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Chronic kidney disease internist

Zerleen S Quader, Mary E Cogswell, Jing Fang, Sallyann M Coleman King, Robert K Merritt
High blood pressure is a major risk factor for cardiovascular disease. The 2013 ACC/AHA Lifestyle Management Guideline recommends counseling pre-hypertensive and hypertensive patients to reduce sodium intake. Population sodium reduction efforts have been introduced in recent years, and dietary guidelines continued to emphasize sodium reduction in 2010 and 2015. The objective of this analysis was to determine changes in primary health care providers' sodium-reduction attitudes and counseling between 2010 and 2015...
2017: PloS One
Joy Gulla, Pamela M Neri, David W Bates, Lipika Samal
BACKGROUND: Timely referral of patients with CKD has been associated with cost and mortality benefits, but referrals are often done too late in the course of the disease. Clinical decision support (CDS) offers a potential solution, but interventions have failed because they were not designed to support the physician workflow. We sought to identify user requirements for a chronic kidney disease (CKD) CDS system to promote timely referral. METHODS: We interviewed primary care physicians (PCPs) to identify data needs for a CKD CDS system that would encourage timely referral and also gathered information about workflow to assess risk factors for progression of CKD...
May 2017: International Journal of Medical Informatics
Sikander Surana, Neeru Kumar, Amita Vasudeva, Gulvahid Shaikh, Kenar D Jhaveri, Hitesh Shah, Deepa Malieckal, Joshua Fogel, Gurwinder Sidhu, Sofia Rubinstein
BACKGROUND: Drug dosing errors result in adverse patient outcomes and are more common in patients with chronic kidney disease (CKD). As internists treat the majority of patients with CKD, we study if Internal Medicine house-staff have awareness and knowledge about the correct dosage of commonly used medications for those with CKD. METHODS: A cross-sectional survey was performed and included 341 participants. The outcomes were the awareness of whether a medication needs dose adjustment in patients with CKD and whether there was knowledge for the level of glomerular filtration rate (GFR) a medication needs to be adjusted...
January 17, 2017: BMC Nephrology
Julia Pohl, Maria Papathanasiou, Martin Heisler, Pia Stock, Malte Kelm, Ulrike B Hendgen-Cotta, Tienush Rassaf, Peter Luedike
BACKGROUND: Macrophage migration inhibitory factor (MIF) is known to amplify the immune response in septic animal models. Few clinical data support this pro-inflammatory role in septic patients. Renal replacement therapy (RRT) as adjuvants in the complex therapy of sepsis has been proposed as a possible approach to eliminate elevated circulating cytokines. Since recent data suggest that MIF can be effectively removed from the circulating blood pool in patients with chronic kidney disease, we here aimed to investigate whether RRT in septic shock can lower plasma levels of this pro-inflammatory cytokine in septic shock patients...
2016: Journal of Intensive Care
Yueh-Han Hsu, Jur-Shan Cheng, Wen-Chen Ouyang, Chen-Li Lin, Chi-Ting Huang, Chih-Cheng Hsu
Schizophrenia is closely associated with cardiovascular risk factors which are consequently attributable to the development of chronic kidney disease and end-stage renal disease (ESRD). However, no study has been conducted to examine ESRD-related epidemiology and quality of care before starting dialysis for patients with schizophrenia. By using nationwide health insurance databases, we identified 54,361 ESRD-free patients with schizophrenia and their age-/gender-matched subjects without schizophrenia for this retrospective cohort study (the schizophrenia cohort)...
2015: PloS One
Maria Boddi, Fabrizia Natucci, Elisa Ciani
The renal resistive index (RRI) is measured by Doppler sonography in an intrarenal artery, and is the difference between the peak systolic and end-diastolic blood velocities divided by the peak systolic velocity. The RRI is used for the study of vascular and renal parenchymal renal abnormalities, but growing evidence indicates that it is also a dynamic marker of systemic vascular properties. Renal vascular resistance is only one of several renal (vascular compliance, interstitial and venous pressure), and extrarenal (heart rate, aortic stiffness, pulse pressure) determinants that combine to determine the RRI values, and not the most important one...
December 2015: Internal and Emergency Medicine
Csaba P Kovesdy
Hyperkalemia is a clinically important electrolyte abnormality that occurs most commonly in patients with chronic kidney disease. Due to its propensity to induce electrophysiological disturbances, severe hyperkalemia is considered a medical emergency. The management of acute and chronic hyperkalemia can be achieved through the implementation of various interventions, one of which is the elimination of medications that can raise serum potassium levels. Because many such medications (especially inhibitors of the renin-angiotensin aldosterone system) have shown beneficial effects in patients with cardiovascular and renal disease, their discontinuation for reasons of hyperkalemia represent an undesirable clinical compromise...
December 2015: American Journal of Medicine
Hadi A R Khafaji, Kadhim Sulaiman, Rajvir Singh, Khalid F AlHabib, Nidal Asaad, Alawi Alsheikh-Ali, Mohammed Al-Jarallah, Bassam Bulbanat, Wael AlMahmeed, Mustafa Ridha, Nooshin Bazargani, Haitham Amin, Ahmed Al-Motarreb, Hussam AlFaleh, Abdelfatah Elasfar, Prashanth Panduranga, Jassim Al Suwaidi
OBJECTIVES: The purpose of this study is to report the prevalence, clinical characteristics, precipitating factors, management and outcome of patients with prior stroke hospitalised with acute heart failure (HF). DESIGN: Retrospective analysis of prospectively collected data. SETTING: Data were derived from Gulf CARE (Gulf aCute heArt failuRe rEgistry), a prospective multicentre study of consecutive patients hospitalised with acute HF in 2012 in seven Middle Eastern countries and analysed according to the presence or absence of prior stroke; demographics, management and outcomes were compared...
April 23, 2015: BMJ Open
José M de Miguel-Yanes, Luis Inglada-Galiana, Ricardo Gómez-Huelgas
AIMS: Few studies have evaluated how physicians prioritize renal function among other patient-related factors when stepping-up in antidiabetic treatment. METHODS: The REDIM Spanish national online survey included 550 internists. We firstly tested proficiency in chronic kidney disease (Agrawal's Questionnaire) and motivation in diabetes (DAS-3p Questionnaire). We then analyzed how physicians prioritized renal function, age, weight, glycemic control, non-renal co-morbidities and patient perceptions in five varying fictitious clinical scenarios (generic; ambulatory vs...
August 2014: Diabetes Research and Clinical Practice
Fathea Abobker Goleg, Norella Chiew-Tong Kong, Ramesh Sahathevan
PURPOSE: End-stage kidney disease (ESKD) is now a worldwide pandemic. In concert with this, ESKD in Libya has also increased exponentially in recent decades. This review aims to define the magnitude of and risks for this ESKD epidemic among Libyans as there is a dearth of published data on this subject. METHODS: A systematic review was conducted by searching PubMed, EMBASE and Google scholar databases to identify all relevant papers published in English from 2003 to 2012, using the following keywords: end stage, terminal, chronic, renal, kidney, risk factors, Arab, North Africa and Libya...
August 2014: International Urology and Nephrology
Jan van Gijn, Joost P Gijselhart, S Azam Nurmohamed
Willem Kolff (1911-2009), son of a physician, studied medicine in Leiden and specialised in internal medicine in Groningen. It was there that he started attempts to apply the phenomenon of dialysis in patients suffering from renal failure. He built the first prototypes of dialysis machines after his appointment as an internist in the municipal hospital in Kampen, during the Second World War. Indeed, in the first 15 patients he managed to decrease urea levels, resulting in temporary clinical improvement, but eventually they all died...
2013: Nederlands Tijdschrift Voor Geneeskunde
Erel Joffe, Ofer Havakuk, Jorge R Herskovic, Vimla L Patel, Elmer Victor Bernstam
OBJECTIVE: To present a framework for combining implicit knowledge acquisition from multiple experts with machine learning and to evaluate this framework in the context of anemia alerts. MATERIALS AND METHODS: Five internal medicine residents reviewed 18 anemia alerts, while 'talking aloud'. They identified features that were reviewed by two or more physicians to determine appropriate alert level, etiology and treatment recommendation. Based on these features, data were extracted from 100 randomly-selected anemia cases for a training set and an additional 82 cases for a test set...
November 2012: Journal of the American Medical Informatics Association: JAMIA
Farahnak Assadi
Chronic kidney disease (CKD) is increasingly becoming a public health challenge worldwide, and its burden on our health care system is becoming enormous. CKD is not being detected early enough to initiate treatment regimens and reduce death and disability. Many children with CKD are unaware that they have this disorder. Therefore, initiatives should be undertaken to make healthcare providers, policy makers, and the general population more aware of the seriousness of CKD, its risk factors, and opportunities for early detection and intervention through screening...
January 2013: Journal of Nephrology
Enzo Bonora, Giovanni Targher
NAFLD is very common in the general population and its prevalence is increasing worldwide in parallel with the increasing incidences of obesity and metabolic diseases, mainly type 2 diabetes. In some cases, however, the diagnosis of NAFLD remains uncertain because other causes of liver disease are not easy to exclude in patients who are diagnosed with NAFLD after a biochemical or ultrasonographic analysis. Several studies have documented a strong association between NAFLD and traditional and nontraditional risk factors for cardiovascular disease (CVD) and chronic kidney disease (CKD)...
July 2012: Nature Reviews. Gastroenterology & Hepatology
Andrew S Levey, Josef Coresh
Chronic kidney disease is a general term for heterogeneous disorders affecting kidney structure and function. The 2002 guidelines for definition and classification of this disease represented an important shift towards its recognition as a worldwide public health problem that should be managed in its early stages by general internists. Disease and management are classified according to stages of disease severity, which are assessed from glomerular filtration rate (GFR) and albuminuria, and clinical diagnosis (cause and pathology)...
January 14, 2012: Lancet
Apiradee Sriwijitkamol, Yuwarat Moungngern, Sathit Vannaseang
BACKGROUND: The purpose of this study is to determine the percent of patients who have been assessed as having diabetic complications as recommended by American Diabetes Association. The secondary goals were to determine factor(s) associated with reduced assessment of diabetic complication and to determine the prevalence of diabetic complications in Thai type 2 diabetes patients. MATERIAL AND METHOD: We conducted a retrospective review of medical records of Thai type 2 diabetes patients who were followed up at the out-patient department (OPD) of Department of Internal Medicine at Siriraj Hospital Mahidol University Thailand during 1st January to 31st December 2006...
February 2011: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
G Spasovski
(Full text is available at Nephrologists and internists who work in the field of renal replacement therapy with dialysis had an opportunity to attend the continuing medical (nephrology) education (CME) on the subject of: Diagnostic and treatment options in CKD in the new millennium. The course was held on 25 April 2009, in the premises of the Macedonian Academy of Sciences and Arts, in honour of the 70th anniversary of Academician Momir Polenakovic, one of the founders of the Macedonian nephrology...
July 2010: Prilozi
Giovanni Cancarini
Proposals of new organizational models and awareness of the limits of the available resources are leading to certain changes in the hospital organization in some Italian regions. These changes consist mainly of the creation of large departments of internal medicine divided into sections according to the different levels of care, and the abolishment of specialty divisions like nephrology. When this happens, it can be hypothesized that specialists will become mere consultants and will no longer take direct care of the patient...
January 2010: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Godela Brosnahan, Mony Fraer
Chronic kidney disease has become a major public health problem due to its high prevalence, its exorbitant cost, and large reductions in life expectancy and quality of life of affected people. Seventy percent of cases of end-stage renal disease are due to diabetes and hypertension, conditions which are usually managed by primary care providers. Other risk factors are cardiovascular disease, obesity, smoking, family history of kidney disease, and age greater than 55 years. Patients with these risk factors should be evaluated for the presence of chronic kidney disease during their primary care visits, because effective treatments for slowing progression are available, particularly if instituted early...
February 2010: Southern Medical Journal
Varun Agrawal, Mohit Agarwal, Amit K Ghosh, Michael A Barnes, Peter A McCullough
Many patients with chronic kidney disease (CKD) receive care from primary care physicians. Identification and management of CKD complications in primary care is suboptimal. It is not known if current residency curriculum adequately prepares a future internist in this aspect of CKD care. We performed an online questionnaire survey of internal medicine residents in the United States to determine knowledge of CKD complications and their management. Four hundred seventy-nine residents completed the survey with postgraduate year (PGY) distribution 166 PGY1, 187 PGY2, and 126 PGY3...
May 2011: American Journal of Therapeutics
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