scholarly journals Comparison of Packed Cell Volume Changes after Erythropoietin Administration and Blood Transfusion in Patients with Anemia of Chronic Kidney Disease on Hemodialysis

2021 ◽  
Vol 1 (2) ◽  
pp. 48-51
Author(s):  
Anju Bajracharya ◽  
Jayendra Bajracharya

Introduction: Anemia of chronic kidney disease (CKD) can be managed by regular administration of erythropoiesis stimulating agents (ESAs) and/or blood transfusion. The response to these therapies can be monitored by serial packed cell volume (PCV). Objective: This study was done to compare the temporal changes in PCV after ESA therapy and blood transfusion in patients with recently diagnosed anemia in CKD stage 5 on hemodialysis (CKD 5 HD). Methods: Medical records of patients undergoing hemodialysis at the National Kidney Center, Balaju, Kathmandu from July to September 2013 were examined retrospectively. The data collected were analyzed using Minitab 16. Results: A total of 44 patients were on ESA therapy while 48 patients were on blood transfusion. The mean PCV at the start of blood transfusion was significantly lower than the mean PCV at the start of ESA therapy (p = 0.000) but at four weeks, the mean PCV in blood transfusion group was significantly greater than that in ESA therapy group (p = 0.008). At eight weeks and twelve weeks, the mean PCVs in both groups were not significantly different from each other (p = 0.949 and p = 0.747). Conclusions: Blood transfusion increases PCV immediately and in sustained manner while with ESA therapy, the response takes a longer time to manifest. A large number of non-responders to ESA therapy may have influenced the findings of this study. It is recommended that adequate dosing of ESA and attention to comorbid conditions be followed during ESA therapy. Keywords: Anemia; chronic renal insufficiency; blood transfusion; hematinics.

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Trisha Sachan ◽  
Anita Saxena ◽  
Amit Gupta

Abstract Background and Aims Changes in dietary phosphorus regulate serum FGF-23, parathyroid hormone, 1,25(OH)(2)D and Klotho concentrations . Cardiovascular disease (CVD) is the principal killer of patients with chronic kidney disease and hyperphosphetemia is a potent risk factor it. Of many causative factors for CVD in CKD, dietary interventions involving restriction of dietary phosphorous intake can help reduce onset of CVD at early stages of CKD with other corrective measures. Muscle wasting is a consequence of uremic syndrome which alters body composition. The aim of the study was to study effect of dietary phosphorous restriction on FGF-23, iPTH, Klotho, 1,25(OH)(2)D and body composition in chronic kidney disease patients. Method This is a longitudinal study with 12 months intervention, approved by Ethics Committee of the institute. A total 132 subjects were recruited (66 healthy controls, 66 CKD patient. of 66 patients 33 were in CKD stage 1 and 33 in stage 2. GFR was calculated with the help of MDRD formula. Biochemical parameters of subjects were evaluated at baseline, 6 and 12 months along with the anthropometric measurements (body weight, height, mid upper arm circumference (MUAC), and skin folds). Three days dietary recall was taken to evaluate energy, protein and phosphorous intake. CKD patients whose dietary phosphorous intake was more than 1000 mg/day, were given intense dietary counseling and prescribed dietary modifications by restricting dietary phosphorous between 800-1000 mg/day. Results The mean age of controls and patients was 37.01±9.62 and 38.27±12.06 and eGFR of 136.94±11.77 and 83.69±17.37 respectively. One way ANOVA showed significant difference among controls and the study groups in hemoglobin (p<0.001), s albumin (p<0.001), FGF-23 (p<0.001), klotho (p<0.001), urinary protein (p<0.001) and Nephron Index (p<0.001).The mean energy intake (p = 0.001) and dietary phosphorous intake (p<0.001) of the CKD patients decreased significantly with the decline in the renal function along with the anthropometric measures i.e. BMI (p = 0.041),WHR (p = 0.015) and all four skin folds (p<0.001). On applying Pearson’s correlation, eGFR correlated negatively with urinary protein (-0.739, 0.000), FGF-23 (-0.679, 0.000) and serum phosphorous (-0.697, 0.000) and positively with klotho (0.872, 0.000). FGF-23 correlated negatively with klotho (-0.742, 0.000). Dietary phosphorous was found to be positively correlated with urinary protein (0.496, 0.000), serum phosphorous (0.680, 0.000) and FGF-23 (0.573, 0.000) and negatively with Klotho (-0.602, 0.000). Nephron index revealed a positive correlation with eGFR (0.529, 0.000). Urinary protein correlated negatively with klotho (-0.810, 0.000). A multiple linear regression was run to predict eGFR from anthropometric variables such as BMI, WHR, MUAC, skin folds thickness and handgrip strength. All anthropometric variables predicted decline in eGFR (p<0.05, R2 =0.223). At 6 and 12 months; repeated ANOVAs analysis showed a statistically significant difference in serum creatinine (p=0.000), serum phosphorous (p=0.000), FGF-23(p=0.000) and klotho (p=0.000). Conclusion Elevated levels of FGF-23 and decreased Klotho levels, with the moderate decline in renal function improved with the restricted phosphorous diet at 6 and 12 months emphasizing the importance of phosphorus restriction at an early stage.


Author(s):  
TAOPHEEQ MUSTAPHA ◽  
VARIJA BHOGIREDDY ◽  
HARTMAN MADU ◽  
ADU BOACHIE ◽  
ABDUL OSENI ◽  
...  

BACKGROUND: Heart failure (HF) and Chronic kidney disease (CKD) are major public health problems that often co-exist with a resultant high mortality and morbidity. Most of the studies evaluating their reciprocal prognostic impact have focused on mortality in majority populations. There is limited literature on the impact of CKD on HF morbidities in ethnic minorities. AIMS: Our study seeks to compare HF outcomes in patients with or without CKD in an African-American predominant cohort. METHODS: We obtained data from the NGH at Meharry Heart Failure Cohort; a comprehensive retrospective HF database comprised of patient care data (HF admissions, non-HF admissions, and emergency room visits) were assessed from January 2006 to December 2008. The study group consist of 306 subjects with a mean age of 65±15 years. 81% were African-American (AA), 19% Caucasian and 48.5% are females. Following the NKF KDOQI guidelines, 5 stages of CKD were outlined based on GFR. RESULTS: The overall prevalence of CKD in this population is 54.2%. CKD stage 1 was most prevalent with 45.8%, prevalence for stages 2-5 are 21.6%, 18.3%, 9.5% and 4.9% respectively. The comparison of the mean of ER visits, non HF hospitalizations and HF hospitalizations between normal and CKD patients was done using independent t-test and showed no significant difference in the mean number of ER visits (p=0.564), or HF hospitalizations(p=0.235). However, there is a statistically significant difference in the mean number of non -HF hospitalizations between normal and CKD patients (p=0.031). CONCLUSION: This study shows that the prevalence of CKD in this minority -predominant HF cohort is similar to prior studies in majority populations. However, only the non-HF hospitalizations were significantly increased in the CKD group. Future prospective studies will be needed to define the implications of this in the management of HF patients with CKD.


2020 ◽  
Author(s):  
Priyank Patel ◽  
Andrew Frankel

Abstract Background Renin–angiotensin–aldosterone system (RAAS) inhibitors provide significant cardiorenal benefits with improved long-term outcomes for patients. This is most significant for patients receiving maximal RAAS inhibition, but some patients are unable to tolerate this therapy because of hyperkalaemia. Recently published National Institute for Health and Care Excellence (NICE) technology appraisal guidance recommended using sodium zirconium cyclosilicate (SZC) and patiromer for patients with chronic kidney disease (CKD) stage 3b to 5 or heart failure with reduced ejection fraction, who are not taking an optimised dosage of RAAS inhibitor because of hyperkalaemia. Objective Determine the impact of a locally produced guideline on effective implementation of NICE recommendation for use of SZC or patiromer to help maximise inhibition of the renin–angiotensin–aldosterone system within the general nephrology clinic. Methods A local guideline to practically support the implementation of recommendations made by NICE in the chronic use of new potassium binders was produced. One hundred sequential patients in a general nephrology clinic with non-immune chronic kidney disease (CKD 3 to 5) had their electronic records reviewed. Those with an indication for RAAS inhibition were identified. Results Of the 100 consecutive patients audited, 46 were female and 54 were male. The mean age of these patients was 64 and the mean estimated glomerular filtration rate (eGFR) was 33. Sixty-eight patients had an indication for being on RAAS inhibition with only 10 on maximal doses. Of the remaining 58 patients, 26 (45%) were limited by hyperkalaemia. Of these 26 patients, 12 of these patients (46%) had hyperkalaemia associated with an episode of acute kidney injury (AKI). Therefore, 14% of patients attending a general nephrology clinic were identified suitable for SZC and patiromer. Conclusions A significant proportion (14%) of unselected patients attending a general nephrology clinic were not on optimum RAAS inhibition due to hyperkalaemia. These patients would meet the criteria established within a working guideline for the implementation of the chronic use of SZC or patiromer and are likely to attain prognostic long-term benefit by using these new potassium binders to maximise RAAS inhibition. This analysis has implications for renal centres across the UK.


2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
A B Md Radzi ◽  
S S Kasim

Abstract Background Arterial damage in chronic kidney disease (CKD) is characterized by aortic stiffness. This is seen in elderly patients with advanced CKD. The association between arterial stiffness and early CKD is not well established. Objective: We aimed to study arterial stiffness using pulse wave velocity (PWV) among patients with chronic kidney disease (CKD) stage 2 to 4 and normal renal function in younger-age population. Design and Method: Patients with confirmed CKD stage 2 to 4 were recruited from various clinics from Universiti Teknologi MARA Medical Center, Sungai Buloh, Malaysia from 1st August 2015 until 31st January 2018. Sociodemographic and anthropometric indices were recorded on recruitment. Each patient underwent carotid-femoral (aortic) PWV measurement to determine arterial stiffness. PWV is determined using a one-probe device (SphygmoSore XCEL). Results: 87 patients with CKD stage 2–4 and 87 control patients were recruited. The mean age was 47 ± 5.4 years. CKD patients had a higher mean PWV (7.8 m/s ± 1.7) than healthy controls (5.6 m/s ± 1.0) (p < 0.001, 95% CI –2.59, –1.77). There was significant difference of mean PWV between control (5.6 m/s ± 1.0) and CKD stage 2 (7.6 m/s ± 1.5) (p < 0.001, 95% CI –2.40, –1.49). Our results showed a stepwise increase in PWV from control subjects, CKD stage 2 through stage 4 (p < 0.001). The mean difference of PWV between CKD stage 2 (7.6 m/s, ± 1.5) and stage 4 (9.0 m/s, ± 0.8) was 1.43 (p < 0.001, 95% CI –2.50, -0.35). There was significant difference of mean PWV between diabetes mellitus (DM) (8.2 m/s ± 1.8) and non-DM (7.3 m/s ± 1.3) patients with CKD stage 2–4 (p = 0.022, 95% CI –1.50, –0.12). Mutiple linear regression analysis showed only age (β = 0.078, p = 0.014), mean arterial pressure (MAP) (β = 0.031, p = 0.007) and diuretics usage as the combination antihypertensive medication (β = 0.839, p = 0.018) were independently associated with PWV (r2 = 0.249, p < 0.001). Conclusions: This study shows that arterial stiffness as assessed by PWV occurs early in CKD patient and increased arterial stiffness occurs in parallel with decline of glomerular filtration rate in patients with mild-to-moderate CKD of younger age population.


Author(s):  
ASHISH KHATTAR ◽  
KARTHIK RAO N ◽  
RAVINDRA PRABHU ◽  
BUDDHI RAJ POKHREL ◽  
SHANTI GURUNG ◽  
...  

Objective: The objective of the study was to evaluate the clinical profile of mineral bone disorders (renal osteodystrophy) in chronic kidney disease (CKD) patients. Methods: A retrospective study was performed involving 100 patients above 15 years of age with previously diagnosed chronic renal failure. A series of tests such as biochemical, radiological, and arterial calcifications were monitored. The mean age of subjects in our study was 52.54 years. Results: Biochemical tests revealed that hypocalcemia was present in 54% of the patients, and hyperphosphatemia was seen in 84% of the participants, while only 22% of the participants had high alkaline phosphate (ALP) levels. Radiological tests revealed that 39 patients had aortic calcification, 42 patients had radial artery calcification, and 27 patients had both. Subperiosteal resorption was seen on 29 participants. The majority of the vascular calcification and subperiosteal resorption was seen in patients with CKD Stage 5, and both aortic and radial artery calcifications were significantly associated with subperiosteal bone resorption. Conclusion: The results point toward a high prevalence of derangement in the mineral, vascular and valvular calcifications. Serum total ALP can serve as a biochemical marker to identify a pattern of bone turnover where intact parathyroid hormone is not available. The results highlight that serum phosphorus and Ca × P product levels were significantly associated with both aortic and radial artery calcifications. There was no significant association of these calcifications with serum calcium and ALP levels.


Author(s):  
Shashank Kotian ◽  
Ashok S. Naik ◽  
Manjunath Revanasiddappa ◽  
Maniyankode Krishnamohan Goutham

Abstract Objectives To compare the proportion of sensorineural hearing impairment (SHI) among patients of chronic kidney disease (CKD) stages 3&4 with CKD stage 5. Materials and Methods This is a cross-sectional study of 30 patients with CKD stages 3 and 4 and 30 patients in stage 5. All patients had an audiological evaluation with pure tone audiometry. Results Our study had 49 males (82%) and 11 females (18%), with the age ranging from 20 to 60 years (mean: 45.13 years). The mean SHI values in stage 3&4 were 28.44 dB and in CKD stage 5 was 31.22 dB. In the right ear, the mean hearing loss in stage 3, stage 4, and stage 5 was 28.17 dB, 28.67 dB, and 31.84 dB, respectively. In the left ear, the mean SHI values in stage 3, stage 4, and stage 5 were 27.05 dB, 31.89 dB, and 30.61 dB, respectively.The mean SHI in stage 3&4 for age group 20 to 30 years was 13.66 dB, for 31 to 40 years was 26.33 dB, for 41 to 50 years was 35.18 dB, for 51 to 60 years was 37.12 dB. The mean SHI in stage 5 for the age group of 20 to 30 years was 16.48 dB, for 31 to 40 years was 28.29 dB, for 41 to 50 years was 31.82 dB, for 51 to 60 years was 34.35 dB. There was a significant correlation between hearing loss and CKD with respect to age (p < 0.001). The duration of renal illness and associated comorbidities was not a significant contributor to hearing loss in our study (p > 0.05). Conclusion As per our study, with progression in the stage of chronic kidney disease, the hearing loss also increased indicating a possible link between the two. We also noted that the hearing loss increased with the increasing age.


2021 ◽  
pp. 23-25
Author(s):  
Brahmarshi Das ◽  
Narendranath Hait ◽  
Titol Biswas ◽  
Debarshi Jana

INTRODUCTION: Chronic Kidney Disease (CKD) is dened as a disease characterized by alterations in either kidney structure or function or both for a minimum of 3 months duration. According to the National Kidney Foundation criteria, 1 CKD has been classied into ve stages with stage 1 being the earliest or mildest CKD state and stage 5 being the most severe CKD stage. To stage CKD, it is necessary to estimate the GFR rather than relying on serum creatinine concentration. Glomerular ltration rate (GFR), either directly measured by computing urinary clearance of ltration marker such as inulin or estimated by calculating from different equations using serum creatinine. is the most commonly used parameter to assess kidney function. AIM AND OBJECTIVES: a) Establish relationship between serum CKD and eGFR MATERIAL AND METHOD: A Cross-sectional study on 100 cases of newly diagnosed Chronic Kidney Disease patients and matched control subjects is undertaken to study.100 Patients who are newly diagnosed as CKD are selected after proper initial screening. RESULT AND ANALYSIS: In case, the mean eGFR (mean± s.d.) of patients was 25.1500 ± 11.8929. In control, the mean eGFR (mean± s.d.) of patients was 87.2200 ± 17.8295. Difference of mean eGFR in two groups was statistically signicant (p<0.0001). In case, the mean creatinine (mean± s.d.) of patients was 3.6350 ± 2.4419 mg/dl. In control, the mean creatinine (mean± s.d.) of patients was .9435 ± .1317 mg/dl. Difference of mean creatinine in two groups was statistically signicant (p<0.0001). CONCLUSION: eGFR was strongly associated with CKD that also statistically signicant. The positive correlation was found in eGFR.


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Merita Rroji (Molla) ◽  
Larisa Shehaj ◽  
Myftar Barbullushi

Abstract Background and Aims Cognitive impairment is an increasingly identified major cause of chronic disability and is commonly found in patients with chronic kidney disease (CKD). Knowledge of the link between kidney dysfunction and impaired cognition may enhance our understanding of risk factors impacting cognitive dysfunction. Our study aimed to evaluate the relation between serum inflammatory markers and the risk of cognitive decline among adults with CKD. Method Forty-six patients predialysis patients CKD stage 5 (mean age 55.6±11.5 years old) accepted to participate in the study. The Montreal Cognitive Assessment (MoCA) scale was administered to patients. Patients with a MoCA global score of 24/30 were considered cognitively impaired. Descriptive analysis was done for the socio-demographic and clinical variables. We measured high-sensitivity C-reactive protein (hs-CRP), ferritin level, albuminemia, and fibrinogen in baseline plasma samples. Results The mean total MoCA score for all the patients was 22.9 ±3.8 points. Thirty-seven patients, 57.7%, were evaluated with CI, where 74.6 % with Mild CI (MCI) and 25.4% with severe CI (SCI) under 20 points). MoCA subscale analysis revealed that the mean score for visuospatial/executive domain and attention were the lowest with 5.41±1.1 /8max and 2.93±1.75/6 max, and scores for orientation were the highest 5.92±0.57/6 max. At baseline, higher levels of each inflammatory marker were associated with poorer age-adjusted performance. In analyses adjusted for baseline cognition, demographics, comorbid conditions, and kidney function, participants in the highest tertile of hs-CRP, the highest tertile of fibrinogen, and the highest tertile of ferritin had an increased risk of impairment in attention compared to participants in the lowest tertile of each marker (p=0.043, p=0.047, p=0.029, respectively. The high level of ferritin was evaluated as a risk of impairment visuospatial/executive ability, and no relationship of inflammatory markers was observed with impairment of orientation p=0.01. hs-CRP and ferritin and low albumin level were independently associated with longitudinal global cognitive function (p=0.04, p=0.02, p=0.49 respectively). Conclusion In CKD patients, we have a relatively high risk for cognitive impairment. Our results extend the findings from prior studies by showing that inflammatory markers used in routine practice contribute and are independently associated with longitudinal changes in some domains of cognitive function in patients with CKD going in parallel with the inflammatory mechanisms that have been implicated in the pathogenesis of vascular and Alzheimer’s dementia.


2021 ◽  
Vol 55 (2) ◽  
pp. 82
Author(s):  
Anak Agung Ngurah Putra Riana Prasetya ◽  
Budi Suprapti ◽  
Bayu Dharma Shanti

Anemia in patient with chronic kidney disease could cause a lot of complication. The first line therapy of this condition is by treating with erythropoiesis-stimulating agents (ESA) or called erythropoietin. The erythropoietin alpha and beta were two types of the human recombinant erythropoietin that are usually used in Indonesia. The aim of this study was to determine the effectivity of erythropoietin alpha compared to erythropoietin beta especially in haemoglobin and haematocrit level. This prospective observational study was conducted in March – September 2016. The inclusion criteria were CKD stage 5 patients with a minimum of 3 months of regular hemodialysis, Hb <10 g/dL with enough iron status ST > 20% and FS > 200ng/mL. The methology of this study had been approved by the Health Research Ethics Committee of the Bhayangkara H.S. Samsoeri Mertojoso Hospital, Surabaya. Patients received 2000 IU subcutaneous erythropoietin twice a week on both groups. Blood sample was withdrawn in pre-treatment and after 4 weeks of post erythropoietin therapy treatment for measurement of haemoglobin and haematocrit. Target for this erythropoietin therapy are increase of Hb 0.5 – 1.5 g/dL (not to exceed 12 g/dL) and increase of Hct level 2 – 4 % in 4 weeks. Based on the inclusion criteria, there were 20 patients in this study (10 patient each of both erythropoietin alpha either beta group) that consist of 7 women and 13 men. After the treatment, the mean of increased haemoglobin level for erythropoietin alpha group was 1.28 ± 0.80 g/dL (p=0.001) and erythropoietin beta was 0.37 ± 0.95 g/dL (p=0.254). The mean of increased haematocrit level for erytropoietin alpha group was 3.56 ± 3.46 % (p=0.010) and erythropoietin beta was 1.34 ± 2.71 % (p=0.152). In comparison of haemoglobin and haematocrit achievement in both groups showed that erythropoietin alpha gave better achievement in haemoglobin parameter (p=0.033), but there were no differences in both groups on haematocrit parameters (p=0.127).


2015 ◽  
Vol 22 (09) ◽  
pp. 1138-1143
Author(s):  
Muhammad Iqbal Shah ◽  
Ramesh Kumar Suthar ◽  
Mukhtiar Ahmed Soomro

Chronic kidney disease is usually related with anemia and the level of anemiacorrelates with the severity of renal failure. A chronic kidney disease is complicated byanemia and anemia may contribute to adverse clinical outcomes. No large-scale populationdata are available for patients with chronic kidney disease regarding prevalence of anemia,subpopulations at risk, and relationships between anemia and renal dysfunctionObjectives:Theobjective of this study is to determine the frequency of different patterns of anemia in relationto glomerular filtration rate in patients suffering from chronic kidney disease stage II and abovepatients.Material &Methods:Study Design: Cross sectional study. Setting:Medical andNephrology wards of Liaquat University Hospital Hyderabad / Jamshoro. Period:20th January2013 to 19thDecember 2013.Results:During the study period, total 339 patients of chronickidney disease with stage II and above patients were enrolled. The mean age + StandardDeviation and range) of patients was 50.65 + 11.86 (16 to 80 years, n = 339). 211(62.2%) weremale and 128(37.8%) were female. (Male to Female Ratio 1:6). Mean Hemoglobin + SD was7.16 + 3.89 (3.0 to 17.0 g/dL). The frequency of anemia was present in 285(84.1%) patientswith mean Hb+ SD 6.02 + 2.1 (g/dL). The mean weight + SD was 56.50 + 9.84 (40 to 81 kg).The mean serum creatinine + SD was 5.63 + 2.48 (0.9 to 12.0 mg/dL) and we observed thatmost frequent pattern of anemia was normocytic-normochromic anemia in 216(77.0%) patients,hypochromic-microcytic in 61(18.0%) and macroyctic in 17(5.0%) patients. We also found thatas anemia increased progressively with declining GFR with mean hemoglobin concentrationof 11.78 +2.8 g/dL in CKD stage 2, 10.14 + 3.6 g/dL in CKD stage 3, 6.8 + 3.6 g/dL in CKDstage 4, 7.44 + 4.0 g/dL in CKD stage 5.Conclusion: Frequency of anemia increases withthe progression of stage of chronic kidney disease (decreased GFR) and anemia was mostcommon in stage 5 patients of chronic kidney disease.Most frequent pattern of anemia isnormocytic normochromic anemia.


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