Surgery for Diverticulitis is Associated with High Risk of In-Hospital Mortality and Postoperative Complications in Older End Stage Renal Disease Patients

Abstract Background IgA nephropathy (IgAN) is the most common glomerular disease worldwide. It has a high incidence in Asians and is more likely to progress to end-stage renal disease (ESRD). For high-risk IgAN, which is clinically characterized by massive proteinuria and renal dysfunction, however, there has been no international consensus on treatment options. Compared with other developed countries, IgAN patients in China are often found to have severe kidney function loss at initial diagnosis. Yi-Qi-Qing-Jie formula (YQF; a compound recipe of Chinese medicinal herbs) has shown potential renal protection in our previous clinical studies. To further confirm the efficacy and safety of YQF in the treatment of high-risk IgAN, we have designed a prospective double-blind randomized placebo-controlled trial. Methods/design The TCM-WINE study is a single-center, prospective, double-blind randomized placebo-controlled trial. We plan to randomize 60 participants with biopsy-proven IgAN to a YQF combined group (YQF compound combined with prednisolone, and cyclophosphamide if necessary) or an immunosuppression group (placebo-YQF combined with prednisolone, and cyclophosphamide if necessary). The two groups will enter a 48-week in-trial treatment phase and receive post-trial follow-up until study completion (3 years). All patients will receive optimal supportive care. The primary composite outcome is defined as the first occurrence of a 40% decrease in estimated glomerular filtration rate (eGFR) from the baseline lasting for 3 months, initiating continuous renal replacement treatment, or death due to chronic kidney disease (CKD) during the 3-year study phase. The secondary endpoint events are defined as the mean annual eGFR decline rate (eGFR slope, ml/min per 1.73 m2 per year), which is calculated by the eGFR regression curve for each eligible patient, and proteinuria remission (prescribed as proteinuria < 0.5 g/day) at weeks 24, 36, and 48 during the in-trial phase. The remission rate of symptoms and inflammation status will be evaluated at week 48. Safety monitoring and assessment will be undertaken during the study. Discussion The TCM-WINE study will evaluate the effects and safety of YQF combined therapy compared with immunosuppression monotherapy on the basis of the optimal supportive treatment in high-risk IgAN. The evidence from this study will provide a novel, effective, and safe Chinese characteristic therapy for high-risk IgAN patients. Trial registration ClinicalTrials.gov, NCT03418779. Registered on 18 June 2018.

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The Impact of Warfarin on Patients with End Stage Renal Disease

Advances in Vascular Medicine ◽

10.1155/2014/542034 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4

Author(s):

Anahita Dua ◽

Sapan S. Desai ◽

Harvey J. Woehlck ◽

Cheong J. Lee

Keyword(s):

Renal Disease ◽

Hospital Mortality ◽

End Stage Renal Disease ◽

Hospital Charges ◽

Care Utilization ◽

Chronic Obstructive ◽

Chronic Obstructive Pulmonary Disorder ◽

Stage Renal Disease ◽

End Stage ◽

The Impact

Introduction. A deficiency in vitamin K through the utilization of warfarin may result in increased vascular calcification and complications. This study aimed to determine the impact of warfarin administration on patients with end stage renal disease (ESRD) in a large, national sample. Methods. A retrospective analysis using the 2005–2010 National Inpatient Sample (NIS), a part of the Health Care Utilization Project (HCUP), was completed using ICD-9 diagnosis codes to capture patients with ESRD prescribed and not prescribed warfarin. Statistical analysis was through ANOVA and chi-squared testing. Results. From 2005–2010, 927,814 patients with ESRD were identified nationally. 3.5% (32,737) were prescribed warfarin. Patients prescribed warfarin had an average age of 64 years and 51% were male. For every comorbid condition (amputation, congestive heart failure, chronic obstructive pulmonary disorder, cerebrovascular accident, diabetes, hypertension, myocardial infarction, peripheral vascular diasese, and valvular disease) patients prescribed Warfarin had significantly higher rates of disease as compared to their nonwarfarin ESRD counterparts. ESRD patients prescribed warfarin had significantly shorter length of stay but increased hospital charges. They were more likely to be discharged to home and had significantly decreased in-hospital mortality. Conclusion. Patients with ESRD taking warfarin are more likely to have comorbidities and/or complications but have a decreased LOS and in-hospital mortality compared to their ESRD counterparts not administered warfarin.

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MP42-16 THE RISK OF PROGRESSION TO END STAGE RENAL DISEASE AFTER RADICAL NEPHRECTOMY IN A HIGH-RISK POPULATION: A DESCRIPTIVE ANALYSIS FROM THE VETERANS AFFAIRS

The Journal of Urology ◽

10.1097/ju.0000000000002063.16 ◽

2021 ◽

Vol 206 (Supplement 3) ◽

Author(s):

Diego Aguilar Palacios ◽

Fredrick Schumacher ◽

Sarah Markt ◽

Brigid Wilson ◽

Steven Campbell ◽

...

Keyword(s):

High Risk ◽

Renal Disease ◽

End Stage Renal Disease ◽

Radical Nephrectomy ◽

Descriptive Analysis ◽

Veterans Affairs ◽

High Risk Population ◽

Risk Of Progression ◽

Stage Renal Disease ◽

End Stage

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Seroprevalence of Leptospirosis in Suspected High Risk Sudanese Patients; A Pilot Exploratory Study

10.21203/rs.3.rs-1246367/v1 ◽

2022 ◽

Author(s):

Wisal Mustafa Ibrahim Mohammed ◽

Nada Abdelghani Abdelrahim

Keyword(s):

High Risk ◽

Renal Disease ◽

End Stage Renal Disease ◽

Exploratory Study ◽

Renal Dialysis ◽

Unknown Origin ◽

Dialysis Unit ◽

Igm Antibodies ◽

Stage Renal Disease ◽

End Stage

Abstract BackgroundThe extent of leptospirosis is unknown in Sudan and it might be mistaken for other more common febrile infectious diseases. Leptospirosis might also be associated with renal diseases that are common in Sudan. We intended to explore the existence of human leptospirosis in suspected high risk patients in Khartoum, Sudan, via sero-screening random febrile patients and those undergoing renal dialysis.MethodsThis is a pilot exploratory study that was conducted in 6 months period from April to September of 2013. Hospitals were selected conveniently following a non-random sampling approach. A total of 119 febrile patients (with or without definitive diagnosis) and patients under renal dialysis were included and their serum specimens, clinical and demographic data were collected. Sera were screened qualitatively for the existence of anti-leptospiral IgM antibodies using rapid lateral flow immunosorbent assay. Ethical clearance and official permissions were obtained.ResultsOut of the total 119 patients, 57 (47.9%) had end stage renal disease and were under dialysis at Renal Dialysis Unit in Asbab Charity Hospital in Bahri, 47 (39.5%), were febrile with unknown origin attending the Tropical Medicine Hospital in Omdurman, and 15 (12.6%) were febrile and were diagnosed as having malaria or typhoid and attended Yastabshiron Medical Centre and Bashauer Teaching Hospital. The overall prevalence of anti-leptospiral IgM antibodies among all 119 screened patients was 7%. The prevalence among the 57 with end stage renal disease was 9%, and among the 47 with fever of unknown origin was 6%. The prevalence among the 15 with fever of known origin (diagnosed as malaria or typhoid) was 0%. Almost all positive patients had recurring episodes of fever, are in close contact with livestock, were farmers and have natural untreated source for drinking water.ConclusionLeptospirosis is probably a common febrile condition and can be easily considered as one of the major causes of chronic kidney disease affecting people in this country. A national sero-screening for leptospirosis among those living in high risk geographical areas and those at occupational risk is highly recommended.

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In-hospital mortality of acute myocardial infarction in patients with and without renal dysfunction

Annals of King Edward Medical University ◽

10.21649/akemu.v11i3.1011 ◽

2016 ◽

Vol 11 (3) ◽

Author(s):

Abdul Rehman Abid ◽

Muhammad Tahir Mohyuddin ◽

Liaqat Ali ◽

Muhammad Shahid Naveed ◽

Nadeem Hayat Mallick

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Renal Insufficiency ◽

Renal Disease ◽

Hospital Mortality ◽

Renal Dysfunction ◽

End Stage Renal Disease ◽

Study Population ◽

Stage Renal Disease ◽

End Stage

Objective: To compare in-hospital mortality of acute myocardial Infarction in patients having normal renal functions with renal dysfunction patients. Setting: Emergency ward, Coronary care units and cardiology wards of the Punjab Institute of Cardiology Lahore. Study design: It was a comparative study. Sample size: 1000 consecutive patients presenting with acute myocardial infarction admitted to the Punjab Institute of cardiology Lahore were studied from 1st March 2004 to 15th August 2004. Results: After fulfilling the inclusion criteria 1000 patients were studied. The mean age of the study population was 60.8+9.38 years. Total number of males in the study population was 642(64.2%) while female patients were 358(35.8%). Patients with any degree of renal dysfunction, except those with end-stage renal disease were more likely to present with anterior MI than were patients without renal dysfunction. Patients with end-stage renal disease and more severe renal dysfunction were more likely to develop heart failure during hospitalization, to experience atrial fibrillation, and to have mechanical complications. Streptokinase therapy was used less frequently in patients with any degree of renal dysfunction than in patients without renal dysfunction, despite a similar incidence of MI. In-hospital mortality was 51(12%) in Group I patients, 46(16.6%) in Group II patients, 36(22%) in Group III patients, 35(27.7%) in Group IV patients and 5(35.7%) in Group V patients with a p value of <0.0001. Severe renal insufficiency had the maximum in-hospital mortality with OR of 5.4 and 95% confidence interval of 2.9-10.3 followed by end stage renal disease OR 5.1 (CI 2.2-12.1), moderate renal insufficiency OR 4.1 (CI 2.3-7.2) and mild renal insufficiency OR 1.9(CI 1.1-3.1) with a p value of <0.0001. Similarly congestive heart failure during hospital stay was observed in 20(4.7%) patients in Group I, 17(6.1%) patients in Group II, 15(9.4%) patients in Group III, 16(12.6%) patients in Group IV and 4(28.6%) patients in Group V. Similar trends were observed in mechanical complications and post myocardial arrhythmias in the study population, Conclusion: Patients with renal dysfunction who have acute MI are a high-risk population and suffer from increased mortality once they are admitted to the hospital. This is because of presence of more risk factors in this sub set of patients.

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