scholarly journals Chronic Kidney Disease in Ecuador: An Epidemiological and Health System Analysis of an Emerging Public Health Crisis

2021 ◽  
Author(s):  
Irene Torres ◽  
Rachel Sippy ◽  
Kevin Louis Bardosh ◽  
Ramya Bhargava ◽  
Martín Lotto-Batista ◽  
...  
Keyword(s):  
Public Health ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Disease Stage ◽  
Medical Attention ◽  
Dialysis Patients ◽  
Health Crisis ◽  
Screening Programs ◽  
Public Health Crisis ◽  
Number Of Patients

AbstractBackgroundThe absence of a chronic kidney disease (CKD) registry in Ecuador makes it difficult to assess the burden of disease, but there is an anticipated increase in the incidence of end-stage kidney disease along with increasing diabetes, hypertension and population age. From 2008, augmented funding for renal replacement treatment expanded dialysis clinics and patient coverage.MethodsWe conducted 73 in-depth interviews with healthcare providers in eight provinces. Findings were analyzed using qualitative methods and triangulated with quantitative data on patients with CKD diagnoses from six national-level databases between 2015 and 2018. We also reviewed grey and scientific literature on CKD and health systems in Ecuador.ResultsDatasets show a total of 17 484 dialysis patients in 2018, or 567 patients per million population (pmp), with an annual cost exceeding 11% of Ecuador’s public health budget. Each year, there were 139—162 pmp new dialysis patients, while doctors report waiting lists. The number of patients on peritoneal dialysis was stable; those on hemodialysis increased over time. Only 13 of 24 provinces have dialysis services, and nephrologists are in major cities, which limits access, delays medical attention, and adds a travel burden on patients. Prevention and screening programs are scarce, while hospitalization is an important reality of CKD patients.ConclusionCKD is an emerging public health crisis that has increased dramatically over the last decade in Ecuador and is expected to continue, making coverage for all patients impossible and the current structure, unsustainable. A patient registry would permit to estimate the demand and progression of patients with consideration for comorbidities, requirements and costs, and mortality, and identify where to focus prevention efforts. Health policy should clearly state CKD definitions and required patient data, including cause, disease stage and follow-up statistics. Organized monitoring of patients would benefit from improvements in patient referral.

Management of advanced chronic kidney disease (CKD)

2021 ◽  
pp. 608-688
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Dialysis Patients ◽  
Medical Problems ◽  
Advanced Chronic Kidney Disease ◽  
Conservative Care ◽  
Number Of Patients ◽  
Essential Components ◽  
The World ◽  
Patients Experience

The number of patients with advanced kidney disease requiring dialysis is increasing in all parts of the world. Managing patients as they transition onto dialysis and providing support and guidance as they make important treatment choices are essential components of a nephrologist’s job. Ensuring timely preparation for dialysis, allowing patients the opportunity to explore all options, including conservative care, and managing individual expectations of dialysis are increasingly important. All nephrologists will manage patients treated with dialysis and therefore it is imperative that they have a sound understanding of different dialysis modalities, how to assess the adequacy of dialysis, and the commonly encountered medical problems dialysis patients experience.

A Study of Lipid Profile in Chronic Kidney Disease Patients

2021 ◽  
Vol 15 (9) ◽  
pp. 3087-3090
Author(s):  
Muhammad Rizwan ◽  
Muhammad Taha Lodhi ◽  
Asim Maqsood ◽  
Tahir Mukhtar Sayed
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Lipid Profile ◽  
Chronic Kidney Disease Stage ◽  
Inverse Correlation ◽  
Lipid Profiles ◽  
Kidney Damage ◽  
Disease Stage ◽  
Dialysis Patients ◽  
Ckd Stage

Background and Aim: Chronic kidney disease patients are more likely to develop cardiovascular diseases caused by atherosclerosis accelerated rate and variety of other factors, of which they exhibit the abnormality of lipid profile atherogonic characteristics. The current study aim was to investigate the lipid profile abnormalities pattern in non-diabetic chronic kidney disease patients and to evaluate the association between the lipid profile alteration extent and renal impairment degree. Methods: This cross-sectional study was carried out on 118 chronic disease patients in the Department of Nephrology, Shaikh Zayed Hospital Lahore during the period, from August 2020 to May 2021. All the patients were carefully chosen based on their eligibility criteria. A history was taken, clinical investigation was performed, and biochemical tests were conducted. Blood was drawn for lipid profile analysis after 9 hours abstaining. The Institutional Ethical Committee approved the study and informed consent was taken from each individual. Chronic Kidney Disease as defined by the KDOQI Criteria Kidney damage for three months, defined as functional kidney abnormalities with or without decreased GFR, manifested by either: Pathological abnormalities; kidney damage markers such as changes in blood or urine composition, or abnormalities in imaging tests. GFR of less than 60 mL/min/1.73m2 for 3 months, with or without kidney damage. SPSS version 20 was used for data analysis. Results: The study included 118 patients, 79 (66.9%) of whom were males and 39 (33.1%) were females. The mean age of patients was 49.46 + 9.35 years with an age range of 28 to 78 years. Stage 5CKD patients were 23 who underwent dialysis. Chronic kidney disease patients had lower HDL and higher levels of triglyceride whereas, with chronic kidney disease stage progression, the HDL and TGL levels increased. In both stages 4 and 5 CKD, there is a positive correlation between triglyceride levels and serum phosphorous and TGL and calcium had inverse correlation. Dialysis patients' lipid profiles do not differ from those of non-dialysis patients. Conclusion: Our study found that patients with non-diabetic CKD have high triglyceride levels, low HDL, and had LDL and total cholesterol unchanged levels. As the CKD stage advances and GFR declines, triglyceride increases, and HDL decreases. TGL and serum phosphorous had a positive association in chronic kidney disease stage 4 and 5 whereas TGL and serum calcium had an inverse correlation in stages 4 and 5. Moreover, no significant difference between dialysed and non-dialysed chronic kidney disease patients’ lipid profiles was observed. Keywords: Chronic Kidney Disease; Lipid Profile; Lipid Profile Abnormalities

scholarly journals Frailty and sarcopenia in elderly non-dialysis patients with chronic kidney disease stage 3-5: a cross sectional study

2020 ◽  
Author(s):  
Jing Chang ◽  
Yan-Fei Wang ◽  
Wen-Wen Hou ◽  
Yan-Chun Li ◽  
Zhuo-Ran Qi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Chronic Kidney Disease Stage ◽  
Cross Sectional Study ◽  
Disease Stage ◽  
Sectional Study ◽  
Dialysis Patients ◽  
Cross Sectional ◽  
Independent Risk Factors

Abstract Background With the aging of the population, chronic kidney disease (CKD) and sarcopenia are the common diseases among the elderly. Non-dialysis patients with CKD account for a relatively high proportion, and the analysis of their general clinical characteristics has been more familiar. However, the study of sarcopenia in non-dialysis with CKD is not enough. Methods This is a cross sectional study. Non-dialysis patients with CKD stage 3–5 were continuously selected. Patients were divided into 3 groups based on the Fried scale, Non-frail group, Pre-frail group and Frail group. At the same time, muscle mass of the hospitalized patients was measured by dual-energy X-ray absorptiometry (DXA), and according to the test results, they were divided into sarcopenia and non-sarcopenia group. Baseline data and the measurement of the sarcopenia of the two groups were analyzed. Results A total of 102 elderly patients with chronic kidney disease stage 3–5 were continuously enrolled. There were 21 patients (20.6%) categorized as sarcopenia, 81 patients (79.4%) categorized as non-sarcopenia according to the measurement results of DXA. Frailty was assessed by the criteria of frailty phenotype, there were 13 patients of sarcopenia in the frail group, 6 patients of sarcopenia in the pre-frail group, and 2 patients of sarcopenia in the non-frail group, accounting for 31.7%, 20.0%, 6.5%, respectively. Moreover, the analysis of the related risk factors of sarcopenia showed that body mass index (BMI)༜23 kg/m2(OR = 3.82, 95%CI 1.33–10.97, P = 0.013), MNA-SF ≤ 11(OR = 3.97, 95%CI 1.08–14.58, P = 0.038) were the independent risk factors for sarcopenia in non-dialysis patients with chronic kidney disease stage 3–5. Conclusions The prevalence of sarcopenia in elderly non-dialysis patients with chronic kidney disease stage 3–5 was high, and sarcopenia was common in the frail patients. BMI༜23 kg/m2 and MNA-SF ≤ 11were the independent risk factors for sarcopenia in non-dialysis patients with chronic kidney disease stage 3–5.

scholarly journals Comparison of the usefulness of selected formulas for GFR estimation in patients with diagnosed chronic kidney disease

2018 ◽  
Vol 72 ◽  
pp. 108-115
Author(s):  
Paweł Wróbel ◽  
Rafał Januszek ◽  
Władysław Sułowicz
Keyword(s):  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Chronic Kidney Disease Stage ◽  
Age Groups ◽  
Disease Stage ◽  
Number Of Patients ◽  
Mdrd Formula

Introduction: The diagnosis and classification of chronic kidney disease (CKD) are based on the glomerular filtration rate value. The simplest way to evaluate glomerular filtration rate is to estimate it based on serum creatinine concentration using one of many specific mathematical formulas. None of the formulas created for this purpose are perfect. Differences in eGFR values are frequently observed in specific stages of chronic kidney disease by KDIGO classification based on different formulas. Aim: The aim of the study is to compare the eGFR value in patients previously diagnosed with CKD treated in the Outpatient Nephrology Unit of the University Hospital in Krakow using the selected formulas. Material/Methods: The study was performed in a group of 882 patients (392 women, 490 men) aged 65.0 ± 14.8 years. GFR values were estimated using Bjornsson, the abbreviated MDRD, and CKD-EPI formulas. These values were then compared according to chronic kidney disease stage and age groups: above and below 60 years. Results: The mean eGFR value was for Bjornsson formula- 47.2 ± 21.1 ml/min/1.73m2, abbreviated MDRD formula- 38.8 ± 15.2 ml/min/1.73m2, and CKD-EPI formula- 37.7 ± 15.9 ml/min/1.73m2. There was a large concordance in eGFR values obtained using the CKD-EPI and abbreviated MDRD formulas in every stage of chronic kidney disease and in both age groups. The Bjornsson formula significantly increased the number of patients in early stages of CKD, G1 - 33 vs 2 (abbreviated MDRD) and 6 (CKD-EPI), G2- 186 vs 70 (abbreviated MDRD) and 69 (CKD-EPI). Conclusions: CKD-EPI and abbreviated MDRD formulas have a similar usefulness in GFR value estimation in patients with diagnosed chronic kidney disease. Lower eGFR values achieved using abbreviated MDRD formula and CKD-EPI equation in comparison with Bjornsson’s formula may result in an increased number of patients diagnosed with CKD.

scholarly journals Analytic Decision Gaming: A Tool for Crisis Response and Clinical Reasoning

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Morgan Decker ◽  
Jacob Graham ◽  
Mark Stephens
Keyword(s):  
Public Health ◽  
Differential Diagnosis ◽  
Medical School ◽  
Medical History ◽  
Clinical Reasoning ◽  
Medical History Taking ◽  
History Taking ◽  
Health Crisis ◽  
Public Health Crisis ◽  
Number Of Patients

Issue:  Medical education traditionally focuses on basic science during the first two years of medical school. To “flip” this model, the Penn State College of Medicine has introduced and inquiry-based educational strategy that introduces students to the challenges of patient care immediately upon their arrival.  To engage students in a process to promote clinical reasoning, we have modified an Analytic Decision Game (ADG) called “EpiCentre” to address a notional public health crisis facing Centre County, Pennsylvania. Methods: In phase 1 of the activity, students are provided with materials describing the ethnography and infrastructure of Centre County.  Students are divided into three communities (teams) to create a strength, weakness, threat, opportunity (SWOT) analysis of local healthcare capabilities.  In phase 2 of the activity, students meet with a standardized patient presenting with a targeted medical complaint. They are pushed to think about their approach to taking a medical history and asked to generate a differential diagnosis.  In phases 3 and 4, students are faced with the challenge of triaging a number of patients with similar medical complaints and create a plan to deal with a likely outbreak scenario. Findings:  Students have found the EpiCentre activity to be worthwhile in multiple contexts.  They have been able to develop an initial approach to medical history taking and creating a differential diagnosis.  They have formulated an approach to the recognition and control of a potential public health crisis. An additional benefit of the exercise has been the overarching theme of teamwork. Students begin the activity (occurring in the first few weeks after arrival to medical school) as relative strangers and quickly develop a sense of camaraderie and mission focus. Conclusions: The EpiCentre ADG has been a successful activity to introduce medical students to Centre County in the context of healthcare infrastructure, an approach to medical history taking, disaster planning, clinical reasoning and team-building. Implications:  EpiCentre derives from an interprofessional collaboration between the College of Medicine and the College of Information Sciences and Technology.  It represents one of potentially limitless opportunities to engage students and faculty from multiple disciplines to address challenges of public health within the academic setting.

scholarly journals COVID-19 in patients with chronic kidney disease stage 5

2021 ◽  
pp. 38-47
Author(s):  
I. Dudar ◽  
E. Krasyuk ◽  
A. Shymova ◽  
Y. Hryhorieva ◽  
M. Malasaiev ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Chronic Kidney Disease Stage ◽  
Disease Stage ◽  
Dialysis Patients ◽  
Duration Of Treatment ◽  
Dialysis Treatment ◽  
Patients With Diabetes

The study aimed to determine the frequency of COVID-19, specific of process and the mortality rate among dialysis patients with COVID-19. Materials and methods: The retrospective study included 764 patients with CKD VD, who received dialysis treatment at the Kyiv City Center for Nephrology and Dialysis, which is the clinical base of the Institute of Nephrology of the National Academy of  Medical  Sciences since September 1, 2020. until December 31, 2020. 155 patients were diagnosed with coronavirus disease. The study was conducted in two stages. In the first stage, dialysis patients with coronavirus disease were divided into groups depending on the severity of the disease. The second stage of the study was determined the influence of age, duration of dialysis treatment, gender, cause of chronic kidney disease VD, obesity, diabetes mellitus and cardiovascular pathology on the course of coronavirus disease, as well as complications and mortality from COVID-19  among the dialysis population. Results: 155 cases of COVID-19 were registered among 764 dialysis patients. Mild coronavirus disease was diagnosed in 38 (24.5%) patients, moderate and severe in 64 (41.3%) and 53 (34.2%) patients, respectively. Oxygen support was required for 76 patients (79%), and artificial lung ventilation was used for 17 (10.9%) patients. Factors associated with severe coronavirus disease in this category of patients were found to be obesity (BMI> 30 kg / m2), diabetes mellitus, concomitant cardiovascular disease, and the need for oxygen support.  In this category of patients, obesity (BMI>30 kg/m2), cardiovascular disease, diabetes mellitus and require supplement oxygen are associated with severe Coronavirus disease COVID-19. There was no significant effect on the severity of coronavirus disease in the age of patients and duration of dialysis treatment. The duration of treatment in patients with diabetes was significantly higher (p <0.05), a direct strong correlation between BMI and duration of treatment was demonstrated. Survival was significantly higher in the group of patients who did not require oxygen support (78% vs. 56%) and had a BMI <30 kg / m2 (87% vs. 37%). Conclusions: the incidence of coronavirus disease among the dialysis cohort was 20.2% of cases. Patients treated with peritoneal dialysis had a significantly lower incidence. Severe coronavirus disease has been associated with obesity, cardiovascular disease, and the need for oxygen support. Men were more likely to have COVID-19 than women. There is no connection between the severe course of coronavirus disease with the age of patients and the duration of dialysis treatment. The duration of treatment of Coronavirus disease in the group of patients with diabetes and high BMI was longer. The following complications predominated in patients with COVID-19: thrombosis of arteriovenous fistula and atrial fibrillation.  During the study period, 20 (12.9%) deaths were registered. Patient survival was higher in the group of patients without oxygen support and with a lower BMI.

Phosphate binders in patients with chronic kidney disease: Between the new and the old.

2019 ◽  
pp. 2-3
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Estimated Glomerular Filtration Rate ◽  
Chronic Kidney Disease Stage ◽  
Disease Stage ◽  
Phosphate Binders ◽  
Advanced Chronic Kidney Disease ◽  
Phosphate Retention ◽  
Stage 4 ◽  
Dietary Phosphate

Impaired phosphate excretion by the kidney leads to Hyperphosphatemia. It is an independent predictor of cardiovascular disease and mortality in patients with advanced chronic kidney disease (stage 4 and 5) particularly in case of dialysis. Phosphate retention develops early in chronic kidney disease (CKD) due to the reduction in the filtered phosphate load. Overt hyperphosphatemia develops when the estimated glomerular filtration rate (eGFR) falls below 25 to 40 mL/min/1.73 m2. Hyperphosphatemia is typically managed with oral phosphate binders in conjunction with dietary phosphate restriction. These drugs aim to decrease serum phosphate by binding ingested phosphorus in the gastrointestinal tract and its transformation to non-absorbable complexes [1].

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