Is Renal Function Recovery and Discontinuation of Long Term Hemodialysis Possible in Patients with Presumed End Stage Kidney Disease? The Role of Toprak’s Kidney Care

2020 ◽  
Keyword(s):  
Renal Function ◽  
Kidney Disease ◽  
End Stage Kidney Disease ◽  
Renal Function Recovery ◽  
Function Recovery ◽  
End Stage

scholarly journals Long-Term Therapeutic Plasma Exchange to Prevent End-Stage Kidney Disease in Adult Severe Resistant Henoch-Schonlein Purpura Nephritis

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Patrick Hamilton ◽  
Olumide Ogundare ◽  
Ammar Raza ◽  
Arvind Ponnusamy ◽  
Julie Gorton ◽  
...  
Keyword(s):  
Renal Function ◽  
Kidney Disease ◽  
Plasma Exchange ◽  
Kidney Injury ◽  
Term Treatment ◽  
Therapeutic Plasma Exchange ◽  
End Stage Kidney Disease ◽  
Long Term Treatment ◽  
End Stage

A 27-year-old man presented with a palpable purpuric skin rash and joint and abdominal pain in April 2010. He had acute kidney injury and his creatinine quickly deteriorated to 687 μmol/L, with associated nephrotic range proteinuria. Kidney biopsy showed crescentic Henoch-Schonlein nephritis. He was treated with intravenous cyclophosphamide and prednisolone despite which his renal function deteriorated; he required haemodialysis for a short duration and seven sessions of therapeutic plasma exchange (TPE). Renal function improved, but after discharge from hospital he suffered 2 further relapses, each with AKI, in 4 months. Cyclophosphamide was not effective and therefore Rituximab was introduced. He initially had a partial response but his renal function deteriorated despite continued therapy. TPE was the only treatment that prevented rapid renal functional deterioration. A novel long-term treatment strategy involving regular TPE every one to two weeks was initiated. This helped to slow his progression to end-stage kidney disease over a 3-year period and to prolong the need for renal replacement therapy over this time.

Age dependence of brachial cuff-based ambulatory PWV in end-stage kidney disease patients undergoing long-term peritoneal dialysis

2021 ◽  
pp. 089686082199692
Author(s):  
Vasilios Vaios ◽  
Panagiotis I Georgianos ◽  
Georgia Vareta ◽  
Dimitrios Divanis ◽  
Evangelia Dounousi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Heart Rate ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Pulse Wave ◽  
Age Dependence ◽  
End Stage Kidney Disease ◽  
End Stage

Background: The newly introduced device Mobil-O-Graph (IEM, Stolberg, Germany) combines brachial cuff oscillometry and pulse wave analysis, enabling the determination of pulse wave velocity (PWV) via complex mathematic algorithms during 24-h ambulatory blood pressure monitoring (ABPM). However, the determinants of oscillometric PWV in the end-stage kidney disease (ESKD) population remain poorly understood. Methods: In this study, 81 ESKD patients undergoing long-term peritoneal dialysis underwent 24-h ABPM with the Mobil-O-Graph device. The association of 24-h oscillometric PWV with several demographic, clinical and haemodynamic parameters was explored using linear regression analysis. Results: In univariate analysis, among 21 risk factors, 24-h PWV exhibited a positive relationship with age, body mass index, overhydration assessed via bioimpedance spectroscopy, diabetic status, history of dyslipidaemia and coronary heart disease, and it had a negative relationship with female sex and 24-h heart rate. In stepwise multivariate analysis, age ( β: 0.883), 24-h systolic blood pressure (BP) ( β: 0.217) and 24-h heart rate ( β: −0.083) were the only three factors that remained as independent determinants of 24-h PWV (adjusted R 2 = 0.929). These associations were not modified when all 21 risk factors were analysed conjointly or when the model included only variables shown to be significant in univariate comparisons. Conclusion: The present study shows that age together with simultaneously assessed oscillometric BP and heart rate are the major determinants of Mobil-O-Graph-derived PWV, explaining >90% of the total variation of this marker. This age dependence of oscillometric PWV limits the validity of this marker to detect the premature vascular ageing, a unique characteristic of vascular remodelling in ESKD.

scholarly journals The Association Between Age of Onset of Type 2 Diabetes with Long-term Risk of End Stage Kidney Disease: A National Registry Study

2020 ◽  
Author(s):  
Jedidiah I Morton ◽  
Danny Liew ◽  
Stephen P McDonald ◽  
Jonathan E Shaw ◽  
Dianna J Magliano
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Disease ◽  
Cumulative Incidence ◽  
Age Of Onset ◽  
End Stage Kidney Disease ◽  
Onset Of Diabetes ◽  
End Stage ◽  
Effect Of Age

<b>Objective</b>: The long-term risk of end-stage kidney disease (ESKD) in type 2 diabetes is poorly described, as is the effect that younger age of diabetes onset has on this risk. Therefore, we aimed to estimate the effect of age of onset on the cumulative incidence of ESKD from onset of type 2 diabetes. <p><b>Research Design and Methods: </b>This study included 1,113,201 people with type 2 diabetes registered on the Australian National Diabetes Services Scheme (NDSS) followed from 2002 until 2013. The NDSS was linked to the Australia and New Zealand Dialysis and Transplant Registry and the Australian National Death Index. </p> <p><b>Results: </b>Between 2002 and 2013,<b> </b>there were 7,592 incident cases of ESKD during 7,839,075 person-years of follow up. In the first 10-15 years following onset of diabetes, the incidence of ESKD was highest in those with an older age of onset of diabetes, whereas over longer durations of diabetes the incidence of ESKD became higher in those with younger-onset diabetes. After 40 years of diabetes, the cumulative incidence of ESKD was 11.8% and 9.3% in those diagnosed with diabetes aged 10-29 and 30-39 years, respectively. When death from ESKD without renal replacement therapy was included, incidence of ESKD remained higher in older onset diabetes for the initial 20 years, with no clear effect of age thereafter.</p> <p><b>Conclusions: </b>The long-term risk of ESKD in type 2 diabetes is high, which disproportionately affects those with younger-onset of diabetes as they are more likely to survive to longer diabetes durations.</p>

The Potential Role of Catheter-Based Renal Sympathetic Denervation in Chronic and End-Stage Kidney Disease

2016 ◽  
Vol 21 (4) ◽  
pp. 344-352 ◽  
Author(s):  
Yusuke Sata ◽  
Markus P. Schlaich
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Kidney Disease ◽  
End Stage Renal Disease ◽  
Renal Denervation ◽  
Potential Role ◽  
Stage Renal Disease ◽  
End Stage ◽  
Renal Sympathetic

Sympathetic activation is a hallmark of chronic and end-stage renal disease and adversely affects cardiovascular prognosis. Hypertension is present in the vast majority of these patients and plays a key role in the progressive deterioration of renal function and the high rate of cardiovascular events in this patient cohort. Augmentation of renin release, tubular sodium reabsorption, and renal vascular resistance are direct consequences of efferent renal sympathetic nerve stimulation and the major components of neural regulation of renal function. Renal afferent nerve activity directly influences sympathetic outflow to the kidneys and other highly innervated organs involved in blood pressure control via hypothalamic integration. Renal denervation of the kidney has been shown to reduce blood pressure in many experimental models of hypertension. Targeting the renal nerves directly may therefore be specifically useful in patients with chronic and end-stage renal disease. In this review, we will discuss the potential role of catheter-based renal denervation in patients with impaired kidney function and also reflect on the potential impact on other cardiovascular conditions commonly associated with chronic kidney disease such as heart failure and arrhythmias.

Demographics and long‐term outcomes of children with end‐stage kidney disease: a 20‐year territory‐wide study

Nephrology ◽  
2021 ◽  
Author(s):  
Eugene Yu Hin Chan ◽  
Desmond Yat Hin Yap ◽  
Wilfred Hing Sang Wong ◽  
Tsz Wai Ho ◽  
Pak Chiu Tong ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Long Term Outcomes ◽  
End Stage Kidney Disease ◽  
End Stage

END-STAGE KIDNEY DISEASE AND REPLACEMENT OF RENAL FUNCTION

2010 ◽  
pp. 99-107
Author(s):  
Michael J. Field ◽  
David C. Harris ◽  
Carol A. Pollock
Keyword(s):  
Renal Function ◽  
Kidney Disease ◽  
End Stage Kidney Disease ◽  
End Stage

Renal Function Recovery and Maintenance of Residual Diuresis in CAPD and Hemodialysis

1986 ◽  
Vol 6 (2) ◽  
pp. 77-79 ◽  
Author(s):  
Giovanni C. Cancarini ◽  
Giuliano Brunori ◽  
Corrado Camerini Silvia ◽  
Brasa Luigi Manili ◽  
Rosario Maiorca
Keyword(s):  
Renal Function ◽  
Creatinine Clearance ◽  
Residual Renal Function ◽  
Significant Drop ◽  
Renal Function Recovery ◽  
Slow Decline ◽  
Function Recovery ◽  
Interstitial Nephropathy ◽  
One Year

During 1981–1984, at our center 6/75 patients on CAPD and 1/86 on HD demonstrated a recovery of renal function. This and the observation that diuresis was maintained on CAPD, led us to study urine output (UO) and creatinine clearance (CrCI) in 41 patients on CAPD (CAPDp) and 45 on HD (HDp) without the use of diuretics. CAPDp had a decline in diuresis from 1201 ± 379 mI/day to 731 ± 572 (p < 0.01). HDp diuresis decreased from 1233 ± 439 to 438 ± 568 (p < 0.01). Creatinine clearance: HDp 5.8 ± 1.6 ml/min before, 1.3 ± 1.5 after; CAPDp 6.4 ± 2.0 before, 3.9 ± 2.9 after. After one year, HDp showed a significant drop in diuresis; three years passed before CAPDp had significant drop. Patients with glomerulonephritis showed the same trend on HD and CAPD. CAPDp with interstitial nephropathy had a smaller mean annual decrease in UO and CrCI, compared to HDp. CAPDp with nephroangiosclerosis showed less decrease in diuresis compared to HDp. These data confirm that, com pared to HD, CAPD treatment maintains residual renal function even in patients not using diuretics, and suggest that CAPD is a treatment of choice for those considered likely to recover renal function. Some workers have reported a slow decline in residual renal function and diuresis in patients on CAPD (1,2,3). Rottembourg (1), in particular, suggests that diuretics may have helped his patients to maintain diuresis. In 161 dialyzed patients (75 on CAPD, 86 on HD) who started dialysis between 1981 and 1984, six CAPD patients recovered renal function but only one HD patient. This disparity led us to inquire whether when compared to HD, CAPO enables us to maintain satisfactory, long-term diuresis, without the use of diuretics.

scholarly journals Advocacy for renal replacement therapy: the role of renal registries

2020 ◽  
Vol 13 (5) ◽  
pp. 742-744
Author(s):  
Cecile Couchoud ◽  
Mohamed Benghanem Gharbi
Keyword(s):  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Replacement Therapy ◽  
South African ◽  
Limited Resource ◽  
Service Planning ◽  
End Stage Kidney Disease ◽  
End Stage ◽  
Resource Environment

Abstract The paper by Jardine et al. reporting results from the South African Renal Registry describes a 2-fold success. First, even in a limited-resource environment, survival of patients on renal replacement therapy (RRT) is favourable. Secondly, this information is available because a few years ago, South African nephrologists started a renal registry. These successes cannot conceal, however, that numerous patients are not offered RRT. Robust health information systems make it possible to define chronic kidney disease and end-stage kidney disease (ESKD) burdens, guide resource allocation, inform service planning and enable policy. Registries can highlight inequitable RRT access and help support advocacy in favour of additional resources for ESKD care.

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