Anaesthesia of the patient with chronic kidney disease

Chronic kidney disease is common, particularly in geriatric animals. General anaesthesia is usually required for routine procedures (dental prophylaxis, ovariohysterectomy or castration) and emergency procedures, which may have profound effects on the body, especially on cardiac output, subsequent blood pressure and on the perfusion of different vital organs. It is essential to understand the effects of renal dysfunction on the patient, as well as the effects that anaesthesia and surgery may have on the kidneys. The understanding of renal physiology, along with the effect of drug choices, is key to successful management of chronic renal failure.

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Systolic blood pressure and heart rate in cats with chronic kidney disease undergoing chemical restraint during hemodialysis

Semina Ciências Agrárias ◽

10.5433/1679-0359.2016v37n2p877 ◽

2016 ◽

Vol 37 (2) ◽

pp. 877

Author(s):

Karine Kleine Figueiredo dos Santos ◽

Daniel Paulino Junior ◽

Julio César Cambraia Veado ◽

Juliana De Abreu Pereira

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Heart Rate ◽

Kidney Disease ◽

Systolic Blood Pressure ◽

Alternative Therapy ◽

Venous Catheter ◽

The Body ◽

Average Weight ◽

Chemical Restraint

Dialysis is one of the used methods for treatment of Acute Renal Injury (ARI) and Chronic Kidney Disease (CKD) to replace the function of the kidneys when refers to blood depuration. Hemodialysis removes toxins accumulated in the body directly from the blood, being a useful alternative therapy for dogs and cats with CKD in advanced stages. Because of the difficulty on handling the patient feline, this procedure requires sedation. However, few studies have been conducted to assess the safety of anesthesia in dogs and cats with CKD undergoing dialysis. The present study aimed to evaluate two different protocols of chemical restraint in cats with CKD and the effect of these on systolic blood pressure (SBP) and heart rate (HR), since the procedure of extracorporeal circulation leads the patient to a hypotensive frame. Twelve adult cats were used, with an average weight of 4 kg, CKD, underwent two anesthetic protocols: Group GP (n = 6) using propofol, and group GCM (n = 6) using ketamine-midazolam association for the implantation procedure of central venous catheter (CVC) and hemodialysis. Cats in GP as well as the GCM group showed statistical difference in the change in SBP and HR only from baseline compared to the other time points evaluated. The two protocols maintained SBP and HR within physiological values.

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GRANTING OF EDUCATION STRUCTURED NUTRITION AND ELECTROLYTE (ESNE) ON CHANGING INTERDIALYTIC WEIGHT GAIN IN CHRONIC CALCULATION FAILURE PATIENTS

INTERNATIONAL JOURNAL OF NURSING AND MIDWIFERY SCIENCE (IJNMS) ◽

10.29082/ijnms/2019/vol3/iss2/205 ◽

2019 ◽

Vol 3 (2) ◽

pp. 89-99

Author(s):

Lutfi Wahyuni ◽

Ika Ainur Rofiah ◽

Mochammad Achwandi

Keyword(s):

Chronic Kidney Disease ◽

Renal Failure ◽

Weight Gain ◽

Chronic Renal Failure ◽

Kidney Disease ◽

Kidney Function ◽

The Body ◽

Artificial Kidney ◽

Fluid Restriction ◽

Interdialytic Weight Gain

ABSTRACT GRANTING OF EDUCATION STRUCTURED NUTRITION AND ELECTROLYTE (ESNE) ON CHANGING INTERDIALYTIC WEIGHT GAIN IN CHRONIC CALCULATION FAILURE PATIENTS By Lutfi Wahyuni, Ika Ainur rofiah, Mochammad Achwandi Chronic kidney disease is a condition when kidney function begins to decline gradually. The condition of the decline in kidney function occurs due to many factors, one of which is because the kidney damage that has occurred intensely for many years. Patients with chronic renal failure need a management or hemodialysis therapy, which is the cleansing process of blood from waste substances, through a screening process outside the body using an artificial kidney in the form of a dialysis machine. Hemodialysis therapy is needed in the management of patients with chronic renal failure who cannot be treated again (terminal). The success of hemodialysis is based on various elements, one of which is compliance with fluid restrictions. Limitation of fluid intake in patients with chronic renal failure is very important. The provision of structured education can be given to patients with chronic kidney failure who are undergoing hemodialysis therapy. Education structured nutrition and electrolyte (ESNE) is a structured health education on nutrition and electrolyte management for chronic renal failure patients undergoing hemodialysis. ESNE is done to improve patients' understanding of diet and electrolyte compliance to prevent an increase in IDWG and to improve patient compliance with fluid restrictions. The stages of service activities that have been carried out are to explain fluid requirements and fluid restriction in patients with chronic renal failure using the Education structured nutrition and electrolyte (ESNE) method, the next recourse is an evaluation after continuous or ESNE administration of respondents given treatment and respondents who were not treated. Keywords: Diet, Chronic Kidney Disease, Hemodialysis

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Daily indices of central and peripheral blood pressure in patients with chronic glomerulonephritis and arterial hypertension at different stages of chronic kidney disease

Kazan medical journal ◽

10.17816/kmj2019-571 ◽

2019 ◽

Vol 100 (4) ◽

pp. 571-577

Author(s):

I V Polyakova ◽

N Yu Borovkova ◽

A A Tulichev ◽

T I Maslova ◽

N Yu Linyova ◽

...

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Renal Failure ◽

Kidney Disease ◽

Arterial Hypertension ◽

Brachial Artery ◽

Peripheral Blood ◽

Systolic Pressure ◽

Chronic Glomerulonephritis ◽

Peripheral Blood Pressure

Aim. To study the daily indices of central and peripheral blood pressure in patients with chronic glomerulonephritis and arterial hypertension at different stages of chronic kidney disease. Methods. 76 patients with chronic glomerulonephritis and arterial hypertension were examined: 13.2% with chronic kidney disease stage 1 (G1), 15.8% G2, 21.0% G3, 23.7% G4, 26.3% G5D. For the daily monitoring of central (in aorta) and peripheral blood pressure (in brachial artery), the BPLab monitor and the Vasotens-24 technology were used. Results. In the examined patients central and peripheral systolic, diastolic, and pulse blood pressure increased with renal function decline. Thus, the daily systolic pressure increased from 112 [107; 129] mm Hg in the aorta and 127 [118; 131] mm Hg in the brachial artery in patients with G1 to 146 [137; 153] and 147 [138; 155] mm Hg with G5D; diastolic — from 76 [70; 83] and 78 [71; 85] to 96 [82; 104] and 97 [81; 107] mm Hg; pulse pressure — from 36 [33; 45] and 48 [42; 51] to 53 [45; 56] and 62 [50; 65] mm Hg (p <0.05). A statistically significant excess of peripheral values over the corresponding parameters of central blood pressure for systolic (in groups G1–2) and pulse (G1–4) pressure was detected. Thus, in patients with G2, the average daily systolic pressure was 132 [115; 136] mm Hg in brachial artery and 113 [110; 127] mm Hg in aorta, pulse pressure — 49 [41; 52] and 33 [30; 41] mm Hg (p <0.05). With further progression of renal failure, these differences were not reliably detected. Most patients had a defect of the daily aortic and brachial blood pressure rhythm but the dipper status of systolic and diastolic blood pressure was less common than brachial one (24 and 20% versus 39 and 35%, χ2=5.21 and 5.64; p <0.05). Conclusion. The features of the peripheral and central blood pressure daily indices at different stages of chronic kidney disease in patients with chronic glomerulonephritis and arterial hypertension determine the relevance of their further study to compare the effect on cardiovascular risk and renal failure progression.

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Predicting Renal Failure Progression in Chronic Kidney Disease Using Integrated Intelligent Fuzzy Expert System

Computational and Mathematical Methods in Medicine ◽

10.1155/2016/6080814 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 24

Author(s):

Jamshid Norouzi ◽

Ali Yadollahpour ◽

Seyed Ahmad Mirbagheri ◽

Mitra Mahdavi Mazdeh ◽

Seyed Ahmad Hosseini

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Renal Failure ◽

Kidney Disease ◽

Diastolic Blood Pressure ◽

Absolute Error ◽

Ckd Progression ◽

Anfis Model ◽

Inference System ◽

Clinical Records

Background.Chronic kidney disease (CKD) is a covert disease. Accurate prediction of CKD progression over time is necessary for reducing its costs and mortality rates. The present study proposes an adaptive neurofuzzy inference system (ANFIS) for predicting the renal failure timeframe of CKD based on real clinical data.Methods.This study used 10-year clinical records of newly diagnosed CKD patients. The threshold value of 15 cc/kg/min/1.73 m2of glomerular filtration rate (GFR) was used as the marker of renal failure. A Takagi-Sugeno type ANFIS model was used to predict GFR values. Variables of age, sex, weight, underlying diseases, diastolic blood pressure, creatinine, calcium, phosphorus, uric acid, and GFR were initially selected for the predicting model.Results.Weight, diastolic blood pressure, diabetes mellitus as underlying disease, and currentGFR(t)showed significant correlation with GFRs and were selected as the inputs of model. The comparisons of the predicted values with the real data showed that the ANFIS model could accurately estimate GFR variations in all sequential periods (Normalized Mean Absolute Error lower than 5%).Conclusions.Despite the high uncertainties of human body and dynamic nature of CKD progression, our model can accurately predict the GFR variations at long future periods.

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Structural and functional abnormalities of cell membranes in the end-stage chronic kidney disease

Almanac of Clinical Medicine ◽

10.18786/2072-0505-2021-49-056 ◽

2021 ◽

Vol 49 (6) ◽

pp. 419-426

Author(s):

E. N. Ievlev ◽

I. A. Kazakova ◽

E. P. Sukhenko

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Oscillation Amplitude ◽

The Body ◽

Control Group ◽

Dialysis Therapy ◽

Cross Sectional ◽

Ckd Stage ◽

End Stage

Background: Chronic kidney disease (CKD) is associated with abnormalities in all functions of the body systems including changes in intracellular processes. Assessment of erythrocyte electrophoretic mobility (EEM) in patients with CKD stage 5 on dialysis (5d) has becoming increasingly relevant, since this method characterizes the pathophysiological state of the patient and gives the possibility to modify treatment.Aim: To identify EEM characteristics in patients on programmed hemodialysis and their association with clinical and laboratory parameters.Materials and methods: We performed a cross-sectional observational study in 220 patients with confirmed CKD 5d. The average age of the patients was 56.5±1.4 years (26 to 85 years) and the duration of dialysis therapy was 3.7±0.4 years. The Kt/V urea adequacy index was 1.54±0.08. The control group included 60 healthy blood donors, comparable for their age and sex. EEM was assessed with Cyto-Expert kit (Axion Holding, Izhevsk, 2010) and the WT-Cell program (LLC Westtrade LTD, 2019). Statistical analysis was performed with BioStat 2019 software.Results: The patients on the programmed hemodialysis had lower values of oscillation amplitude (10.2±0.5 μm and 21.2±2.1 μm, p<0.001) and lower proportion of mobile red blood cells (69.5±1.8%, 89.7±9.9%, p<0.001), compared to the control group. Lower values of the oscillation amplitude were found in the age group of 25 to 44 years (9.0±1.0 μm, p<0.05). There was a weak positive correlation between age and amplitude of erythrocyte oscillation (R=0.20, p<0.05). There were differences in the oscillation amplitude values in the patients with various dialysis experience: 1 to 2 years, 11.3±0.8 μm, 2 to 5 years, 9.9±0.7 μm, 6 to 10 years, 9.4±1.3 μm, and over 11 years, 7.4±0.9 μm (p<0.05). The duration of dialysis therapy demonstrated a weak negative correlation with the amplitude of erythrocyte oscillation (R=-0.24, p<0.01). The erythrocyte oscillation amplitude was associated with systolic blood pressure before hemodialysis procedure (R=0.34, p<0.05) and with pulse pressure before hemodialysis (R=0.37, p<0.05). The proportion of mobile erythrocytes correlated with parathyroid hormone level (R=0.32, p<0.05).Conclusion: EEM in the patients receiving programmed hemodialysis have their specific characteristics related to a significant decrease in the oscillation amplitude proportional to the effective cell charge and lower proportions of mobile erythrocytes compared to those in the healthy control. The erythrocyte oscillation amplitude is negatively correlated with age and duration of dialysis therapy and is associated with blood pressure parameters and mineral bone indices.

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Chronic kidney disease in children: problems of arterial hypertension

Nephrology (Saint-Petersburg) ◽

10.24884/1561-6274-2019-23-5-47-55 ◽

2019 ◽

Vol 23 (5) ◽

pp. 47-55

Author(s):

I. A. Karimdzhanov ◽

G. K. Iskanova ◽

N. A. Israilova

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Renal Failure ◽

Risk Factor ◽

Cardiovascular Diseases ◽

Kidney Disease ◽

Arterial Hypertension ◽

Ckd Progression ◽

Vascular Regulation ◽

Target Organs

The review contains materials on the course of chronic kidney disease (CKD) in children with arterial hypertension (AH). The relationship between CKD and AH was shown, where hastening of CKD progression to end-stage renal failure in the presence of AH was established. The regulation of AH in children is necessary for the treatment of CKD, because AH is not established on time, is not well controlled and is often masked. Impaired vascular regulation, fluid overload, increased cardiac output, and peripheral vascular resistance, alone or in combination, can lead to hypertension in CKD. The use of modern methods for monitoring and controlling blood pressure is crucial to improve the management of AH and prevent damage to target organs in children. 24-hour blood pressure measurements are an important tool in determining the prognosis and treatment of children with CKD. To identify impaired renal function in CKD, a large number of biomarkers are used. Glomerular filtration rate (GFR), serum creatinine and cystatin C are currently used as biomarkers for renal failure. Recently, biomarkers, including KIM-1, LFABP, NGAL, and IL-18 have been proposed as markers of acute kidney injury, and they may be useful in the future for early detection of CKD progression in children. In newborns and children of early and older age, hypertension occurs due to renovascular and parenchymal diseases.AH is considered a marker of CKD severity and is a risk factor for progressive deterioration of kidney function, as well as thedevelopment of cardiovascular diseases. Sympathetic hyperactivity, excessive formation of free radicals, reduced bioavailability of nitric oxide (NO) and excessive production of angiotensin II leads to an increase in blood pressure. Obesity or an increase in body mass index (BMI) is currently considered as a risk factor not only for cardiovascular diseases and diabetes but also for CKD. Hyperuricemia and CKD are closely related, as the accumulation of uric acid is associated with hypertension, metabolic syndrome and microalbuminuria, which are also risk factors for the progression of CKD. AH has a detrimental effect on target organs, including the kidneys, eyes, and heart. Lifestyle modifications, weight control, healthy eating, reduced sodium intake, maintenance exercises and basic drug therapy using angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin receptor blockers can slow the progression of CKD in children.

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COMPARISON OF ANTIHYPERTENSIVE EFFECT OF MOXONIDINE VERSUS CLONIDINE IN RENAL FAILURE PATIENTS.

Journal of Drug Discovery and Therapeutics ◽

10.32553/jddt.v6i9.440 ◽

2018 ◽

Vol 6 (9) ◽

Author(s):

DR.MATHEW GEORGE ◽

DR.LINCY JOSEPH ◽

MRS.DEEPTHI MATHEW ◽

ALISHA MARIA SHAJI ◽

BIJI JOSEPH ◽

...

Keyword(s):

Blood Pressure ◽

Renal Failure ◽

Blood Flow ◽

Blood Vessel ◽

Blood Vessels ◽

High Blood Pressure ◽

Antihypertensive Effect ◽

The Body ◽

Ability To Work ◽

Blood Flows

Blood pressure is the force of blood pushing against blood vessel walls as the heart pumps out blood, and high blood pressure, also called hypertension, is an increase in the amount of force that blood places on blood vessels as it moves through the body. Factors that can increase this force include higher blood volume due to extra fluid in the blood and blood vessels that are narrow, stiff, or clogged(1). High blood pressure can damage blood vessels in the kidneys, reducing their ability to work properly. When the force of blood flow is high, blood vessels stretch so blood flows more easily. Eventually, this stretching scars and weakens blood vessels throughout the body, including those in the kidneys.

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THYROID DYSFUNCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE: THE STATE OF THE PROBLEM AND THE WAYS OF SOLVING

Nephrology (Saint-Petersburg) ◽

10.24884/1561-6274-2018-22-4-40-49 ◽

2018 ◽

Vol 22 (4) ◽

pp. 40-49 ◽

Cited By ~ 1

Author(s):

A. R. Volkova ◽

O. D. Dygun ◽

B. G. Lukichev ◽

S. V. Dora ◽

O. V. Galkina

Keyword(s):

Chronic Kidney Disease ◽

Thyroid Gland ◽

Kidney Disease ◽

Thyroid Hormones ◽

Thyroid Function ◽

Thyroid Dysfunction ◽

The Body ◽

Type I ◽

Low T3 ◽

Iodine Excretion

Disturbance of the thyroid function is often detected in patients with different profiles. A special feature of patients with chronic kidney disease is the higher incidence of various thyroid function disturbances, especially hypothyroidism. It is known that in patients with chronic kidney disease (CKD) iodine excretion from the body is violated, since normally 90% of iodine is excreted in urine. Accumulation of high concentrations of inorganic iodine leads to the formation of the Wolf-Chaikoff effect: suppression of iodine organization in the thyroid gland and disruption of the thyroid hormones synthesis. Peripheral metabolism of thyroid hormones is also disturbed, namely, deiodinase type I activity is suppressed and peripheral conversion of T4 into T3 is inhibited (so-called low T3 syndrome). Therefore, patients with CKD are often diagnosed with hypothyroidism, and the origin of hypothyroidism is not always associated with the outcome of autoimmune thyroiditis. The article presents an overview of a large number of population studies of thyroid gland dysfunction in patients with CKD, as well as experimental data specifying the pathogenetic mechanisms of thyroid dysfunction in patients with CKD. Therapeutic tactics are still not regulated. However, in a number of studies, replacement therapy with thyroid hormones in patients with CKD had some advantages.

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