nephrology (OJNeph) , 2016, DOI: 10.4236/ojneph.2016.63010
Abstract: Introduction: Chronic renal failure is a disease that affects many patients worldwide and increasingly in Africa. At the end of 2003, about 1.1 million people were suffering from End-Stage Renal Disease (ESRD) and were treated with periodic dialysis [12]. In Africa, CKF represents 2% to 10% of hospital admissions and is responsible for 4% to 22% of deaths [14]. So, this study is conducted for the first time in Chad, with the aims to determine the prevalence of CKD. Methods: This was a retrospective, descriptive and analytical study over a period of 12 months from April 29, 2011 to April 28, 2012. All patients with chronic renal failure regardless of etiology and stage of chronic kidney disease were included in the study. Chronic renal failure was defined as a glomerular filtration rate below 60 ml/min/1.73m (MDRD) for more than 3 months. This study was conducted in several departments of the National General Reference Hospital (NGRH) of N’Djamena. Result: Among 2039 inpatients, 195 patients had chronic renal failure, as a frequency of 9.6%. The average age of our patients was 51 ± 16.8 years, ranging from 11 to 85 years. Male predominance was noted to be 59% of men against 41% of women. We noted that high blood pressure accounted for 66.2% (N = 129) of cases, diabetes in 48.2% (N = 94), alcoholism in 28.7% (N = 56), smoking in 14.9% (N = 29) and the association alcoholism-smoking in 19.5% (N = 38). Hypertension was the leading cause of chronic renal failure (66.2%). All patients had a serum creatinine and creatinine clearance was assessed. Among them, we noted 57 patients (29%) with end-stage renal failure. The average calcium and phosphate serum were 1.8 mmol/l and 1.6 mmol/l, respectively. We noted that 120 patients as 61.5%, currently took herbal medicine. 48 out of 57 of our patients with ESRD as 24.6% of patients in the study had received replacement therapy (hemodialysis) with 12.5% of deaths. Conclusion: Chad, who compiled the first study with 195 patients at the General Hospital of N’Djamena National Reference over a period of one year has objectified a prevalence of chronic renal failure of 9.6%.
The Chronic Kidney Disease Model: A General Purpose Model of Disease Progression and Treatment
Lori A Orlando, Eric J Belasco, Uptal D Patel, David B Matchar
BMC Medical Informatics and Decision Making , 2011, DOI: 10.1186/1472-6947-11-41
Abstract: Monte Carlo simulation of CKD natural history and treatment. Health states include myocardial infarction, stroke with and without disability, congestive heart failure, CKD stages 1-5, bone disease, dialysis, transplant and death. Each cycle is 1 month. Projections account for race, age, gender, diabetes, proteinuria, hypertension, cardiac disease, and CKD stage. Treatment strategies include hypertension control, diabetes control, use of HMG-CoA reductase inhibitors, use of angiotensin converting enzyme inhibitors, nephrology specialty care, CKD screening, and a combination of these. The model architecture is flexible permitting updates as new data become available. The primary outcome is quality adjusted life years (QALYs). Secondary outcomes include health state events and CKD progression rate.The model was validated for GFR change/year -3.0 ± 1.9 vs. -1.7 ± 3.4 (in the AASK trial), and annual myocardial infarction and mortality rates 3.6 ± 0.9% and 1.6 ± 0.5% vs. 4.4% and 1.6% in the Go study. To illustrate the model's utility we estimated lifetime impact of a hypothetical treatment for primary prevention of vascular disease. As vascular risk declined, QALY improved but risk of dialysis increased. At baseline, 20% and 60% reduction: QALYs = 17.6, 18.2, and 19.0 and dialysis = 7.7%, 8.1%, and 10.4%, respectively.The CKD Model is a valid, general purpose model intended as a resource to inform clinical and policy decisions improving CKD care. Its value as a tool is illustrated in our example which projects a relationship between decreasing cardiac disease and increasing ESRD.Chronic kidney disease (CKD) affects 13% of the US population and its incidence is increasing with the rise in major CKD risk factors, hypertension and diabetes[1]. An expanding body of evidence indicates that early control of hypertension and diabetes and the use of angiotensin converting enzyme inhibitors (ACEIs) can reduce progression of CKD and improve outcomes of those who do progress to end
Obesity and chronic kidney disease
Nefrología (Madrid) , 2011,
Abstract: obesity is associated with the early onset of glomerulomegaly, hemodynamic changes of a hyperfiltering kidney, and increased albuminuria, which are potentially reversible with weight loss. however, pathologic lesions of focal segmental glomerulosclerosis develop in experimental models of sustained obesity, and are observed in morbidly obese humans presenting with massive proteinuria. in addition, several observational, cross sectional and longitudinal studies document that obesity is as an independent risk factor for the onset, aggravated course, and poor outcomes of chronic kidney disease, even after adjustment for confounding co-morbidities including metabolic syndrome, diabetes and hypertension, the major causes of chronic kidney disease. early dietary intervention to reduce weight, and where necessary bariatric surgery, should be considered in the management of overweight and obese chronic kidney disease (ckd) patients.
Hypertension in Chronic Kidney Disease: Navigating the Evidence  [PDF]
F. M. Tedla,A. Brar,R. Browne,C. Brown
International Journal of Hypertension , 2011, DOI: 10.4061/2011/132405
Abstract: Hypertension is both an important cause and consequence of chronic kidney disease. Evidence from numerous clinical trials has demonstrated the benefit of blood pressure control. However, it remains unclear whether available results could be extrapolated to patients with chronic kidney diseases because most studies on hypertension have excluded patients with kidney failure. In addition, chronic kidney disease encompasses a large group of clinical disorders with heterogeneous natural history and pathogenesis. In this paper, we review current evidence supporting treatment of hypertension in various forms of chronic kidney disease and highlight some of the gaps in the extant literature.
Study on quality of life of chronic kidney disease stage 5 patients on hemodialysis  [PDF]
Mahasagar Gyawali,HC Paudel,PK Chhetri,PR Shankar,SK Yadav
Janaki Medical College Journal of Medical Science , 2013, DOI: 10.3126/jmcjms.v1i2.9265
Abstract: Background and Objectives: Chronic Kidney Disease (CKD) is a worldwide public health problem with increasing incidence and prevalence. The causes of CKD may be diabetes mellitus, hypertension and polycystic kidney disease. The main objective of this study is to study quality of life of chronic kidney disease stage 5 patients on hemodialysis.
Relevance of Protein Content within the Renal Scaffold for Kidney Bioengineering and Regeneration  [PDF]
Fatima Guerrero, Andres Carmona, Rosa Ortega, Sagrario Ca?adillas, Rodolfo Crespo, Concha Herrera, Pedro Aljama
Journal of Biomedical Science and Engineering (JBiSE) , 2017, DOI: 10.4236/jbise.2017.1011039
Abstract: Chronic kidney disease is currently a major public health problem around the world. Although hemodialysis increases survival of patients with end-stage renal disease, kidney transplantation remains the only potentially curative treatment. However, transplantation as a therapeutic option is limited by availability of suitable donor organs. This situation highlights the urgent need to find new and potentially inexhaustible sources of transplantable organs. Perfusion decellularizarion of whole organs is a novel approach to organ engineering and regeneration. In the present research, we used a continuous perfusion decellularization protocol to eliminate cellular componet of kidney and evaluated residual scaffold components after decellularizarion process by proteomics analysis. Our proteomic data show that this protocol results in incomplete removal of cellular proteins. However, unlike other authors, we assume that proteins retained within decellularized kidney scaffold could be the basis for specific homing and celular differentation in the recellularization process.
Recommendations for early diagnosis of chronic kidney disease  [cached]
Bosan I
Annals of African Medicine , 2007,
Abstract: Background : Chronic kidney disease is an important component of chronic non– communicable diseases that are now of pandemic proportions and are the major cause of morbidity and mortality worldwide. Patients with reduced renal function represent a population not only at risk for progression of kidney disease and development of end stage renal disease (ESRD), but also at a greater risk of cardiovascular disease and mortality. Unfortunately, chronic kidney disease is under diagnosed and undetected resulting in lost opportunities for improving the clinical outcome. Early diagnosis with appropriate interventions will improve the quality of care of patients and prevent or delay progression to end stage renal disease. Our objective is to review existing recommendations and examine their adaptation to improving the quality of care for patients with chronic kidney disease in our environment. Method : Hand searches of published articles and electronic data were the primary sources. Only articles published in the English language were consulted excluding case reports, letters and conference abstracts. Articles of original data were searched from 1980 while review articles and expert committee reports were from 2000. Results : Early diagnosis of chronic kidney disease is crucial to improving the clinical outcome and reducing the incidence of end stage renal disease. Certain individuals with specific socio demographic and clinical factors are at increased risk of chronic renal disease. All individuals should be assessed as part of routine health encounter, to determine whether they are at increased risk of developing chronic kidney disease based on clinical and socio demographic factors. Individuals at increased risk of developing chronic kidney disease should undergo testing for markers of kidney damage, and to estimate the level of GFR.Individuals found to have chronic kidney disease should be evaluated and treated appropriately. A clinical action plan should be developed for each patient based on the type and stage of renal disease, co-morbid conditions, complications of the disease and risk factors for progression of renal disease or development of cardiovascular disease. Conclusion : Individuals at increased risk, but found not to have chronic kidney disease, should be advised to follow of risk factor reduction, if appropriate, and undergo repeat periodic evaluation.
Cardiovascular disease in patients with chronic kidney disease  [cached]
Julian Wright,Alastair Hutchison
Vascular Health and Risk Management , 2009,
Abstract: Julian Wright, Alastair HutchisonManchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester, UKAbstract: Patients with chronic kidney disease have a high burden of cardiovascular morbidity and mortality. The vast majority of patients with chronic kidney disease do not progress to end stage renal failure, but do have a significantly higher incidence of all cardiovascular co-morbidities. Traditional cardiovascular risk factors only partially account for this increased incidence of cardiovascular disease. In patients with kidney disease the basic biology underlying cardiovascular disease may be similar to that in patients without kidney disease, but it would seem many more risk factors are involved as a consequence of renal dysfunction. Although emphasis is placed on delaying the progression of chronic kidney disease, it must be appreciated that for many patients it is vital to address their cardiovascular risk factors at an early stage to prevent premature cardiovascular death. This review examines available epidemiological evidence, discusses common cardiovascular risk factors in patients with chronic kidney disease, and suggests possible treatment strategies. Potential areas for important research are also described.Keywords: cardiovascular risk factors, chronic kidney disease, hypertension, diabetes
Chronic Kidney Failure
Tanr?verdi MH et al.
Konuralp Tip Dergisi , 2010,
Abstract: Chronic kidney failure (CKF) is a state of permanent decrease in glomerular filtration rate (GFR) that will cause established changes in kidney functions. This status usually occurs when GFR decreases below 25 ml/min. When GFR decreases as much as 75% of the normal value, failure in kidney functions proceeds even if the reason for this situation is abolished. CKF is a pathophysiological process that ends with decrease in nephron numbers and functions; it usually has many etiological factors which cause end stage renal disease (ESRD). ESRD is characterized with irreversible loss of renal functions and this constitutes a clinical state that requires renal replacement treatments such dialysis and transplantation in order to be protected from harmful and life threatening effects of uremia. Uremia occurs as a result of acute or chronic renal failure and it characterizes a clinical and laboratory syndrome that reflects a state of functional defect in all systems. In presented review, the etiology and clinical and laboratory features of CKF were discussed in the light of current literature.
Decrease in Irisin in Patients with Chronic Kidney Disease  [PDF]
Ming-Shien Wen, Chao-Yung Wang, Shuei-Liong Lin, Kuo-Chun Hung
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0064025
Abstract: Patients with chronic kidney disease have abnormal energy expenditure and metabolism. The mechanisms underlying altered energy expenditure in uremia are unknown and remain to be elucidated. Irisin is a peroxisome proliferator-activated receptor γ coactivator 1-α–dependent myokine, and it increases energy expenditure in the absence of changes in food intake or activity. We hypothesize that chronic kidney disease patients have altered irisin levels. We measured resting irisin levels in 38 patients with stage 5 chronic kidney disease and in 19 age- and sex-matched normal subjects. Plasma irisin levels were significantly decreased in chronic kidney disease patients (58.59%; 95% CI 47.9%–69.2%, p<0.0001). The decrease in irisin levels was inversely correlated with the levels of blood urea nitrogen and creatinine. Further association analysis revealed that irisin level is independently associated with high-density lipoprotein cholesterol level. Our results suggest that chronic kidney disease patients have lower than normal irisin levels at rest. Furthermore, irisin may play a major role in affecting high-density lipoprotein cholesterol levels and abnormal energy expenditure in chronic kidney disease patients.
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