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Conservative treatment of CKD

Farag E Salama, Qasem A Anass, Abdelnaem A Abdelrahman, Elsayed B Saeed
Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). The carotid intima-media thickness (CIMT) and arterial stiffness are useful markers of subclinical atherosclerosis and significantly correlate with various metabolic risk factors. Chemerin is one of the adipokines that may represent a link between obesity and inflammation and may be a potential candidate playing a role in the pathogenesis of atherosclerosis and cardiovascular complications. Therefore, we studied the relationship of chemerin levels with atherosclerosis as measured by CIMT in diabetic CKD patients, either predialysis or on hemodialysis (HD)...
September 2016: Saudi Journal of Kidney Diseases and Transplantation
Sheila Johnston
Chronic kidney disease (CKD) stages 3-5 now affects 8.5% of adults in the United Kingdom; with 4% of patients expected to reach stage 5 CKD. Increasing numbers of older patients are contributing to the growth of demand of kidney services. With the exception of transplantation, dialysis has been the main form of renal replacement therapy (RRT) for advanced CKD. This elderly population is usually too frail and has many other co-existing medical complaints or co morbidities to undergo transplantation. Dialysis is an invasive treatment, and some frail elderly patients can experience many dialysis related symptoms...
September 22, 2016: Healthcare (Basel, Switzerland)
Abd El-Hamid Salah Al-Hamshary, Osama Saad El-Shaaer, Doaa Refaay Soliman, Ghada Mohamed El-Mashad, Ahmed Ibraheem Hussien
INTRODUCTION: High serum resistin levels are associated with the incidence of chronic kidney disease (CKD). The objectives of this study were to determine the serum concentrations of resistin in children that present with chronic renal failure (CRF) and end stage renal disease (ESRD), in order to examine the impact of hemodialysis (HD) on serum resistin levels, and to determine if a correlation exists between resistin and growth retardation in patients with CRF. METHODS: This case control study was undertaken in the pediatric hemodialysis unit of the Benha and Menoufia University hospitals from April 2014 to March 2015...
July 2016: Electronic Physician
Ana Rodríguez-Carmona, Miguel Pérez Fontán, Susana Sangiao Alvarellos, Teresa García Falcón, María Lara Pena Bello, Andrés López Muñiz, Fernando Cordido
BACKGROUND: Irisin is an adipomyokine with claimed anti-obesity and anti-diabetic effects. This hormone has been insufficiently studied in patients with advanced chronic kidney disease (CKD). OBJECTIVE: To perform an exploratory analysis of serum irisin levels in patients undergoing different CKD treatments. METHOD: Following a cross-sectional design, we estimated serum levels of irisin in 95 patients with CKD managed conservatively (advanced CKD), with peritoneal dialysis (PD) or with haemodialysis, and compared our findings with a control group of 40 healthy individuals...
September 2016: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Vincenzo Bellizzi, Giuseppe Conte, Silvio Borrelli, Adamasco Cupisti, Luca De Nicola, Biagio R Di Iorio, Gianfranca Cabiddu, Marcora Mandreoli, Ernesto Paoletti, Giorgina B Piccoli, Giuseppe Quintaliani, Maura Ravera, Domenico Santoro, Serena Torraca, Roberto Minutolo
This position paper of the study group "Conservative treatment of Chronic Kidney Disease-CKD" of the Italian Society of Nephrology addresses major practical, unresolved, issues related to the conservative treatment of chronic renal disease. Specifically, controversial topics from everyday clinical nephrology practice which cannot find a clear, definitive answer in the current literature or in nephrology guidelines are discussed. The paper reports the point of view of the study group. Concise and practical advice is given on several common issues: renal biopsy in diabetes; dual blockade of the renin-angiotensin-aldosterone system (RAAS); management of iron deficiency; low protein diet; dietary salt intake; bicarbonate supplementation; treatment of obesity; the choice of conservative therapy vs...
August 27, 2016: Journal of Nephrology
Rachael L Morton, Manjula Kurella Tamura, Joanna Coast, Sara N Davison
Kidney supportive care describes multiple interventions for patients with advanced CKD that focus on improving the quality of life and addressing what matters most to patients. This includes shared decision making and aligning treatment plans with patient goals through advance care planning and providing relief from pain and other distressing symptoms. Kidney supportive care is an essential component of quality care throughout the illness trajectory. However, in the context of limited health care resources, evidence of its cost-effectiveness is required to support decisions regarding appropriate resource allocation...
August 10, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Vincenzo Bellizzi, Stefano Bianchi, Piergiorgio Bolasco, Giuliano Brunori, Adamasco Cupisti, Giovanni Gambaro, Loreto Gesualdo, Pasquale Polito, Domenico Santoro, Antonio Santoro
The conservative management of chronic kidney disease (CKD) includes nutritional therapy (NT) with the aim to reduce the intake of proteins, phosphorus, organic acids, sodium, and potassium, while ensuring adequate caloric intake. While there is evidence that NT may help to prevent and control metabolic alterations in CKD, the criteria for implementing a low-protein regimen in CKD are still debated. There is no final consensus on the composition of the diet, nor indications for specific patient settings or different stages of CKD...
October 2016: Journal of Nephrology
Elzbieta Wojtowicz-Prus, Katarzyna Kiliś-Pstrusińska, Adam Reich, Katarzyna Zachwieja, Monika Miklaszewska, Maria Szczepanska, Jacek C Szepietowski
This study evaluated the frequency and severity of pruritus and dry skin in children with chronic kidney disease (CKD). A total of 103 children were included: 72 with CKD stage 3-5 (34 on dialysis and 38 treated conservatively without dialysis) and 31 as a reference group. Pruritus was assessed using the 4-item Itch Questionnaire and a visual analogue scale. Skin dryness was evaluated clinically, by non-invasive assessment of epidermis moisturizing and measurement of transepidermal water loss. Pruritus occurred in 20...
May 12, 2016: Acta Dermato-venereologica
Yeleine Martínez Echevers, Néstor Gabriel Toapanta Gaibor, Nathasha Nava Pérez, Francisco Barbosa Martin, Rafael Montes Delgado, María Ángeles Guerrero Riscos
INTRODUCTION: The number of elderly patients with advanced chronic kidney disease (ACKD) has increased in recent years, and the best therapeutic approach has not been determined due to a lack of evidence. OBJECTIVES: To observe the progression of elderly patients with ACKD (stages 4 and 5) and to compare the survival of stage 5 CKD patients with and without dialysis treatment. MATERIAL AND METHODS: All patients ≥70 years who began ACKD follow-up from 01/01/2007 to 31/12/2008 were included, and their progression was observed until 31/12/2013...
May 2016: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Sanah Parvez, Khaled Abdel-Kader, V Shane Pankratz, Mi-Kyung Song, Mark Unruh
BACKGROUND AND OBJECTIVES: Despite the potential benefits of conservative management, providers rarely discuss it as a viable treatment option for patients with advanced CKD. This survey was to describe the knowledge, attitudes, and practices of nephrologists and primary care providers regarding conservative management for patients with advanced CKD in the United States. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We developed a questionnaire on the basis of a literature review to include items assessing knowledge, attitudes, and self-reported practices of conservative management for patients with advanced CKD...
May 6, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Pietro C Dattolo, Pamela Gallo, Stefano Michelassi, Nunzia Paudice, Rossella Cannavò, Elena Romoli, Filippo Fani, Aris Tsalouchos, Alma Mehmetaj, Giuseppe Ferro, Sergio Sisca, Francesco Pizzarelli
BACKGROUND: Benefits and risks of angiotensin converting enzyme inhibitors (ACE-I) in advanced chronic kidney disease (CKD) are controversial. We tested the role of ACE-I in slowing the progression of renal damage in a real-world elderly population with CKD stage 5. METHODS: We evaluated all patients consecutively referred to our CKD stage 5 outpatient clinic from January 2002 to December 2013. Chronicity was defined as two consecutive estimated glomerular filtration rate (eGFR) measurements below 15 ml/min/1...
March 25, 2016: Journal of Nephrology
Andrea Corsonello, Sergio Fusco, Silvia Bustacchini, Carlos Chiatti, Raffaella Moresi, Anna Rita Bonfigli, Giuseppina Di Stefano, Fabrizia Lattanzio
Chronic kidney disease (CKD) is common in older adults, and its burden is expected to increase in older populations. Even if the knowledge on the approach to older patient with CKD is still evolving, current guidelines for pharmacological management of CKD does not include specific recommendations for older patients. Additionally, decision-making on renal replacement therapy (RRT) for older patients is far from being evidence-based, and despite the improvement in dialysis outcomes, RRT may cause more harm than benefit compared with conservative care when prognostic stratification is not carefully assessed...
2016: Expert Review of Clinical Pharmacology
Guillermo De'Marziani, Gervasio Soler Pujol, Liliana Miriam Obregón, Elisa Mabel Morales, Claudio Daniel Gonzalez, Luciana Gonzalez Paganti, Leonardo Cacciagiú, Graciela Lopez, Laura Schreier, Alicia Elbert
In Argentina, there have been no studies aimed at establishing the prevalence of dysglycaemia (impaired fasting glucose [IFG], impaired glucose tolerance [IGT] and diabetes mellitus [DM]) in patients with chronic kidney disease (CKD). Our group decided to conduct an observational study to evaluate the frequency with oral glucose tolerance test (OGTT) in CKD patients with no previous data for dysglycaemia in their medical records. OGTT was performed in 254 patients (60.62% male) with stage 3, 4 and 5 CKD under conservative treatment, haemodialysis or transplantation...
2016: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Mi-Kyung Song
With the evidence that dialysis may not necessarily be beneficial for older adults with advanced chronic kidney disease (CKD), there is a growing interest in promoting conservative care without dialysis as a viable treatment option for these individuals. This review summarizes the current empirical evidence of symptom experiences and quality of life of patients receiving conservative care. Data suggest that conservative care may yield symptom experiences and quality of life that are compatible with those of patients on dialysis...
March 2016: Seminars in Dialysis
Alessandra Moioli, Barbara Maresca, Andrea Manzione, Antonello Maria Napoletano, Daniela Coclite, Nicola Pirozzi, Giorgio Punzo, Paolo Menè
Metformin (MF) accumulation during acute kidney injury is associated with high anion gap lactic acidosis type B (MF-associated lactic acidosis, MALA), a serious medical condition leading to high mortality. Despite dose adjustment for renal failure, diabetic patients with chronic kidney disease (CKD) stage III-IV are at risk for rapid decline in renal function by whatever reason, so that MF toxicity might arise if the drug is not timely withdrawn. Sixteen consecutive patients were admitted to our Hospital's Emergency Department with clinical findings consistent with MALA...
January 22, 2016: Journal of Nephrology
Joanna Stępniewska, Barbara Dołęgowska, Elżbieta Cecerska-Heryć, Edyta Gołembiewska, Alicja Malinowska-Jędraszczyk, Małgorzata Marchelek-Myśliwiec, Kazimierz Ciechanowski
PURPOSE: The changes in redox status characterise physiological platelet activation. Increased oxidative stress in chronic kidney disease (CKD) associated with uremic toxicity and procedures of renal replacement therapy leads to the impairment of antioxidant properties of platelets. It may contribute to thrombosis and cardiovascular complications increasing morbidity and mortality among the CKD patients. The object of the research was to assess the influence of conservative treatment, peritoneal dialysis and haemodialysis on platelet prooxidative-antioxidative balance...
April 2016: International Urology and Nephrology
Douglas S Johnson, Toros Kapoian, Robert Taylor, Klemens B Meyer
Care coordination for patients with chronic kidney disease has been shown to be effective in improving outcomes and reducing costs. However, few patients with CKD benefit from this systematic management of their kidney disease and other medical conditions. As a result, outcomes for patients with kidney disease are not optimal, and their cost of care is increased. For those patients who transition to kidney failure treatment in the United States, the transition does not go as well as it could. The effectiveness of treatments to delay progression of kidney disease in contemporary clinical practice does not match the efficacy of these treatments in clinical trials...
March 2016: Seminars in Dialysis
Divya Raghavan, Jean L Holley
Palliative care is a branch of medicine dedicated to the relief of symptoms experienced during the course of illness. Renal palliative medicine or kidney supportive care is an evolving branch of nephrology, which incorporates the principles of palliative care into the care of CKD and ESRD (dialysis, transplant, and conservatively managed) patients. Conservative (non-dialytic) management is a legitimate option for frail, elderly CKD patients in whom dialysis may not lead to an improvement in quality or duration of life...
January 2016: Advances in Chronic Kidney Disease
Helen Tam-Tham, Brenda R Hemmelgarn, David J T Campbell, Chandra M Thomas, Karen Fruetel, Robert R Quinn, Kathryn M King-Shier
BACKGROUND: Although primary care physicians (PCPs) are often responsible for the routine care of older adults with chronic kidney disease (CKD), there is a paucity of evidence regarding their perspectives and practice of conservative (non-dialysis) care. We undertook a qualitative study to describe barriers, facilitators and strategies to enhance conservative, non-dialysis, CKD care by PCPs in the community. METHODS: Semi-structured telephone and face-to-face interviews were conducted with PCPs from Alberta, Canada...
December 17, 2015: Nephrology, Dialysis, Transplantation
Anne-Cécile Rouveure, Marc Bonnefoy, Maurice Laville
Hemodialysis is the predominant replacement therapy in the 70 year-old French population (18% in peritoneal dialysis, 72% in hemodialysis from the REIN registry). Managing older patients reaching the end stage renal disease poses many ethical questions, since outcomes balanced regarding survival and quality of life. The aim of this study was to compare the survival of patients aged over 70 years according to the ESRD treatment choice: conservative treatment without dialysis (CT), hemodialysis (HD) and peritoneal dialysis (PD)...
February 2016: Néphrologie & Thérapeutique
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