Assessment of quality of life in patients with end stage renal failure using KDQOL-SF

Background: Chronic Renal Failure (CRF) is a general health problem having a genuine effect on the quality of life of the patients experiencing hemodialysis. Objectives: The aim and objectives of this cross-sectional study was to evaluate the effect of dialysis on the quality of life of patients with End Stage Renal Failure (ESRF). Methodology: Sample of 103 Patients Undergoing hemodialysis were included in study from two hospitals (public sector) of Quetta Pakistan. Information was gathered by the fruition of a self-utilized survey a part of KDQOL-SF fusing the instrument of the SF-36 survey of health and an extra poll so as to incorporate demographics. Writing survey depended on studies, audits and articles got from global information bases concerning the quality of life of individuals with end stage renal failure. Result: A total of 103 responses were collected out of which 54 (53.4%) were males and 49 (47.6%) were females with the mean age between 30 and 45 (38.8%) years old. Majority of the patients were in a Moderate state of health 56 (54.4 %) and 33(32%) were those who had Bad health state, while 14 (13.6%) patients with Good quality of health. Majority of the patients were not at all bothered by dryness of skin (27.2%), itchy skin (39.8%), lack of appetite (32%), washed out or exhausted (39%), soreness of muscles (35%), pain in their joints (32%), easy brouising (45.6%), sleepiness at the day time (42.7%), cramps during dialysis (60.2%) and after dialysis (36.9%), stiffness of joints (33%), back pain (31.1%), numbness in hands or feet (37.9%), bone aches (30.1%), muscle pain (41.7%), headache (26.2%), stomach problem or nausea (31.1%), shortness of breath (43.7%), faintness or dizziness (64.1%), hot or cold spells (36.9%), trouble concentration (52.4%), trouble in getting breath (52.4%), blurred vision (42.7%), chest pain (52.4%), swelled ankles (34%), loss of tast 3 (35.9%), clotting or other access site problems (62.1%) and majority of the patients were extremely bothered by lack of strength (36.9%), weakness and fatigue (51.5%), excessive thirst (41.7%), dryness of mouth (34%), trouble in sleeping (37.9%), head ach (26.2%). Majority of the patients were somewhat bothered by high blood pressure (19.4%) and low blood pressure (13.6%). Conclusion: Specific variables, such as age, gender, social support, income, the quality of life of the patients is effected either negatively or positively by education physical functioning health and disease symptoms. Particular factors, for example, age, gender, social support, income, education, physical working wellbeing and ailment side effects can influence either decidedly or adversely the quality of patients life.

Ranger™ paclitaxel-coated balloon versus conventional balloon angioplasty for treatment of failing arteriovenous fistulas and grafts in haemodialysis patients: A retrospective cohort study

Background: Aim was to compare the safety and patency efficacy outcomes between Ranger™ paclitaxel-coated balloon (PCB)- versus conventional balloon angioplasty (POBA) in the treatment of haemodialysis access-related conduit stenosis. Methods: Retrospective single-centre, multi-investigator, consecutive, double-arm comparative cohort study. About 130 end-stage renal failure Asian patients with dysfunctional arteriovenous fistula (AVF) or arteriovenous graft underwent PCB or POBA fistuloplasty between November 2018 and June 2020. All stenotic lesions were prepared with high pressure non-compliant balloon angioplasty prior to PCB angioplasty. All patients received at least one antiplatelet agent for 3 months duration post procedure. Results: Mean age was 66.0 ± 10 years and 79/130 (61%) were males. PCB arm ( n = 65) versus POBA arm ( n = 65). Majority were AVFs circuits (122/130, 94%). Main indication for intervention was dropping access flow (98/130, 76%). About 172 lesions were treated (56% POBA, 44% PCB), and the juxta-anastomosis (JAS) was the main target lesion (87/172, 51%). There were no significant differences in safety outcomes (30-day adverse events, access thrombosis, abandoned AVF and death) between treatment groups. Mean time to target lesion reintervention (TLR) was longer in PCB-treated lesions (7.1 ± 2.7 vs 5.8 ± 3.2 months, p = 0.03), especially amongst recurrent lesions (7.3 ± 2.4 vs 5.7 ± 3.2, p = 0.02). Mean time to circuit reintervention was also longer in PCB-treated circuits (6.9 ± 2.8 vs 5.8 ± 3.7months, p = 0.04). There were 16 deaths (12%), all attributed to patient’s underlying comorbidities. Conclusions: Fistuloplasty with Ranger™ PCB for failing arteriovenous circuits in end-stage renal failure patients, is a safe and efficacious modality compared to POBA in terms of longer freedom from TLR.

Surgical Treatment of Gastric Malignancy in Chronic Kidney Disease Patient with Long-Term Haemodialysis

Background. Gastric cancer is the world 5th top malignancy, with treatment success largely conditioned by comorbidity. Patients with end-stage renal failure developed with chronic kidney disease could not expect a specialty cancer treatment before the advent of long-term haemodialysis.Aim. A case description of successful perioperative therapy and surgery in a long-term haemodialysis patient performed by a multi-specialty team of oncologists and transplantologists.Materials and methods. We case-illustrate surgical treatment options in a gastric cancer patient with long-term haemodialysis.Results and discussion. A specialty oncological treatment of end-stage renal failure patients requiring long-term haemodialysis is a complex multidisciplinary task feasible in hospitals equipped for different haemodialysis regimens. The treatment plan should be laid out by a multi-specialty team, as chronic kidney disease influences the choice of the drug class, dosage and administration mode. Moreover, such patients need laboratory (control of acid-base balance, haemoglobin, electrolytes, creatinine and urea) and clinical (body weight, liquid balance, etc.) monitoring.Conclusion. Perioperative management studies in gastric cancer and chronic kidney disease-comorbid patients under long-term haemodialysis is a promising area of combining eff ort in oncology and transplantation science. Further research is needed in this topic for data enrichment and analysis in complex comorbidity patients.

HOW TO CONTROL INTERDIALYTIC WEIGHT GAIN (IDWG) AMONG HEMODIALYSIS PATIENTS?

Background: Chronic kidney failure is a terminal disease that often affects the patient's quality of life. One of the problems that often occurs in patients with end-stage renal failure is the increase in fluid volume between two dialysis times. The increase in Interdialytic Weight Gain (IDWG) has a serious impact, 60-80% of patients die from excess fluid and food intake during the interdialytic period. Objective: This review aimed to describe the importance of Interdialytic Weight Gain (IDWG) in end-stage renal failure patients undergoing hemodialysis. Design: This study design is a systematic review to search and review article from database and the theory underlying this study or guidance in this systematic literature review using PRISMA. Data Sources: This systematic review was conducted using a database with electronic searches on EBSCO, ProQuest, Scopus, SAGE, and Science Direct published in 2017-2021. Review Methods: The method used in the preparation of the Literature review using the PRISMA checklist and PICOT. Secondary data obtained from the journal with a predetermined discussion. Results: The results of the database search strategy were 1,907 articles were obtained, but 1,340 articles were excluded. There were seven articles that met the inclusion criteria. Two articles identified that uncontrolled IDWG is at risk of death in chronic renal failure patients undergoing hemodialysis. Conclusion: Two articles state that IDWG affects hemoglobin concentration and cardiovascular disorders and triggers complications, two other articles state that the factors that contribute to IDWG are fluid intake, thirst, self-efficacy and dietary behavior, one article states that controlled IDWG will improve the quality of life of patients with end-stage renal failure/End-Stage Renal Disease (ESRD undergoing hemodialysis. Uncontrolled IDWG is at risk of death in patients undergoing hemodialysis. Control of IDWG through adherence to dietary behavior will improve the quality of life of end-stage renal failure patients undergoing hemodialysis.

Temporal macular thinning: a salient sign of Alport syndrome

Alport syndrome is a hereditary, multisystemic disorder that causes abnormalities of the ear, kidney, and eye. A teenager who was suffering from end-stage renal failure and hearing problems was referred to us suspected of Alport syndrome. He did not have any ocular complaints and wore glasses for myopic astigmatism. His best-corrected visual acuity was 6/7.5 bilaterally. Anterior segment examination was unremarkable. Posterior segment examination showed perimacular dot-andfleck retinopathy with bull’s eye maculopathy. Optical coherence tomography revealed temporal macular thinning. The findings were in keeping with the diagnosis of X-linked Alport syndrome. Ocular findings can help diagnose Alport syndrome. Early detection and treatment can help delay the progression of kidney failure.