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Interventional nephrology

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https://www.readbyqxmd.com/read/28219579/glomerular-diseases-and-renal-transplantation-pathogenic-pathways-and-evolution-of-therapeutic-interventions
#1
S Marinaki, C Skalioti, J Boletis
Glomerular diseases and renal transplantation are the main fields of nephrology in which the immune system plays a prevalent role. Glomerular diseases have traditionally been attributed to auto-immune conditions, whereas allograft rejection has been considered an allo-immune response. However, common immunopathologic mechanisms that include Toll-like receptors, complement and B-cell activation, as well as genetic and infectious factors appear to be involved in the pathogenesis of both entities. Novel therapeutic regimens directed against specific targets of the immune system show promising results in glomerulopathies as well as in renal transplantation...
March 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28182261/improving-the-electronic-capture-of-advance-care-directives-in-a-healthcare-delivery-system
#2
Norifumi Kamo, Barbara L Williams, Donna L Smith, C Craig Blackmore
OBJECTIVES: To determine the effectiveness of a multifaceted quality improvement intervention in outpatient clinics at an integrated healthcare delivery system on capture rate of advance directives (ADs) in the electronic medical record (EMR). DESIGN: Interrupted time series analysis with control groups between January 2010 and June 2015. SETTING: Oncology, nephrology, and primary care outpatient clinics in an integrated healthcare delivery system...
February 9, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28177103/-quality-of-life-anxiety-and-distress-in-patients-suffering-from-chronic-kidney-disease-pre-dialysis-and-start-of-dialytic-treatment
#3
Maria Monica Ratti, Giulia Bruna Delli Zotti, Eleonora Sangiovanni, Benedetta Vai, Aurelio Limido, Silvio Bertoli, Lucio Sarno, Donatella Spotti
The psychological impact of the Chronic Kidney Disease is well known and several factors contribute to a reduction of quality of life, increase of anxiety levels and psychological distress for affected patients. Psychological intervention is becoming ever more consolidating within the Departments of Nephrology. Nevertheless, literature is lacking about the psychological intervention specificity, especially concerning the dialysis and pre-dialysis phase. The purpose of the study is to identify the mainly critical periods for the dialysed patients in terms of anxiety and distress and to examine the impact of medical management in pre-dialysis period on life quality...
January 2017: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
https://www.readbyqxmd.com/read/28161697/in-the-wake-of-systolic-blood-pressure-intervention-trial-new-targets-for-improving-hypertension-management-in-chronic-kidney-disease
#4
Crystal C Tyson, Thomas M Coffman
Systolic Blood Pressure Intervention Trial (SPRINT) was a multicenter randomized controlled trial showing the significant benefit of intensive reduction of blood pressure to a target of 120 mm Hg in individuals with hypertension and elevated cardiovascular risk. Because SPRINT includes the largest cohort of adults with chronic kidney disease (CKD) to be prospectively studied in a hypertension intervention trial, it has particular relevance to the field of nephrology. Here, we review the findings of SPRINT and assess their potential impact on guidelines for treatment of hypertension in patients with CKD...
February 4, 2017: Nephron
https://www.readbyqxmd.com/read/28152018/acute-kidney-injury-burden-in-different-clinical-units-data-from-nationwide-survey-in-china
#5
Xiaojing Tang, Dongping Chen, Shengqiang Yu, Li Yang, Changlin Mei
BACKGROUND: The inpatient morbidity and mortality of acute kidney injury (AKI) vary considerably in different clinical units, yet studies to compare the difference remain limited. METHODS: We compared the clinical characteristics of AKI in Intensive Care Unit (ICU), medical and surgical departments by using the data derived from the 2013 nationwide cross-sectional survey of AKI in China to capture variations among different clinical departments in recognition, management, and outcomes of AKI...
2017: PloS One
https://www.readbyqxmd.com/read/28151965/prevention-of-contrast-induced-acute-kidney-injury-in-patients-undergoing-cardiovascular-procedures-a-systematic-review-and-network-meta-analysis
#6
Eliano P Navarese, Paul A Gurbel, Felicita Andreotti, Michalina Marta Kołodziejczak, Suetonia C Palmer, Sofia Dias, Antonino Buffon, Jacek Kubica, Mariusz Kowalewski, Tomasz Jadczyk, Michał Laskiewicz, Marek Jędrzejek, Maximillian Brockmeyer, Flavio Airoldi, Marinella Ruospo, Stefano De Servi, Wojciech Wojakowski, Christopher O' Connor, Giovanni F M Strippoli
BACKGROUND: Interventional diagnostic and therapeutic procedures requiring intravascular iodinated contrast steadily increase patient exposure to the risks of contrast-induced acute kidney injury (CIAKI), which is associated with death, nonfatal cardiovascular events, and prolonged hospitalization. The aim of this study was to investigate the efficacy of pharmacological and non-pharmacological treatments for CIAKI prevention in patients undergoing cardiovascular invasive procedures with iodinated contrast...
2017: PloS One
https://www.readbyqxmd.com/read/28122510/a-prospective-2-site-parallel-intervention-trial-of-a-research-based-film-to-increase-exercise-amongst-older-hemodialysis-patients
#7
Pia Kontos, Shabbir M H Alibhai, Karen-Lee Miller, Dina Brooks, Romeo Colobong, Trisha Parsons, Sarbjit Vanita Jassal, Alison Thomas, Malcolm Binns, Gary Naglie
BACKGROUND: Evidence suggests that exercise training for hemodialysis patients positively improves morbidity and mortality outcomes, yet exercise programs remain rare and are not systematically incorporated into care. We developed a research-based film, Fit for Dialysis, designed to introduce, motivate, and sustain exercise for wellness amongst older hemodialysis patients, and exercise counseling and support by nephrologists, nurses, and family caregivers. The objective of this clinical trial is to determine whether and in what ways Fit for Dialysis improves outcomes and influences knowledge/attitudes regarding the importance of exercise for wellness in the context of end-stage renal disease...
January 26, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28115076/cognitive-bias-and-the-creation-and-translation-of-evidence-into-clinical-practice
#8
REVIEW
Donald A Molony
The optimal translation of evidence into the clinical practice of nephrology follows validated evidence-based medicine (EBM) principles. Most importantly, the evidence-based medicine practitioner requires that the evidence, as much as possible, addresses in an unbiased manner clinical questions of importance to patients and reflects the truth. In this chapter, we evaluate how cognitive biases that affect medical decision making might systematically bias the overall management of patients with kidney disease and, thus, distort the observations about disease causation, prognosis, diagnosis, and management that are derived from analysis of administrative databases or electronic medical records of health care systems...
November 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/28104336/indicators-of-cognitive-impairment-from-a-medical-record-review-correlations-with-early-30-d-readmissions-among-hospitalized-patients-in-a-nephrology-unit
#9
Matthew J Jasinski, Mark A Lumley, Sandeep Soman, Jerry Yee, Mark W Ketterer
BACKGROUND: Patients with end-stage renal disease have the highest 30-day hospital readmission rates of any medical condition. Previous research suggests that cognitive impairment contributes to readmission. It is important to identify patients at risk for early readmission, and this might be accomplished efficiently using medical record data. METHOD: We reviewed the medical records of 100 patients with kidney disease (57 women, mean age = 61.2) who were hospitalized in the nephrology unit at an urban U...
October 19, 2016: Psychosomatics
https://www.readbyqxmd.com/read/28088183/incidence-aetiology-and-outcome-of-community-acquired-acute-kidney-injury-in-medical-admissions-in-malawi
#10
Rhys D R Evans, Ulla Hemmilä, Alison Craik, Mwayi Mtekateka, Fergus Hamilton, Zuze Kawale, Christopher J Kirwan, Hamish Dobbie, Gavin Dreyer
BACKGROUND: Epidemiological data on Acute Kidney Injury (AKI) from low-income countries is sparse. The aim of this study was to establish the incidence, severity, aetiology, and outcomes of community-acquired AKI in Malawi. METHODS: We conducted a prospective observational study of general medical admissions to a tertiary hospital in Blantyre between 27(th) April and 17(th) July 2015. All patients were screened on admission with a serum creatinine; those with creatinine above laboratory reference range were managed by the nephrology team...
January 14, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28076578/confirmed-clinical-case-of-chronic-kidney-disease-of-nontraditional-causes-in-agricultural-communities-in-central-america-a-case-definition-for-surveillance
#11
Alejandro Ferreiro, Guillermo Álvarez-Estévez, Manuel Cerdas-Calderón, Zulma Cruz-Trujillo, Elio Mena, Marina Reyes, Mabel Sandoval-Diaz, Vicente Sánchez-Polo, Régulo Valdés, Pedro Ordúnez
Over the last 20 years, many reports have described an excess of cases of chronic kidney disease (CKD) in the Pacific coastal area of Central America, mainly affecting male farmworkers and signaling a serious public health problem. Most of these cases are not associated with traditional risk factors for CKD, such as aging, diabetes mellitus, and hypertension. This CKD of nontraditional causes (CKDnT) might be linked to environmental and/or occupational exposure or working conditions, limited access to health services, and poverty...
November 2016: Revista Panamericana de Salud Pública, Pan American Journal of Public Health
https://www.readbyqxmd.com/read/28075321/effects-of-exercise-and-lifestyle-intervention-on-oxidative-stress-in-chronic-kidney-disease
#12
David M Small, Kassia S Beetham, Erin J Howden, David R Briskey, David W Johnson, Nicole M Isbel, Glenda C Gobe, Jeff S Coombes
OBJECTIVES: Determine the effects of a 12-month exercise and lifestyle intervention program on changes in plasma biomarkers of oxidative stress in pre-dialysis chronic kidney disease (CKD) patients. METHODS: A total of 136 stage 3-4 CKD patients were randomized to receive standard nephrological care with (N = 72) or without (N = 64) a lifestyle and exercise intervention for 12 months. Plasma total F2-isoprostanes (IsoP), glutathione peroxidase (GPX) activity, total antioxidant capacity (TAC), anthropometric and biochemical data were collected at baseline and at 12 months...
January 11, 2017: Redox Report: Communications in Free Radical Research
https://www.readbyqxmd.com/read/28069285/dialysis-modality-and-readmission-following-hospital-discharge-a-population-based-cohort-study
#13
Jeffrey Perl, Eric McArthur, Chaim Bell, Amit X Garg, Joanne M Bargman, Christopher T Chan, Shai Harel, Lihua Li, Arsh K Jain, Danielle M Nash, Ziv Harel
BACKGROUND: Readmissions following hospital discharge among maintenance dialysis patients are common, potentially modifiable, and costly. Compared with patients receiving in-center hemodialysis (HD), patients receiving peritoneal dialysis (PD) have fewer routine dialysis clinic encounters and as a result may be more susceptible to a hospital readmission following discharge. STUDY DESIGN: Population-based retrospective-cohort observational study. SETTINGS & PARTICIPANTS: Patients treated with maintenance dialysis who were discharged following an acute-care hospitalization during January 1, 2003, to December 31, 2013, across 164 acute-care hospitals in Ontario, Canada...
January 6, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28042071/the-edmonton-symptom-assessment-system-25-years-later-past-present-and-future-developments
#14
REVIEW
David Hui, Eduardo Bruera
CONTEXT: Routine symptom assessment represents the cornerstone of symptom management. ESAS is one of the first quantitative symptom assessment batteries that allows for simple and rapid documentation of multiple patient-reported symptoms at the same time. OBJECTIVE: To discuss the historical development of ESAS, its current uses in different settings, and future developments. METHODS: Narrative review RESULTS: Since its development in 1991, ESAS has been psychometrically validated and translated into over 20 languages...
December 29, 2016: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28042060/the-relationship-between-fatigue-and-depression-in-adults-with-end-stage-renal-disease-on-chronic-in-hospital-hemodialysis-a-scoping-review
#15
REVIEW
Janine F Farragher, Helene J Polatajko, Sarbjit V Jassal
CONTEXT: Fatigue and depression are two prominent concerns in patients on in-hospital hemodialysis (IHHD) that have recently been identified as research priorities in the nephrology community. Although they are often reported to co-exist, no synthesis of the literature examining their relationship is available. OBJECTIVE: To characterize the literature on the relationship between fatigue and depression in IHHD patients. METHODS: A scoping review as described by Arksey and O'Malley was conducted...
December 29, 2016: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28007671/magnesium-based-interventions-for-normal-kidney-function-and-chronic-kidney-disease
#16
Ziad A Massy, Ionut Nistor, Mugurel Apetrii, Vincent M Brandenburg, Jordi Bover, Pieter Evenepoel, David Goldsmith, Sandro Mazzaferro, Pablo Urena-Torres, Marc G Vervloet, Mario Cozzolino, Adrian Covic, On Behalf Of Ckd-Mbd Working Group Of Era-Edta
Magnesium (Mg) is one of the most important cations in the body, playing an essential role in biological systems as co-factor for more than 300 essential enzymatic reactions. In the general population, low levels of Mg are associated with a high risk of cardio-vascular disease (CVD). Despite the accumulating literature data, the effect of Mg administration on mortality in chronic kidney disease (CKD) patients has never been investigated as a primary end-point. We conducted a systematic search of studies assessing the benefits and harms of Mg in CKD (stages 1 to 5 and 5D), and considered all randomized controlled trials (RCTs) and quasi-RCTs evaluating Mg-based interventions in CKD...
April 1, 2016: Magnesium Research: Official Organ of the International Society for the Development of Research on Magnesium
https://www.readbyqxmd.com/read/28005240/complicated-pregnancies-in-inherited-distal-renal-tubular-acidosis-importance-of-acid-base-balance
#17
Harald Seeger, Peter Salfeld, Rüdiger Eisel, Carsten A Wagner, Nilufar Mohebbi
Inherited distal renal tubular acidosis (dRTA) is caused by impaired urinary acid excretion resulting in hyperchloremic metabolic acidosis. Although the glomerular filtration rate (GFR) is usually preserved, and hypertension and overt proteinuria are absent, it has to be considered that patients with dRTA also suffer from chronic kidney disease (CKD) with an increased risk for adverse pregnancy-related outcomes. Typical complications of dRTA include severe hypokalemia leading to cardiac arrhythmias and paralysis, nephrolithiasis and nephrocalcinosis...
December 22, 2016: Journal of Nephrology
https://www.readbyqxmd.com/read/27942956/building-on-evidence-to-improve-patient-care
#18
REVIEW
Evelien Snauwaert, Johan VandeWalle, Evi V Nagler, Wim Van Biesen
Evidence-based medicine (EBM) is gaining importance in the current paediatric healthcare landscape. Improvement of paediatric health status is its major aim. However, for EBM to be successful, all stakeholders involved should understand what EBM really is, why and how EBM should or should not be practiced, and have the necessary skills to distinguish methodologically sound papers from biased opinion papers, and understand how and why guidelines are different from systematic reviews. Improving patient outcome requires attention to high-quality evidence and understanding of the processes of medical decision-making...
December 9, 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/27942955/management-dilemmas-in-pediatric-nephrology-time-limited-trials-of-dialysis-therapy
#19
Aaron Wightman
BACKGROUND: Time-limited trials of dialysis have been proposed as a third option in addition to initiation of treatment and comfort-care only in the setting of high uncertainty or discordance between the treating team and child/family or among the treating team. CASE-DIAGNOSIS/TREATMENT: The index case was noted antenatally to have severe kidney disease and pulmonary hypoplasia. In light of the guarded, but uncertain prognosis and a lack of consensus among the treating team, as well as between the treating team and the family, a time-limited trial of dialysis was initiated...
December 9, 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/27915329/acute-kidney-injury-risk-assessment-and-the-nephrology-rapid-response-team
#20
Lilia Maria Rizo-Topete, Mitchell H Rosner, Claudio Ronco
Acute kidney Injury (AKI) is a serious medical condition affecting more than 10 million people around the world annually and resulting in poor outcomes. It has been suggested that late recognition of the syndrome may lead to delayed interventions with increased morbidity and mortality. Early diagnosis and timely therapeutic strategies may be the cornerstone of future improvement in outcomes. The purpose of this article is to provide a practical model to identify patients at high risk for AKI in different environments, with the goal to prevent AKI...
December 3, 2016: Blood Purification
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