Malaysian KidneySPA

2012-02-29T14:35:00.000+08:00

Prehypertension - Time to Act

Preeti Gupta¹, Shankar Prasad Nagaraju², Ankur Gupta², Kiran B Mandya Chikkalingaiah³
¹ Central Government Health Scheme, New Delhi, India
² Division of Nephrology, The Ottawa Hospital, Ottawa, Canada³ Nephrology Division, University of Tennessee, Memphis, USA

Saudi Journal of Kidney Diseases and Transplantation Pg 223-333, Issue 2, Vol 23 Year 2012

Abstract
The term "prehypertension" defined as systolic blood pressure between 120 and 139 mmHg and/or diastolic
pressures between 80 and 89 mmHg has now gained general acceptance. Prehypertension is associated
with ~3-fold greater likelihood of developing hypertension, and roughly twice the number of cardiovascular
events, than BP < 120/80 mmHg. When compared with normotensive individuals, prehypertensive individuals
are more likely to be overweight and obese, to have other cardiovascular risk factors, to progress to established
hypertension, and to experience premature clinical cardiovascular disease. The major unresolved issue is the
appropriate management of such patients. Lifestyle modification is recommended for all patients with
prehypertension as it effectively reduces rate of cardiovascular events. Presently pharmacological therapy
is indicated for some patients with prehypertension who have specific comorbidities, including diabetes mellitus,
chronic kidney disease, and coronary artery disease.

2012-02-23T12:58:00.000+08:00

Acute removal of common sepsis mediators does not explain the effects of extracorporeal blood purification in experimental sepsis

Zhi-Yong Peng^1,4, Hong-Zhi Wang^1,2,4, Melinda J Carter¹, Morgan V Dileo³, Jeffery V Bishop¹, Fei-Hu Zhou¹, Xiao-Yan Wen¹, Thomas Rimmelé¹, Kai Singbartl¹, William J Federspiel^1,3, Gilles Clermont^1,3 and John A Kellum^1,

^{¹The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute illness) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
²Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Intensive Care Unit, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, China
³McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
Kidney International (2012) 81, 363–369; doi:10.1038/ki.2011.320; published online 14 September 2011
http://www.nature.com/ki/journal/v81/n4/abs/ki2011320a.html

Abstract

The effect of extracorporeal blood purification on clinical outcomes in sepsis is assumed to be related to modulation of plasma cytokine concentrations. To test this hypothesis directly, we treated rats that had a cecal ligation followed by puncture (a standard model of sepsis) with a modest dose of extracorporeal blood purification that did not result in acute changes in a panel of common cytokines associated with inflammation (TNF-α, IL-1β, IL-6, and IL-10).

Pre- and immediate post-treatment levels of these cytokines were unchanged compared to the sham therapy of extracorporeal circulation without blood purifying sorbent. The overall survival to 7 days, however, was significantly better in animals that received extracorporeal blood purification compared to those with a sham procedure. This panel of common plasma cytokines along with alanine aminotransferase and creatinine was significantly lower 72 h following extracorporeal blood purification compared to sham-treated rats. Thus, the effects of this procedure on organ function and survival do not appear to be due solely to immediate changes in the usual measured circulating cytokines.

These results may have important implications for the design and conduct of future trials in sepsis including defining alternative targets for extracorporeal blood purification and other therapies}

2012-02-17T14:36:00.001+08:00

Non-infected hemodialysis catheters are associated with increased inflammation compared to arteriovenous fistulasNon-infected catheters increase CRP

Stuart L Goldstein, T Alp Ikizler, Michael Zappitelli, Douglas M Silverstein and Juan C Ayus

Kidney International 76, 1063-1069 (November (2) 2009) doi:10.1038/ki.2009.303http://www.nature.com/ki/journal/v76/n10/full/ki2009303a.html

Although hemodialysis catheters predispose to infection which, in turn, causes inflammation, we studied whether they induce inflammation independent of infection. We compared the level of the inflammatory marker C-reactive protein (CRP) in maintenance hemodialysis patients, comparing those dialyzed using a non-infected catheter to those using arteriovenous fistulas. All incident patients had catheters and fistula placement at dialysis initiation. In 35 patients the fistulas matured, the catheters were removed and the patients were evaluated at 6 months (catheter–fistula).

These results were compared to 15 patients in whom the fistula did not mature and catheter use persisted for 6 months (catheter–catheter). There was a significant 82% reduction in the CRP level in the catheter–fistula group but a 16% increase in the catheter–catheter group at 6 months. The changes in CRP did not differ by gender, diabetes status, or by race, and was not correlated with a change in phosphorus, age, or urea reduction ratio at 1 month following hemodialysis initiation. Decreased CRP was associated with increased hemoglobin and albumin. Patients with persistent fistula use from dialysis initiation through 6 months had consistently low CRP levels over that time period.

Our study shows that catheters might contribute to increased inflammation independent of infection, and supports avoidance of catheters and a timely conversion to fistulas with catheter removal.

2012-02-15T13:21:00.000+08:00

Dietary salt influences postprandial plasma sodium concentration and systolic blood pressure

Rebecca J Suckling¹, Feng J He², Nirmala D Markandu² and Graham A MacGregor²

¹Department of Cardiovascular Medicine, St George's University of London, London, UK
²Barts and The London School of Medicine & Dentistry, Wolfson Institute of Preventive Medicine, London, UK

Kidney International (2012) 81, 407–411; doi:10.1038/ki.2011.369; published online 2 November 2011

To resolve this we compared the effect of soup with or without 6 g of salt (an amount similar to that in a single meal) on the plasma sodium concentration and blood pressure in 10 normotensive volunteers using a randomized, crossover design. The plasma sodium concentration was significantly increased by 3.13±0.75 mmol/l with salted compared with unsalted soup. Blood pressure increased in volunteers ingesting soup with added salt, and there was a significant positive correlation between plasma sodium concentration and systolic blood pressure. A 1-mmol/l increase in plasma sodium was associated with a 1.91-mm Hg increase in systolic blood pressure by linear regression.

Thus, changes in plasma sodium concentration occur each time a meal containing salt is consumed. A potential mechanism for the changes in blood pressure seen with salt intake may be through its effects on plasma sodium concentration.

Read full text here

2012-02-09T20:28:00.002+08:00

Does a reduction in dialysate sodium improve blood pressure control in

haemodialysis patients?

Anoop Shah MRCP1, 2, Andrew Davenport FRCP1

1.UCL Centre for Nephrology, Royal Free Hospital, University College London, Medical School, London.

2. Department of Clinical Toxicology, Guy's and St Thomas’ NHS Foundation Trust, London

Nephrology - Vol. 17 Issue 2 DOI: 10.1111/j.1440-1797.2012.01576.x

Submitted by Mr CS Soong

Abstract

Introduction: There has been debate as to the value of lower sodium dialysates to control blood pressure in haemodialysis patients, as sodium is predominantly removed by ultrafiltration.

Methods: Re-audit of clinical practice following reduction in dialysate sodium concentration.

Results: Overall dialysate sodium concentration decreased from 138.9 ± 1.7 to 137.8 ± 1.7 mmol/l (mean ± standard deviation), resulting in a reduction in pre and post dialysis mean arterial pressure (MAP) of 4 mmHg (from 100.6 ± 15.6 to 97.1 ± 15.6, p < 0.01 and from 91.7 ± 15.6 to 87.1 ± 14.6, p < 0.001 respectively), yet fewer patients were prescribed antihypertensives (49.6 vs 60.6%), and less antihypertensive medications/patient (mean 0.86 vs 1.05), ultrafiltration requirements (2.8% vs 3.2% body weight, p < 0.001), and symptomatic intradialytic hypotension (0.19 vs 0.28 episodes per week, p < 0.001). A multivariable model showed that for a dialysate sodium of 136 mmol/l, younger patients had higher MAP than older patients (0.35 mmHg lower MAP/year older; but with a dialysate sodium of 140 mmol/l, there was minimal association of MAP with age (0.07 mmHg higher MAP/year older).

Conclusion: Change in clinical practice, amounting to a modest reduction

2012-02-07T09:55:00.000+08:00

Health Ministry to hire graduate nurses

By JOSEPH SIPALAN - jsipalan@thestar.com.my

http://thestar.com.my/news/story.asp?file=/2012/2/7/nation/10687110&sec=nation

PUTRAJAYA: The Health Ministry is working on creating vacancies at government hospitals to absorb the large number of unemployed graduate nurses.

Health Minister Datuk Seri Liow Tiong Lai said a special committee, led by Health director-general Datuk Seri Dr Hasan Abdul Rahman, had been set up to find a solution to the issue.

“We are working on a programme to promote those who are already in the system and the vacancies can then be filled up by the graduates,” he said yesterday.

Liow pointed out that the proposed programme aimed to train the current crop of nurses to specialise in one of the many fields in government hospitals and in the process, create vacancies in lower-level positions.

In the long run, however, he said private institutions of higher learning would need to streamline their syllabus to match the demands of the local health industry.

Over the past week, The Star ran several reports highlighting the difficulty faced by nursing graduates from private institutes in finding jobs.

A government study found that over 54% of private nursing diploma graduates could not find work three to four months after graduating in 2010, compared to 21.7% in 2008.

Liow said the main factor leading to the surplus of nursing graduates was that private institutes appeared to not be in touch with the areas of expertise that were in demand.

He said the Government currently runs around 30 colleges, whose graduates are trained to meet the needs of public hospitals.

On the other hand, most of the estimated 70 private nursing colleges nationwide were providing general training and in many cases, did not meet private sector demand for specialised nurses.

“We are not looking at it as a surplus. We do need nurses, and so does the private sector because it is also expanding.

“This is mostly an issue of a mismatch between training and market demand. However, we do not control the numbers (of student intake) in private colleges.

“This is something we will have to work out with the Higher Education Ministry, and hopefully all of this (syllabus and market demand) will be streamlined,” he said.

Liow did not give a deadline for the committee to find a solution, saying that it had only just been formed and held its first meeting recently.

2012-02-03T13:58:00.002+08:00

Nasal Carriage of Methicillin-resistant Staphylococcus aureus Is Associated with Higher All-Cause Mortality in Hemodialysis Patients.

Clinical Journal of American Society of Nephrology Jan 2011

Abstract

Background and objectives Methicillin-resistant Staphylococcus aureus(MRSA) nasal carriage is a recognized risk factor for subsequent endogenous infections. However, the association between MRSA carriage and patient survival in hemodialysis patients has not been established.

Design, setting, participants, & measurements In March 2007, this prospective cohort study enrolled 306 outpatients under maintenance hemodialysis from a hospital-based dialysis center in Taiwan. They received two consecutive weekly nasal swab cultures at the beginning of the study. Patients having at least one positive culture of MRSA were defined as MRSA carriers. Subjects were followed up until December 31, 2008. The primary outcome was all-cause mortality. Main secondary outcomes were infection-related mortality and morbidity.

Results We identified 29 MRSA carriers (9.48%) at study entry. After a median of 613 days of follow-up, Kaplan-Meier analysis showed significant survival differences between MRSA carriers and noncarriers (log-rank P = 0.02). Compared with noncarriers, MRSA carriers had a 2.46-fold increased risk of dying from any cause, after adjusting for covariates at the start of follow-up. The adjusted hazard ratios of infection-related mortality and occurrence of subsequent S. aureusinfection in carriers were 4.99 and 4.31, respectively.

Conclusions A major limitation is the relatively small sample size of MRSA carriers. Nevertheless, we demonstrated that there may be an association between MRSA nasal carriage and poor clinical outcomes in an outpatient hemodialysis population. This underscores the need for routine surveillance of MRSA nasal carriage and should alert the physicians of a group at high risk of morbidity and mortality.

Read full tex here

2012-01-29T10:06:00.002+08:00

Prevalence of methicillin-resistant and methicillin-sensitive Staphylococcus aureus nasal colonization among patients at time of admission to the hospital.

Bodh R Panhotra

Dept of Infection Control, King Fahad Hospital, Al Hoful, Al Hasa, Saudi Arabia

Abstract:
BACKGROUND : Methicillin-resistant Staphylococcus aureus (MRSA) is an important agent of hospital-acquired infection. The mode of entry of MRSA in the hospital might be on admission of patients with MRSA infection or nasal colonization. The present study was undertaken to determine the prevalence of MRSA nasal colonization among patients on admission to hospital.

METHODS : Six hundred patients were screened for nasal colonization of MRSA on admission to hospital. Nasal swabs were cultured on salt mannitol agar and blood agar. Age, sex, previous admission to hospital and antibiotic therapy were recorded.

RESULTS : S. aureus was isolated from the nasal swabs of 122 patients (20.2%) on admission to hospital. MRSA was isolated from 7 patients (1.1%) and methicillin-sensitive S. aureus (MSSA) from 115 patients (19.1%). Nasal colonization of S. aureus was higher in younger and elderly patients and significantly higher colonization was observed among females. The MRSA strains isolated from nasal swabs had a different antibiotic susceptibility pattern than those isolated from patients having hospital-acquired MRSA infection. Previous admissions to hospital, underlying disease antibiotic therapy were not risk factors for MRSA nasal colonization.

CONCLUSION: MRSA nasal colonization of patients on admission to hospital is low in this region. The screening of every new admission would not be cost effective, but patients transferred form other institutions should be screened for MRSA. Standard infection control precautions should be strictly implemented to prevent the spread and control of MRSA infections.

Read full text here

2012-01-21T09:58:00.000+08:00

Wishing All

Chinese Sisters and Brothers

Very Happy and Prosperous

Chinese New Year

Best Wishes and Waramest Regards

MalaysianKidneySPA

2012-01-17T19:38:00.002+08:00

Cleaning and Disinfection in a Hemodialysis Setting

by John Micheal Weir, BBA, CHESP, REH

http://johnmichaelweir.com/tag/mrsa/

The process of physical cleaning of environmental surfaces using detergent (soap), water, and friction is the critical step required prior to surface disinfection. The combination of the cleaning and disinfection processes is designed to remove and kill vegetative microorganisms on surfaces. Disinfection will not be effective in the presence of dirt, blood, or other bio burden. The goal of the cleaning step is to remove bio burden and with it, the majority of pathogens. Disinfection is designed to be a synergistic and somewhat redundant step to ensure comprehensive removal/kill of pathogens on surfaces.

The CDC’s Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, states that, “noncritical surfaces (e.g., dialysis bed or chair, countertops, external surfaces of dialysis machines) should be disinfected with an EPA-registered disinfectant unless the item is visibly contaminated with blood. In that case, an EPA registered tuberculocidal agent with specific label claims for HBV and HIV should be used.”1 the commonly used disinfectant for blood contaminated environmental surfaces is a 1:100 dilution of bleach (500–600 parts per million [ppm] free chlorine).

Read full text here

2012-01-11T21:43:00.003+08:00

Revisitng Methicillin-Resistant Staphyloccus Aureas

(MRSA) infections

Abdelkarim Waness
Division of Internal Medicine, King Abdulaziz Medical City, Dept of Medicine, Code #1443 PO Box11465 Saudi Arabia

Abstract

Within less than 50 years, methicillin-resistant Staphylococcus aureus (MRSA) made a tremendous impact worldwide. It is not limited to medical facilities and healthcare institutions anymore. Indeed since two decades, cases of MRSA infections arising from the community among apparently healthy individuals are increasing. In this paper, I will present a case of community-associated MRSA sepsis followed by a comprehensive review about the history, pathogenesis, epidemiology, clinical presentations, diagnostic modalities, therapeutic options, contributing factors, growing cost and other pertinent elements of this newly evolving epidemic of MRSA infections.

MUST READ - full text here

2012-01-05T19:30:00.001+08:00

The Challenge of Methicillin-Resistant Staphylococcus aureus

Prevention in Hemodialysis Therapy.

Parker MG, Doebbeling BN.

Source

Division of Nephrology and Transplantation, Maine Medical Center, Portland, Maine VA HSR&D Center on Implementing Evidence-Based Practice, Indianapolis VAMC, Indianapolis, Indiana Regenstrief Institute and Indiana University Center for Health Services and Outcomes Research, Indianapolis, Indiana Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.

Semin Dial. 2011 Dec 9. doi: 10.1111/j.1525-139X.2011.00999.x. [Epub ahead of print]

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) infections have challenged care process and resource utilization in the acute hospital care setting for nearly 30 years. These infections have become important causes of morbidity, mortality, and a source of concern in the primary and emergency care context over the past decade.

As individuals receiving recurrent therapy with features of both ambulatory care and acute care, hemodialysis patients are exposed to numerous opportunities for MRSA acquisition. Surprisingly, high prevalence rates for MRSA colonization have been demonstrated for both hemodialysis patients and their care providers.

The necessity of vascular access and the persistent high prevalence of endovascular catheter use among patients repeatedly exposed to healthcare settings provide the perfect milieu for the troubling rates of MRSA infection, particularly bloodstream infections, in outpatient dialysis care. Dialysis industry shifts, including increased requirements for compliance and reporting in other areas of dialysis care, tax resources for infection prevention processes.

Multifaceted strategies that include reassessment of vascular access care, attention to the interruption of MRSA transmission dynamics, and emphasis on organizational learning processes are needed to accomplish a meaningful reduction in the morbidity, mortality, and cost associated with MRSA infections in dialysis care.

2011-12-31T11:11:00.002+08:00

WISHING

ALL MALAYSIAN

MERRY AND HAPPY

NEW YEAR 2012

Warmest Regards and Best Wishes

MalaysianKidneySPA

2011-12-29T13:07:00.000+08:00

The Scribner shunt: 50 years later

Joseph B Lockridge¹ and Sindhu Chandran²

¹Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
²Division of Nephrology, Kidney Transplant Unit, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
http://www.nature.com/ki/journal/v81/n1/full/ki2011344a.html

A 49-year-old male with end-stage renal disease returned to the United States 6 months following a repeat renal transplant in the Philippines that had failed 1 month after surgery. He presented with no records of his surgery or hospitalization, and stated that he had been on hemodialysis for 5 months. A Scribner shunt in the left arm (Figure 1) was identified by the nephrology service about 24 h following admission, with the connecting segment visible about 0.5 cm between the shunt lines (Figure 2). The arm was immediately covered with a dressing to minimize the risk of avulsion or interruption of the tubing, arterial clamps were made available at the bedside, and the device was removed 3 days later by a vascular surgeon. The ‘simplified’ or ‘poor-man's’ Scribner shunt (as it was known in the United Kingdom because it was inserted by the renal senior house officer rather than the surgeon) was developed in 1964 and consists of a simple loop of Teflon, which connects indwelling cannulae in the artery and vein. The connecting segment allows the artery and vein extensions to be attached to the dialyzer during dialysis and to be re-connected to each other after the treatment is completed. These shunts were prone to thrombosis, infection, and dislodgement and disappeared from most countries in the late 1970s and early 1980s, as venous catheters became widely adopted for temporary hemodialysis access. Many younger nephrologists in the United States have never seen a Scribner shunt. Prompt visual recognition is essential to avoid inadvertent manipulation or cannulation of the shunt, which can result in catastrophic bleeding.

2011-12-25T10:47:00.002+08:00

2011-12-24T09:13:00.002+08:00

Wishing

All Christian Brothers and Sisters

A Merry & Blessed

Christmas

A Happy New Year

Best Wishes and Warmest Regards

MalaysianKidneySPA

2011-12-24T09:08:00.002+08:00

2011-12-23T13:40:00.000+08:00

Dietary salt influences postprandial plasma sodium concentration and systolic blood pressure

Rebecca J Suckling¹, Feng J He², Nirmala D Markandu² and Graham A MacGregor²

¹Department of Cardiovascular Medicine, St George's University of London, London, UK
²Barts and The London School of Medicine & Dentistry, Wolfson Institute of Preventive Medicine, London, UK

Kidney International advance online publication 2 November 2011; doi: 10.1038/ki.2011.369

Abstract:

The plasma sodium concentration has a direct effect on blood pressure in addition to its effects on extracellular volume regulated through changes in the endothelium. The mechanism for elevated blood pressure seen with habitually increased salt intake is unclear, especially the effect of salt in a single meal on plasma sodium concentration and blood pressure. To resolve this we compared the effect of soup with or without 6 g of salt (an amount similar to that in a single meal) on the plasma sodium concentration and blood pressure in 10 normotensive volunteers using a randomized, crossover design. The plasma sodium concentration was significantly increased by 3.13±0.75 mmol/l with salted compared with unsalted soup. Blood pressure increased in volunteers ingesting soup with added salt, and there was a significant positive correlation between plasma sodium concentration and systolic blood pressure. A 1-mmol/l increase in plasma sodium was associated with a 1.91-mm Hg increase in systolic blood pressure by linear regression. Thus, changes in plasma sodium concentration occur each time a meal containing salt is consumed. A potential mechanism for the changes in blood pressure seen with salt intake may be through its effects on plasma sodium concentration.

2011-12-21T11:25:00.002+08:00

Dietary acid reduction with fruits and vegetables or bicarbonate attenuates kidney injury in patients with a moderately reduced glomerular filtration rate due to hypertensive nephropathy

Nimrit Goraya^1,2, Jan Simoni³, Chanhee Jo⁴ and Donald E Wesson^1,4

¹Department of Internal Medicine, Texas A&M College of Medicine, Temple, Texas, USA
²Department of Internal Medicine, Scott and White Healthcare, Temple, Texas, USA
³Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
⁴Department of Biostatistics, Scott and White Healthcare, Temple, Texas,
USAKidney International (2012) 81, 86–93; doi:10.1038/ki.2011.313; published online 31 August 2011

Abstract

The neutralization of dietary acid with sodium bicarbonate decreases kidney injury and slows the decline of the glomerular filtration rate (GFR) in animals and patients with chronic kidney disease. The sodium intake, however, could be problematic in patients with reduced GFR. As alkali-induced dietary protein decreased kidney injury in animals, we compared the efficacy of alkali-inducing fruits and vegetables with oral sodium bicarbonate to diminish kidney injury in patients with hypertensive nephropathy at stage 1 or 2 estimated GFR. All patients were evaluated 30 days after no intervention; daily oral sodium bicarbonate; or fruits and vegetables in amounts calculated to reduce dietary acid by half. All patients had 6 months of antihypertensive control by angiotensin-converting enzyme inhibition before and during these studies, and otherwise ate ad lib. Indices of kidney injury were not changed in the stage 1 group. By contrast, each treatment of stage 2 patients decreased urinary albumin, N-acetyl β-d-glucosaminidase, and transforming growth factor β from the controls to a similar extent. Thus, a reduction in dietary acid decreased kidney injury in patients with moderately reduced eGFR due to hypertensive nephropathy and that with fruits and vegetables was comparable to sodium bicarbonate. Fruits and vegetables appear to be an effective kidney protective adjunct to blood pressure reduction and angiotensin-converting enzyme inhibition in hypertensive and possibly other nephropathies.

2011-12-16T14:49:00.001+08:00

Chronic renal failure from lead: myth or evidence-based fact?

Evans M, Elinder CG

Nephrology Unit, Department of Clinical Sciences Intervention and Technology, Karolinska Institute, Stockholm, Sweden. marie.evans@ki.se

Kidney Int. 2011 Feb;79(3):272-9. Epub 2010 Oct 13.

Abstract

In this mini review, we would like to challenge the well-established 'fact' that lead exposure causes chronic renal failure (CRF). Even though only scarce evidence exists of the relationship between lead and renal failure, a World Health Organization Environmental Health Criteria document summarizes that 'Lead has been a very common cause of acute or chronic renal failure'. It is also written and cited in textbooks and numerous publications that chronic lead nephropathy causes a slowly progressive interstitial nephritis manifested by a reduced glomerular filtration rate, and that there is a growing consensus that lead contributes to hypertension in the general population. We will argue that, when published reports are carefully scrutinized, such statements on lead and CRF are not evidence based but are rather founded on a few narrative reports on lead-exposed individuals and statistical associations between lead and serum creatinine (or urea) in a few population studies. We will, however, not argue that lead is not toxic and that lead does not cause other types of severe health effects where the evidence is unquestionable, but we do not believe that the kidneys are an early victim after lead exposure.

2011-12-12T13:34:00.001+08:00

Daulat Tuanku!

2011-12-07T12:26:00.000+08:00

The deleterious effect of metabolic acidosis on nutritional status of hemodialysis patients.

Soleymanian T, Ghods A.

Source

Division of Nephrology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Saudi J Kidney Dis Transpl. 2011 Nov;22(6):1149-54.

Abstract

One of the main causes of protein-energy malnutrition in patients on maintenance hemodialysis (MHD) is metabolic acidosis. The aim of this study was to evaluate the effect of metabolic acidosis on nutritional status in a group of MHD patients with adequately delivered dialysis treatment. Of 165 eligible anuric MHD outpatients with Kt/V ≥ 1 and no underlying inflammatory diseases, 47 subjects were enrolled. In order to evaluate the effect of different parameters on serum albumin, we measured the pre-dialysis serum albumin, blood pH, serum bicarbonate (HCO 3‾ ), Kt/V, normalized protein catabolic rate (nPCR) and body mass index (BMI) in these patients. The mean age of the study patients was 55 ± 13.8 years; there were 22 females and six diabetics. The average Kt/V was 1.22 ± 0.16, pH was 7.40 ± 0.15, serum HCO 3‾ was 23.18 ± 2.38 mEq/L, serum albumin was 4.03 ± 0.56 g/dL, nPCR was 1.00 ± 0.16 g/kg/day, post-dialysis body weight was 58.50 ± 11.50 kg and BMI was 23.47 ± 2.70 kg/m 2 . There was a statistically significant direct correlation between serum albumin and BMI (r = 0.415, P = 0.004), and between serum albumin and serum HCO 3 (r = 0.341, P = 0.019). On multiple regression analysis, the predictors of serum albumin were serum HCO3‾ and BMI (direct effect) and nPCR (inverse effect). In 17 patients on MHD with serum HCO3‾ <22 mEq/L, there was a significant inverse correlation between HCO 3 and nPCR (r = 0.492, P = 0.045), and these patients had significantly lower serum albumin compared with patients with serum HCO3‾ >22 mEq/L (P = 0.046). These data demonstrate that patients on MHD with metabolic acidosis had a lower serum albumin concentration despite adequate dialysis treatment. The inverse effect of nPCR on serum albumin concentration in acidotic MHD patients may be due to hypercatabolism in the setting of metabolic acidosis, leading to deleterious effects on the nutritional status of patients on MHD

2011-12-02T12:12:00.000+08:00

Long interdialytic interval and mortality among patients receiving hemodialysis.

Robert N Foley, David T Gilbertson, Thomas Murray and Allan J Collins N Engl J Med 365(12):1099-107 (2011) PMID 21992122 DOI: 10.1056/NEJMoa1103313

Patients with end-stage renal disease requiring dialysis have limited tolerance of metabolic and volume-related deviations from normal ranges; in addition, the prevalence of cardiovascular disease is high among such patients. Given these problems, we hypothesized that a long interdialytic interval is associated with adverse events in patients receiving hemodialysis. We studied 32,065 participants in the End-Stage Renal Disease Clinical Performance Measures Project, a nationally representative sample of U.S. patients receiving hemodialysis three times weekly, at the end of calendar years 2004 through 2007. We compared rates of death and cardiovascular-related hospital admissions on the day after the long (2-day) interdialytic interval with rates on other days. The mean age of the cohort was 62.2 years; 24.2% of the patients had been receiving dialysis treatment for 1 year or less. Over a mean follow-up interval of 2.2 years, the following event rates were higher on the day after the long interval than on other days: all-cause mortality (22.1 vs. 18.0 deaths per 100 person-years, P<0.001), mortality from cardiac causes (10.2 vs. 7.5, P<0.001), infection-related mortality (2.5 vs. 2.1, P = 0.007), mortality from cardiac arrest (1.3 vs. 1.0, P = 0.004), mortality from myocardial infarction (6.3 vs. 4.4, P<0.001), and admissions for myocardial infarction (6.3 vs. 3.9, P<0.001), congestive heart failure (29.9 vs. 16.9, P<0.001), stroke (4.7 vs. 3.1, P<0.001), dysrhythmia (20.9 vs. 11.0, P<0.001), and any cardiovascular event (44.2 vs. 19.7, P<0.001). The long (2-day) interdialytic interval is a time of heightened risk among patients receiving hemodialysis. (Funded by the National Institutes of Health.).

2011-11-29T19:16:00.002+08:00

Hypercholesterolemia promotes early renal dysfunction in apolipoprotein E-deficient mice

Camille M Balarini, Mariana ZT Oliveira, Thiago MC Pereira, Nyam F Silva, Elisardo C Vasquez, Silvana S Meyrelles andAgata L Gava

Published: 26 November 2011 Lipids in Health and Disease 2011, 10:22doi:10.1186/1476-511X-10-220

Abstract

Background

Aging and dyslipidemia are processes which can lead to deleterious consequences to renal function. Therefore, the aim of this study was to determine the effects of both hypercholesterolemia and aging on renal function in mice.

Methods

Male hypercholesterolemic apolipoprotein E-deficient mice (ApoE, n=13) and age-matched C57BL/6 control mice (C57, n=15) were studied at 2 (young) and 8 (adult) month-old. At each time point, animals were placed in metabolic cages for 24 hours to urine volume and urinary creatinine quantification. Blood samples were collected for serum cholesterol, urea and creatinine measurements. Glomerular filtration rate (GFR) was estimated through creatinine clearance determination. Mesangial expansion was evaluated by Periodic Acid Schiff staining, renal fibrosis was determined through Masson's trichrome staining and neuronal nitric oxide synthase (nNOS) expression in the kidney was performed by Western Blotting. To statistical analysis two- way ANOVA followed by Fisher's post hoc test was used.

Results

Total plasma cholesterol was increased about 5-fold in ApoE mice at both time points compared to C57 animals. At 2-month-old, GFR was already markedly reduced in ApoE compared to C57 mice (187 +/- 28 vs 358 +/- 92 uL/min, p<0.05). Adult C57 (-77%) and ApoE (-50%) mice also presented a significant reduction of GFR. In addition, serum urea was significantly increased in young ApoE animals compared to C57 mice (11 +/- 1.3 vs 7 +/- 0.9 mmol/L, p<0.01). A significant mesangial expansion was observed at 2-month old ApoE mice compared to C57 mice (35 +/- 0.6 vs 30 +/- 0.9 %, respectively, p<0.05), which was aggravated at 8-month old animals (40 +/- 3 and 35 +/- 3 %, respectively). Tubulointersticial fibrosis was augmented at both young (17 +/- 2%, p<0.05) and adult (20 +/- 1 %, p<0.05) ApoE mice compared to respective C57 age controls (8 +/- 1 and 12 +/- 2%, respectively). The expression of nNOS was markedly reduced in a time-dependent manner in both strains.

Conclusions

These data show that both hypercholesterolemia and aging contribute to the loss of renal function in mice.

2011-11-25T11:12:00.000+08:00

Uric acid is a strong independent predictor of renal dysfunction in patients with rheumatoid arthritis

Dimitrios Daoussis¹, Vasileios Panoulas¹, Tracey Toms¹, Holly John¹, Ioannis Antonopoulos¹, Peter Nightingale², Karen MJ Douglas¹, Rainer Klocke¹ and George D Kitas^1,³^*

¹Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, Pensnett Road, Dudley, West Midlands, DY1 2HQ, UK

²Wolfson Laboratory, Department of Medical Statistics, School of Medicine, University of Birmingham, Queen Elizabeth Medical Centre, Edgbaston, Birmingham, B15 2TH, UK

Arthritis Research & Therapy 2009, 11:R116 doi:10.1186/ar2775

Introduction

Arthritis Research Campaign Epidemiology Unit, University of Manchester, Oxford Road, Stopford Building, Manchester, M13 9PT, UKRecent evidence suggests that uric acid (UA), regardless of crystal deposition, may play a direct pathogenic role in renal disease. We have shown that UA is an independent predictor of hypertension and cardiovascular disease (CVD), and that CVD risk factors associate with renal dysfunction, in patients with rheumatoid arthritis (RA). In this study we investigated whether UA associates with renal dysfunction in patients with RA and whether such an association is independent or mediated through other comorbidities or risk factors for renal impairment.

Methods

Renal function was assessed in 350 consecutive RA patients by estimated glomerular filtration rate (GFR) using the six-variable Modification of Diet in Renal Disease equation. Risk factors for renal dysfunction were recorded or measured in all participants. Linear regression was used to test the independence of the association between GFR and UA.

Results

Univariable analysis revealed significant associations between GFR and age, systolic blood pressure, total cholesterol, triglycerides, RA duration and UA. UA had the most powerful association with renal dysfunction (r = -0.45, P < 0.001). A basic model was created, incorporating all of the above parameters along with body mass index and gender. UA ranked as the first correlate of GFR (P < 0.001) followed by age. Adjustments for the use of medications (diuretics, low-dose aspirin, cyclooxygenase II inhibitors and nonsteroidal anti-inflammatory drugs) and further adjustment for markers of inflammation and insulin resistance did not change the results.

Conclusions

UA is a strong correlate of renal dysfunction in RA patients. Further studies are needed to address the exact causes and clinical implications of this new finding. RA patients with elevated UA may require screening for renal dysfunction and appropriate management

2011-11-21T18:13:00.002+08:00

The Effect of High-Flux Hemodialysis on Hemoglobin Concentrations in Patients with CKD: Results of the MINOXIS Study.

Schneider A, Drechsler C, Krane V, Krieter DH, Scharnagl H, Schneider MP, Wanner C; for the MINOXIS Study Investigators.

Source

Division of Nephrology, University Hospital Würzburg, Würzburg, Germany;

Abstract

Background and objectivesHemodialysis treatment induces markers of inflammation and oxidative stress, which could affect hemoglobin levels and the response to erythropoietin use. This study sought to determine whether high-flux dialysis would help improve markers of renal anemia, inflammation, and oxidative stress compared with low-flux dialysis.Design, settings, participants, & measurementsIn a prospective, controlled study, 221 patients undergoing maintenance hemodialysis and receiving darbepoetin-alfa treatment (mean age, 66 years; 55% male) from 19 centers were screened in a 20-week run-in period of low-flux hemodialysis with a synthetic dialysis membrane. Thereafter, 166 patients were enrolled and randomly assigned to receive a synthetic high-flux membrane or to continue on low-flux dialysis for 52 weeks. Data on myeloperoxidase, oxidized LDL, high-sensitivity C-reactive protein, and the Malnutrition Inflammation Score were collected at baseline and after 52 weeks; routine laboratory data, such as hemoglobin, ferritin, and albumin, and the use of darbepoetin-alfa, were also measured in the run-in period.

Results. After 52 weeks, the low-flux and the high-flux groups did not differ with respect to hemoglobin (mean ± SD, 11.7±0.9 g/dl versus 11.7±1.1 g/dl; P=0.62) or use of darbepoetin-alfa (mean dosage ± SD, 29.8±24.8 μg/wk versus 26.0±31.1 μg/wk; P=0.85). Markers of inflammation, oxidative stress, or nutritional status also did not differ between groups.

Conclusion. Over 1 year, high-flux dialysis had no superior effects on hemoglobin levels or markers of inflammation, oxidative stress, and nutritional status. These data do not support the hypothesis that enhanced convective toxin removal would improve patient outcome.

Clin J Am Soc Nephrol. 2011 Nov 17. [Epub ahead of print]: http://www.ncbi.nlm.nih.gov/pubmed/22096040

2011-11-15T15:04:00.001+08:00

Handgrip strength is an independent predictor of renal outcomes in patients with chronic kidney diseases

¹Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan

²Department of Nutrition, National Cheng Kung University Hospital, Tainan, Taiwan
³Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
⁴Children's Medical Center, China Medical University Hospital, Taichung, Taiwan

http://ndt.oxfordjournals.org/content/26/11/3588.

Abstract

Background. In dialysis patients, protein-energy wasting (PEW) is associated with high mortality, and some indicators of PEW, such as serum albumin value, subjective global assessment (SGA) score and handgrip strength (HGS), may predict mortality. However, whether PEW is associated with poor renal outcomes and whether the indicators of PEW can predict renal outcomes in patients with non-dialysis-dependent chronic kidney disease (CKD-ND) is still unclear.

Methods. We enrolled 128 clinically stable patients with CKD-ND and followed up for 33.8 ± 9.2 months. Baseline characteristics, echocardiographic information, laboratory data, HGS, SGA scores, anthropometric parameters, bioimpedance analyses and other indicators of PEW were examined in relation to the risk of reaching renal composite end points of pre-dialysis mortality or dialysis-dependent end-stage renal disease.

Results. Twenty-six patients reached composite renal end points. Multivariate Cox regression analyses showed that HGS was an independent predictor of renal outcome in patients with CKD-ND of Stages 1–5 [CKD_1–5, hazard ratio (HR) = 0.90, P = 0.004] or advanced CKD-ND of Stages 3b [defined as estimated glomerular filtration rate (eGFR) of 30–44 mL/min/1.73m²] to 5 (CKD_3b–5, HR = 0.91, P = 0.031), but not serum albumin, SGA score or other indicators of PEW. When the cutoffs were set at 24.65 kg in men with CKD_1–5, 20.15 kg in men with CKD_3b–5 and 10.15 kg in women with CKD_1–5 or CKD_3b–5, which were deduced from receiver-operating characteristics analyses, patients with lower HGS had significantly poor renal outcomes in Kaplan–Meier survival analyses in all subgroups and higher HR for reaching renal end points in multivariate Cox regression analyses in all subgroups except for women with CKD_3b–5, whose HR had marginal significance (HR = 3.78, P = 0.068) after adjusting for age and eGFR.

Conclusions. This is the first study demonstrating that HGS is an independent predictor of composite renal outcomes in CKD-ND patients. HGS can be incorporated to clinical practice for assessing nutrition status and renal prognosis in patients with CKD-ND

2011-11-08T14:05:00.002+08:00

Effect of intradialytic resistance band exercise on physical function in patients on maintenance hemodialysis: a pilot study.

Bullani R, El-Housseini Y, Giordano F, Larcinese A, Ciutto L, Bertrand PC, Wuerzner G, Burnier M, Teta D.

Source

Department of Nephrology, University Hospital (CHUV), Rue du Bugnon 17, Lausanne, Switzerland. Roberto.Bullani@chuv.ch

Abstract

Although physical activity is recommended in patients on maintenance hemodialysis (MHD), randomized controlled trials testing the effects of exercise in this population have given conflicting results. In general, aerobic exercises mostly failed to produce improvements in physical function, whereas resistance exercises, although less studied, appeared to be more promising. The use of sophisticated materials such as leg press and free weights may preclude widespread application of resistance training in patients on MHD. Simple and cheap elastic bands may thus be an attractive alternative. We tested the feasibility of a supervised intradialytic resistance band exercise training program, and its effects on physical function, in patients on MHD. A total of 11 unselected adult patients on MHD from our center, aged 70 ± 10.7 (mean ± standard deviation) years, including 8 men and 3 women, accepted to follow the program under the supervision of qualified physiotherapists. Thirty-six exercise sessions of moderate intensity (twice a week, mean duration 40 minutes each, during 4.5 to 6 months), mainly involving leg muscles against an elastic resistance, were performed. The exercise program was well tolerated and all patients completed it. Statistically significant improvements were observed in the following tests: Tinetti test, 23.9 ± 3.9 points before versus 25.7 ± 3.5 points after the program (P = .022); the Timed Up and Go test, 12.1 ± 6.6 versus 10 ± 5.8 seconds (P = .0156). Improvements in the 6-minute walk distance and in the one-leg balance tests just failed to reach statistical significance. In this single-center pilot study, an intradialytic resistance band exercise program was feasible, well tolerated, and showed encouraging results on physical function.

PMID:: 21195922; [PubMed - indexed for MEDLINE]

2011-11-04T19:39:00.002+08:00

Wishing All

Our Muslim Brothers and Sisters

A Selamat Hari Raya Adil Adha

(May all your scarifices be blessed)

Best Wishes & Warmest Regards

Malaysian KidneySPA

2011-11-02T14:35:00.000+08:00

The primary patency of percutaneous transluminal angioplasty in hemodialysis patients with vascular access failure.

Kim WS, Pyun WB, Kang BC.

Source

Division of Cardiology, Department of Internal Medicine, Mokdong Hospital, School of Medicine, Ewha Womans University, Seoul, Korea.

PMID:

22022326 PubMed - in process]
PMCID: PMC3193042

Abstract

BACKGROUND AND OBJECTIVES:

Dysfunction of arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) contributes significantly to morbidity and hospitalization in the dialysis population. We evaluated the primary patency of AVFs following percutaneous transluminal angioplasty (PTA) in haemodialysis patients.

SUBJECTS AND METHODS: We performed 231 interventions in 118 patients with a mean age of 62.1±12.9 years. We performed 122 interventions in 53 AVG patients (44.9%), and 109 interventions in 65 AVF patients (55.1%). If there was thrombosis of the vascular access, urokinase was administered and/or thrombus aspiration was performed. The stent was inserted when balloon dilatation did not expand sufficiently or elastic recoil occurred.

RESULTS:

For the 118 patients, the median patency time was 10.45±10.29 months at 92 months of follow-up. The primary patencies for stenotic AVFs at 6, 12, 24, 36, 48, and 60 months were 63.4%, 41.4%, 17.0%, 9.7%, 7.3%, and 2.4%, respectively. The primary patencies for AVGs at 6, 12, 24, and 36 months were 36.9%, 19.5%, 10.8%, 2.1%, respectively, and were obtained by means of the Kaplan-Meier analysis (log rank=6.42, p<0.05). The median patency time was 11.0 months and 4.45 months in the non-thrombus and thrombus groups, respectively. The complication rate was 1.73% (4/231); two cases of pseudoaneurysms and two cases of extravasation were detected. All therapy failures (5/231) occurred in thrombotic lesions of AVGs and were treated surgically.

CONCLUSION:

PTA is an efficacious method for the correction of stenosis of AVFs for hemodialysis, thus prolonging the patency of the fistulas.

2011-10-27T14:16:00.002+08:00

Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality

Jennifer E. Flythe,¹ Stephen E. Kimmel,² and Steven M. Brunelli¹

¹Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA

²Cardiology Division, Department of Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

PruMed Central: PMCID: PMC3091945

Abstract

Patients receiving hemodialysis have high rates of cardiovascular morbidity and mortality that may be related to the hemodynamic effects of rapid ultrafiltration. Here we tested whether higher dialytic ultrafiltration rates are associated with greater all-cause and cardiovascular mortality, and hospitalization for cardiovascular disease. We used data from the Hemodialysis Study, an almost-7-year randomized clinical trial of 1846 patients receiving thrice-weekly chronic dialysis. The ultrafiltration rates were divided into three categories: up to 10 ml/h/kg, 10–13 ml/h/kg, and over 13 ml/h/kg. Compared to ultrafiltration rates in the lowest group, rates in the highest were significantly associated with increased all-cause and cardiovascular-related mortality with adjusted hazard ratios of 1.59 and 1.71, respectively. Overall, ultrafiltration rates between 10–13 ml/h/kg were not associated with all-cause or cardiovascular mortality; however, they were significantly associated among participants with congestive heart failure. Cubic spline interpolation suggested that the risk of all-cause and cardiovascular mortality began to increase at ultrafiltration rates over 10 ml/h/kg regardless of the status of congestive heart failure. Hence, higher ultrafiltration rates in hemodialysis patients are associated with a greater risk of all-cause and cardiovascular death.

Read full article here

2011-10-25T08:50:00.002+08:00

Wishing All Our

Hindu Brothers & Sisters

A Happy and Blessed Diwali

May the "True Light" prevail

Best and Warmest Regards

MalaysianKidneySPA

2011-10-24T09:47:00.000+08:00

Inform family about pledges, organ donors told

The Star Online 24/10/2011

http://thestar.com.my/news/story.asp?file=/2011/10/24/nation/9760649&sec=nation

KUALA LUMPUR: Those who have pledged to be organ and tissue donors should inform their families to avoid “complications”.

Deputy Health Minister Datuk Rosnah Abdul Rashid Shirlin said that in most cases, family members of the deceased did not know of the pledge made.

“If they do not inform their next-of-kin, no one will know about it. If the family does not allow it, there is nothing that can be done,” she told reporters after launching the Bicara Hati programme in conjunction with Organ Donation Awareness Week 2011.

To create more awareness, she said the ministry had stepped up its campaigns and held forums, debates and health workshops through the “Young Doctors” programme.

Rosnah said donors should be hailed as community heroes and for upholding the 1Malaysia spirit.

She also paid tribute to family members who consented to the organ pledges.

2011-10-17T13:32:00.000+08:00

Measuring the quality of end of life management in patients with advanced kidney disease: results from the pan-Thames renal audit group

Stephen P. McAdoo1,
Edwina A. Brown1,
Alistair M. Chesser2
Ken Farrington3,
Emma M. Salisbury1 and
on behalf of pan-Thames renal audit group

1. ¹Imperial College Kidney and Transplant Institute, Hammersmith Hospital, London, UK
2. ²Renal Department, Barts and the London NHS Trust, London, UK
3. ³Lister Hospital Renal Unit, North Herts NHS Trust, Stevenage, UK
Background. Despite a recent increased awareness of the need for quality End of Life (EOL) care for patients with advanced kidney disease, there is no established method for measuring or auditing outcomes relating to EOL care in this population.
Methods. We designed a one-page proforma, which was used to collect data on various aspects of EOL care relating to all deaths of patients on dialysis and patients dying on specialist renal wards, over a predefined 8-week period in 10 hospitals in London and South–East England.
Results. One hundred and thirty-eight deaths were recorded over the 8-week study period. The majority of patients (83%) were receiving maintenance haemodialysis prior to their terminal presentation. About 69% of deaths occurred during an in-patient hospital admission—of these, 36% were considered ‘unexpected’ and most quality markers of good EOL management were significantly less likely to be achieved in these patients, including use of palliative care strategies, good symptom control and overall quality of death. Thirty-six per cent of patients were from various ethnic minorities, and in this group, there was a trend towards lower use of palliative care pathways and lower rates of withdrawal from dialysis.
Conclusions. This study confirms that it is possible to measure many important outcomes relating to quality of EOL care using a proforma completed at the time of death. Our findings suggest that many aspects of good EOL care are under-achieved in our region. This, in part, is due to a failure to recognize the worsening trajectory of the deteriorating patient, resulting in missed opportunities for EOL care planning and appropriate symptom control. Our observations suggest that there is a need for improved education and training in this area, particularly in detection of the dying patient, the value of advance care planning and the utility of tools such as the Liverpool Care Pathway.

2011-10-17T13:23:00.002+08:00

No meds for unapproved ops

By WONG PEK MEI
pekmei@thestar.com.my

http://thestar.com.my/news/story.asp?file=/2011/10/17/nation/9711992&sec=nation

BANGI: Malaysians who travel abroad for organ transplants provided on commercial basis will not be allowed to get free supply of immunosuppressant drugs from Government hospitals, which costs between RM800 and RM1,000 per patient per month.

These drugs are used to inhibit or prevent activity of the immune system and to prevent the rejection of transplanted organs and tissues.

Health Minister Datuk Seri Liow Tiong Lai said the move, which takes effect from January, is to stop people from going overseas to get such treatment from unrecognised hospitals without the ministry's approval or knowledge.

He said many patients go for organ transplants at hospitals in foreign countries that are not recognised.

Read full article here

2011-10-12T12:19:00.002+08:00

57% rise in dialysis patients since 2006

The Star Online 12/10/2011

http://thestar.com.my/news/story.asp?file=/2011/10/12/parliament/9678055&sec=parliament

THE number of patients who had dialysis treatment rose by 56.7% from 14,946 patients in 2006 to 23,420 in 2010.

Deputy Health Minister Datuk Rosnah Abdul Rashid Shirlin said that of the total, 7,115 underwent treatment at government dialysis centres, 9,813 at private centres and 6,492 at centres run by non-governmental organisations (NGOs).

“In 2009, the number of patients with kidney failure who underwent dialysis nationwide was 21,543.

“Of the total, 7,103 underwent dialysis in government dialysis centres, 8,356 in private centres and 6,084 at centres run by NGOs,” she told Chong Eng (DAP-Bukit Mertajam).

Chong had asked for the number of kidney dialysis centres operated by the Government and private sectors as well as NGOs.

She had also asked for the number of patients receiving treatment at these centres each year for the past five years.

Rosnah said there were 181 government-operated dialysis centres, 297 private dialysis centres and 140 dialysis centres operated by NGOs last year.

She added that for Penang, there were 10 dialysis centres operated by the Government, 27 private dialysis centres and 20 operated by NGOs.

“The number of people seeking treatments at these centres is increasing yearly,” she said.

2011-10-12T10:02:00.000+08:00

For listening pleasure....

2011-10-06T19:00:00.000+08:00

Chinese are 50pc of organ donors since 1997

October 06, 2011

http://www.themalaysianinsider.com/malaysia/article/chinese-are-50pc-of-organ-donors-since-1997/

KUALA LUMPUR, Oct 6 — Out of 28 million Malaysians, only 181,534 persons became organ donors since 1997, with 55.29 per cent of them Chinese.

Organ Donation Action Committee chairman Tan Sri Lee Lam Thye told Bernama Online today that number only represents 0.64 per cent of the population.

In 2011 so far, 342 donors underwent successful transplant surgery — 33 of them cadaveric donors.

He said there were 14,037 patients on the wait list for organs, almost all of them (14,013) needing kidneys.

He was speaking at a press conference in conjunction with the 2011 National Organ Donation Awareness Week.

While the Chinese topped the number of donors in terms of race demographics, Indians were at 24.25 per cent and Malays, 17.64 per cent, said Lee.

But the Malay donors are increasing said Lee, with the 6,412 registered in 2011 up to September outstripping the 2010 total of 4,275.

The awareness campaign begins on October 16 and the health ministry is targeting those between the ages of 15 and 25.

Lee explained that early education was important, and that donors should inform their registration to their families.

The upcoming campaign is themed "1Malaysia 1Hope: Donate for Life", and will have walkathons, seminars, an Islamic forum entitled "Organ Donation" and the Friday sermon at the National Mosque will cover the subject.

2011-10-05T19:39:00.000+08:00

Should there be an expanded role for palliative care in end-stage renal disease?

Kurella Tamura M, Cohen LM.

Source

Division of Nephrology, Stanford University School of Medicine and Geriatric Research and Education Clinical Center, Palo Alto Veterans Affairs Healthcare System, Palo Alto, California, USA. mktamura@stanford.edu

Curr Opin Nephrol Hypertens. 2010 Nov;19(6):556-60.

http://www.ncbi.nlm.nih.gov/pubmed/20644475

Abstract

PURPOSE OF REVIEW:

In this review, we outline the rationale for expanding the role of palliative care in end-stage renal disease (ESRD), describe the components of a palliative care model, and identify potential barriers in implementation.

RECENT FINDINGS:

Patients receiving chronic dialysis have reduced life expectancy and high rates of chronic pain, depression, cognitive impairment, and physical disability. Delivery of prognostic information and advance care planning are desired by patients, but occur infrequently. Furthermore, although hospice care is associated with improved symptom control and lower healthcare costs at the end of life, it is underutilized by the ESRD population, even among patients who withdraw from dialysis. A palliative care model incorporating communication of prognosis, advance care planning, symptom assessment and management, and timely hospice referral may improve quality of life and quality of dying. Resources and clinical practice guidelines are available to assist practitioners with incorporating palliative care into ESRD management.

SUMMARY:

There is a large unmet need to alleviate the physical, psychosocial, and existential suffering of patients with ESRD. More fully integrating palliative care into ESRD management by improving end-of-life care training, eliminating structural and financial barriers to hospice use, and identifying optimal methods to deliver palliative care are necessary if we are to successfully address the needs of an aging ESRD population.

2011-09-29T19:30:00.004+08:00

A master's masterpiece, for your listening pleasure.....

2011-09-28T13:15:00.002+08:00

Probe commercial organ transplant claims, urge doctors

TheStar Online - http://thestar.com.my/news/story.asp?file=/2011/9/28/nation/9586539&sec=nation

By AUSTIN CAMOENS
austin@thestar.com.my

KUALA LUMPUR: Doctors from the Malaysian Transplant Association (MTA) and Malaysian Nephrology Association (MNA) have called on the police to investigate allegations that a Malaysian hospital is involved in commercial organ transplants.

MTA president Datuk Dr Harjit Singh said that recent media reports alleging Malaysia to be among several South-East Asian countries involved in commercial organ transplants had to be investigated.

He said the Malaysian Government had adopted the Istanbul Declaration regarding commercial organ transplants and is also a signatory to the World Health Organisation’s Guiding Principle on Organ Transplantation.

“Our national transplant policy cle-arly states that commercial and forced organ transplants are illegal,” he said.

Reand full article here

2011-09-27T10:21:00.002+08:00

Health Ministry looks into so-called Bangladeshi connection

The Star Online - (http://thestar.com.my/news/story.asp?file=/2011/9/27/nation/9582086&sec=nation)

KUALA LUMPUR: The Health Ministry will liaise with the Home Ministry and police concerning allegations that Malaysia is being probed over illegal kidney trade in Bangladesh.

Health director-general Datuk Dr Hasan Abdul Rahman said Malaysia took a serious view of recent press reports on the alleged involvement of Malaysian hospitals in the illegal activity.

“Malaysia, being a member of the World Health Organisation and a signatory to the Declaration of Istanbul on Organ Trafficking and Transplant Tourism, is committed to ensuring that such illegal practices are not undertaken in this country,” he said in a statement yesterday.

Dr Hasan reiterated that his ministry was committed to upholding the highest ethical and professional standards in organ donation and transplantation in the country.

He said transplants from unrelated donors needed to be vetted by the independent Unrelated Transplant Approval Committee but from records, there were no such requests or applications.

“To further regulate transplants in the country, the ministry is currently drafting a new comprehensive Transplantation Bill,” he said.

Read full article here

2011-09-23T12:46:00.000+08:00

Another beautiful Sarawak Sape music by Jerry Kamit

2011-09-22T13:03:00.002+08:00

Should there be an expanded role for palliative care in end-stage renal disease?

Curr Opin Nephrol Hypertens. 2010 Jul 16.

Kurella Tamura M, Cohen LM.

http://www.hemodialysis.com/should_there_be_an_expanded_role_for_palliative_care_in_end-stage_renal_disease.html

Abstract

PURPOSE OF REVIEW: In this review, we outline the rationale for expanding the role of palliative care in end-stage renal disease (ESRD), describe the components of a palliative care model, and identify potential barriers in implementation.

RECENT FINDINGS: Patients receiving chronic dialysis have reduced life expectancy and high rates of chronic pain, depression, cognitive impairment, and physical disability. Delivery of prognostic information and advance care planning are desired by patients, but occur infrequently.

Furthermore, although hospice care is associated with improved symptom control and lower healthcare costs at the end of life, it is underutilized by the ESRD population, even among patients who withdraw from dialysis.

A palliative care model incorporating communication of prognosis, advance care planning, symptom assessment and management, and timely hospice referral may improve quality of life and quality of dying. Resources and clinical practice guidelines are available to assist practitioners with incorporating palliative care into ESRD management.

SUMMARY: There is a large unmet need to alleviate the physical, psychosocial, and existential suffering of patients with ESRD. More fully integrating palliative care into ESRD management by improving end-of-life care training, eliminating structural and financial barriers to hospice use, and identifying optimal methods to deliver palliative care are necessary if we are to successfully address the needs of an aging ESRD population.

2011-09-17T09:22:00.003+08:00

Enjoy this beautiful tradtional Sarawak Sape music by Tan Nyan

2011-09-15T15:36:00.002+08:00

To All

MALAYSIANS

"Happy Malaysia Day"

Best Wishes and Warmest Regards

MalayianKidneySPA

Malaysian KidneySPA

Acute removal of common sepsis mediators does not explain the effects of extracorporeal blood purification in experimental sepsis

Non-infected hemodialysis catheters are associated with increased inflammation compared to arteriovenous fistulasNon-infected catheters increase CRP

Dietary salt influences postprandial plasma sodium concentration and systolic blood pressure

Health Ministry to hire graduate nurses

By JOSEPH SIPALAN - jsipalan@thestar.com.my

http://thestar.com.my/news/story.asp?file=/2012/2/7/nation/10687110&sec=nation

Nasal Carriage of Methicillin-resistant Staphylococcus aureus Is Associated with Higher All-Cause Mortality in Hemodialysis Patients.

The Challenge of Methicillin-Resistant Staphylococcus aureus

Prevention in Hemodialysis Therapy.

Source

The Scribner shunt: 50 years later

Dietary salt influences postprandial plasma sodium concentration and systolic blood pressure

Dietary acid reduction with fruits and vegetables or bicarbonate attenuates kidney injury in patients with a moderately reduced glomerular filtration rate due to hypertensive nephropathy

Chronic renal failure from lead: myth or evidence-based fact?

Kidney Int. 2011 Feb;79(3):272-9. Epub 2010 Oct 13.

Abstract

The deleterious effect of metabolic acidosis on nutritional status of hemodialysis patients.

Source

Abstract

Long interdialytic interval and mortality among patients receiving hemodialysis.

Hypercholesterolemia promotes early renal dysfunction in apolipoprotein E-deficient mice

Background

Methods

Results

Conclusions

Uric acid is a strong independent predictor of renal dysfunction in patients with rheumatoid arthritis

Methods

Results

Conclusions

The Effect of High-Flux Hemodialysis on Hemoglobin Concentrations in Patients with CKD: Results of the MINOXIS Study.

Source

Abstract

Handgrip strength is an independent predictor of renal outcomes in patients with chronic kidney diseases

http://ndt.oxfordjournals.org/content/26/11/3588.

Effect of intradialytic resistance band exercise on physical function in patients on maintenance hemodialysis: a pilot study.

Source

Abstract

The primary patency of percutaneous transluminal angioplasty in hemodialysis patients with vascular access failure.

Source

PMID:22022326 PubMed - in process] PMCID: PMC3193042

Abstract

BACKGROUND AND OBJECTIVES:

RESULTS:

CONCLUSION:

Inform family about pledges, organ donors told

Measuring the quality of end of life management in patients with advanced kidney disease: results from the pan-Thames renal audit group

No meds for unapproved ops

By WONG PEK MEIpekmei@thestar.com.my

http://thestar.com.my/news/story.asp?file=/2011/10/17/nation/9711992&amp;sec=nation

57% rise in dialysis patients since 2006

Chinese are 50pc of organ donors since 1997

Should there be an expanded role for palliative care in end-stage renal disease?

Source

Curr Opin Nephrol Hypertens. 2010 Nov;19(6):556-60.

http://www.ncbi.nlm.nih.gov/pubmed/20644475

Abstract

PURPOSE OF REVIEW:

RECENT FINDINGS:

SUMMARY:

Probe commercial organ transplant claims, urge doctors

By AUSTIN CAMOENSaustin@thestar.com.my

Health Ministry looks into so-called Bangladeshi connection

Should there be an expanded role for palliative care in end-stage renal disease?

PMID:

22022326 PubMed - in process]
PMCID: PMC3193042

By WONG PEK MEI
pekmei@thestar.com.my

http://thestar.com.my/news/story.asp?file=/2011/10/17/nation/9711992&sec=nation

By AUSTIN CAMOENS
austin@thestar.com.my